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Deep plane facelift vs SMAS facelift – Which is better?

This is a question that patients ask from time to time who may be unsure of the difference between these facelift techniques and which one may be the most suitable for them. The SMAS facelift, which stands for the Superficial Musculo Aponeurotic System, treats the facial skin and SMAS musculature as two separate units. In contrast, a deep plane facelift lifts the skin and SMAS together as one unit, where the surgery is conducted at a deeper tissue level.

During your consultation, your surgeon will conduct an assessment and discussion that considers your facial shape, age-related concerns, and what your anticipated outcomes for a facelift procedure may be. Most surgeons specialise in a single facelift surgery technique, having developed a vast wealth of experience in that method. Therefore, it is vital to understand the difference between these techniques and discuss which technique may be employed with your potential surgeon.

What are the differences between these techniques?

There has certainly been a recent trend in promoting deep plane facelift techniques, which may be due to specific individuals or groups’ training and popularisation of this technique. Popularity does not always equate to superior results, though, as most of the commentary about deep plane facelifts is based on opinion rather than rigorous supporting data. However, this does not mean it is an ineffective technique.

Advocates for the deep plane technique suggest that it can provide an enhanced correction of smile lines and the upper cheek area, as the surgery is conducted at the deep tissue level. It is also claimed to provide better skin circulation during your body’s natural healing process and may result in a decreased risk of skin necrosis, as well as minimised visible bruising. Proponents of the deep plane facelift technique indicate it can potentially reduce a patient’s downtime by roughly one week. However, the possible disadvantages of the deep plane technique must be considered.

Some surgeons would argue that the deep plane facelift’s combined elevation can result in a ‘windswept’ or stretched look, but this may depend on what concerns you wish to target. Another concern with this surgical technique is a potentially greater risk of facial nerve damage due to dissection occurring at the deeper tissue level. It is important to note, though, that a metanalysis in 2019 revealed no elevated risk for permanent nerve injury. Still, compared to the SMAS facelift approach, temporary nerve injury was higher, although the rates remain low overall, with reported nerve injuries being under one percent.

The SMAS technique allows for a more customisable facelift as the underlying SMAS musculature can be lifted in a different direction the skin correction. Differentiations in the technique, such as SMASplication and SMASectomy, provide surgeons with a more tailored approach in boosting facial volume and is particularly beneficial for individuals with significant volume loss in the lower face and neck area. However, the upper cheek area is not amenable to improvement with SMAS facelift techniques, but fat grafting can be utilised to overcome this in both techniques. Understanding these approaches to both methods is vital in helping you decide which one may best help you achieve your desired goals.

So, which approach is better for me?

The reality is that one technique is not better than the other, and very little data supports this. However, data indicates that both deep plane and SMAS facelifts can provide excellent outcomes for patients. This will depend on how well your treating surgeon understands the pros and cons of each approach and, during your consultation, considers your facial shape, individual concerns, and desired outcomes. Irrespective of what technique is employed, a well-trained surgeon who is competent in a chosen method and can create a suitable treatment plan for you will play a significant role in achieving an optimal outcome. Patients who endeavour to attend regular post-operative appointments and adhere to their recovery instructions will have a highly satisfying result, regardless of what facelift technique is used.