Patients often send me the same question, in many languages: should I have a deep plane facelift or a SMAS facelift? It sounds like a choice between two products. It is not. Both operations work on the same layer of the face, and both can give a natural result. What differs is where the surgeon works in relation to that layer, what is released, and how the tissue moves.
Every facelift I perform is a deep plane operation, and I explain why below, but I will be fair to the SMAS facelift, because in the right patient it works well. The operation itself is described on the facelift in Turkey page, and the longer version is in my facelift guide.
SMAS Facelift and Deep Plane Facelift: What the Names Mean
SMAS is a layer of the face; deep plane is a technique. The SMAS (superficial musculoaponeurotic system) is the thin sheet of muscle and fibrous tissue under the skin and fat of the cheek, continuous with the platysma muscle of the neck. It descends with age and carries the jowl with it. Every modern facelift works on the SMAS; the techniques differ in how.
- SMAS facelift (SMAS lift). The skin is first lifted off the face, and the SMAS underneath is then tightened as a separate layer. Skin and SMAS move independently.
- SMAS plication, SMASectomy, imbrication. The SMAS is folded and stitched without being cut (plication), a strip is removed and the edges joined (SMASectomy), or it is cut and overlapped (imbrication). All three tighten the layer from its surface.
- SMAS flap, high SMAS, extended SMAS. The SMAS is cut and lifted as its own flap (in a high SMAS lift, from higher along the cheekbone), but skin and SMAS still move as two layers.
- Deep plane facelift. The dissection goes beneath the SMAS, the ligaments that tether the face are released, and skin and SMAS move together as one unit, upward rather than backward. Composite and extended deep plane lifts carry the same release further, around the lower eyelid muscle or into the neck.
- Skin-only facelift. Only the skin is pulled; the result relaxes early and the scars widen. I do not perform it.
- Mini facelift, MACS lift. Shorter incisions and a limited lift, usually a SMAS technique for early jowls. I do not perform mini facelifts.
What Actually Differs in the Operating Room
The level of the dissection. In a SMAS facelift the skin is separated from the SMAS over a wide area, and the SMAS is tightened from above. In a deep plane facelift the skin stays attached to the SMAS over most of the cheek, and the surgeon works beneath it, so the two move together.
The ligaments. Retaining ligaments, short fibrous bands over the cheekbone and along the jaw, hold the face to the bone. With age the soft tissue slides down around them, and the jowl forms below a fixed line. A SMAS plication leaves the ligaments in place and tightens the SMAS against them. A deep plane lift releases them, so the cheek and the jowl can move back to where they were.
Where the tension sits. In a SMAS facelift the lift is carried by the tightened SMAS, usually pulled backward toward the ear. In a deep plane facelift it is carried by the deep layer and moves more vertically. Because the tension is in the deep layer and not in the skin, the skin heals under no tension and the scars behave better.
What does not differ: the incisions around the ear and into the hairline are essentially the same, so you cannot tell the technique from the scar. Neither name tells you whether the neck is treated; loose skin under the chin or muscle bands need a neck lift. And neither replaces lost volume.
What the Studies Show About Results
A split-face trial found no visible difference at one year. Twenty-one patients had a limited or conventional SMAS lift on one side of the face and an extended SMAS or composite lift on the other. On the operating table the deeper side looked better in the cheek; within 24 hours that difference disappeared, and three independent surgeons could not tell the sides apart at six and twelve months.
Two photographic comparisons disagreed. In one, four surgeons rated masked photographs of 20 deep plane and 20 SMAS plication patients: plication scored higher between 50 and 69, deep plane slightly higher only between 70 and 80. In the other, blinded observers rated 25 patients per group and found the deep plane significantly better in the midface and the neck.
The reviews conclude that both work. A 2025 review of 47 studies and 10,766 patients found clear improvement with both, but only one direct comparison, which favored the deep technique in the midface. Another 2025 review of 21 studies reported satisfaction of 94.4 percent after deep plane and 87.8 percent after SMAS facelifts and concluded that both give robust, long-term results. Those figures come from different patients and surgeons, not from a head-to-head trial.
