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Deep Plane vs SMAS Facelift: What Is the Difference?

Both facelifts lift the deeper SMAS layer; deep plane works beneath it and moves skin and SMAS together. Neither is proven better, and risks differ slightly.

By Vireon Medical Editorial TeamFirst published Evidence checked through

Short answer

Both are facelifts that work on the SMAS (superficial musculoaponeurotic system, the layer of muscle and fibrous tissue under the skin and fat), not just the skin. The difference is depth: a SMAS facelift tightens or lifts this layer separately from the skin, while a deep plane facelift works underneath it and moves skin and SMAS together as one unit. Neither has been proven to give better or longer-lasting results, and a large meta-analysis found differences in complication profiles rather than a clearly safer technique.1 The choice depends on your anatomy and the surgeon’s experience.

Key points

  • “SMAS facelift” covers several techniques: plication, SMASectomy and SMAS flaps.
  • Deep plane surgery works beneath the SMAS layer rather than on top of it.
  • Permanent nerve injury rates did not differ between techniques in a 183-study meta-analysis.
  • Major haematoma was somewhat more frequent with deep plane and SMAS imbrication.
  • Claims that one technique lasts longer are not backed by strong comparative evidence.

What the SMAS is, and why it matters

Facelifts today generally lift the deeper tissues, not only the skin. The American Society of Plastic Surgeons describes deeper layers of the face and the muscles being lifted, and Mayo Clinic describes lifting the skin and tightening the tissue beneath it.23

The SMAS is that deeper layer. It connects the facial muscles with the overlying skin and fat, so moving it repositions sagging cheeks and jowls more naturally than skin tension alone. Almost every modern facelift does something with the SMAS; the techniques differ in how.

Layers of the face from skin to bone, with the planes used in SMAS and deep-plane facelifts Simplified cross-section of the soft tissues of the cheek, not to scale. From the surface downwards: skin; subcutaneous fat, crossed by fibrous strands that link the SMAS to the skin; the SMAS (superficial musculoaponeurotic system), a fibrous layer that contains the muscles of facial expression; the sub-SMAS space, a series of soft-tissue spaces bordered by retaining ligaments, which are anchored in the deep layer and run up through the SMAS and fat towards the skin; and finally the deep fascia, periosteum and bone, shown as one bottom layer. A dashed line in the fat just above the SMAS marks where the skin is raised in a SMAS facelift, with the SMAS tightened as a separate layer. A second dashed line just beneath the SMAS marks the deep plane, where a deep-plane facelift works beneath the SMAS. Skin Subcutaneous fat SMAS and expression muscles Sub-SMAS space Deep fascia, periosteum and bone Retaining ligament SMAS facelift skin raised above the SMAS; SMAS tightened as a separate layer Deep-plane facelift works beneath the SMAS
The face is built in layers: skin, subcutaneous fat, the SMAS with the expression muscles, the sub-SMAS space with its retaining ligaments, then deep fascia, periosteum and bone. SMAS and deep-plane facelifts differ mainly in the layer the surgeon works in. Simplified diagram, not to scale.

How the techniques differ

A 2019 meta-analysis in Aesthetic Surgery Journal grouped SMAS facelifts into plication (folding and stitching the layer), SMASectomy or imbrication (removing a strip and stitching the edges), SMAS flaps and high lateral SMAS flaps, and compared them with deep plane and composite techniques.1

FeatureSMAS facelift (plication, SMASectomy, flap)Deep plane facelift
Layer of dissectionSkin lifted off the SMAS; the SMAS is then tightened, folded or partly liftedSurgery passes beneath the SMAS; skin and SMAS moved together
Main ideaTwo layers adjusted separatelyOne combined layer released and repositioned
Midface (cheek) effectVaries by techniqueVaries with surgeon and technique
Major haematoma in meta-analysisHighest with SMAS imbrication (1.92%)1.22%, higher than plication
Permanent nerve injuryNo significant difference between techniques
Complication figures are pooled rates from Jacono and colleagues, 2019.1

Because “SMAS facelift” is an umbrella term, two people told they are having one may have quite different operations. It is worth asking exactly what will be done to the SMAS and why.

What the evidence says

On safety, the evidence is Moderate. The meta-analysis pooled 183 studies.1 Temporary facial nerve weakness was most frequent with high lateral SMAS (1.85%) and composite techniques (1.52%), permanent nerve injury did not differ between techniques, and skin necrosis (death of an area of skin) was most frequent with SMAS flaps (1.57%).1 The authors advised choosing a technique on the quality of results rather than its complication profile.1

On appearance and longevity, the evidence is Limited. We did not find randomised trials comparing deep plane with SMAS facelifts that we could verify. Much of the published work is from surgeons reporting their own preferred technique, which makes fair comparison difficult. Statements that deep plane results last much longer should be treated with caution.

What may matter more than the label

The cause of the concern comes first. The American Society of Plastic Surgeons lists sagging facial skin, jowls, deepened folds from nose to mouth, and loose skin and fat in the neck as features a facelift can address.4 Mayo Clinic notes that a facelift will not change fine lines or other sun damage, and that results are not lifelong because the face continues to age.3

Personal risk factors also weigh heavily. Mayo Clinic identifies haematoma (a collection of blood under the skin) as the most common complication, and notes that smoking raises the risk of poor healing, haematoma and skin loss.3 A surgeon’s experience with a particular technique is likely to influence the result as much as the technique’s name.

Common questions

Is a deep plane facelift riskier?

Not clearly. In the meta-analysis its major haematoma rate was somewhat higher than SMAS plication, but permanent nerve injury did not differ between techniques.1

Does a deep plane facelift last longer?

This has not been shown in good-quality comparative studies. For what is known about longevity, see how long a facelift lasts.

Is recovery different?

Comparative recovery data are limited. For facelifts in general, the NHS says full recovery takes about two to four weeks, with bruising for at least two weeks and the full effect visible after six to nine months.5

Are the scars different?

Not necessarily, since both use similar incisions around the ear and into the hairline.5 See where facelift scars are.

Bottom line

Deep plane and SMAS facelifts both lift the deeper facial layer; they differ in the plane the surgeon works in. Complication rates vary a little between techniques, but no technique has been shown to be clearly better overall. A clear explanation of what will be done, and why it suits your face, is worth more than the name of the operation.

Sources

  1. 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. https://doi.org/10.1093/asj/sjz045
  2. American Society of Plastic Surgeons. Facelift procedure steps. ASPS. https://www.plasticsurgery.org/cosmetic-procedures/facelift/procedure Accessed 5 November 2026.
  3. Mayo Clinic. Face-lift. Mayo Foundation for Medical Education and Research; 2026. https://www.mayoclinic.org/tests-procedures/face-lift/about/pac-20394059 Accessed 5 November 2026.
  4. American Society of Plastic Surgeons. Facelift. ASPS. https://www.plasticsurgery.org/cosmetic-procedures/facelift Accessed 5 November 2026.
  5. NHS. Facelift. NHS website. https://www.nhs.uk/conditions/cosmetic-procedures/cosmetic-surgery/facelift/ Accessed 5 November 2026.

Article history

  • — First published.