If you have started researching facelift surgery, you have probably encountered several terms repeatedly: deep plane facelift and SMAS (or High SMAS) facelift. Social media, surgeon websites, and online discussions often present them as opposing choices, with each technique promoted as more advanced or natural. That framing makes the decision sound straightforward. Choose the “best” technique, and you should get the best result.
Facelift surgery is not quite that simple.
Deep plane and SMAS facelifts are both established approaches to facial rejuvenation. Both can improve jowls, restore jawline definition, elevate descended facial tissues, and create a more refreshed appearance. The best approach depends on your anatomy, aging pattern, skin quality, neck anatomy, previous treatments, and goals. Just as importantly, the result depends on how thoughtfully and skillfully the operation is planned and performed. As the old age goes, it is the archer not the bow.
At Dr. Fagien and Dr. Vaca’s practice in Boca Raton, board-certified plastic surgeon Dr. Elbert Vaca does not apply one standardized operation to every face. He often performs a variation of an Extended Dual Plane High SMAS facelift with medial platysmaplasty, but he customizes the exact surgical plan for each individual. His priority is not using the trendiest label. It is restoring youthful structure and balance while preserving the features, expressions, and character that make each patient unique.
Key Takeaways
- Deep plane and SMAS facelifts both lift and reposition the same deeper tissue layer beneath the skin rather than relying on skin tension
- “SMAS”, short for Superficial Musculoaponeurotic System, is an anatomy term describing the fascial support structure of the face deep to the skin. Both Deep Plane and SMAS facelift techniques reposition this. “SMAS facelift” describes a broad category of operations, not one single standardized technique.
- Current evidence does not show that one technique is superior
- In a recent 2025 review article in Plastic and Reconstructive Surgery, “Deep Plane” facelift techniques were associated with a higher incidence of facial nerve injury.
- Your anatomy and the surgeon’s experience, aesthetic judgment, surgical execution, and postoperative care may matter more than the procedure’s name.
What Is the SMAS?
SMAS stands for the superficial musculoaponeurotic system. Despite its complicated name, the basic concept is fairly straightforward. The SMAS is a supportive layer of fibrous and muscular tissue located beneath the skin and facial fat. It connects with other structures of the face and neck, including the platysma, the thin muscle that extends across the neck and lower face.
The SMAS matters because facial aging is not limited to loose skin. Over time, deeper facial tissues descend, facial fat changes position or diminishes, retaining ligaments and connective tissues loosen, and the neck loses definition. These changes contribute to sagging cheeks, jowls, deepened folds around the mouth, vertical neck bands, and a less defined jawline.
Earlier skin-only facelifts primarily pulled and removed excess skin. Techniques relying solely on skin tension tend to be short-lived as skin stretches when under tension. In addition this tends to create an unnatural, tight, or windswept appearance. Modern facelift surgery instead focuses on restoring deeper support. The SMAS is much more robust and able to withstand tension with minimal stretch. The skin can then be redraped more gently without tension over the repositioned contours.
Both deep plane and SMAS facelift techniques grew from this more anatomically informed understanding of facial aging.
What Is a SMAS Facelift?
A SMAS facelift lifts, tightens, folds, removes, or repositions part of the SMAS layer to improve facial contours. However, the term does not refer to one exact operation. It includes several techniques that manipulate the SMAS in different ways and to different degrees.
Common SMAS-based approaches include:
- SMAS plication: The SMAS is folded and secured with sutures.
- SMASectomy: A selected strip of SMAS is removed before the remaining tissue is tightened and secured.
- High SMAS facelift: The surgeon enters a surgical plane beneath the SMAS, releases certain retaining ligaments that tether the facial tissues, and elevates and repositions the SMAS at a higher level to influence the cheeks, lower face, and jawline.
- Extended SMAS facelift: The surgeon mobilizes a wider area of deeper tissue to address more extensive facial descent.
- Dual Plane facelift: The skin and SMAS are elevated in different planes, allowing each layer to be adjusted according to the patient’s anatomy.
This is why comparing a “SMAS facelift” with a “deep plane facelift” can be misleading. SMAS surgery represents an entire family of techniques. A limited SMAS application is not the same operation as an Extended Dual Plane High SMAS lift, even though both may be described as SMAS facelifts.
The versatility of SMAS techniques allows an experienced surgeon to adjust the direction, extent, and strength of the lift. When performed well, a SMAS facelift can restore cheek and jawline contours while avoiding excessive skin tension.
What Is a Deep Plane Facelift?
A deep plane facelift involves entering a surgical plane beneath the SMAS in selected portions of the face. The surgeon releases certain retaining ligaments that tether the mobile facial tissues to deeper structures. The main difference between a Deep Plane and other SMAS elevation techniques is that there tends to be less separation of the skin from the SMAS (i.e. more Single Plane, than Dual Plane). Therefore, this release allows the skin, SMAS, and overlying facial fat to be repositioned together as a connected unit.
