Deep plane vs SMAS facelift: what is the difference?

The short answer: a deep plane facelift and a SMAS facelift both lift the deeper supporting layer of the face, not just the skin. In a SMAS facelift, the skin is lifted off that layer and the two are tightened separately. In a deep plane facelift, the surgeon works underneath it, releases the ligaments that hold it down, and lifts skin, fat and muscle together as one unit. Neither is the best facelift for everyone. The right one depends on your face, your neck and what you want to change.

I am asked about deep plane vs SMAS facelift techniques at almost every facelift consultation. Usually someone has read online, or seen on social media, that deep plane is the only facelift worth having. It is an understandable conclusion, because the term is everywhere at the moment. But it is not quite how surgeons think about it, so here is how I explain it to my patients.

“Most people who ask me for a deep plane facelift don’t really want a technique. They want to look like themselves on a good day. My job is to work out what has changed in their face, and choose the operation that fixes that.”

Mr Siva Kumar, Consultant Plastic Surgeon

Deep plane vs SMAS facelift at a glance

	SMAS facelift	Deep plane facelift
Where the surgeon works	Above the SMAS layer, then tightens it	Beneath the SMAS layer
What moves	Skin and SMAS, lifted separately	Skin, fat and SMAS together, as one unit
Retaining ligaments	Usually left in place	Released, so tissue can move further
Often suits	Early to moderate jowls and a softening jawline	Moderate to advanced jowls, deep cheek folds and a looser neck
Scars	The same in both: around the ear and into the hairline
Operation	Around three and a half hours under general anaesthetic, one night in hospital
Back to desk work	Usually two to four weeks
How long it lasts	Most people enjoy the benefit for many years, often around ten

First, what is the SMAS?

SMAS stands for superficial musculo-aponeurotic system. It is a thin, fibrous layer of tissue that sits under the skin and the fat just beneath it, and it is joined to the small muscles we use for facial expression. Think of it as the scaffolding that holds the soft tissues of your lower face and neck in shape. It was first described in 1976, and almost every modern facelift is built around it.

The SMAS is held to the bone and the deeper tissues by tough bands called retaining ligaments, a bit like guy ropes on a tent. As we age, the skin loses elasticity, the fat pads of the cheek slip downwards, and the SMAS and its ligaments slacken. That is what creates jowls, a heavier fold between the nose and mouth, a softer jawline and looseness in the neck.

Older facelifts mainly pulled the skin tight. That can look stretched or “windswept”, and it does not last well, because skin is not designed to carry that load. Modern facelifts lift the SMAS instead, so the skin can be laid back over the new contour without tension. Both deep plane and SMAS facelifts do this. What differs is where the surgeon works, and how far the tissue can move.

What is a SMAS facelift?

In a SMAS facelift, the skin is lifted off the SMAS through incisions around the ear. The SMAS is then tightened, either by folding it and stitching it (often called plication), or by trimming a strip and stitching the edges together (imbrication or SMASectomy). Finally, the skin is re-draped and the excess removed. Variations you may come across include the high SMAS facelift, which extends the lift higher on the cheek, and shorter-scar versions sometimes marketed as mini facelifts.

It is a well-established, reliable operation that has been refined over decades. It tends to work very well for:

• early to moderate jowling
• a jawline that has started to soften
• people in their late forties to early sixties with reasonable skin quality
• people who have had a facelift before and need a smaller revision

What is a deep plane facelift?

The deep plane facelift was popularised in the early 1990s. Instead of separating the skin from the SMAS, the surgeon goes beneath the SMAS and releases the key retaining ligaments in the cheek and jawline. Skin, fat and SMAS stay attached to each other and are lifted together as a single, thicker layer.

Because the ligaments are released, the tissue can move further and more freely. That can give a stronger correction of:

• jowls and a heavy lower face
• the fold between the nose and the corner of the mouth
• the cheek fat that has slipped downwards
• a looser neck, especially when combined with a neck lift

The trade-off is that the surgeon is working closer to the branches of the facial nerve, which control the muscles of expression. It is not inherently dangerous in experienced hands, but it does demand detailed anatomical training and experience.

Is a deep plane facelift better than a SMAS facelift?

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 (more upwards than backwards), and not over-tightening the skin.

The research supports this. A well-known split-face study in the 1990s, in which different techniques were used on each side of the same patients’ faces, found no clear difference in the results a year later. More recently, a 2026 study of 166 patients comparing deep plane and SMAS plication facelifts found similar satisfaction, similar recovery times and no significant difference in complications. Neither technique has been shown to be clearly better for every patient.

“If a surgeon offers exactly the same named facelift to everyone who walks through the door, I would ask why. Faces don’t age in the same way, so the operation shouldn’t be the same either.”

Mr Siva Kumar, Consultant Plastic Surgeon

You may also see newer brand names such as “Level 5” or “9D” facelifts. These are usually variations or combinations of the same principles, sometimes with extra work on the neck or deeper tissues. It is always worth asking a surgeon exactly what they will do, rather than relying on the name.

Where I think a deep plane approach can earn its place is in someone with more advanced ageing of the lower face and neck, heavier jowls, or a deep fold between the nose and mouth. In someone younger with early changes, a well-performed SMAS facelift often gives a beautifully natural result with a little less surgery.

How long does a deep plane or SMAS facelift last?

Most people enjoy the benefits of either technique for many years, often around ten. You may read that a deep plane facelift lasts 10 to 15 years and a SMAS facelift 7 to 10. That is plausible, because the release of the ligaments allows a more structural lift, but good long-term studies comparing the two directly are lacking.

