SMAS Facelift vs. Deep Plane Facelift: The Anatomical Difference That Determines Your Result

SMAS Facelift vs. Deep Plane Facelift: The Anatomical Difference That Determines Your Result

The most important decision you make before a facelift is not where you have surgery. It is understanding what operation is actually being performed.

Most patients begin by searching for terms like “natural facelift” or “best facelift surgeon in Beverly Hills.” They compare before-and-after photos and read reviews, but very few understand the anatomical differences between the procedures themselves.

Here is the reality: not all facelifts treat the same structures, so they should not be expected to produce the same result. A facelift is not simply about removing loose skin. Facial aging occurs because the deeper support structures gradually descend over time. The retaining ligaments stretch, the facial fat compartments shift downward, and the relationship between the face, jawline, and neck begins to change. The loose skin you see in the mirror is only one part of that process.

That is why understanding the difference between a SMAS facelift and a deep plane facelift matters. Both operations improve facial aging, and both have a role in modern facial rejuvenation. The difference lies in which anatomical structures they address and how they restore them.

SMAS vs. Deep Plane Facelift: At a Glance

What the SMAS Facelift Does

The SMAS, or superficial musculoaponeurotic system, is a layer of fibromuscular tissue located beneath the skin and above the deeper muscles of the face. During a SMAS facelift, this layer is tightened by folding or overlapping it before the skin is re-draped.

This is a legitimate operation that can produce excellent results in appropriately selected patients. Individuals with mild to moderate laxity often achieve meaningful improvement.

The limitation is not that the procedure fails; the limitation is anatomical. As we age, the retaining ligaments that connect the deeper tissues of the face to the underlying skeleton gradually stretch. The fat compartments descend, the cheeks flatten, the nasolabial folds deepen, and the jawline loses definition. A SMAS facelift improves the tissues above those retaining ligaments, but it does not fully release the structures creating the descent. As aging continues, those deeper anatomical changes remain, which is one reason SMAS facelifts often last a shorter time than deep plane procedures.

What the Deep Plane Facelift Does Differently

A deep plane facelift approaches facial aging from a different anatomical layer. Instead of simply tightening the SMAS, the surgeon works beneath it. The retaining ligaments are released, allowing the SMAS and the overlying facial fat to move together as a single composite unit.

That difference changes everything.

First, the tissues are restored to a position that more closely reflects their original anatomy. Rather than pulling the face sideways to remove loose skin, the deeper structures are repositioned where they naturally belong.

Second, the nasolabial folds improve because the descended cheek fat is physically elevated rather than stretched by skin tension alone.

Third, the skin is no longer responsible for holding the lift. The structural support comes from the deeper tissues. When the skin is allowed to simply re-drape without significant tension, the result generally appears more natural both at rest and during facial expression.

Finally, because the deeper structural changes are addressed, deep plane facelifts often maintain their results longer than more superficial techniques.

Dr. Gould’s Approach to Deep Plane Facelift in Beverly Hills

Most surgeons describe a deep plane facelift by talking about the layer they operate in. Dr. Gould approaches it differently.

What is really being treated is anatomy. During surgery, Dr. Gould identifies the retaining ligaments that connect the deeper facial structures to the skeleton, releases those attachments under direct visualization, and restores the tissues according to their native anatomy.

When you restore anatomy instead of forcing tissue into an arbitrary position, it becomes much more difficult to create a face that looks tight, pulled, or unnatural.

The neck follows the same philosophy. An exceptional facelift requires an exceptional neck and jawline. Depending on the patient’s anatomy, Dr. Gould’s deep neck contouring may include management of deep fat, the anterior digastric muscles, and, in selected patients, the submandibular glands. The goal is to restore the structural foundation of the neck rather than simply tighten the surface.

• The Crevasse Technique. Dr. Gould uses this approach to release deep tethering beneath the jawline, restoring structural support to the jaw-to-neck transition. It addresses the anatomical binding that other techniques leave intact, which is why patients with persistent jowling or soft definition along the mandibular border see more thorough correction.

• Deep neck contouring under direct visualization. When the neck requires it, Dr. Gould treats structures beyond skin and subcutaneous tissue, including deep fat, the anterior digastric muscles, and, in some cases, the submandibular glands. This is not standard in most facelift practices.

• TIVA anesthesia. Dr. Gould uses Total IV Anesthesia rather than gas anesthesia. Benefits include reduced post-operative nausea, clearer waking, and a more comfortable first 24 hours of recovery.

• Procedure length. The surgery takes six to seven hours. That duration reflects thoroughness. Patients evaluating deep plane surgeons should treat shortened procedure times as a reason to ask more questions, not fewer.

After the deeper structures have been restored, the skin is allowed to re-drape naturally. Excess skin is removed, but the skin itself is not asked to hold the lift. That distinction is one of the most important differences between structural restoration and skin tightening.

Which Patients Are Candidates?

Deep plane facelift candidates are typically between 45 and 75, though Dr. Gould evaluates candidacy based on anatomy rather than age. A 48-year-old with significant ligament laxity and jowling is a better candidate than a 62-year-old with minimal descent.

The procedure addresses:

• Jowls and lower face definition

• Neck laxity and platysmal banding

• Midface descent and flattened cheeks

• Deep nasolabial folds

• Jawline definition and the jaw-to-neck transition

• Downward migration of the facial fat compartments

Candidates should be healthy, nicotine-free, and at a point where nonsurgical treatments no longer produce meaningful correction.

