How does a deep plane facelift differ from a SMAS facelift?
⚠️ Contact your surgeon promptly if you notice these after facelift surgery
Sudden swelling on one side of the face, increasing pain, weakness or asymmetry of facial movement, skin that looks dark or feels numb, or signs of infection (fever, redness, discharge) should all be reported to your surgeon right away. Facial nerve injury and hematoma are the most serious known risks of facelift surgery and are best treated as early as possible.
Short answer
An ordinary or SMAS facelift tightens the superficial musculoaponeurotic system (SMAS), a fibrous layer under the skin, while leaving the deeper retaining ligaments intact, so it is generally aimed at the lower face, jawline, and neck. A deep plane facelift works one layer deeper, releasing those ligaments so the skin and SMAS move together and the midface can be repositioned along with the lower face. Direct comparative evidence is limited and mixed: both techniques show high patient satisfaction and durable results, with one meta-analysis linking the deep plane to slightly higher satisfaction but also a higher complication rate. Neither is clearly better for every patient, and the right choice depends on your anatomy, goals, and your surgeon's experience.
What the research shows
Facelift techniques are grouped mainly by how deeply the surgeon works beneath the skin. The most common approach, often described as a traditional or SMAS facelift, tightens or trims the superficial musculoaponeurotic system (SMAS), a fibrous layer that sits just under the skin and connects to the muscles of facial expression. [3] Because it leaves the deeper retaining ligaments intact, this approach is generally directed at sagging of the lower face, jawline, and neck. [3]
A deep plane facelift works one layer deeper. The surgeon releases the facial retaining ligaments, such as the zygomatic and masseteric cutaneous ligaments, so the skin and SMAS move together as a single composite flap. [4] [6] Because the tissues are repositioned as one unit, the technique is designed to address the midface and cheek along with the lower face. [6] It requires detailed knowledge of the layers beneath the SMAS and the course of the facial nerve. [4] [5] Some surgeons perform deep plane dissection through smaller or endoscopic incisions. [7] [8]
How outcomes compare
Direct comparisons between the two techniques are limited, and the available evidence points in more than one direction. A 2025 systematic review and meta-analysis pooling 21 studies and nearly 2,900 patients reported high patient satisfaction for both approaches, about 94.4% for the deep plane and 87.8% for SMAS. [1] In the same analysis, the overall complication rate was higher with the deep plane (17.2%) than with SMAS (10.3%), which may reflect the more extensive dissection involved. [1] Importantly, this review largely pooled results from separate, non-comparative studies rather than head-to-head data, which limits how strongly the two sets of figures can be compared. [1]
The only randomized comparison is a small 2004 trial of 40 patients that assessed improvement in the cheeks, jowls, and nasolabial folds (the lines from the nose to the corners of the mouth). In patients aged 50 to 69, experienced reviewers rated SMAS results at least as high as deep plane results, and the deep plane showed a slight advantage only in the oldest group (ages 70 to 80). [2] Taken together, these findings suggest that neither technique is clearly superior for every patient, and the best-supported conclusion is that both can produce strong, durable results. [1] [2]
What this means for you
Choosing between the two approaches is a matter of trade-offs rather than a clear winner. A SMAS-based lift is well suited to concerns centered on the lower face, jawline, and neck, and the available data associate it with a somewhat lower complication rate. [1] [3] A deep plane approach releases the deeper ligaments and is designed to reposition the midface and cheek together with the lower face, which some patients and surgeons prefer when the midface is a major concern; the meta-analysis linked it to slightly higher satisfaction but also more complications. [1] [6] Surgeon experience matters a great deal, because a surgeon who performs one technique frequently may achieve better results with it than with an approach they use less often. The right choice depends on your anatomy, your goals, and your surgeon's expertise, so a detailed consultation is essential.
What to ask your surgeon
- Which technique do you recommend for my specific areas of concern, and why?
- How many of each procedure have you performed, and what is your personal complication rate with each?
- Would a SMAS approach fully address my midface, or would I need an additional procedure?
- What recovery, scarring, and follow-up should I expect with each option for someone with my anatomy?