August 19, 2026 | Facelift
15 minute read
Dr. Sean Delaney, Board Certified Facial Plastic Surgeon
If you are researching facelift surgery, you have probably encountered terms such as SMAS facelift, deep plane facelift, extended deep plane facelift, and preservation facelift. It can quickly become confusing, particularly because two surgeons may use the same term to describe operations that are actually quite different.
I have performed both traditional SMAS facelift techniques and extended deep plane facelifts. Over time, my approach has evolved significantly. Today, I perform the extended deep plane technique for almost all of my facelift patients.
Why did I change?
The simplest explanation is this: a traditional SMAS facelift relies more on tension and suspension, while an extended deep plane facelift relies more on release and mobilization.
That distinction fundamentally changed what I was able to accomplish with facelift surgery.
What is the SMAS?
The superficial musculoaponeurotic system, or SMAS, is a fibromuscular layer beneath the skin and subcutaneous fat of the face. It is continuous with the platysma muscle in the neck and plays an important role in facelift surgery.
Modern facelifts generally do more than simply pull and remove excess skin. Instead, surgeons manipulate the deeper SMAS layer to reposition descended facial tissues and allow the skin to be redraped with less tension.
The major difference among facelift techniques is how the surgeon manipulates this deeper layer and how extensively the surrounding tissues are released.
What is a SMAS Facelift?
There are many variations of a SMAS facelift.
With techniques such as SMAS plication, the surgeon tightens the SMAS by folding and suturing it onto itself. Other techniques may remove a strip of SMAS or elevate a SMAS flap before repositioning it.
These techniques can produce excellent results in appropriately selected patients.
Earlier in my career, I frequently performed SMAS plication facelifts. I was able to create significant improvements, particularly along the jawline and lower face. But as I gained experience and followed my patients over time, I became dissatisfied with some of the limitations.
I wanted more powerful elevation of the midface. I wanted greater improvement of the tissues contributing to the nasolabial folds. I also wanted the correction to hold up better as my patients continued to age.
That led me toward the extended deep plane.
What is a Deep Plane Facelift?
A deep plane facelift approaches facial rejuvenation differently.
Instead of relying primarily on tightening the SMAS against tissues that remain tethered by retaining ligaments, the surgeon enters a deeper anatomical plane and releases specific retaining ligaments that restrict movement of the face.
This distinction is important.
I often explain it as:
SMAS plication is more about tension. Deep plane surgery is more about release.
Once the appropriate ligaments have been released, the cheek, jowl and lower facial tissues can move much more freely. This allows me to reposition them more vertically rather than simply pulling the face laterally.
What Makes an Extended Deep Plane Facelift “Extended”?
Not every operation called a deep plane facelift is the same.
This is one of the most important things I want patients to understand.
The term “deep plane facelift” has increasingly become a marketing term, but it does not define exactly how far a surgeon dissects, which retaining ligaments are released or how much of the central face is mobilized.
An extended deep plane facelift takes the release farther toward the central face.
During my operation, I may release the zygomatic, masseteric, mandibular and cervical retaining ligaments, depending on the patient’s anatomy and the areas that need to be treated. The dissection can extend toward the nasolabial fold and modiolus.
This is more technically demanding and takes additional surgical time. In my experience, however, the additional release is worth it.
By releasing the structures tethering the face rather than simply pulling against them, I can achieve a more powerful vertical repositioning of the cheek, jawline and lower face.
SMAS vs. Deep Plane: Tension vs. Release
Imagine trying to move a rug while someone is standing on it.
You can pull harder, but the rug is still tethered.
Another option is to remove the obstruction and then reposition the rug with considerably less force.
Although facial anatomy is obviously much more complex, this illustrates an important difference between the two approaches.
With a traditional SMAS plication, the surgeon creates tension to reposition the SMAS while many of the facial retaining ligaments remain intact.
With an extended deep plane facelift, I release the appropriate retaining ligaments first. The tissues then move more freely into the position I want.
This allows the deeper tissues to carry the lift instead of relying on excessive tension on the skin.
Why Is the Vertical Vector So Important?
One of my primary goals with facelift surgery is vertical elevation.
The aging face does not simply become loose. Facial tissues descend.
The cheek falls. The jawline becomes less defined. Jowls develop. The transition between the cheek and nasolabial fold changes.
Simply pulling everything toward the ear does not necessarily reverse those changes in the direction they occurred.
With an extended deep plane facelift, releasing the retaining ligaments allows me to elevate the facial tissues more vertically.
For me, that is one of the most important advantages of the operation.
Does a Deep Plane Facelift Improve the Nasolabial Folds?
It can soften the nasolabial folds, but patients should not expect a facelift to erase them.
The nasolabial fold is a normal anatomical feature of the face.
One limitation I noticed with my earlier SMAS plication technique was that it had relatively little effect on the medial cheek and nasolabial fold.
With an extended deep plane dissection, I can mobilize the cheek farther toward the central face. This allows me to reposition descended cheek tissue and often soften the appearance of the nasolabial fold.
