SMAS Facelift vs Deep Plane Facelift

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What is a SMAS facelift? | SMAS vs deep plane | Dr Turner’s clinical view | Limits of SMAS techniques | How long it lasts | SMAS techniques | How technique is chosen | Risks and complications | Recovery and scars | Cost<

What Is a SMAS Facelift?

SMAS stands for Superficial Musculoaponeurotic System. It is a continuous fibromuscular layer sitting beneath the skin and superficial fat, connecting regions of the face and neck. It blends with the platysma muscle below and the temporoparietal fascia and orbicularis muscle above, and it carries the superficial fat compartments. Deeper again sit the facial retaining ligaments, which tether soft tissue to bone, and the branches of the facial nerve. That anatomy is the reason dissection below the SMAS demands particular care and specific training.

With time, the SMAS descends. This contributes to jowls, loss of jawline definition and lower-face tissue descent. A SMAS facelift addresses that descent by acting on the layer itself: the skin is elevated as a separate flap, and the SMAS is then folded, tightened, partially excised or repositioned depending on the technique. The skin is redraped over the lifted SMAS and excess is trimmed.

Facelift surgery moved to this layer for a reason. Earlier operations focused mainly on redraping skin, and pulling on skin alone tends not to hold. Once surgeons were working on the SMAS rather than relying on skin tension, the support for a correction came from structure rather than surface.

The short version: skin is the surface, the SMAS is the support layer underneath, and the difference between facelift techniques largely comes down to how that layer is handled. SMAS techniques work on the layer, from above. A deep plane facelift works beneath it and allows selected retaining ligaments to be released. Almost every difference between the two approaches follows from that. Dr Turner uses the deep plane technique for every facelift of the jowls, jawline and neck, and his facelift options are compared on the facelift surgery page.

SMAS Facelift vs Deep Plane Facelift

Because a SMAS technique works from above the layer, the correction is held substantially by tension across the SMAS and the redraped skin. A deep plane technique releases selected retaining ligaments, which allows the skin, fat and SMAS to be repositioned together as a composite unit rather than held under surface tension. This also changes the direction of repositioning available, which is relevant where descent is more vertical than lateral.

The practical consequence is reach. Standard SMAS approaches are often effective across the lower face and jawline, but they can undercorrect the midface in patients whose midface has descended significantly, because the tissue is anchored below the plane being worked in.

The full technique is explained on the Deep Plane Facelift in Sydney page.

Dr Turner’s Clinical View: SMAS or Deep Plane

This comes up in almost every facelift consultation, so I will answer it directly. Every facelift I perform is a deep plane facelift. Working beneath the SMAS allows selected retaining ligaments to be released, so the skin, fat and SMAS can be repositioned together as a composite unit rather than held by tension across the layer, and the direction of repositioning can follow the direction of descent.

The deep plane sits closer to the branches of the facial nerve, and the technique demands specific training and regular practice. It is a more extensive dissection than most SMAS techniques, and both carry the risks set out below.

This is my clinical judgement rather than a settled question in the literature. SMAS facelift remains an established technique that many surgeons perform. Whether a deep plane facelift suits you, which neck procedure it is combined with, and whether facelift surgery is appropriate at all depend on your anatomy, tissue position, skin quality, neck findings, prior surgery and what assessment finds at consultation.

Dr Scott J Turner, Specialist Plastic Surgeon (FRACS)

The Limits of SMAS Techniques

Every technique family has a reach, and being clear about the edges matters more than the names.

• Significant midface descent. Standard SMAS approaches work on the layer from above, which limits how directly they can reposition tissue anchored below it. Where midface descent is a major part of the picture, a lower SMAS technique may not reach it. This is why high SMAS exists, and why deep plane approaches are often discussed instead.
• Deep neck structures. Subplatysmal fat, digastric muscle bulk and submandibular gland prominence sit beneath the plane a SMAS facelift works in. Where these drive the appearance of the neck, dedicated deep neck lift surgery is required.
• Skin quality. No SMAS variant changes texture, pigmentation or sun damage. These need skin-directed treatment regardless of what happens to the layer underneath.

None of this makes SMAS surgery obsolete. It defines the cases it fits.

How Long Does a SMAS Facelift Last?

Facelift longevity varies between patients. Technique is one factor, alongside anatomy, skin quality, weight stability, smoking status, sun exposure, general health and continuing ageing, and it may not be the largest one. Ageing continues after any facelift.