My reading: no study shows that one plane is better for every face. The deep plane’s advantage, where it appears, is in the midface, the neck, and older or heavier faces. In a younger patient with milder laxity along the jawline, a well-executed SMAS plication gives an excellent, natural result. The label matters less than the execution: a skilled surgeon doing a SMAS lift will get a better result than a mediocre surgeon marketing a “deep plane”.
How Long Each One Lasts
I have not found a study that followed deep plane and SMAS patients in parallel for ten years, so any comparison in years is an estimate. What exists is single-practice data. In a 30-year review of 93 revision facelifts after deep plane lifts, the average interval to the second operation was 10.9 years: 12.4 years when the first lift was at 53 or younger, 9.3 years when older. That measures when patients chose a second lift, and it counts only those who came back.
Most of my patients feel the benefit holds for around a decade. The repositioning is lasting, and the face continues to age from its new starting point; weight changes, smoking, sun and skin thickness move that date more than the name of the technique. I have written separately about second facelifts and their timing.
Who Suits Which
I assess every face in three parts: position (has the deep tissue descended?), volume (has fat been lost?) and skin quality. A facelift of any kind treats only the first.
- Faces that do well with a SMAS plication. Lighter tissue, mild to moderate laxity, aging concentrated along the jawline, usually younger patients. Here the comparisons favor plication or find no difference.
- Faces where the deep plane shows its advantage. Descent of the cheek and midface, deep folds beside the mouth, heavier tissue, more pronounced jowls and a neck that has lost its angle, where surface tightening runs out of reach.
- Faces that need something else. Fine lines, texture or early laxity without real descent need skin treatment, and hollowness needs volume, not a lift.
Every facelift I perform is a deep plane operation. The choice I make case by case is not the plane; it is the extent and the access. Aging in the middle of the face with a clean jawline may need only an endoscopic mid-face lift through small incisions in the hairline, which I perform either under the SMAS or on the bone (subperiosteal), depending on the face; a dropped outer brow, a temporal lift (see the brow lift page); jowls and descent across the whole face, a full deep plane facelift. I work in one plane because it moves the deep layer where it has fallen, lets the skin close without tension, and makes a second facelift easier if one is ever needed. I do not perform SMAS plication. If your face is one where a plication would do as well, I will tell you so; the plan is then a smaller deep plane operation, or no lift yet.
When a Facelift Is Not the Answer
Filler adds volume but does not lift descended tissue; used instead of surgery, it makes a face heavier rather than younger. A thread lift is short lived and does not reposition the deep layer; I do not perform thread lifts. Wrinkle-relaxing injections do nothing for jowls. Fotona 4D laser and mesotherapy improve texture and early laxity. Fat restores lost volume, often in the same session as a lift (fat transfer is not a filler), but it does not move tissue that has fallen.
How I Perform a Deep Plane Facelift
The operation is performed in an accredited hospital under general anesthesia, with an anesthesiologist present. Beneath the SMAS, the retaining ligaments are released from cheek to jawline; the cheek, the jowl and the skin are repositioned together, vertically; and the skin is redraped without tension. A deep plane full facelift takes six to seven hours, because releasing and repositioning the deep layer across the whole face is slow, deliberate work; an endoscopic mid-face lift takes about two to three. You stay one night in hospital.
Eyelid surgery, a brow or temporal lift, a neck lift, a canthopexy and fat grafting can be added in the same session; a facelift is never combined with body surgery. Whether drains are used depends on the case; often a hemostatic net, a temporary quilting of sutures that closes the space where fluid would collect, makes them unnecessary. It is removed on day three.
Your Week in Istanbul
- Day 0. Surgery, followed by one night in hospital under observation.
- Days 1 to 3. Rest at your hotel with a compression garment and thin adhesive strips along the incision lines, plus the hemostatic net if one was placed. My team is in touch with you every day.
