Deep Plane vs SMAS Facelift: Which Technique Is Right for You?

A SMAS facelift lifts and tightens the SMAS layer, then re-drapes the skin separately over the top. A deep plane facelift goes one layer deeper, releasing the ligaments that anchor the face in its descended position so the skin, fat and SMAS move together as a single unit. That single anatomical difference separates two of the most effective types of facelift, and it is why your surgeon will recommend one over the other based on your anatomy rather than on which sounds more advanced.

At Centre for Surgery we perform both the SMAS facelift and the deep plane facelift, usually with a neck lift. This guide compares them in full: what SMAS means, what each technique does, who suits which, and how results, recovery, risks and longevity differ. If you are deciding between a shorter-scar lift and a full facelift instead, see our guide to facelift vs mini facelift.

SMAS Meaning: What Does SMAS Stand For?

SMAS stands for superficial musculoaponeurotic system. It is a continuous layer of fibrous tissue and thin muscle that lies under the skin and facial fat and over the deeper facial muscles, running from the temple down into the platysma muscle of the neck. It supports the soft tissues of the face, and as it loosens with age, the cheeks slide down, jowls form and the jawline softens.

The SMAS was first described in 1976.^[1] Its discovery changed facelift surgery. Before then, facelifts lifted the skin alone, which stretched, relaxed quickly and could look tight or windswept. Once surgeons began lifting the SMAS instead, the deeper layer carried the tension and the skin could close without strain, giving results that looked more natural and lasted longer. Every modern SMAS lifting technique, and the deep plane facelift, builds on that idea. Our guide on whether a facelift involves muscle repair explains the layers in more detail.

What Is a SMAS Facelift?

In a SMAS facelift, the surgeon lifts the skin first, exposing the SMAS underneath. The SMAS is then tightened in one of several ways before the skin is re-draped over the top and closed separately:

• SMAS plication: the SMAS is folded and stitched on itself, with no cut into the layer.
• SMASectomy: a strip of SMAS is removed and the edges are stitched together.
• SMAS flap, extended or high SMAS: the SMAS is raised as a separate flap, sometimes higher towards the cheekbone, and lifted before being fixed in place.

Skin and SMAS are treated as two separate layers throughout, each moved in its own direction. This is the facelift most patients have. It is reliable and well established, and because the SMAS takes the tension rather than the skin, results look lifted rather than pulled and scars heal as fine lines. It corrects sagging jowls, a blurred jawline and moderate marionette lines, and with a neck lift it tightens loose neck skin and bands.

What Is a Deep Plane Facelift?

A deep plane facelift goes beneath the SMAS, into the space directly above the facial muscles. The surgeon identifies and selectively releases the retaining ligaments, the zygomatic, masseteric and mandibular ligaments, which tether the skin and SMAS to the deeper structures and hold the face in its descended position. These ligaments were mapped in detail in 1989, and that work showed that they have to be released if the overlying tissue is to move upwards fully.^[2]

Once they are released, the whole tissue envelope, skin, fat and SMAS together, is lifted as a single composite flap and anchored to firm deep structures such as the deep temporal fascia. The technique was described in 1990 for patients whose nasolabial folds did not improve enough with standard lifts.^[3] Nothing is separated, so there is no tension between the layers, which gives natural movement and expression. The dissection runs closer to branches of the facial nerve and takes specific training, so the surgeon’s deep plane experience matters as much as the technique.

Deep Plane vs SMAS Facelift: The Anatomy in Simple Terms

Think of the face as four stacked layers: skin and fat on the outside, the SMAS beneath that, the deep plane containing the retaining ligaments beneath the SMAS, and the facial muscles and bone underneath everything. A SMAS facelift works above the SMAS: the surgeon separates the skin from the SMAS, tightens the SMAS, then re-drapes the skin. A deep plane facelift works below the SMAS: it releases the ligaments holding the tissue down, then lifts skin, fat and SMAS together.

The incision is much the same for both, from the temple hairline, around the ear and into the hairline behind it, with a small cut under the chin when the neck is tightened. What differs is how deep the surgeon works once inside.

