Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney
If you’ve started researching facelift surgery, you’ve probably noticed two terms that come up constantly: deep plane facelift and SMAS facelift. They’re often discussed as if they’re competing options, when in reality they’re related techniques that work at different anatomical depths and suit different patterns of facial ageing. Understanding the actual difference, and where each fits, helps make the choice between them clearer when you sit down with a surgeon.
I’m Dr Scott J Turner, a Specialist Plastic Surgeon (FRACS) at our Bondi Junction and Manly clinics in Sydney. I perform both deep plane and SMAS facelift techniques, and the choice between them depends on the individual patient rather than one being universally “better” than the other. This guide compares the two approaches across the factors that actually matter to your decision: how each works, what each addresses, recovery, longevity, risk, and cost.
The Anatomy You Need to Know First
Both techniques work on the same underlying anatomy, just at different depths. A quick orientation helps the rest of the comparison make sense.
Beneath the skin of the face sits a fibromuscular layer called the SMAS (Superficial Musculoaponeurotic System). It was first described in 1976 by French anatomists Mitz and Peyronie, and modern facelift surgery is built around the recognition that this layer, rather than the skin itself, is the structural foundation of the face. The SMAS supports the cheek, jawline, and upper neck, and it’s continuous with the platysma muscle in the neck.
Beneath the SMAS, fibrous bands called retaining ligaments anchor the deeper soft tissues to the facial skeleton. There are several major retaining ligament groups: the zygomatic ligaments at the cheekbone, the masseteric ligaments along the jaw muscle, the mandibular ligaments along the jawline, and the cervical retaining ligaments in the neck. With age, these ligaments stretch and weaken, allowing the soft tissues they were holding in place to descend.
The difference between SMAS and deep plane facelift comes down to where the surgeon works in relation to these structures.
How Each Technique Works
SMAS Facelift
A SMAS facelift addresses the SMAS layer itself, working at the level of the layer rather than dissecting beneath it. There are several technical variations within the SMAS category.
SMAS plication folds and sutures the SMAS without separating it from the underlying tissues. The retaining ligaments remain intact. This is the most conservative SMAS technique and suits patients with mild laxity.
SMASectomy removes a strip of the SMAS and sutures the remaining edges together. This produces tightening and partial release of some deeper attachments as the tissue is closed. Lateral SMASectomy positions this strip closer to the ear.
High SMAS places the SMAS incision above the cheekbone arch, allowing the dissection to extend into the midface and cheek. This shares anatomical territory with the deep plane technique and is often a step between conservative SMAS and full deep plane work.
Extended SMAS describes wider dissection with partial ligament release. There’s no rigid definition. The term covers a spectrum of techniques between standard SMAS and full deep plane.
In all SMAS variations, the work is at or just below the SMAS layer. The deeper retaining ligaments may be partially addressed but are typically not fully released.
Deep Plane Facelift
A deep plane facelift dissects beneath the SMAS into a deeper anatomical plane. The surgeon directly identifies and releases the retaining ligaments. Once the ligaments are released, the entire composite of skin, fat, and SMAS can be repositioned as a single unit.
This is the key conceptual difference. SMAS techniques work on the support layer. Deep plane techniques release what’s holding the deeper tissues in place and reposition the whole composite. The depth of dissection is greater, the technical complexity is higher, and the scope of what can be repositioned (particularly in the midface) is wider.
Modern deep plane technique often uses a vertical vector of lift, repositioning tissues upward against the direction of gravitational descent rather than pulling them laterally toward the ears. The Vertical Restore Facelift is an example of this vector approach.
What Each Approach Addresses
The two techniques address overlapping but not identical territory.
Both techniques address: the lower face (jowls, jawline definition), the cheek to varying degrees, neck laxity (when neck work is included).
SMAS techniques are typically used for: mild to moderate facial ageing, primarily lower face and jawline concerns, patients who prioritise shorter recovery, first-time facelift in 40s to early 60s, revision cases where altered anatomy makes deep plane dissection technically risky.
Deep plane techniques are typically used for: moderate to advanced facial ageing, significant midface descent (deep plane addresses this more directly), patients with deep nasolabial folds where midface repositioning matters, situations where longer-lasting results are a priority, comprehensive face and neck work in a single operation.
The midface is where the two approaches diverge most. SMAS techniques (other than high SMAS or extended SMAS) typically address the midface indirectly through the SMAS lift. Deep plane techniques address it directly through ligament release and composite flap repositioning. For patients whose primary concern is midface descent, deep plane often produces more direct correction.
