One of my pet peeves about the internet is the sheer amount of misinformation being circulated. My specialty, aesthetic plastic surgery, is frequently the target of this—especially when it comes to facelift techniques. The popularity of certain procedures often fluctuates based on social media buzz rather than facts. In this article, I’ll address some of the most common myths currently surrounding facelift techniques.
Not a day goes by in my clinic without a consultation with a patient who arrives with a preconceived idea of what type of facelift they want. More often than not, their preference is based on misinformation found online. This is especially true right now when it comes to deep plane facelifts. Because I was hearing so many requests for this specific technique—and I’m not a fan of it—I went online to explore what was driving the fascination. After reading through several layperson message boards, I wasn’t surprised by how often this technique was being requested.
First, it’s genuinely difficult for patients to understand the differences between facelift techniques because the terminology is confusing. For example, I perform facelifts using an extended SMAS technique. (SMAS stands for superficial musculo-aponeurotic system.) When I researched online comparisons between deep plane facelifts and extended SMAS facelifts, most of what I found was actually comparing deep plane to SMAS plication, which is entirely different. To make an informed choice, we need to compare apples to apples—so I’ll explain the differences here.
All facelifts involve lifting and repositioning the skin. The main differences lie in how the deeper tissues—the SMAS—are handled. The SMAS is made up of connective tissue, fat, and muscle, and is tethered to both the skin above and the muscles and bone below by strong ligaments.
In a deep plane facelift, the skin and SMAS are lifted together in the same vertical direction without separating the two. This can result in a shorter surgery, but in my opinion, that benefit is more for the surgeon than the patient.
In an extended SMAS technique, the skin is lifted first, and then the SMAS is lifted and repositioned separately. This allows me to release the retaining ligaments and place the SMAS in a higher, more youthful position—effectively lifting the midface, jowls, and neck. When done properly, these deeper tissues are returned to where they naturally existed earlier in life—not to unnatural or overly elevated positions. The skin is then re-draped in a direction that is not vertical, but rather perpendicular to the fold between your nose and mouth. This direction matters—a lot. No tension should be applied to the skin, or it will look pulled and unnatural.
One of the biggest concerns I have with the deep plane technique is that both the skin and underlying tissues are lifted vertically. If a patient already has facial wrinkles, these may end up reoriented into odd angles—sometimes resembling a “Nike swoosh” across the cheek. Even in younger patients without wrinkles, this can become an issue as the skin ages.
Some claim the deep plane technique results in quicker recovery and less bruising. I haven’t seen that to be true in real-life patients. But even if that were the case, is a slightly shorter recovery worth the risk of long-term aesthetic issues? I don’t think so.
Many of the online articles comparing deep plane to SMAS techniques inaccurately compare deep plane to SMAS plication. Plication refers to folding the SMAS and stitching it in place—without lifting it or releasing any ligaments. In my experience, this method yields only minimal and short-lived improvement. Several articles also claimed that SMAS techniques don’t lift the midface because the ligaments aren’t released. That may be true of SMAS plication—but it’s absolutely not true of an extended SMAS technique.
As you can see, facelift terminology and technique can be confusing, and unfortunately, internet commentary tends to oversimplify or misrepresent the facts. My focus is on delivering results that restore a refreshed version of you—not one that looks tight, overly pulled, or unfamiliar to friends and family. That’s why I avoid the deep plane approach.
If you’re considering a facelift, your best bet is to consult with an experienced, board-certified plastic surgeon who can guide you through your options. Online buzz can be misleading. Come to your consultation with questions—and an open mind. If your goal is to look naturally refreshed and avoid telltale signs of surgery, I would personally recommend steering clear of the deep plane technique.
Categorized in: Facelift