Deep Plane vs SMAS Facelift: Key Differences at a Glance

Is Deep Plane Better Than SMAS?

Not for everyone. Deep plane gives more correction in the mid face, but whether that extra correction is worth a longer operation and longer cheek swelling depends on your face.

The largest pooled analysis to date is a 2025 systematic review and meta-analysis in Aesthetic Plastic Surgery, which combined 21 studies and 2,896 patients. Satisfaction was high with both techniques, at 94.4% for deep plane and 87.8% for SMAS, and the authors concluded that both give robust, long-term results.^[4] The studies were not head-to-head trials, so the figures describe each technique’s track record rather than a direct contest between them.

When more and less extensive lifts have been compared directly, the gap has been small. In a 1996 randomised split-face study in Plastic and Reconstructive Surgery, 21 patients had a standard or limited SMAS lift on one side of the face and an extended SMAS or composite (deep plane-type) lift on the other. The deeper side looked better on the operating table, but independent surgeons could not tell the sides apart at six and twelve months, and the authors judged the extra risk and recovery unjustified for the average patient.^[5] A study of two sets of identical twins, each operated on by a different surgeon using a different technique (including a composite lift and SMAS lifts) and photographed at one, six and ten years, was designed to let surgeons compare long-term results side by side rather than to name a winner.^[6]

A systematic review has also noted how few good comparative studies of facelift techniques exist.^[7] In practice, the deep plane facelift earns its place when the anatomy calls for it: heavy cheeks, deep folds, thick skin, a male face or a previous facelift that has relaxed. For everyone else, a well-performed SMAS facelift gives an equivalent result with an easier recovery.

SMAS vs Deep Plane: Who Suits Which Technique?

The right technique depends on how much laxity you have and where it sits, how thick your skin is, and whether you are prioritising maximum correction or a shorter recovery.

Who Typically Suits a SMAS Facelift

A SMAS facelift tends to suit people in their 40s and 50s with moderate signs of ageing: visible jowling, some loss of jawline definition and early-to-moderate neck laxity. It works particularly well on standard-to-thin skin, where the SMAS alone gives enough structural correction. If you want a more predictable, shorter recovery, or your neck is the main concern alongside the jowls, a SMAS facelift with a neck lift is usually the right choice.

Who Typically Suits a Deep Plane Facelift

A deep plane facelift is usually recommended for more advanced ageing: moderate-to-severe jowling, deep nasolabial folds and heavier cheek descent, where a SMAS lift alone may not move enough tissue. It suits thicker skin and heavier faces, and it is often preferred for a male facelift, because men tend to have thicker skin and stronger ligaments (our guide to the differences between male and female facelifts explains why). It is also useful in a revision facelift, because the surgeon can work in a plane that the first operation did not touch.

Age alone does not decide it. A 45-year-old with heavy, thick skin and deep nasolabial folds may suit deep plane better than a 60-year-old with thin skin and mild laxity, who may do very well with SMAS. If your concern is mainly the cheeks with little jowling, an endoscopic facelift may suit you better than either.

What’s the Best Age for a Deep Plane Facelift?

Most people who have a deep plane facelift are in their late 40s to 70s, because that is when mid-face descent and heavy jowls usually appear. People in their 40s with early change are more often suited to a SMAS or mini facelift. Older age is not a barrier on its own: in a study of 216 facelift patients, those aged 65 and over had similar major complication rates to younger patients (2.9% against 2.0%).^[8] General health, smoking and skin quality matter more than the number. Our facelift age guide explains how to judge your timing.

Deep Plane vs SMAS Facelift Results

Both techniques give natural-looking, long-lasting results when performed by an experienced surgeon. The differences are in degree and location.

A SMAS facelift restores jawline definition, softens jowls and smooths moderate nasolabial folds and marionette lines. For people with moderate ageing, SMAS results are often indistinguishable from deep plane results: the technique is not a compromise, it is calibrated to a different starting point.

A deep plane facelift gives stronger correction in the mid face, the cheeks, the area beside the nose and the nasolabial folds, because releasing the ligaments lets the surgeon move tissue that a SMAS lift cannot reach. People with heavy cheek descent or deep folds usually see more improvement with deep plane.

