As you research the difference between a deep plane facelift and a SMAS facelift, you may wonder whether they are different names for the same operation. Cheeks that sit lower, tissue gathering along the jawline, or neck laxity may have prompted your search. When explaining the choice of technique, we show which tissue will be moved in these areas and how it will be reached.
A deep plane facelift also involves the supporting layer called the SMAS. Plication, SMASectomy, and high SMAS are techniques that work on this layer in different ways. Understanding the distinction means identifying which tissues are folded, removed, or released and repositioned. We can also explain how the neck and eye area fit into the plan within this anatomical framework.
Facial layers and retaining ligaments
From the outside inward, the face has skin, subcutaneous fat, and the SMAS. SMAS stands for superficial musculoaponeurotic system, a supporting layer of muscle and connective tissue linked to the facial expression muscles. Fat is distributed in compartments and contributes to cheek fullness and the transitions between neighboring areas. The same face may have volume loss in the upper cheek and tissue gathering along the lower jawline.
Retaining ligaments attach superficial tissues to bone and deeper connective tissue structures. The attachments around the cheekbone are called zygomatic ligaments, while those along the front border of the chewing muscle are called masseteric ligaments. Attachments near the lower jawline are called mandibular ligaments. Their positions affect the direction and extent of cheek tissue movement.
Managing excess skin and repositioning the SMAS are separate steps in a facelift. After reshaping the supporting tissue, we adapt the skin to its new position and remove the excess. When explaining our choice of technique, we also describe what will be done beneath the skin. An incision around the ear alone does not reveal which layer is being treated inside.
The relationships between layers are not the same throughout the face. The relationship of the facial nerve branches that activate facial expression muscles to deeper tissues varies between the temple, cheek, and jawline. The surgical field is therefore described according to each area’s anatomical boundaries. The layer diagram on our face and neck lift page can help you see how the skin, SMAS, and deep plane are arranged.
SMAS plication, SMASectomy, and high SMAS
The term SMAS facelift covers different procedures involving the supporting layer. Their shared aim is to reposition sagging tissues. They differ in whether this layer is folded, partly removed, or lifted and repositioned. We explain which procedure may be considered according to the distribution of laxity in the cheeks and along the jawline.
Plication means folding tissue with sutures. In SMAS plication, we create folds by placing sutures in the layer without dissecting extensively beneath it. We choose the direction of the sutures according to the tissue we want to reposition in the lower face. The existing layer is reshaped by folding, which is how this technique addresses the supporting tissue.
In SMASectomy, we remove a planned strip of the supporting layer. We then bring the edges of the remaining tissue together with sutures. Folding tissue over itself in plication and removing a section before joining the remaining edges in SMASectomy are different procedures. Tissue thickness and the location of laxity inform this choice.
In the high SMAS technique, we lift the supporting layer over an area extending to the level of the cheekbone arch. The lifted piece of tissue is called a flap. Because the skin and SMAS can be prepared separately, the direction of the supporting tissue and the placement of the skin can be adjusted independently. The word high describes the upper boundary of the SMAS layer being prepared.
When comparing these techniques, you can ask at what level the SMAS is accessed and which part is mobilized. The area described by high SMAS differs from the suture line used in plication. When recommending a SMAS facelift, we therefore explain which technique it involves. This explanation also covers the cheek tissue to be moved and the planned direction of movement along the jawline.
What happens in a deep plane facelift?
In a deep plane facelift, we work beneath the SMAS. We release the necessary portions of the retaining ligaments that limit cheek movement, preparing the area through which the supporting tissue can be repositioned. We move the SMAS together with the overlying skin and subcutaneous tissue as a unit, preserving their connections. The supporting structures are then secured in their new position.
Release means freeing the relevant portion of an attachment that holds tissue at a particular point. We choose how to address the ligaments around the cheekbone and chewing muscle according to the area into which the cheek will be moved. A plan extending to the jawline also takes the attachments in that region into account. Which ligaments are released and to what extent are anatomical aspects of the surgical plan.
The midface is the region extending from below the lower eyelid into the cheeks. The position of its fat pads contributes to the eyelid-to-cheek transition and the fold running from the side of the nose to the corner of the mouth. When explaining a deep plane facelift, we show how these tissues relate to one another down to the jawline. The direction of repositioning depends on where tissue has moved downward.
This is where the difference in mechanism between deep plane surgery and plication becomes apparent. Plication folds the SMAS with sutures, while deep plane surgery goes beneath the layer to reach the ligaments limiting tissue movement. High SMAS also works with an elevated supporting layer. When comparing it with deep plane surgery, we explain the extent to which the skin is prepared separately and the area over which the supporting tissue is lifted.
Which facelift technique is considered for each pattern of sagging?
Downward displacement of the cheek and a localized accumulation of tissue along the jawline involve different surgical areas. During the examination, the distribution of sagging in the midface, lower face, or neck is assessed. Skin elasticity and the volume of tissue beneath the skin are part of the same assessment. Explaining technique selection through this distribution helps you see how the proposed procedure relates to your face.
