Lower Facelift Surgery Techniques:
The Deep Plane Facelift and The SMAS Facelift

Facelift Before and After Photos.
Facelift Procedure Information.

As facelift surgery has become increasingly common, and in demand, so too have variations in face lifting techniques. There are so many different names for facelifts today that patients are often left wondering which procedure is right for them, whether or not there are truly any differences between them and which facelift technique(s) actually produce results. While many named or branded facelift techniques are simply new labels applied to preexisting procedures, some named facelifts based upon specific technique do, in fact, address different areas of the face and employ original methods. The two of the most common techniques are: SMAS/Platysma Facelift Technique and the Deep Plane Facelift Technique.

The difference of the two is described below and in the illustrations to follow. In a published study where the authors did a deep plane technique on one side and a SMAS/Platysma on the other side, they found that there was no difference in outcome. However, the study did have some flaws in the design and patient selection.

In my practice, I use both techniques depending on the anatomical features of the face. Every patient is unique in his or her facial anatomy and the technique should vary accordingly.

Developed by facial plastic surgeons in the mid 1980's, the Deep Plane facelift is a legitimate innovation in facelifting techniques. Using a more extensive approach described below, the Deep Plane facelift corrects the lower and mid portions of the face, but specifically addresses sagging cheeks and prominent nasolabial folds, also known as "parentheses" or the "smile lines" around the mouth.

While everyone gets older, some of us age differently. Over time, some patients notice drooping cheeks accompanied by deep folds around the mouth. In our youth, we have healthy, plump cheeks. As one ages, the skin cells become thinner, produce less collagen and lose elasticity. With the help of gravity, the malar fat pads that form the once-plump cheeks, begin to sag. Drooping cheeks "pool" at the nasolabial line between the nose and mouth and create creases. We also lose facial fat as we age, so we're less able to fill our developing folds and wrinkles. Adding insult to injury, nasolabial folds are enhanced throughout our lives by smiling. The pull of our "smiling muscle" creates a depression that runs from the nose to the corner of the mouth. Correction of these complaints requires specific attention to the midface area and a specialized surgical technique.

Many surgical facelifts share the same fundamental technique. Incisions are made in the skin along the ear and hairline. The length of those incisions, (how far up into the hairline they go), determines how much of the face will be affected by the lift. Varying amounts of skin, fat and muscle tissue are lifted away from the face in a flap or "plane". The plane of tissue is pulled, repositioned and secured. Excess tissue is trimmed away. An adaptation of this general concept, the SMAS facelift, remains the standard technique featured in most surgical facelifting today. SMAS (Sub Muscular Aponeurotic System) is the medical term for the muscle layer underneath the skin in the face and neck. Not surprisingly, the SMAS facelift elevates part of the continuous band of muscle fiber in the lower face and neck. Although many plastic surgeons have reported variations of the SMAS technique, the only real modifications have been the extent of the elevation, the direction in which the tissue is pulled and the way that the tissue is secured.

The Deep Plane facelift is more than just a slight variation on the popular SMAS facelift. It differs from other procedures in that sagging fat from the cheek area is included in the lifted flap. Elevating this additional tissue allows the cheek to be repositioned, thus lessening or eliminating the heavy nasolabial fold. The SMAS facelift technique and derivative procedures fail to address sagging cheeks and nasolabial folds because the responsible tissue is not included in the lifted flap. Patients with heavy nasolabial folds who have facelift surgery without this modification can experience disharmony between their newly sleek jawline and uncorrected deep smile lines.

Dr. Oleh Slupchynskyj reports that the Deep Place and SMAS facelifts typically lasts up to 10 years, depending on patient age, health and genetics. Another consideration Dr. Slupchynskyj discusses with all patients considering a facelifting procedure is the recuperation time. Patients that have the common complaints of sagginess and jowling in the face, in addition to significant nasolabial fold and cheek heaviness are the best candidates for the Deep Plane facelift. For individuals with sagging cheeks but no jowls or drooping in the neck, a Mid-Facelift may be the best solution. The Mid-facelift addresses only the area for which it is named. Those patients who have a sagging neck and jawline without very prominent smile lines and sagging cheeks would likely be better served by other, less extensive facelifting procedures like the SMAS facelift. Dr. Slupchynskyj, a top facial plastic surgeon in New York City, will consult in depth with you to determine which procedure is really the best for you.

Deep Plane Facelift Technique
Deep Plane Facelift Technique: In deep plane lower facelifts the skin flap, SMAS (underlying muscle in the face) and the Platysma (underlying muscle in the neck)  are raised as unit. The SMAS in the face and the Platysma in the neck are the layers of muscle tissue, which will be pulled, trimmed and sutured to the preauricular or pre-earlobe area for tightening of the loose skin in the face and neck.
Deep Plane Facelift Technique: Next, the SMAS Muscle and Platysma are tightened sutured and trimmed.
Deep Plane Facelift Technique: The skin is the redrapped over the ear in a tensionless fashion, trimmed and sutured in place.
Deep Plane Facelift Technique: The skin is the redrapped over the ear in a tensionless fashion, trimmed and sutured in place. The result is an even pull and removal of sagging skin from the jowl area and the neck area. There is also no tension on the wound  creating an ideal circumstance for scareless healing.
SMAS Facelift Technique
SMAS Facelift Technique: In all traditional lower facelifts a skin flap is raised to expose the underlying SMAS Muscle (Submuscular Apeuneurotic Fascia) and the Platysma. The SMAS in the face and the Platysma in the neck are the layers of muscle tissue, which will be pulled, trimmed and sutured to the preauricular or pre-earlobe area for tightening of the loose skin in the face and neck.
SMAS Facelift Technique: Next the SMAS Muscle and Platysma are tightened sutured and trimmed.
SMAS Facelift Technique: The skin is the redrapped over the ear in a tensionless fashion, trimmed and sutured in place.
SMAS Facelift Technique: The result is an even pull and removal of sagging skin from the jowl area and the neck area. There is also no tension on the wound  creating an ideal circumstance for scareless healing.

Facelift Before and After Photos.