Does a SMAS Facelift Look Natural?

Yes, when it is done well. The unnatural “pulled” look comes from skin-only lifts, or from lifts where the skin was pulled tight to make up for a weak deep repair. In a SMAS facelift, the SMAS carries the lift and the skin closes without tension, so the face looks rested rather than operated on. Direction matters too: lifting tissue upwards along the line it fell looks more natural than pulling it straight back towards the ears. Our guide to a botched facelift shows what goes wrong when these principles are ignored.

Neither technique replaces lost volume, so both are often combined with facial fat transfer. Neither treats skin quality either: sun damage, fine lines and pigmentation are better treated with laser treatment, usually a few months after the face has healed.

Deep Plane vs SMAS Facelift Recovery

Most patients go home the same day after either operation, with a responsible adult who stays with them for 24 hours. For longer or combined operations, we may ask you to stay locally overnight so our nursing team can check on you in the morning.

Recovery from both techniques follows a similar pattern in the first week. Swelling and bruising peak over the first three days, and stitches come out at about a week. After that the paths separate:

• SMAS facelift: desk work from around day 10 to 14, gentle cardio from week 3, weights and contact sport from week 6, and cheek swelling settled within 6 to 8 weeks.
• Deep plane facelift: desk work from around day 12 to 14, closer to three weeks if your work is public-facing. The cheeks look fuller for longer and can take up to three months to settle fully, which is an expected effect of releasing the ligaments rather than a complication.

For both, you sleep with your head raised for two weeks, numbness around the ears and jaw settles over three to six months, and scars keep fading for 6 to 12 months. If you cannot accommodate a few extra weeks of visible cheek fullness, that is a legitimate reason to lean towards SMAS. Our facelift recovery guide sets out the week-by-week timeline.

Does a Deep Plane Facelift Really Last 10 Years?

Deep plane results are generally quoted as lasting 10 to 15 years, against 10 years or more for a SMAS facelift. The reasoning is anatomical: deep plane anchors the lifted tissue to firm deep structures that do not stretch, while a SMAS lift relies more on the SMAS holding itself. But no head-to-head trial has measured the difference, and most follow-up studies run for months to a few years rather than decades.^[4] The twin study, which photographed patients at one, six and ten years after four different techniques, is one of the few to follow results that long.^[6]

So yes, a well-performed deep plane facelift can comfortably look better than no facelift at ten years, but you keep ageing from your new starting point. Genes, skin quality, sun exposure, smoking and weight stability affect how long any result lasts at least as much as the technique. Our guides to how long a facelift lasts and what happens to your face 10 years after a facelift go into more detail.

What Are the Disadvantages of a Deep Plane Facelift?

• Longer cheek swelling, up to three months, against six to eight weeks after SMAS.
• A longer operation, about an hour more than an equivalent SMAS facelift with a neck lift.
• It depends heavily on surgeon experience, because the dissection runs closer to facial nerve branches.
• It costs more, reflecting the longer theatre time and extra training.
• It can be more than you need. For moderate ageing and standard skin, it adds recovery without a visibly better result.

Deep Plane vs SMAS Facelift Risks

Both techniques share the same general risks: haematoma (a collection of blood under the skin), infection, poor scarring, temporary numbness and, rarely, skin loss, which is much more likely in smokers. In a database of 11,300 facelifts, 1.8% had a major complication needing a hospital visit, admission or further surgery. Haematoma was the most common at 1.1%, and it was more likely in men and when other operations were done at the same time.^[10]

The technique-specific differences are smaller than often claimed. A 2019 meta-analysis of 183 studies in Aesthetic Surgery Journal found that temporary facial nerve weakness was most common after high lateral SMAS (1.85%) and composite lifts (1.52%), and that the risk of permanent nerve injury did not differ between techniques. Major haematoma was slightly more common after deep plane surgery (1.22%) and SMAS imbrication (1.92%) than after simple SMAS plication.^[9] The 2025 review recorded a higher overall complication rate for deep plane (17.2%) than for SMAS (10.3%), though this counted minor problems and pooled studies that defined complications differently.^[4]

Temporary nerve weakness usually recovers over weeks to months. Choosing a surgeon with specific, demonstrable experience in your chosen technique lowers every one of these risks. Stopping nicotine four weeks before and four weeks after surgery sharply reduces the risk of poor healing. Our guide to facelift complications covers each risk in detail.

