Deep plane vs SMAS facelift: what is the difference?

The short answer: both techniques lift the deeper layer of the face, not just the skin. A SMAS facelift tightens that layer with stitches. A deep plane facelift releases it and lifts it together with the skin as one unit. Neither is the best facelift for everyone. The right one depends on your face.

I am asked about this at almost every facelift consultation, usually because someone has read that deep plane is the only technique worth having. So here is how I explain it.

First, what is the SMAS?

Underneath the skin of the face there is a supporting layer of tissue called the SMAS. As we age, the skin loses elasticity and the SMAS slackens. That is what causes jowls, a softer jawline and looseness in the neck.

Older facelifts mainly pulled the skin tight. That can look stretched and windswept, and it does not last well, because skin is not designed to carry that load. Modern facelifts lift the deeper layer instead, so the skin can be re-draped without tension. Both deep plane and SMAS facelifts do this. They differ in how.

The SMAS facelift

The SMAS layer is tightened and secured with stitches, and then excess skin is removed. It is a well-established, reliable approach, and it works very well for early to moderate jowling and a softening jawline.

The deep plane facelift

Here the deeper layer is released and lifted as one unit together with the skin. Because of that release, it can reposition the cheeks, jowls and neck more fully. It tends to suit moderate to more advanced ageing of the face and neck.

What is the same

• The scars. In both, the incisions run around the ear and into the hairline, following natural creases so they are well hidden.
• The operation. Around three and a half hours under general anaesthetic, with one night in hospital.
• The recovery. Swelling and bruising peak at two to three days. Most people are back at desk work in two to four weeks.
• How long it lasts. Most people enjoy the benefits for many years, often around ten. Your face keeps ageing, just from a better starting point.

So which is better?

Honestly, the technique matters less than the plan. The things that make the biggest difference to how natural a facelift looks are an accurate assessment of what has actually changed in your face, lifting in the right direction, and not over-tightening. Research comparing the techniques head to head has not shown one to be clearly superior for every patient.

I would be wary of anyone who offers the same named facelift to everyone. Faces age differently. Someone in their late forties with early jowls needs something different from someone in their late sixties with a loose neck.

What else is often part of the plan

The neck usually ages alongside the lower face, so a neck lift is often combined with a facelift so the two match. Eyelid surgery or CO₂ laser resurfacing are sometimes added too. A facelift will not change fine lines or skin texture on its own, and it will not lift a low brow or change the shape of your eyes.

At your consultation

I start with what bothers you when you look in the mirror. Then I examine your face, your skin quality and your neck, and recommend the approach I think will give you a result that still looks like you. If I think a smaller procedure would suit you better, I will say so. You can read more on my facelift page, and guide prices are on the facelift cost page.