- Day 3. The net comes off, drains come out if any were used, and I check your face.
- Days 5 to 7. Final examination, and you fly home. Five to seven days in Istanbul is enough.
Recovery After You Fly Home
Recovery depends more on the extent of the operation than on the name of the technique. Most patients are presentable in ordinary company and back to desk work at around two weeks, and exercise can restart from week four to six. The result is judged at six to twelve months. The recovery planner builds a day by day calendar around your surgery date.
Risks and Honest Limits
The risks are the same for both techniques: a hematoma (bleeding under the skin) in the first hours, which is why you stay the night in hospital; temporary weakness of a facial nerve branch; numbness that fades over months; skin healing problems; and scars.
Nerve injury. A 2019 analysis of 183 studies found temporary nerve weakness most often after high lateral SMAS (1.85 percent) and composite lifts (1.52 percent), the only techniques that differed significantly from plication; the deep plane did not. Permanent injury did not differ among techniques. A 2026 review of 10,784 deep plane patients found temporary weakness in 1.2 percent and no permanent facial nerve injury.
Bleeding. Major hematoma occurred in 1.22 percent of deep plane lifts in the 2019 analysis, a small but significant increase over plication, and a 2025 review reported 3 percent after deep techniques and 2 percent after SMAS facelifts. The deeper release leaves a larger space where blood can collect; the night in hospital and the hemostatic net are there for this reason.
Overall complications. The review that reported higher satisfaction after deep plane lifts also reported more complications overall, 17.2 against 10.3 percent, defined differently between studies. Skin healing problems were most frequent after the SMAS flap (1.57 percent); smoking raises this risk in every facelift.
The honest limits: a facelift of either kind moves the face back; it does not stop it from aging, restore volume or improve skin quality. The rates above are averages across many surgeons; what lowers your own risk is a surgeon who works in that plane routinely, because the nerves are seen and protected rather than worked around blindly. The surgeon matters more than the technique, as I wrote in ten truths about facelift.
What Shapes the Price and What Is Included
- The extent: an endoscopic mid-face lift or a full deep plane facelift.
- What is combined: a neck lift, eyelid surgery, a brow or temporal lift, a canthopexy and fat grafting each add operating time.
- A first lift or a secondary lift: a revision is planned as a separate category, because scarred tissue slows every step.
- The anesthesia and the hospital stay: one night.
Every quotation is all inclusive: the surgery, the hospital stay, the anesthesia, medication, the compression garment (if relevant), your accommodation, airport and clinic transfers, and the follow-up visits and post-operative contact in Istanbul. For facelift patients I usually quote in writing after a video consultation, because the plan depends on how your face moves.
Before and After: How to Read the Photographs
A photograph cannot show which plane the surgeon worked in, but it can show whether the result holds. Judge results at six to twelve months, not at three (the facelift swelling timeline explains why). Compare the same view and light, look at the profile, and check the earlobe and the hairline. My results with consent are in the before and after gallery and the deep plane facelift case study. Many facelift patients do not want their face published, and I show more cases in a video consultation.
Send your photographs for an assessment. Front, profile and oblique views, relaxed and smiling, with your hair pulled back from the ears, are enough for a first opinion on whether your face needs an endoscopic mid-face lift, a full deep plane facelift, a neck lift, or nothing yet. Send them on WhatsApp, +90 544 772 0772, or by email, info@mustafaaydinol.com, whichever you prefer.
Frequently Asked Questions
Is a deep plane facelift better than a SMAS facelift?
Not automatically. A well-executed SMAS plication gives an excellent result in a well-selected patient, particularly a younger one with milder laxity. The deep plane’s advantage shows in the midface, the neck and more pronounced descent. My own practice is deep plane in every case.
How long does a SMAS facelift last?
No study has compared the two techniques side by side over a decade, and reviews report long-term results for both. In a long-term deep plane series, patients came back for a second lift after about 11 years on average. Most patients feel the benefit holds for around a decade.
