What is a deep plane facelift?
The “deep plane” refers to the level in the face that is deep to the SMAS layer (the Superficial Musculo-Aponeurotic System) which is effectively the soft tissue skeleton of the face. The SMAS layer includes the muscles that allow us to move our face, and is the layer that is the ultimate cause of most facial ageing. It is the SMAS that descends and sags over time, dragging with it the overlying skin, resulting in facial sagging and the development of jowls and the turkey neck. A deep plane facelift refers to a facelifting approach that is performed deep to the SMAS layer.

SMAS Facelifts
There are many different approaches to SMAS facelifting, some of which involve tightening the SMAS from on top (once the SMAS layer is visible after the skin is lifted up). However, the possible drawback with these approaches is that some of the adherent and stuck down ligaments deep to the SMAS limit the amount of movement the SMAS can be mobilised and lifted through this approach.

How a deep plane facelift is performed
The deep plane approach (and there are many ways of approaching or entering the deep plane) involves surgery that under the SMAS layer. This allows the adherent, tethering ligaments in the face to be detached creating a more mobile SMAS which can then be elevated with less tension, more accurately and to a higher level in the face – i.e. it provides a better lift.

Deep plane facelifting is not undertaken by all surgeons – it is time-demanding and exposes complex and intricate structures such as branches of the facial nerve, the buccal fat pad and facial blood vessels. However once a surgeon is comfortable and familiar in this area, these structures cannot only be seen, but dissected around and preserved safely. In addition other manoeuvres can be added to the procedure when deep to the SMAS, such as buccal fat reduction, which, in some people, can help to sculpt the shape of the face.

Once the deep plane has been elevated and released to allow the SMAS to become more mobile, the SMAS can then be lifted and elevated with a series of internal stitches. The sagging skin, which, as discussed before, is effectively a passenger on the SMAS is then also elevated. Once the skin has been lifted into a higher position, it can be very gently and conservatively trimmed, then stitched into place without any undue tension. This minimises the risk of poor scarring and issues with earlobe deformities.

What is the best facelift technique?
The deep plane approach is my preferred approach to facelifting, as, in my opinion, it provides the most reliable option for a natural appearing, long-lasting facelift. However, there are times when it may not be appropriate, such as in revision or secondary facelifting cases and in people with very thin and poor-quality tissues.

Ultimately the best approach for you needs to be decided after a thorough assessment and a discussion about your goals, and the findings on examination.

This video shows the steps taken in a deep plane facelift with the use of a haemostatic net. YouTube have age-restricted it due to the surgical content, so you when you click on it, you will need to log in to your YouTube account (or create one if you do not have one)