Plication and SMASectomy are options when reshaping the lower face’s supporting tissue by folding it or removing a strip is considered. Approaches such as high SMAS can be used when the supporting layer needs to be lifted and repositioned. When cheek tissue is to be moved by releasing retaining ligaments, we explain the scope of a deep plane facelift. The amount of sagging visible from the outside does not determine this choice on its own.
Cheek position, local tissue volume, and bony support all contribute to the appearance of the fold running from the side of the nose to the corner of the mouth. If you point to a fold, we may ask whether your concern is the tissue gathering beneath it, the line on the surface, or the adjacent hollow. This helps distinguish tissue to be repositioned from an area where adding volume may be considered. If volume is lacking, fat transfer is among the options that can be added to a facelift plan.
Cheek volume and the distribution of tissue along the jawline may differ on the right and left. Front, side, and angled views show how these differences affect the transition from face to neck. Previous facial operations and injections also help us understand the tissue structure. At your consultation, you can share which areas have been treated and what you would like to change about their appearance.
How are a facelift and neck treatment planned together?
The SMAS in the lower face continues into a thin, broad neck muscle called the platysma. This muscle, which can appear as vertical bands at the front of the neck, is assessed separately from skin laxity. The appearance of the bands at rest and during muscle movement affects the scope of surgery. Alongside the facial technique, we determine which neck tissues will be addressed.
Platysmaplasty reshapes and supports this muscle with sutures. Bringing the muscle edges together at the front of the neck or including the side portions in the lifting plan may be considered. Excess fat beneath the chin may require a procedure targeting subcutaneous fat. Excess skin, muscle bands, and fat deposits are separate targets, so each is included according to its own findings.
Chin projection also affects the neck profile. Fullness beneath the chin may not come entirely from subcutaneous fat. During the examination, the contributions of bony support and soft tissues are distinguished. This allows us to explain which procedures may address fullness at the front of the neck and skin laxity extending toward the sides.
Incisions around the ears provide access to the tissues at the sides. An incision beneath the chin may be added when direct access to the muscle at the front of the neck is needed. You can therefore ask about the neck plan separately from the name of the facelift technique. The incision locations indicate which muscle or skin areas will be reached.
The scope of a mini facelift and treatment around the eyes
A mini facelift generally refers to procedures addressing a limited part of the lower face. This scope focuses on the jawline and neighboring cheek tissues and does not, by itself, define treatment of muscle bands at the front of the neck. Mini refers to the extent of the surgical field, while SMAS or deep plane refers to how the tissues are treated. At your consultation, you can ask which areas are included under the term mini.
We plan incisions in relation to the front and back of the ear and, when needed, the hair-bearing area. Their extent varies with the hairline and distribution of excess skin. Different areas may need to be reached even when the technique has the same name. Reshaping the supporting layer and removing excess skin are separate steps before skin closure.
A low brow can accompany tissue gathering over the upper eyelid. A brow lift aims to change brow position through tissues associated with the forehead and temples. When an upper eyelid fold is examined, the brow’s contribution to its appearance is also distinguished. The excess skin remaining when the brow is supported affects the plan for the eyelid’s own tissue.
Lower eyelid fat bags and downward displacement of the cheek may be present in the same person. Eyelid surgery (blepharoplasty) addresses skin and fat in the eyelid, while a facelift targets the cheek’s supporting layers. When we can include these procedures in the same plan, we explain separately which tissue will be repositioned and which will be reshaped at the eyelid-to-cheek transition. Excess upper eyelid skin, a low brow, and a drooping eyelid margin where the lashes grow are also separate findings.
Frequently asked questions
Does a deep plane facelift involve the SMAS?
Yes, a deep plane facelift involves the SMAS. The surgeon works beneath it to release the necessary portions of the retaining ligaments. The supporting layer is moved together with the overlying skin and subcutaneous tissue, preserving their connections.
What is the difference between SMAS plication and SMASectomy?
Plication folds the supporting layer with sutures. SMASectomy removes a strip of the layer and brings the remaining edges together. Tissue thickness and the distribution of laxity affect which procedure may be considered.
Are high SMAS and deep plane the same technique?
High SMAS and deep plane approaches differ in how the supporting layer is prepared. In high SMAS, the layer extending to the level of the cheekbone arch is elevated, and the skin can be prepared separately. In deep plane surgery, ligament release allows tissue to be moved as a unit while preserving the connections between the skin and SMAS.
Does a mini facelift include a neck lift?
A mini facelift usually covers a limited part of the lower face. Procedures addressing excess neck skin and platysma bands are described separately. Whether an incision beneath the chin is needed also depends on the neck findings.
Can a brow lift and eyelid surgery be added to a facelift?
We can add a brow lift and eyelid surgery to a facelift plan. Brow position, excess eyelid skin, and lower eyelid bags determine which areas will be treated. If a brow lift is also planned, the upper eyelid skin to be removed is marked according to the brow’s intended position.