It helps to think of a facelift as winding the clock back rather than stopping it. Your face keeps ageing, just from a better starting point. Ten years on, most people still look younger than they would have done without surgery. What makes the biggest difference to longevity is:

• your skin quality, including sun damage and genetics
• a stable weight, because large changes stretch the tissues again
• not smoking, which harms healing and speeds up skin ageing
• daily sun protection and a good skincare routine
• the neck, which is often treated at the same time so the face and neck age together

Is recovery different?

For most people, recovery from a deep plane or SMAS facelift is broadly similar. In the 2026 study mentioned above, the median recovery time was around four weeks for both. Some surgeons find that deep plane patients have a little more swelling in the cheeks for longer, while others find less bruising because the skin stays attached to the layer beneath. In practice, your own healing matters more than the technique.

As a rough guide:

• The first night: you stay in hospital. Your face feels tight and swollen rather than very painful, and simple painkillers are usually enough.
• Days 2 to 3: swelling and bruising are at their peak. Sleeping propped up and cold compresses help.
• Around a week: stitches are removed and you start to look more like yourself.
• Two to four weeks: most people are back at desk work and out socially, sometimes with a little make-up.
• Six weeks: most people return to the gym and more strenuous exercise.
• Three to six months: the last of the swelling settles and the scars fade.

If you are wondering about getting back behind the wheel, I have written a separate guide on when you can drive after a facelift.

What are the risks?

A facelift is major surgery, and both techniques carry similar risks. The main ones are:

• Haematoma, a collection of blood under the skin, usually in the first 24 hours. It is the most common complication and is more likely in men and in people with high blood pressure. It usually means a return to theatre, but it rarely affects the final result if dealt with promptly.
• Facial nerve weakness, which can affect the smile or the lower lip. It is uncommon, and nearly always temporary, recovering over weeks to months. Permanent nerve injury is rare.
• Numbness of the cheeks and around the ears, which gradually improves over months.
• Scarring, which usually fades well but can occasionally stretch or thicken.
• Problems with healing of the skin, which are much more common in smokers. I ask everyone to stop smoking and vaping well before and after surgery.

I will go through these with you in detail, along with how we reduce each risk, before you make any decision.

What about a mini facelift, neck lift or non-surgical options?

A facelift is not always the answer. Depending on what bothers you, other options might suit you better or be combined with it:

• A mini facelift uses shorter scars and a smaller lift. It can work well for early jowls, but it will not deal with a loose neck.
• A neck lift is often combined with a facelift, because the neck usually ages alongside the lower face.
• Facial fat grafting restores lost volume in the cheeks, temples and around the eyes. You can read more about what fat grafting can do and how long it lasts.
• Eyelid surgery, such as an upper blepharoplasty, deals with hooded eyelids, which a facelift will not change.
• CO₂ laser resurfacing improves fine lines and skin texture, which a facelift does not change on its own.
• Skin tightening with energy devices such as Morpheus8 can help mild laxity, but it cannot match the lift of surgery when the skin is truly loose.

How much does a facelift cost in the UK?

The cost of a facelift in the UK varies with the technique, whether the neck or eyelids are treated at the same time, the hospital, and what aftercare is included. A deep plane facelift is often priced higher than a SMAS facelift because the operation can take longer. When comparing quotes, check that they include the anaesthetist, the hospital stay, your follow-up appointments and the management of any complications. My guide prices are on the facelift cost page.

How I decide which facelift is right for you

I start with what bothers you when you look in the mirror. Then I examine your face, your skin quality, the position of your cheeks and jawline, and your neck. I look at photographs from ten or fifteen years ago if you have them, because they show what has actually changed. Then I recommend the approach I think will give you a result that still looks like you.

Sometimes that is a deep plane facelift and neck lift. Sometimes it is a SMAS facelift. And sometimes it is something smaller, such as eyelid surgery or fat grafting. If I think a smaller procedure would suit you better, I will say so.

“The best facelift is the one nobody notices. Friends should tell you that you look well, or rested, or ask if you have been on holiday. They shouldn’t be asking who your surgeon is.”

Mr Siva Kumar, Consultant Plastic Surgeon

Questions I’m often asked

Does a deep plane facelift include the neck?

Not automatically. A facelift lifts the lower face and jawline, and it improves the upper neck. If the neck has loose skin or vertical bands, a neck lift is usually added at the same time. Most people I see for a facelift benefit from both.

Is a deep plane facelift painful?

Most people are surprised by how little pain there is. The face feels tight, swollen and numb for the first few days rather than sore. Simple painkillers are usually enough.

Can a facelift be done under local anaesthetic?

Smaller lifts can sometimes be done under local anaesthetic, with or without sedation. A full deep plane or SMAS facelift with a neck lift is a longer operation, and I prefer to do it under general anaesthetic so you are comfortable and safe throughout.

What is the best age for a facelift?

There is no ideal age. It depends on how your face has aged, your skin and your general health. Most of my facelift patients are in their fifties and sixties, but some are younger and some are in their seventies.

Will I look different, or “done”?

The aim is for you to look like a fresher version of yourself, not like a different person. Over-tightening and lifting in the wrong direction are what create an operated look, and that is exactly what I plan to avoid.

Can I have a facelift if I have had one before?

Yes. A second, or secondary, facelift is common, often ten or more years after the first. The planning is a little different because of the previous surgery and scars, so it is worth seeing a surgeon who does these regularly.

Next steps

If you are thinking about a facelift, the best place to start is a consultation, where we can talk through what bothers you and what would genuinely help. You can read more on my facelift page, see before and after photographs, or book a consultation at one of my clinics in Kent, Surrey and Sussex.