“Deep Plane”, however, is not always a uniform label. Surgeons may differ in where they enter the plane, which retaining ligaments they release, how far the dissection extends, the direction in which they reposition tissues, and how they treat the face and neck together.
This does not mean the terminology is meaningless. The surgical plane and tissue-release method matter. It simply means the words “deep plane” do not tell you everything about the actual operation or guarantee a particular result.
Deep Plane vs. SMAS Facelift: What Is the Difference?
The central difference involves where the surgeon dissects and how the facial tissues are mobilized.
In a deep plane facelift, the surgeon works beneath the SMAS in key areas and releases selected retaining ligaments. This permits the skin and deeper tissues to move together as a composite unit. In many SMAS techniques, the surgeon elevates the skin separately before folding, trimming, elevating, or otherwise repositioning the SMAS.
That distinction matters technically, but it does not mean every patient falls neatly into one category. Modern facelift methods frequently overlap. A High SMAS operation may incorporate extensive release and mobilization, while a deep plane procedure may vary substantially between surgeons. Advanced facial rejuvenation is often better understood as a spectrum of anatomical strategies than as two entirely unrelated operations.
The practical questions are therefore more useful than the label alone:
- Which areas of the face are being released and repositioned?
- How will the operation address the cheeks, jowls, jawline, and neck?
- Will the plan restore lost volume and lift descended tissue?
- How will the surgeon avoid excessive skin tension?
- Where does the surgeon place the incisions?
- How will the procedure preserve the hairline, ears, expressions, and natural proportions?
- How will the surgeon contour the deep structures of the neck?
- Why is this particular approach appropriate for this patient’s anatomy?
Is a Deep Plane Facelift Better Than a SMAS Facelift?
No single facelift technique is best for every patient or every surgeon.
Recent systematic reviews comparing deep plane and SMAS techniques have found high satisfaction and meaningful rejuvenation with both approaches. Some analyses report differences in selected outcomes, but the available studies are difficult to compare because surgical definitions, patient populations, follow-up periods, outcome measurements, and surgeon experience vary. Much of the evidence consists of observational studies rather than randomized, head-to-head trials.
This makes sweeping claims difficult to support. A deep plane facelift is not automatically more natural. Likewise, a carefully designed SMAS facelift is not inherently better. Either approach can produce elegant results when selected appropriately and performed meticulously. Either can also produce disappointing results when the plan does not match the anatomy or when the operation is poorly executed.
Patients should therefore be cautious about “catchy” marketing terms that treat one technique as a universal answer. A facelift is not a branded device with an identical protocol in every office. It is a complex operation shaped by the surgeon’s training, anatomical understanding, judgment, and hands.
Why Dr. Vaca Frequently Uses an Extended Dual Plane High SMAS Approach
Dr. Vaca frequently performs a variation of the Extended Dual Plane High SMAS facelift combined with a medial platysmaplasty. This advanced approach allows him to reposition the deeper support structures of the face while minimizing skin tension.
The “High SMAS” portion refers to elevating the supportive tissue at a higher level, helping address more than the lowest portion of the face. “Dual Plane” means the skin and deeper layer can be managed in separate but coordinated planes. “Extended” reflects a broader mobilization of tissue when the anatomy requires it.
A distinct advantage of a “Dual Plane” technique is that the skin and SMAS can be vectored in somewhat independent directions and tensions. The SMAS (or deep layer) is tensioned in an oblique or vertical direction to best improve jowling and facial tissue descent. Meanwhile, the skin is gently redraped mostly laterally. This matters because this avoids shifting thinner neck skin vertically onto the lower face. This also avoids skin pleats, otherwise known as “dog ears”, along the temple, a common issue with deep plane techniques when shin is shifted vertically as the must shift in the same direction as the tensioned deeper layer since these layers are not separated.
This flexibility is valuable because facial aging is rarely identical from one person to the next. One patient may have substantial jowling but relatively good cheek volume. Another may have cheek descent, hollow temples, and deep folds around the mouth. A third may be most concerned about loose neck skin, fullness beneath the chin, and visible platysmal bands.
Dr. Vaca adapts the operation to those differences rather than making the patient fit a predetermined technique. The approach aims to restore structure, proportion, and natural transitions, not simply pull the face tighter.
The Neck Requires Its Own Surgical Plan
Facelift terminology often places most of the attention on the cheeks and SMAS, but the neck can be just as important to the final result. The face and neck age together. Jowls, loose neck skin, fullness beneath the chin, weakened jawline definition, and vertical platysmal bands often develop as part of the same aging process.
For many patients, Dr. Vaca combines the facial lift with a medial platysmaplasty. Through a carefully concealed incision beneath the chin, the platysma can be tightened and repositioned when appropriate. This may reduce neck bands, refine the area beneath the chin, strengthen jawline definition, and restore a clearer cervicomental angle, the transition between the chin and neck.