A SMAS facelift is a reasonable option for patients with early laxity, minimal jowling, and a preference for a shorter recovery. It is also appropriate for younger patients who want an improvement now with the expectation of a revision procedure in several years. For patients who want one procedure done thoroughly, with a result that holds for a decade or more, deep plane is the appropriate technique.

What Credentials to Look for in a Beverly Hills Deep Plane Surgeon

Board certification is the baseline, not the differentiator. Every surgeon worth consulting should hold certification from either the American Board of Plastic Surgery or the American Board of Facial Plastic and Reconstructive Surgery.

Beyond certification, the relevant filters for deep plane specifically are:

• Fellowship training with a focus on facial surgery. General plastic surgery residency does not produce deep plane experience. Look for fellowship training specifically oriented around face and neck procedures.

• High procedural volume in deep plane techniques. Deep plane facelift is technically demanding. Surgeons who perform it regularly develop the anatomical familiarity that matters in the ligament release and composite flap repositioning phases.

• Academic training pedigree. Training at UCLA, USC, or similarly structured programs with dedicated facial surgery faculty indicates rigorous technical grounding.

• Consistent focus on facial aesthetics. Surgeons who divide their practice between face, body, and reconstructive work typically accumulate less deep plane volume than those whose practice centers on the face and neck.

Dr. Gould holds an MD and a PhD, trained at UCLA, and focuses his Beverly Hills practice on complex facial surgery, including primary and revision deep plane cases.

What Recovery Looks Like After a Deep Plane Facelift

• Days 1 to 7. Swelling is most significant in this window. Most patients rest at home. Dr. Gould performs the procedure drainlessly in most cases, which removes early discomfort and drainage management from the first-week experience.

• Days 7 to 14. Bruising fades. Sutures come out in stages. Most patients can manage short, private outings by the end of this window.

• Weeks 2 to 3. Social downtime is generally over. Most patients return to low-key professional settings and normal daily activity. Residual swelling is present but manageable.

• Three months. The natural appearance settles. Swelling in the deeper planes has resolved. Patients who look at their before-and-after photos at this stage often cannot identify the surgical landmarks.

• Six months. Final refinement. The skin has fully accommodated the repositioned underlying structures, and the result reflects its long-term character.

Frequently Asked Questions

Is a deep plane facelift worth it compared to a SMAS facelift?

For patients with meaningful jowling, midface descent, or neck laxity, deep plane produces a more thorough and longer-lasting correction. It addresses the structural causes of facial aging rather than the surface effects. SMAS is a real procedure with real results, but it does not address the retaining ligaments, which limits how durable the correction can be. Whether it is worth it depends on your anatomy, your goals, and your willingness to invest in a two-to-three-week recovery.

How long does a deep plane facelift last?

Published evidence and clinical experience consistently point to ten to fifteen years for deep plane results, compared to five to seven for SMAS. Individual factors including sun exposure, significant weight changes, and baseline skin quality affect longevity for both techniques.

What is the Crevasse Technique?

The Crevasse Technique is an approach Dr. Gould uses during a deep plane facelift to release deep tethering beneath the jawline. It restores structural support to the jaw-to-neck transition, which contributes to more defined and longer-lasting correction along the mandibular border and upper neck.

How much does a deep plane facelift cost in Beverly Hills?

There is no standard price for a deep plane facelift because there is no standard operation. The scope of surgery is determined by each patient’s anatomy, goals, and whether additional procedures such as deep neck contouring, fat grafting, or eyelid surgery are appropriate. Following a comprehensive consultation and physical examination, a personalized treatment plan is developed, along with a detailed cost estimate.

What is TIVA anesthesia and why does it matter?

TIVA stands for Total Intravenous Anesthesia. It uses IV medications rather than inhaled gas to maintain unconsciousness during surgery. Benefits include significantly reduced post-operative nausea, clearer waking, and a more comfortable first 24 hours of recovery. Dr. Gould uses TIVA for all deep plane procedures at his Beverly Hills practice.

Can a deep plane facelift be combined with other procedures?

Yes. Many patients combine a deep plane facelift with fat grafting for volume restoration, nanofat for skin quality improvement, blepharoplasty, or brow lifting. The appropriate combination depends on facial anatomy and patient goals and is determined during consultation.

What makes deep plane facial rejuvenation different from a standard facelift?

A standard facelift typically refers to a SMAS-level procedure. Deep plane facial rejuvenation enters a deeper anatomical layer, releases the retaining ligaments that tether the face, and repositions the SMAS and overlying fat as a single unit. The result addresses the structural causes of aging rather than the skin-surface consequences, which produces a more natural appearance and a longer-lasting result.

Who is a candidate for a deep plane facelift in Beverly Hills?

Ideal candidates are generally healthy nonsmokers experiencing facial aging that is no longer meaningfully improved with nonsurgical treatments. Common concerns include jowling, loss of jawline definition, neck laxity, midface descent, and deepening nasolabial folds. Candidacy is determined primarily by anatomy rather than age, with factors such as ligament laxity, tissue quality, skin elasticity, and overall health guiding the surgical plan. A comprehensive consultation includes a physical examination, review of medical history, and discussion of aesthetic goals, recovery expectations, and the most appropriate treatment approach.

To schedule a consultation with Dr. Gould at Gould Aesthetics in Beverly Hills, visit gouldaesthetics.com.