SMAS vs Deep Plane Facelift Cost

A deep plane facelift costs more than a SMAS facelift. The difference reflects real factors rather than the name of the technique: deep plane takes longer in theatre (four to six hours with a neck lift, against three to five for SMAS), it needs a surgeon with specific additional training, and fewer surgeons perform it. Adding a neck lift, eyelid surgery or fat transfer increases the price of either.

Your surgeon will give you a fixed, itemised quote after your consultation, and our facelift cost guide sets out current prices for every facelift technique and common combination. Finance is available through Chrysalis Finance, subject to status.

Frequently Asked Questions

Why Choose Centre for Surgery for a SMAS or Deep Plane Facelift?

Every facelift at Centre for Surgery is performed by a GMC-registered plastic surgeon, at our CQC-regulated hospital at 95–97 Baker Street, which is rated Good overall and has been caring for patients for over 10 years. The surgeon who assesses you at consultation is the surgeon who performs your surgery. We offer the full range of facelift techniques, from mini and one stitch through to SMAS, deep plane, endoscopic and revision facelifts, so your surgeon will recommend the technique that fits your anatomy, and will tell you plainly if a SMAS facelift would serve you as well as deep plane. We recommend a two-week cooling-off period before any surgery. We publish our clinical outcomes and patient safety data.

Finance is available through Chrysalis Finance, subject to status. See our finance options page for details.

Phone: 020 7993 4849 | Address: 95–97 Baker Street, Marylebone, London W1U 6RN
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References

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2. Furnas DW. The retaining ligaments of the cheek. Plastic and Reconstructive Surgery 1989;83(1):11–16. doi:10.1097/00006534-198901000-00003
3. Hamra ST. The deep-plane rhytidectomy. Plastic and Reconstructive Surgery 1990;86(1):53–61. PubMed 2359803
4. Khoury S, Almubarak Z, Khan H, Boldt G, Villemure-Poliquin N, Nichols AC. The deep plane versus SMAS facelift: a systematic review and meta-analysis. Aesthetic Plastic Surgery 2025;49(21):5895–5903. doi:10.1007/s00266-025-05118-x
5. Ivy EJ, Lorenc ZP, Aston SJ. Is there a difference? A prospective study comparing lateral and standard SMAS face lifts with extended SMAS and composite rhytidectomies. Plastic and Reconstructive Surgery 1996;98(7):1135–1143. doi:10.1097/00006534-199612000-00001
6. Alpert BS, Baker DC, Hamra ST, Owsley JQ, Ramirez O. Identical twin face lifts with differing techniques: a 10-year follow-up. Plastic and Reconstructive Surgery 2009;123(3):1025–1033. doi:10.1097/PRS.0b013e31819ba755
7. Chang S, Pusic A, Rohrich RJ. A systematic review of comparison of efficacy and complication rates among face-lift techniques. Plastic and Reconstructive Surgery 2011;127(1):423–433. doi:10.1097/PRS.0b013e3181f95c08
8. Martén E, Langevin CJ, Kaswan S, Zins JE. The safety of rhytidectomy in the elderly. Plastic and Reconstructive Surgery 2011;127(6):2455–2463. doi:10.1097/PRS.0b013e3182131da9
9. Jacono AA, Alemi AS, Russell JL. A meta-analysis of complication rates among different SMAS facelift techniques. Aesthetic Surgery Journal 2019;39(9):927–942. doi:10.1093/asj/sjz045
10. Gupta V, Winocour J, Shi H, Shack RB, Grotting JC, Higdon KK. Preoperative risk factors and complication rates in facelift: analysis of 11,300 patients. Aesthetic Surgery Journal 2016;36(1):1–13. doi:10.1093/asj/sjv162