Is a deep plane facelift riskier?
Pooled data show slightly more bleeding under the skin after deep plane lifts, and no significantly higher rate of temporary or permanent nerve injury than after plication.
What is the right age for a SMAS or deep plane facelift?
There is no right age in years. The question is whether your face shows descent that surgery can correct, and whether you are healthy enough for general anesthesia.
Is a mini facelift a SMAS facelift?
Usually, yes: most mini facelifts, including the MACS lift, tighten the SMAS through a shorter incision with a limited reach. I do not perform mini facelifts; an endoscopic mid-face lift or a temporal lift may be the smaller operation that fits.
About the Surgeon
Dr. Mustafa Aydınol is a plastic, reconstructive and aesthetic surgeon practicing in Istanbul, a member of ISAPS and of the Turkish Society of Plastic Reconstructive and Aesthetic Surgeons. The practice holds Health Tourism Authorization from the Turkish Ministry of Health.
Sources
- Ivy EJ, Lorenc ZP, Aston SJ. Is there a difference? A prospective study comparing lateral and standard SMAS face lifts with extended SMAS and composite rhytidectomies. Twenty-one patients, randomized split face; differences seen on the operating table were lost within 24 hours, and no difference between the two sides was detectable at 6 and 12 months. Plastic and Reconstructive Surgery, 1996. DOI
- Becker FF, Bassichis BA. Deep-plane face-lift vs superficial musculoaponeurotic system plication face-lift: a comparative study. Twenty patients per group, masked review by four surgeons; plication scored higher at ages 50 to 69, deep plane slightly higher at 70 to 80. Archives of Facial Plastic Surgery, 2004. DOI
- Adamson PA, Dahiya R, Litner J. Midface effects of the deep-plane vs the superficial musculoaponeurotic system plication face-lift. Twenty-five patients per group, three blinded observers; deep plane significantly better in two of five areas, midface and neck, with improvements twice those of plication. Archives of Facial Plastic Surgery, 2007. DOI
- Jacono AA, Alemi AS, Russell JL. A meta-analysis of complication rates among different SMAS facelift techniques. 183 studies; temporary nerve injury 1.85 percent after high lateral SMAS and 1.52 percent after composite lifts; permanent injury no different among techniques; major hematoma 1.22 percent after deep plane; skin necrosis 1.57 percent after SMAS flap. Aesthetic Surgery Journal, 2019. DOI
- Vayalapra S, Guerero DN, Sandhu V, et al. Comparing the safety and efficacy of superficial musculoaponeurotic system and deep plane facelift techniques: a systematic review and meta-analysis. 47 studies, 10,766 patients; hematoma 3 percent after deep and 2 percent after SMAS techniques; nerve injury similar; one direct comparison, favoring the deep technique in the midface. Annals of Plastic Surgery, 2025. DOI
- Khoury S, Almubarak Z, Khan H, et al. The deep plane versus SMAS facelift: a systematic review and meta-analysis. 21 studies, 2,896 patients; satisfaction 94.4 percent after deep plane and 87.8 percent after SMAS; overall complications 17.2 and 10.3 percent; both robust and long-term. Aesthetic Plastic Surgery, 2025. DOI
- Koroma P, Reji N, Burridge I, et al. Deep plane facelifts: a systematic review and meta-analysis of outcomes. 45 studies, 10,784 patients; overall complications 6.6 percent; temporary facial nerve injury 1.2 percent; no permanent facial nerve injury; hematoma 1.8 percent. Aesthetic Plastic Surgery, 2026. DOI
- Levin M, Frankel A. Thirty years of deep plane facelifts: characterizing outcomes and longevity. 93 revision facelifts; mean interval to the second lift 10.9 years, 12.4 years when the first lift was at 53 or younger and 9.3 years when older. Facial Plastic Surgery and Aesthetic Medicine, 2026. DOI