That does not mean the fold disappears—and I would not want to completely eliminate normal facial anatomy.
The goal is rejuvenation, not erasure.
Does a Deep Plane Facelift Look More Natural?
I believe it can.
A natural facelift result should not look like the face has been pulled toward the ears.
One reason an extended deep plane facelift can produce a natural appearance is that less tension is required to achieve the desired movement.
Once the retaining ligaments have been appropriately released, the deeper facial tissues can be repositioned while the skin is redraped more naturally over them.
Excessive skin tension can contribute to some of the classic signs people associate with an unnatural facelift, including:
- A pulled or windswept appearance
- Widened scars
- Distortion around the ears
- Hairline changes
- Hair loss around incisions
My objective is for someone to look at a patient and think that she looks refreshed—not to immediately recognize that she has had a facelift.
Does a Deep Plane Facelift Last Longer?
This is a more complicated question.
Scientific literature has not definitively established that every deep plane facelift lasts longer than every SMAS facelift. Both approaches can provide durable rejuvenation, and excellent surgeons can achieve excellent results with multiple techniques.
I can, however, speak to my own experience performing both operations.
I began transitioning toward deep plane facelift surgery in 2023. As I have followed my patients, I have found that my extended deep plane results maintain their correction better than the SMAS plication results I performed earlier in my career.
Just as importantly, I think they age more naturally.
As a face continues aging after a more lateral SMAS suspension, a patient can sometimes develop what surgeons call a lateral sweep, where the direction of the previous lift becomes increasingly apparent.
My goal with vertical deep plane repositioning is not only to produce an excellent early result but also to create a result that continues to look natural as the patient ages.
Is Recovery Longer After a Deep Plane Facelift?
Many patients assume that a more extensive operation must mean a more difficult recovery.
That has not been my experience.
In my own practice, I have observed less bruising and a faster return toward baseline with my current extended deep plane technique than with the SMAS techniques I previously performed.
Part of this relates to how my technique itself has evolved.
I now use a preservation-oriented, limited-delamination approach. Rather than extensively separating the skin from the deeper tissues, I limit skin-SMAS separation and preserve more of the face as a composite flap.
Preserving those tissue connections can reduce the amount of surgical trauma to the superficial tissues.
My facelift technique has also evolved to become drainless, which simplifies the early postoperative experience for my patients.
Can Other Procedures Be Combined With a Deep Plane Facelift?
Frequently.
A facelift repositions descended tissues, but aging is more complicated than tissue laxity alone.
Skin quality, facial volume and skeletal anatomy are critically important to the final result.
A facelift does not correct every sign of facial aging.
For example, a patient may have significant sun damage, fine lines or textural changes that are better addressed with fractional CO₂ laser resurfacing. Another patient may have facial volume loss that benefits from fat grafting.
Because my current preservation approach limits skin undermining and maintains more of the composite tissue, it allows me to be more aggressive with complementary treatments such as fat grafting and laser resurfacing when appropriate.
The result is a more comprehensive approach to facial rejuvenation rather than asking one operation to solve every component of aging.
Why Might I Recommend a Brow Lift With a Facelift?
This sometimes surprises patients.
With powerful vertical elevation of the midface, the relationship between the cheek, temple and brow becomes important.
If the lower two-thirds of the face are substantially elevated while significant brow descent remains untreated, the upper and lower portions of the face may no longer look harmonious.
For that reason, some patients undergoing an extended deep plane facelift may also benefit from a brow lift.
That does not mean every facelift patient needs one. It means I evaluate the entire face rather than treating the jawline in isolation.
Does a Facelift Fix Facial Asymmetry?
No facelift can make a naturally asymmetric face perfectly symmetric.
Every human face has asymmetry before surgery, and those differences remain relevant afterward.
Similarly, a facelift does not directly rejuvenate every structure of the face. The lips, for example, are not lifted by a facelift.
This is why I spend considerable time evaluating facial proportions, skin quality, volume distribution, skeletal structure and asymmetries before recommending an operation.
Deep plane surgery is powerful, but it is not magic.
A technically excellent operation still has to work within the anatomy and tissue quality the patient brings to surgery.
Is a Deep Plane Facelift Safer or More Dangerous Than a SMAS Facelift?
One concern patients sometimes encounter online is facial nerve injury.
The facial nerves travel in predictable anatomical locations. Deep plane surgery requires the surgeon to understand those locations and operate carefully around them.
I sometimes explain it using a stop sign at the end of your street.
If you know the stop sign is there, you don’t drive toward it blindly. As you approach it, you slow down because you know exactly what you are looking for.
Facial nerve anatomy is similar in concept. I know where the nerves should be, I know where I am approaching areas of increased risk, and my dissection changes accordingly.
Published research is also more nuanced than the idea that “going deeper means more nerve injuries.”