Recovery: The Real Differences
Recovery differs between the two approaches in ways that matter to patients planning around work, social events, and family commitments.
SMAS facelift recovery. Most patients go home the same day or the morning after surgery. Visible bruising fades over the first two to three weeks. Most patients return to desk-based work around the two-week mark, although bruising may still be present. Social activities typically resume from three to four weeks. Light exercise from three to four weeks, demanding activity from four to six weeks.
Deep plane facelift recovery. Hospital stay is typically one to two nights, particularly for extended deep plane or Vertical Restore approaches. Bruising can be more prominent in the first week given the depth of dissection. Most patients return to desk-based work around two to three weeks. Social activities from three to four weeks. Light exercise from four weeks, demanding activity from six weeks. Subtle deeper swelling continues to settle over three to six months.
The practical difference for most patients is approximately one week of additional recovery on the deep plane side. The trade-off is more substantial structural correction and (often) longer-lasting results.
Longevity: How Long Does Each Last?
This is one of the most common questions in consultation, and the honest answer involves ranges rather than precise numbers.
SMAS facelift. Published clinical experience suggests structural improvements may last approximately eight to twelve years, depending on the specific technique, individual patient factors, and lifestyle.
Deep plane facelift. Some published series suggest twelve to fifteen years for deep plane techniques, particularly when combined with vertical vector repositioning. The anatomical rationale for greater longevity is that the retaining ligaments are released and repositioned, so the deep structural change is more substantial than tightening a more superficial layer.
Both techniques produce durable results. The longevity difference reflects the depth and extent of the structural change, not a fundamental difference in whether one “works” and the other doesn’t.
What both techniques share: the face continues to age after surgery. No facelift stops the ageing process. Maintaining stable weight, sun protection, non-smoking status, and good general health all contribute to how long either result remains visible.
Individual outcomes vary considerably based on starting anatomy, skin quality, bone structure, genetics, and lifestyle factors after surgery.
Risk: How Do They Compare?
Both techniques are performed by Specialist Plastic Surgeons under general anaesthesia in accredited hospitals, and both have established safety profiles. The risk patterns differ in some respects.
Common to both. Swelling, bruising, temporary numbness, sensation of tightness, haematoma risk, infection risk (uncommon), unfavourable scarring, prolonged altered sensation, asymmetry, hair loss around incisions, rare risks of any major surgery including deep vein thrombosis.
Where SMAS may have a slight advantage. The dissection is more superficial, which means the facial nerve is at less direct surgical exposure. Published series report temporary facial nerve weakness in approximately 1 percent of SMAS cases, with permanent injury very rare. The shorter operating time also generally translates to a slightly lower anaesthesia-related risk burden.
Where deep plane requires more careful technique. The deeper dissection brings the surgeon closer to the facial nerve branches. The technical demands are higher, and the margin for error in the deep plane is smaller. In experienced hands, the risk profiles of the two techniques are broadly comparable, but deep plane technique requires more specialised training and experience to perform safely.
Revision rates. Published revision rates for facelift surgery vary from approximately 5 to 15 percent across both technique categories, depending on definition of revision and length of follow-up.
Cost: SMAS vs Deep Plane in Australia
Cost differs because operating time and technical complexity differ. In the Australian market, deep plane and Vertical Restore facelifts typically cost more than SMAS facelifts because they involve longer operating time, more complex dissection, and (often) longer hospital stay.
The cost difference is meaningful for some patients but should not be the primary driver of which technique is chosen. The right technique is the one that addresses your specific anatomical pattern of ageing. Choosing a SMAS facelift purely on cost when the anatomy calls for deep plane (significant midface descent, advanced ageing, complex neck involvement) often results in disappointment with the outcome and, sometimes, the eventual cost of revision surgery.
Specific costs are provided after consultation, when the surgical plan has been confirmed. Costs typically include the surgeon’s fee, anaesthetist’s fee, hospital accommodation, and post-operative care. Medicare rebates do not apply to cosmetic facelift surgery, and private health insurance typically does not cover cosmetic procedures.
For patients comparing techniques on cost specifically, the SMAS facelift cost ecosystem is detailed on our SMAS Facelift page, and the deep plane facelift cost detail is on our Deep Plane Facelift page.
Which Is Right for You? A Decision Framework
There’s no universal answer to which technique is “better.” There’s only which technique fits your specific situation. The questions below help frame the decision, although the actual choice happens during consultation with a Specialist Plastic Surgeon who can assess your anatomy directly.