A specific figure on a website implies a precision that facelift longevity does not have, so expected duration is discussed against your own anatomy at consultation.

SMAS Facelift Techniques

SMAS facelift is a category rather than a single operation. The variants differ in how the layer is handled, and selection between them follows assessment rather than preference. The thickness and quality of the SMAS itself is a genuine factor: a thin, attenuated layer may not hold a plication the way a robust one will, which can steer the plan toward removing tissue rather than folding it, or toward working in a different plane altogether.

How Facelift Technique Is Chosen

Which facelift technique is used, and whether facelift surgery is appropriate at all, follows from assessment rather than from the name of a procedure. Considerations assessed at consultation include:

• How far change extends across the lower face, jowls and midface.
• The pattern of descent across the face, and whether it is mainly lateral or more vertical.
• Neck findings, and whether deep neck structures are contributing.
• The thickness and quality of the SMAS layer itself.
• Skin quality and how redraped tissue is likely to settle.
• Prior surgery, and whether it has altered the tissue planes.
• General health and suitability for general anaesthesia.
• Smoking status and wound healing considerations.
• Realistic expectations about what surgery can and cannot change.

Two patients with similar findings can still be planned differently once these factors are weighed.

In Dr Turner’s practice, these findings decide how the deep plane facelift is planned, which neck procedure it is combined with, and whether facelift surgery is appropriate at all. Where changes span several facial zones, the Vertical Restore Facelift may be discussed as an alternative to separate operations. A face-to-face consultation following GP referral is required to determine suitability, two consultations are required before surgery, and a seven-day cooling-off period applies before surgery can be booked or a deposit paid.

Risks and Complications

All facelift surgery carries risk, and a technique should never be chosen because of the language attached to it. The operation needs to match your anatomy and your risk profile, which is the entire purpose of the assessment.

Risks relevant to SMAS facelift surgery, discussed in detail at consultation, may include:

• Haematoma. A collection of blood beneath the skin, most common in the first 24 hours.
• Infection. Uncommon in clean facial surgery but possible.
• Scarring. Including the uncommon possibility of hypertrophic or keloid scarring.
• Delayed wound healing. Increased in patients who smoke or have poorly controlled medical conditions.
• Facial nerve injury. Temporary or, less commonly, permanent weakness of the muscles of facial expression.
• Altered sensation or numbness. Around the ears and cheeks, usually improving over months.
• Asymmetry. Minor asymmetry may persist, as no two sides of any face are identical.
• Hairline or skin changes. Including temporary hair loss near incisions.
• Anaesthetic risks. Associated with general anaesthesia.
• Need for further surgery. To address healing or to revise an outcome.
• Dissatisfaction with the outcome. Where the result does not meet expectations.

Deep plane facelift carries the same categories of risk. It involves a more extensive dissection in a plane closer to the branches of the facial nerve, and it is a larger operation, which is part of why technique selection is a clinical decision rather than a preference. Outcomes vary between patients and cannot be guaranteed with any technique.

Risk is reduced by smoking cessation, optimisation of general health, careful surgical technique, an accredited private hospital setting and structured follow-up. Further information is available on the risks and complications page.

Recovery and Scars

Recovery varies between patients and depends on the technique used, whether other procedures are performed, health factors and individual healing. Swelling, bruising, tightness and temporary altered sensation are expected.

Dr Turner’s facelift patients stay in hospital overnight, with reviews at day 3 and day 7. Swelling and bruising build over the first week and then begin to settle, with sutures removed in stages from around day 7. Many patients plan two to three weeks away from desk-based work. Healing continues over several months, with tissue settling and scar maturation over 6 to 12 months. Combining a facelift with eyelid surgery, a brow lift or a neck lift generally lengthens recovery, because the surgical area is broader.

Incision placement depends on the technique and the surgical plan, generally around the ear and within the hairline, with short scar techniques using a more limited pattern. Scars appear pink initially and typically fade over months, and healing is influenced by skin type, health factors, smoking history and aftercare.

The facelift recovery guide and the facelift scars guide cover both subjects in detail.

SMAS Facelift Cost

Every facelift Dr Turner performs is a deep plane facelift, so he does not quote for SMAS facelift surgery.

Deep plane facelift fees are calculated on theatre time and cover the surgeon, specialist anaesthetist, private hospital and scheduled post-operative reviews. The facelift cost page sets out each fee, including what to check when comparing quotes between practices. There is no Medicare rebate or private health insurance benefit for facelift surgery performed for facial ageing.