The deep plane facelift has become one of the most buzzed-about procedures in aesthetic medicine, with patients walking into consultations asking for it by name. Social media is flooded with dramatic before-and-after images, and some surgeons tout it as a superior technique with longer-lasting results. But is it truly better than other facelift techniques, or is it just the latest marketing trend?
To cut through the hype, we spoke with Encino, CA plastic surgeon George Sanders, MD, who has performed both deep plane and SMAS facelifts throughout his career. His take? The technique matters less than the surgeon’s skill.
A Look Back at Facelift Evolution
Facelift techniques have evolved dramatically over the past century. “Originally, surgeons would simply remove a strip of skin in front of the ear and stitch it back together. Not surprisingly, that didn’t do much,” says Dr. Sanders. Over time, doctors realized that tightening only the skin didn’t create long-lasting results, which led to the development of the SMAS facelift in the 1970s.
SMAS, or the superficial musculoaponeurotic system, is a connective tissue layer that sits beneath the skin and above the facial muscles. “If you just pull on the skin, you’re not addressing the real issue—the fat and deeper structures that have descended over time,” explains Dr. Sanders. “The SMAS facelift lifts and tightens this deeper layer, giving a more natural, long-lasting result.”
The deep plane facelift, which emerged in the 1980s, takes things a step further by lifting the SMAS and repositioning it, rather than simply tightening it. While it’s often marketed as the most advanced technique, Dr. Sanders says the research doesn’t necessarily support that claim.
The Twin Study: SMAS vs. Deep Plane
One of the most well-known studies comparing facelift techniques was the Twin Study, or "Identical Twin Face Lifts with Differing Techniques: A 10-Year Follow-Up," where identical twins underwent different types of facelifts—one with a deep plane technique and the other with a SMAS facelift. “They were followed for 10 years, and the results showed no significant difference,” says Dr. Sanders. “Both looked like younger, refreshed versions of themselves, and neither technique proved to be superior.”
Despite the growing demand for deep plane facelifts, the data suggests that the longevity and outcome of a facelift depend more on the surgeon’s expertise than the specific technique used.
The Real Risks of Deep Plane Facelifts
While the deep plane facelift isn’t necessarily a bad procedure, Dr. Sanders cautions that it comes with higher risks. “With a deep plane facelift, you’re working in the area where the facial nerve runs,” he explains. “If that nerve is affected, even temporarily, it can cause weakness in facial movements like smiling or raising your eyebrows. Most of the time, it resolves within six weeks, but that’s a long time for a patient to be worried about their outcome.”
Additionally, he notes that the deep plane approach requires more precision when lifting tissue. “You have to make sure you leave enough thickness on the SMAS to pull it effectively. If it’s too thin, it won’t hold well, and you could run into complications,” he says.
The Bottom Line
With so much emphasis on deep plane facelifts in the media, it’s easy for patients to assume it’s the “best” option. But Dr. Sanders stresses that a skilled surgeon can achieve beautiful, natural-looking results with either technique. “It all comes down to the expertise of the person performing the procedure and selecting the right technique for each patient,” he says.
For those considering a facelift, the takeaway is clear: Instead of focusing solely on a specific technique, find a surgeon with extensive experience, strong before-and-after results, and a deep understanding of facial anatomy. “The most important thing isn’t whether you have a deep plane or SMAS facelift—it’s choosing a surgeon who knows how to tailor the procedure to your needs.”