A SMAS facelift may be appropriate if:
You have mild to moderate ageing concentrated in the lower face and jawline; your midface still has reasonable position and volume; you have good skin elasticity in the upper face; you prioritise shorter recovery time; this is your first facelift in your 40s to early 60s; you’re considering revision surgery and your anatomy is challenging for deeper dissection; or your overall pattern of change does not require comprehensive midface or extended neck correction.
A deep plane facelift may be appropriate if:
You have moderate to advanced ageing across multiple zones; significant midface descent or deep nasolabial folds are part of what you want addressed; you have substantial neck laxity that needs addressing alongside facial work; you want the longest reasonable longevity from a single operation; you’re prepared for a slightly longer recovery in exchange for more substantial structural change; or your anatomy specifically calls for the wider repositioning that deep plane allows.
For more details on each procedure:
For the technical detail, candidacy criteria, recovery, and cost specifics of each technique, see our Deep Plane Facelift page or our SMAS Facelift page. For an overview of all the facelift techniques available, including ponytail, mini, Vertical Restore, lower facelift, and revision, see our main facelift page.
A Note on High SMAS: The Middle Ground
One technique often comes up in this comparison and deserves a separate mention. High SMAS is a SMAS technique in name but shares anatomical territory with deep plane. It places the SMAS incision higher on the face, above the zygomatic arch, allowing the dissection to extend into the midface. For some patients, high SMAS produces midface correction that’s closer to deep plane than to traditional SMAS plication, with a recovery profile somewhere in between.
If you’ve heard high SMAS positioned as a separate option, it’s worth understanding that it sits on the spectrum between standard SMAS and full deep plane rather than being a distinct third technique. Whether it’s appropriate for you depends on the specific midface changes present and the degree of ligament release needed.
Frequently Asked Questions
What is the difference between deep plane and SMAS facelift? SMAS facelift works at the level of the SMAS layer (the fibromuscular support layer beneath the skin), tightening or repositioning it through plication, excision, or wider dissection. Deep plane facelift dissects beneath the SMAS into a deeper anatomical plane and directly releases the retaining ligaments that anchor facial tissues to the skeleton. Once released, the entire composite of skin, fat, and SMAS can be repositioned as a single unit. The depth of dissection is greater for deep plane, the technical complexity is higher, and the scope of midface correction is typically wider.
Is deep plane facelift better than SMAS? Neither technique is universally better than the other. Deep plane is generally more appropriate for moderate to advanced ageing, significant midface descent, or comprehensive face-and-neck work. SMAS is generally more appropriate for mild to moderate ageing concentrated in the lower face, patients prioritising shorter recovery, and revision cases where deeper dissection is technically risky. The right choice depends on individual anatomy assessed during consultation.
Is SMAS the same as deep plane facelift? No. They are related but distinct. Both work on the same anatomical structures (the SMAS layer and the retaining ligaments beneath it), but at different depths. SMAS techniques work at or just below the SMAS layer. Deep plane techniques work beneath the SMAS, releasing the retaining ligaments. The high SMAS variation sits between traditional SMAS and full deep plane technique in terms of dissection depth.
How long does a SMAS facelift last compared to deep plane? Published clinical experience suggests SMAS facelifts may last approximately eight to twelve years, while deep plane techniques may last twelve to fifteen years in some published series. The longevity difference reflects the greater extent of structural repositioning achieved with deep plane technique. Individual outcomes vary considerably based on patient factors, technique specifics, and lifestyle factors after surgery.
What is the cost difference between SMAS and deep plane facelift? In the Australian market, deep plane facelift costs typically more than SMAS facelift due to longer operating time, more complex dissection, and longer hospital stay. The cost difference is meaningful but should not be the primary driver of which technique is chosen. The right technique is the one that addresses your specific anatomy. Cost detail for each procedure is provided after consultation. For procedure-specific cost information, see the SMAS Facelift page or the Deep Plane Facelift page.
Book a Consultation
If you’re comparing facelift techniques and want an honest assessment of which approach fits your situation, book a consultation with me at our Bondi Junction or Manly clinic in Sydney. I also consult at clinics in Brisbane, Canberra, and Newcastle.
Please obtain a GP referral before your appointment. The consultation includes a detailed facial anatomy assessment, discussion of all facelift technique options (not only SMAS or deep plane), realistic information about recovery and outcomes, and the mandatory two-consultation cooling-off process required under Australian cosmetic surgery law.
Contact our clinic on 1300 437 758 or email [email protected].
General information only, not medical advice. All surgery carries risk. Outcomes vary considerably between patients based on anatomy, skin quality, health factors, and individual response to surgery. Any decision about facelift surgery requires individual clinical assessment by a qualified health practitioner.
