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.
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
| Feature | SMAS facelift (plication, SMASectomy, flap) | Deep plane facelift |
|---|---|---|
| Layer of dissection | Skin lifted off the SMAS; the SMAS is then tightened, folded or partly lifted | Surgery passes beneath the SMAS; skin and SMAS moved together |
| Main idea | Two layers adjusted separately | One combined layer released and repositioned |
| Midface (cheek) effect | Varies by technique | Varies with surgeon and technique |
| Major haematoma in meta-analysis | Highest with SMAS imbrication (1.92%) | 1.22%, higher than plication |
| Permanent nerve injury | No significant difference between techniques | |
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.
Related reading
- Facelift: what it involves, risks and recovery
- How Long Does a Facelift Last?
- Neck Lift vs Facelift: Which Addresses What?
- Where Are Facelift Scars and How Visible Are They?
Sources
- 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
- American Society of Plastic Surgeons. Facelift procedure steps. ASPS. https://www.plasticsurgery.org/cosmetic-procedures/facelift/procedure Accessed 5 November 2026.
- 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.
- American Society of Plastic Surgeons. Facelift. ASPS. https://www.plasticsurgery.org/cosmetic-procedures/facelift Accessed 5 November 2026.
- NHS. Facelift. NHS website. https://www.nhs.uk/conditions/cosmetic-procedures/cosmetic-surgery/facelift/ Accessed 5 November 2026.
Article history
- — First published.