Not every patient needs the same neck operation. Most require platysma management, while others have excess fat, loose skin, prominent digastric muscles and submandibular glands, limited chin projection, or a combination of these concerns. A customized plan for the neck is the cornerstone of achieving a great result. Concentrating on whether the facelift is called “deep plane” or “SMAS” can distract from these equally important anatomical details.
Why Volume Matters Along With Lift
Facial aging involves both descent and deflation. Tissues move downward, but volume is also lost in areas such as the cheeks, temples, under-eyes, lips, and the area around the mouth. A facelift can restore position, but lifting alone may not fully recreate soft, youthful contours.
For this reason, Dr. Vaca performs facial fat grafting in nearly all of his facelift patients. Fat is carefully placed in selected areas to replenish volume and improve facial balance. The goal is not to make the face look full or overfilled. It is to restore volume where aging has created hollowing or disrupted natural proportions.
Depending on the patient, a balanced plan may also include eyelid surgery, a brow lift, lip lift, chin augmentation, buccal fat reduction, or skin resurfacing. These are not routine add-ons for everyone. Consider them when another area of aging would otherwise limit the harmony of the overall result.
The Surgeon’s Judgment Matters More Than a Buzzword
Technique matters. It determines which tissues are released, how they are repositioned, where tension is placed, and what areas can be improved. But technique is only one part of a successful facelift.
The surgeon must analyze the entire face and neck, recognize asymmetry, understand the changing relationship among skin, fat, muscle, ligaments, and bone, and select an appropriate correction. During surgery, the surgeon must protect important nerves and blood vessels, control bleeding, preserve healthy tissue, position incisions carefully, and create balanced tension. Artistic judgment is also essential because technically lifting tissue does not automatically create attractive proportions.
Small decisions can have a large visual impact. The direction of lift affects the cheeks and jawline. Incision design affects the hairline and scar visibility. Earlobe positioning can help prevent a pulled or “pixie ear” appearance. Volume restoration can make a result look soft and youthful rather than tight or hollow. Neck contouring must flow naturally into the jawline and lower face.
These details cannot be summarized by a single surgical label. They reflect the surgeon’s experience, precision, restraint, and ability to adapt the plan in real time.
How to Choose a Facelift Surgeon
Instead of asking only, “Do you perform deep plane facelifts?” consider asking questions that reveal how the surgeon thinks and plans:
- Are you certified by the American Board of Plastic Surgery?
- How frequently do you perform facial rejuvenation surgery?
- Which facelift approaches do you use, and why?
- What do you see in my anatomy and aging pattern?
- Which areas would my surgical plan address?
- How would you treat my neck, jawline, and volume loss?
- Where would my incisions be placed?
- How do you minimize tension on the skin and earlobes?
- Would you recommend fat grafting or another complementary procedure?
- Can I see before-and-after results from patients with concerns similar to mine?
- What should I realistically expect during recovery?
- How are questions or concerns handled after surgery?
A thoughtful surgeon should be able to explain the recommended approach in understandable terms. The explanation should connect the operation to your anatomy rather than relying on a fashionable procedure name.
A Facelift Should Be Designed Around Your Face
Deep plane and SMAS facelifts are not opposing choices in which one is modern, and the other is obsolete. They are part of an evolving group of techniques designed to restore deeper facial support and create natural-looking rejuvenation. Each has variations, strengths, and appropriate applications.
Dr. Vaca’s approach is based on the belief that no two faces should receive the same procedure. Through a comprehensive analysis, he evaluates facial descent, volume distribution, skin quality, neck anatomy, proportions, previous treatments, and personal goals. He then develops a surgical plan that may incorporate an Extended Dual Plane High SMAS facelift, medial platysmaplasty, facial fat grafting, or other complementary procedures when appropriate.
The aim is not to make you look like someone else or advertise that you have had surgery. It is to restore the contours that aging has changed while protecting the expressions and features that still feel like you. Ultimately, the best facelift is not the one with the most recognizable name. It is the one that is thoughtfully selected, precisely performed, and artistically tailored to your face.
Schedule a Face and Neck Lift Consultation in Boca Raton, FL
If you are considering face and neck lift surgery in Boca Raton, FL, schedule a personalized consultation with board-certified plastic surgeon Dr. Elbert Vaca. During your consultation, Dr. Vaca will evaluate your facial anatomy, neck contours, skin quality, and aging patterns. He will also listen to your concerns, explain the structural changes contributing to them, and develop a customized surgical plan focused on elegant, balanced, and natural-looking rejuvenation.
Located in Boca Raton, the practice welcomes patients from Fort Lauderdale, Miami, Palm Beach, and throughout the United States and beyond. Call (561) 393-9898 or complete the online form below to schedule your consultation.