A large 2019 meta-analysis examining complications across multiple SMAS facelift techniques did not find a significant increase in permanent facial nerve injury among techniques. More recent systematic reviews have likewise reported that nerve injuries are uncommon and that most reported injuries are temporary. The available comparative evidence, however, remains heterogeneous, so no facelift technique should be considered risk-free.
Is an Extended Deep Plane Facelift Better Than a SMAS Facelift?
For the type of facial rejuvenation I want to achieve, I believe the extended deep plane facelift is a superior operation.
That does not mean a SMAS facelift is a bad operation.
With the right patient and an experienced surgeon, SMAS techniques can produce beautiful results. Current systematic-review evidence supports both SMAS and deep plane approaches as effective operations with high patient satisfaction, and the literature does not establish one technique as universally superior for every patient.
There is also emerging evidence supporting more extensive deep-plane release. A recent prospective study comparing conventional and extended deep plane techniques reported greater improvement with the extended approach in jowls, marionette lines and cervical laxity, although larger and longer-term studies are still needed.
My preference comes primarily from performing these operations myself.
I have seen what I could accomplish with SMAS plication, and I have seen what I can accomplish now with an extended deep plane approach.
For patients with more challenging anatomy or more significant facial descent, I find the additional release particularly valuable.
Deep Plane Facelift vs. SMAS Facelift: Which Should You Choose?
I actually think this is the wrong question for most patients.
A better question is:
Who is performing my facelift, and do I like that surgeon’s results?
“Deep plane” does not guarantee an excellent facelift.
Different surgeons can perform very different operations and call all of them deep plane facelifts. The extent of dissection, ligament release, vector of elevation, treatment of the neck and handling of the skin can all differ.
That is why I encourage patients to look beyond terminology.
Study the surgeon’s before-and-after photographs. Look at many patients—not just one spectacular result.
Ask yourself:
Do these people still look like themselves?
Look at the jawline, neck, cheeks, ears, hairline and scars. Most importantly, look at the overall face.
The best facelift should not announce itself.
My Approach to Facelift Surgery Has Continued to Evolve
I began performing deep plane facelifts in 2023, and today advanced facial rejuvenation is one of the primary focuses of my surgical practice.
My technique is still evolving.
I have transitioned to a drainless approach. I have progressively limited skin delamination. I continue refining how I release and reposition the deeper tissues and how I integrate complementary procedures.
That evolution is intentional.
Surgical technique should not remain static simply because a surgeon was trained to perform an operation a certain way.
I was fortunate to train in a practice with an extraordinary attention to detail and an unwavering dedication to achieving the best possible result for each patient. I have carried those principles forward even as my surgical technique has evolved.
Ultimately, patients do not come to me because they want a particular dissection plane.
They want to look like themselves—only refreshed, rested and more youthful.
The technique is simply how we get there.
Frequently Asked Questions
What is the main difference between a SMAS and deep plane facelift?
A traditional SMAS facelift generally tightens or repositions the SMAS while leaving more of the facial retaining ligaments intact. An extended deep plane facelift releases selected retaining ligaments so the cheek and lower facial tissues can be mobilized more freely and repositioned vertically.
Is an extended deep plane facelift the same as a regular deep plane facelift?
Not necessarily. “Deep plane” describes a broad category of facelift techniques. An extended deep plane approach generally involves more extensive ligament release and dissection toward the central face. The exact operation can still vary considerably among surgeons.
Does a deep plane facelift improve jowls?
Yes. Repositioning descended facial tissues can substantially improve jowling and restore a cleaner jawline. The degree of improvement depends on the patient’s anatomy and the specifics of the operation.
Can a deep plane facelift improve nasolabial folds?
An extended deep plane facelift can often soften nasolabial folds by mobilizing and elevating descended cheek tissue. It should not be expected to completely eliminate them.
Does a deep plane facelift look more natural?
Technique alone does not guarantee a natural result. In my approach, releasing the tissues before repositioning them allows me to achieve the desired elevation with less reliance on skin tension, which I believe contributes to a more natural appearance.
Does a deep plane facelift last longer?
Both SMAS and deep plane facelifts can provide long-lasting rejuvenation. The scientific literature has not definitively proven that every deep plane facelift lasts longer. In my own patients, however, I have found that my extended deep plane results maintain their correction and age more naturally than the SMAS plication results I performed earlier in my career.
Is deep plane facelift recovery longer?
Not necessarily. In my practice, patients undergoing my current preservation-oriented extended deep plane technique tend to return toward baseline faster and experience less bruising than patients did with the SMAS techniques I previously performed.
Is a deep plane facelift more dangerous?
All facelift surgery carries risks, including bleeding, hematoma, infection, scarring, hair loss and temporary or permanent facial nerve injury. Current research does not show a clear overall difference in nerve-injury risk between SMAS and deep-plane techniques, and permanent nerve injuries are uncommon in published series.
How do I choose a deep plane facelift surgeon?
Do not choose a surgeon based solely on the words “deep plane.” Look at the surgeon’s training, experience, volume of facelift surgery and—most importantly—a large collection of before-and-after results.
