When you're considering facial rejuvenation in Los Angeles, you're likely to encounter two terms that dominate the conversation: deep plane facelift and SMAS facelift. Both techniques promise to turn back the clock, but the question remains, which approach delivers the most natural, enduring results?
As an Associate Clinical Professor of Plastic Surgery at UCLA and Past-President of both the Aesthetic Surgery Education and Research Foundation (ASERF) and the California Society of Plastic Surgeons, Dr. Steven Teitelbaum has performed hundreds of facelifts using a range of advanced techniques. His philosophy centers on proportion, restraint, and creating results so natural that you simply look like a more rested, youthful version of yourself.
In this blog, we'll explore the differences between deep plane and SMAS facelifts, examine what each technique can and cannot accomplish, and help you understand which approach may be right for your unique anatomy and aesthetic goals.
Understanding the Anatomy: What Is the SMAS?
Before comparing these two facelift techniques, it's essential to understand the foundational anatomy they both address. The superficial musculoaponeurotic system, commonly known as SMAS, is a fibromuscular layer that lies beneath your skin and subcutaneous fat. First described by plastic surgeons Mitz and Peyronie in 1976, the SMAS is a network of tissue that connects facial muscles to your skin, allowing for the coordinated movements that create facial expressions.
Key characteristics of the SMAS layer include:
- Anatomical position: The SMAS sits between the superficial fat layer and the deeper facial muscles, extending from the zygomatic arch down to the platysma muscle in the neck.
- Functional role: This layer transmits muscular movements to the skin, enabling everything from smiles to frowns.
- Aging process: As we age, the SMAS loses elasticity and begins to sag, contributing to jowls, deepening nasolabial folds, and loss of definition along the jawline.
- Surgical significance: Manipulating the SMAS layer during facelift surgery provides more substantial, longer-lasting results than simply tightening skin alone.
According to research published in the National Library of Medicine, the SMAS plays a vital role in facial rejuvenation surgery, and surgical maneuvering and tightening of this layer allows for comprehensive facial rejuvenation. Understanding this anatomical foundation helps explain why both deep plane and SMAS techniques focus on this critical structure, though they approach it in fundamentally different ways.
What Is a SMAS Facelift?
A SMAS facelift, also called a traditional facelift or SMAS plication facelift, is one of the most commonly performed facial rejuvenation procedures. Developed by Swedish plastic surgeon Tord Skoog in the 1970s, this technique represented a significant advancement over older "skin-only" facelifts that simply pulled the skin tighter without addressing underlying structures.
During a SMAS facelift procedure:
- Incision placement: The surgeon makes discreet incisions around the ears and possibly along the hairline.
- Tissue elevation: The skin is carefully lifted away from the SMAS layer.
- SMAS manipulation: The SMAS layer itself is then tightened, either through plication (folding and suturing the tissue to create tension) or by elevating and repositioning the SMAS as a flap.
- Skin redraping: After the SMAS has been secured in its new position, the skin is redraped over the improved foundation with minimal tension.
- Final closure: Excess skin is trimmed, and incisions are meticulously closed.
The SMAS technique offers several advantages. It provides more substantial improvement than skin-only lifts, addressing the lower two-thirds of the face including jowls, sagging cheeks, and loss of jawline definition. The procedure is highly customizable, allowing surgeons to tailor the direction and degree of lift to each patient's specific anatomy.
However, there are limitations to consider. The standard SMAS approach treats the skin and SMAS layers as separate structures, which means they're lifted independently. Additionally, traditional SMAS techniques typically don't release the deeper facial ligaments that anchor tissues to bone, which can limit the degree of midface elevation achievable.
What Is a Deep Plane Facelift?
The deep plane facelift represents a more comprehensive approach to facial rejuvenation. Rather than treating the skin and SMAS as separate entities, the deep plane technique involves dissecting beneath the SMAS layer to release facial retaining ligaments, then lifting the skin and SMAS together as a unified composite flap.
Key aspects of the deep plane technique include:
- Deeper dissection: The surgeon works in a plane beneath the SMAS, accessing the deeper facial structures.
- Ligament release: Critical facial ligaments that tether the cheeks and jawline to the underlying bone are carefully released, allowing for more substantial repositioning.
- Composite elevation: The skin, subcutaneous fat, and SMAS are lifted together as one unit rather than separately.
- Midface rejuvenation: This approach can more effectively address cheek descent and restore youthful fullness to the midface.
- Reduced skin tension: Because the deeper structures provide the support, there's less tension on the skin itself, which can contribute to more natural-looking results.
The deep plane facelift has gained significant attention in recent years, with proponents highlighting several potential advantages. By working at a deeper anatomical level, the technique can provide more dramatic improvements in the midface, cheeks, and jawline. The results are often described as appearing more natural because facial tissues move as an integrated unit rather than as separate layers.
Nevertheless, this technique requires considerable expertise. The deep plane approach involves working in close proximity to facial nerves, demanding meticulous anatomical knowledge and surgical precision.
Comparing Results
When patients ask Dr. Teitelbaum which technique produces more natural results, his answer is nuanced because the outcome depends far more on the surgeon's skill, aesthetic judgment, and understanding of facial anatomy than on the technique name alone. Both deep plane and SMAS facelifts can deliver beautiful, natural results when performed by an experienced surgeon who understands the principals of facial proportion and restraint.
Factors that contribute to natural-looking results include:
- Appropriate patient selection
- Surgical precision
- Facial proportion
- Skin tension
- Volume considerations
In terms of longevity, research published by the National Center for Biotechnology Information suggests that both techniques can provide durable results when properly executed. Deep-plane facelifts are frequently cited as offering 10 to 15 years of benefit, while SMAS facelifts typically provide 5 to 10 years of improvement.
One critical point that deserves emphasis: the aging process doesn't stop after facelift surgery. Your face will continue to age naturally from its new, more youthful baseline.
Recovery and Downtime
Recovery expectations differ somewhat between these two techniques, though both procedures require patience as your face heals and settles into its new contours.
SMAS Facelift Recovery
- Initial recovery: 3–5 days of peak swelling and bruising
- Return to work: 7–10 days
- Activity restrictions: Light exercise at 3 weeks; full activity at 6 weeks
- Final results: Around 6 months
Deep Plane Facelift Recovery
- Early healing: More pronounced swelling, especially in cheeks
- Work return: About 2 weeks
- Exercise resumption: Light activity at 3 weeks; strenuous activity at 6–8 weeks
- Final results: 6 months to 1 year
The Critical Question: Is One Technique Superior?
Both techniques, when performed by skilled surgeons, can deliver excellent outcomes with high patient satisfaction. The reality is that one technique is not universally superior to the other—they're simply different approaches that may be more or less appropriate depending on your individual circumstances.
Schedule Your Consultation
If you're considering facelift surgery in Los Angeles or Santa Monica and want honest, expert guidance on which approach is right for you, schedule a consultation with Dr. Teitelbaum today. Call (310) 315-1121 or visit our Santa Monica office to book your consultation.
