Deep plane or SMAS facelift: which is right for you?
In short: both techniques reposition the deeper tissues of the face rather than simply pulling the skin, and both give durable, natural results in experienced hands. A SMAS facelift lifts the muscle-and-fat layer from above; a deep plane facelift works beneath it and releases the ligaments that hold the cheek down, which tends to give a stronger effect on the midface and the nasolabial folds. Recent studies report slightly higher satisfaction with deep plane but no clear-cut winner, so the right choice depends on your anatomy and, above all, on your surgeon’s experience with the technique.
First, what is the SMAS?
SMAS stands for superficial musculo-aponeurotic system: a thin layer of muscle and fibrous tissue lying under the skin and fat of the face and continuing into the neck (where it becomes the platysma muscle). As we age, this layer and the fat pads attached to it descend, creating jowls, deeper folds beside the mouth and a less defined jawline.
Old-style facelifts only tightened the skin, which gave the « wind-swept » look and did not last. Modern facelifts treat the SMAS as the structure to reposition, with the skin simply redraped over it. The difference between the techniques is how the SMAS is handled.
The SMAS facelift
The surgeon lifts the skin, then tightens the SMAS, either by folding and stitching it (plication), by removing a strip and suturing the edges (SMASectomy), or by lifting a flap of it (SMAS flap). The SMAS and the skin are treated as two separate layers.
- Strengths: a well-established, versatile technique; very effective on the jawline and jowls.
- Limits: the retaining ligaments of the cheek are often left in place, so the effect on the midface and nasolabial folds can be more limited.
The deep plane facelift
The surgeon goes beneath the SMAS and releases the key retaining ligaments that tether the cheek and jowl. Skin and SMAS are lifted together as one thicker flap and moved as a single unit.
- Strengths: stronger repositioning of the cheek and midface, less tension on the skin, often a very natural result.
- Limits: technically demanding; the dissection runs close to branches of the facial nerve, so the surgeon’s training and volume of experience matter a great deal.
Side-by-side comparison
| SMAS facelift | Deep plane facelift | |
|---|---|---|
| Layer worked on | Above the SMAS, tightened separately | Beneath the SMAS, lifted with the skin |
| Retaining ligaments | Often left intact | Released |
| Main strength | Jawline and jowls | Midface, nasolabial folds, jawline |
| Tension on the skin | Moderate | Low |
| Technical difficulty | Standard for facial plastic surgeons | High, longer learning curve |
| Neck | Can be combined with a neck lift | Can be combined with a neck lift |
What the studies say
Head-to-head randomised trials are rare, so the evidence comes mostly from case series pooled in meta-analyses. A 2025 systematic review and meta-analysis published in Aesthetic Plastic Surgery found patient satisfaction of about 94% after deep plane facelifts and about 88% after SMAS facelifts, with durable results for both. The same review reported a higher overall complication rate in the deep plane group, although the studies differed in how they defined and recorded complications. An earlier large review in the Aesthetic Surgery Journal found no difference in the risk of permanent facial nerve injury between techniques.
The honest summary: both techniques work, the deep plane may give a little more in the midface, and the surgeon’s skill matters more than the label on the technique.
Which one suits you?
Your surgeon will consider:
- Where your ageing shows most. Mainly jowls and neck: a SMAS technique may be enough. Marked descent of the cheeks and deep nasolabial folds: a deep plane approach is often favoured.
- Your skin quality and previous facial surgery.
- Your health: smoking, blood pressure and blood-thinning medication affect the risk of haematoma whatever the technique.
- Complementary procedures: eyelid surgery, fat transfer, neck lift.
Rather than asking for a technique by name, describe what bothers you and ask the surgeon why they recommend one approach for your face. Ask how many of these procedures they perform and to see before-and-after photos of patients with a similar starting point.
Recovery: similar for both
In both cases, expect swelling and bruising for two to three weeks, a feeling of tightness or numbness in front of the ears for longer, and a result that keeps refining over several months. Some surgeons report faster settling after a deep plane lift because the skin is under less tension, but this varies from person to person.
For a facelift in Tunisia, the indicative stay is 7 to 10 days, which covers the most sensitive period, including the first dressings and the check-up before you are authorised to fly home.
Facelift in Tunisia with Medespoir
For more detail on the deep plane technique, with before-and-after photos, see our article in French. The Medespoir package costs around 60% less than in Switzerland and includes the pre-operative consultation and tests, the operation with the whole surgical team, the hospital stay, daily care at the hotel, the hotel on full board for you and one companion, transfers, and remote follow-up after your return. Consultations and medical documents are in French. Request a free quote, personalised and sent within 48 hours.
FAQ
Does a deep plane facelift last longer?
It is often described as longer lasting, but robust long-term comparisons are lacking. Both techniques give durable results; no facelift stops the ageing process.
Is a deep plane facelift riskier?
Some pooled studies report more complications, mainly minor ones, but the data are heterogeneous. The surgeon’s experience with the technique is the decisive safety factor.
What is a « mini facelift »?
A shorter procedure with smaller incisions, usually a limited SMAS technique. It suits early jowling but does little for the neck or midface.
Can I have a facelift and eyelid surgery at the same time?
Often, yes. Combining them is common and avoids a second recovery, if your surgeon considers it safe for you.
This article is for general information and does not replace a consultation with a plastic surgeon.
Main sources: The Deep Plane versus SMAS Facelift: A Systematic Review and Meta-Analysis, Aesthetic Plastic Surgery, 2025; Jacono et al., Aesthetic Surgery Journal, 2019; American Society of Plastic Surgeons, Facelift.