Deep Plane Facelift

Traditional facelift surgeries were cutaneous, meaning that only the skin was pulled back, with no repositioning or tightening of the underlying tissue or muscles—which often led to an overly tight or “done” appearance. However, these signs of facial aging are the result of more than just sagging skin. The soft tissue of the face below the skin level also tends to sag with age as the ligaments of the face weaken. Hence the SMAS facelift was developed to address the superficial musculoaponeurotic system (SMAS), which is the layer of connective soft tissue that sits within the subcutaneous layer of the face between the facial muscles and the skin and plays an important role in our facial expressions.

The SMAS layer of the face can be treated in many ways, through plication, SMASectomy and SMAS flap elevation. With SMAS plication the SMAS layer is folded over on itself after it is pulled in a posterior and upward direction and sutured into place. With SMASectomy, the small section of the SMAS that is folded over on itself when a plication is performed is actually excised. Typically plication would be performed in patients who can benefit from volume distributed to the lateral aspect of the face and cheek bone area where the plication occurs. A patient who does not need additional volume in this area would likely be treated with SMASectomy. SMAS plication and SMASectomy are good options for some facelift patients (generally those with good skin elasticity and mild to moderate facial aging).

Extended SMAS flap and deep plane lift both involve a dissection below the SMAS layer with repositioning of the muscles and fat pads themselves. Extended dissection under the SMAS, employed with these techniques, allows for greater elevation and repositioning of the soft tissues of the face in order to restore a youthful appearance. As an added benefit of deep plane face lifting, minimal tension is placed on the skin closure, which will contribute to more inconspicuous scarring.¹

While some consider the deep plane lift more invasive than an SMAS flap, the deep plane technique keeps the muscles, fat and skin intact as one composite layer. The skin does not need to be elevated off of the SMAS to the extent that it may when a SMAS flap is performed—thus the skin and SMAS are lifted and repositioned together, as opposed to the SMAS flap technique that separates the skin from the muscle and tissue. By moving not just the skin, but also the underlying deeper tissue, ligaments, and muscles, the deep plane facelift technique allows for increased flattening of the nasolabial fold, greater restoration of facial volume, and possibly longer-lasting results than a SMAS lift.