Deep Plane Facelift vs. SMAS Facelift
Facelift surgery remains a cornerstone of aesthetic procedures for facial rejuvenation, with two primary techniques emerging as the standard in modern practice: the Superficial Musculoaponeurotic System (SMAS) facelift and the Deep Plane facelift. While both procedures address similar anatomical structures, they differ significantly in their approach, depth of dissection, and the resulting long-term effects on facial aesthetics.
This article offers a detailed comparison of both techniques, examining the specific anatomical considerations, step-by-step procedural approaches, and clinical indications for each method. By understanding these nuances, surgeons can select the most appropriate technique for their patients based on their unique clinical needs and desired outcomes. This analysis draws upon the work of Sykes, Dilger, and Cotofana (2020) in Facial Plastic Surgery and Graça Neto et al. (2024) in the Revista Brasileira de Cirurgia Plástica, offering insights grounded in rigorous clinical research.
Anatomy of the Face: Key Structures Involved in Facelift Surgery
Understanding the anatomy of the face is crucial to performing successful facelift surgeries. Each facelift technique targets specific layers of facial tissues, from the skin down to the deeper fascia and muscle structures.
Skin: The outermost layer, which is prone to laxity and sagging as a result of aging, primarily affecting the jawline, cheeks, and neck.
SMAS (Superficial Muscular Aponeurotic System): A fibrous structure located beneath the skin that connects the skin to the underlying muscles. The SMAS plays a key role in the sagging of the midface and jawline, making it a target for many facelift techniques.
Fat Compartments: As facial fat volumes diminish with age, the fat compartments such as the zygomatic fat pad and submalar fat contribute to hollowing and sagging, particularly in the midface.
Facial Muscles: Muscles such as the platysma (neck) and zygomaticus (cheeks) lose tone over time, resulting in jowling, sagging, and skin folds.
Ligaments: Ligaments such as the zygomatic ligament and masseter ligament anchor facial tissues. Over time, these ligaments stretch and loosen, allowing for facial descent.
Both the SMAS and Deep Plane facelift techniques seek to reposition these tissues to restore youthful contours and improve facial aesthetics.
The SMAS Facelift: Overview and Step-by-Step Technique
The SMAS facelift is one of the most widely performed procedures in aesthetic surgery, targeting the superficial muscular aponeurotic system to reposition tissues that contribute to sagging in the lower face and neck.
Step-by-Step Surgical Approach
Incision Placement:
The incisions are typically placed along the hairline (preauricular) and extend around the ear and, in some cases, into the postauricular area. The key to a natural result is careful incision placement to avoid visible scarring.
Dissection:
The skin is carefully separated from the underlying tissues to expose the SMAS layer. Care must be taken to ensure minimal trauma to the skin to maintain blood supply.
The SMAS is then mobilized, often through a sub-SMAS plane, allowing access to the deeper structures.
SMAS Plication or Advancement:
The SMAS is typically sutured or pleated (SMAS plication) to tighten and reposition the lower face. This can be done through a repositioning or redraping technique depending on the degree of descent.
In some cases, a SMAS flap may be advanced for additional lifting in more severe cases.
Redraping and Excess Skin Removal:
Once the SMAS is tightened and repositioned, the excess skin is excised, and the skin is redraped over the new contours. It is essential to ensure that the skin is not overstretched to avoid an unnatural, overly tight appearance.
Final Closure:
The incisions are closed in layers, ensuring meticulous attention to hemostasis and tension-free closure to minimize scarring.
Targeted Anatomy in the SMAS Facelift:
Primarily addresses the SMAS layer and, to a lesser extent, the neck and jawline through platysma plication.
It does not directly engage the deeper fat compartments or reposition the midface tissues, which can limit volume restoration.
Case Suitability
The SMAS facelift is ideal for patients with:
Moderate jowling and neck sagging.
Mild midface descent, where comprehensive mobilization is unnecessary.
A preference for shorter recovery and less invasive surgery.
Limitations of SMAS Technique
It does not fully address midface sagging or malar fat descent, as these issues require deeper tissue manipulation.
The Deep Plane Facelift: A More Comprehensive Approach
The Deep Plane Facelift targets not just the SMAS but also the deeper layers, including fat compartments, muscles, and ligaments, offering a more thorough restoration of youthful facial aesthetics, particularly in the midface.
Step-by-Step Surgical Approach
Incision Placement:
Similar to the SMAS facelift, the incisions are made around the hairline and ears. However, the dissection will extend deeper into the sub-SMAS plane to access the deeper tissues.
Dissection of Deeper Layers:
After careful skin dissection, the surgeon advances to the deep plane, which includes the SMAS, midfacial fat compartments (such as the zygomatic fat pad), and the muscles (platysma).
The zygomatic ligament and other facial ligaments are released to facilitate tissue mobilization and lifting.
Lifting of the Deep Plane:
The key step in the deep plane facelift is lifting the tissues as a single unit, which includes the SMAS, fat compartments, and muscles. This step not only repositions sagging tissues but also provides significant restoration of volume, particularly in the midface, cheeks, and neck.
The fat compartments (such as the zygomatic and submalar fat pads) are repositioned to restore fullness in the cheek area and smooth out nasolabial folds.
Redraping the Skin:
Once the deeper tissues are lifted and positioned, the skin is redraped with minimal tension, ensuring a more natural and longer-lasting result. Careful skin closure is critical to avoid visible scarring.
Final Closure:
Similar to the SMAS technique, the incision sites are closed with layered sutures, ensuring no tension on the skin.
Targeted Anatomy in the Deep Plane Facelift:
Directly targets SMAS, fat compartments, and facial muscles (e.g., platysma) for a comprehensive facial rejuvenation.
The technique is especially effective in restoring volume to the midface, enhancing the overall appearance of cheeks, jawline, and neck.
Clinical Indications
The Deep Plane facelift is recommended for:
Patients with advanced aging, significant midface sagging, and volume loss.
Those requiring comprehensive rejuvenation across the face and neck.
Learning Curve Studies indicate higher rates of nerve injury during early cases (15%), dropping to 0% as surgeons gain experience. This underscores the importance of training and anatomical precision.
Comparison of SMAS Facelift and Deep Plane Facelift: Clinical Implications for Surgeons
Feature | SMAS Facelift | Deep Plane Facelift |
Depth of Dissection | Superficial, targeting SMAS | Deep, targeting SMAS, fat compartments, and muscles |
Anatomical Targets | Primarily lower face, jawline, and neck | Midface, cheeks, jawline, neck, and upper face |
Volume Restoration | Minimal volume restoration | Significant volume restoration in the midface and cheeks |
Rejuvenation of Neck | Effective for lower face and neck | Comprehensive rejuvenation, including neck and platysma |
Surgical Complexity | Less invasive, faster recovery | More complex, longer recovery with a higher risk of complications |
Longevity of Results | 5-10 years | 10-15 years |
Complications and How to Prevent Them
SMAS Facelift:
Common Complications: Skin necrosis (1%) due to tension or vascular compromise.
Prevention: Avoid overstretching skin and ensure meticulous closure.
Deep Plane Facelift
Common Complications: Nerve injuries (8% in early cases, reduced with experience).
Prevention: Detailed anatomical understanding and careful blunt dissection near ligaments reduce risks.
Clinical Indications: Choosing the Right Technique
SMAS Facelift: Best suited for patients with mild to moderate aging, particularly in the lower face and neck. Ideal for those with less midfacial volume loss and neck laxity.
Deep Plane Facelift: Indicated for patients with advanced aging, significant volume loss in the midface, and neck sagging. This technique provides long-lasting results and addresses multiple layers for comprehensive rejuvenation.
Conclusion
Both the SMAS facelift and the Deep Plane facelift are highly effective techniques in facial aesthetic surgery. Understanding the anatomical differences and procedural steps is crucial for surgeons to select the most appropriate approach based on patient goals. While the SMAS facelift offers a more traditional approach focused on the lower face, the Deep Plane facelift provides a more comprehensive, multi-layered approach that restores youthful volume and contour across the entire face.
For optimal results, surgeons should tailor their technique based on the patient's anatomical characteristics and aging pattern, ensuring natural and long-lasting rejuvenation.
References:
Sykes, J., Dilger, A.E., & Cotofana, S. (2020). Demystifying the Deep Plane Facelift: What It Means Anatomically and Why It Works. Facial Plastic Surgery, 36, 351 - 357.
LINCOLN GRAçA NETO, ANA CLARA MINGUETTI GRAçA and SUSANA PUGA RIBEIRO. From Surface to Depth: Learning Curve in Extended Deep Facelift - My First 100 Cases.. Rev. Bras. Cir. Plást.. 2024. Vol. 39(1). DOI: 10.5935/2177-1235.2023rbcp0823-en
Learn techniques behind Asian Surgical Face Lifting
in our upcoming mini-fellowship:
IFAAS Mini Fellowship (Observation)
Korean Advanced Facial Aesthetic Surgeries
- Advanced Asian Surgical Facelifting & Facial Rejuvenation
March 11-12, 2025 - Seoul, South Korea - [Register Now]
May 7-8, 2025 - Singapore General Hospital - [Register Now]
More Upcoming Global Events
コメント