Deep-plane facelift: what the research shows

What is a deep-plane facelift?

Facelift surgery has evolved since the early 1900s, and as understanding of facial anatomy and the aging process grew, the superficial musculoaponeurotic system (SMAS) came to be treated as central to achieving long-lasting, natural results ^[1]. Several approaches to repositioning the SMAS layer then emerged, including subperiosteal, composite, and deep-plane lifts ^[1].

The deep-plane approach is based on entering the layer beneath the SMAS and moving the skin and SMAS together. A review of deep-plane anatomy emphasized the points where the facial nerve branches change in depth and course during dissection beneath the SMAS, as well as the role that the potential spaces beneath the SMAS play in deep-plane dissection ^[2].

Study results compared with the SMAS lift

A systematic review and meta-analysis published in 2025 searched studies from 2000 to 2024, screened 2474 articles, and ultimately included 21 studies with 2896 patients ^[3]. The main outcome measured was overall satisfaction as rated by the patients ^[3].

Patient satisfaction was 94.4% for the deep-plane facelift (95% confidence interval, 84.8 to 99.7) and 87.8% for the SMAS lift (95% confidence interval, 84.3 to 91.3) ^[3]. The overall complication rate was reported as 17.2% for the deep-plane facelift and 10.3% for the SMAS lift ^[3].

These results need to be read with caution. Because this was a single-arm meta-analysis that pooled the results of each method separately, it did not compare the two methods directly under the same conditions, and the confidence interval for deep-plane satisfaction is wide ^[3]. The same study stated that which method lasts longer is still debated, and it concluded that both methods showed solid, long-lasting results and high patient satisfaction ^[3].

Is there a better technique?

The main goal of a facelift is to restore the shape, volume, and contours of a youthful face, and many techniques have been developed to achieve the same result ^[4]. A review of the controversies in facelift surgery addressed the question of whether there is a best technique and summarized that, in the literature, the effectiveness of the various options is broadly similar ^[4].

The same review stressed the need for high-quality studies with standardized preoperative assessment and evaluation of postoperative results ^[4]. One author who has refined a SMAS overlapping (plication) technique for more than 25 years also reported that the method is reliable and safe, with high patient satisfaction ^[1]. It is difficult to judge results by the name of a technique alone.

Anatomy and safety

A review of deep-plane anatomy explained that a firm understanding of facial anatomy is essential for surgeons who perform facelifts, and that understanding how aging affects facial anatomy is equally important for preoperative assessment ^[2]. The same review also covered the key anatomical structures deep in the neck ^[2].

Methods that dissect beneath the SMAS are performed in a layer close to the branches of the facial nerve, so knowing how the depth and course of these nerve branches change is emphasized ^[2]. In the meta-analysis described above, the overall complication rate for the deep-plane facelift was reported as 17.2% ^[3]. It is important to receive a thorough explanation before surgery about risks such as bleeding, a collection of blood under the skin (hematoma), infection, nerve injury, scarring, and asymmetry, and the speed of recovery also varies from person to person.

Considerations for Asian faces

A review of facelifts in Asian patients explained that cultural differences and differences in facial shape change expectations about beauty and youthfulness, so current techniques need to be adapted ^[5]. It stated that a strategy is needed that understands the cultural aspects and anatomy of Asian patients and uses techniques suited to them ^[5].

The authors of this review considered the deep-plane technique they presented to be well suited to Asian patients ^[5]. However, this is an opinion based on the authors' experience, and the ethnic makeup of the patients included in the meta-analysis above is not given in the research summary.

Anesthesia and extent of surgery

A review of facelifts under local anesthesia explained that a careful medical history is important in selecting patients, and that people who have had no problems with dental treatment and have no history of severe anxiety are better candidates ^[6]. It stated that when sedation is added, oxygen saturation, heart rhythm (ECG), and blood pressure need to be monitored ^[6].

The same review considered a short-scar anterior lift, which involves limited deep-plane dissection and a short operating time, to be suitable for local anesthesia ^[6]. The extent of dissection is also a factor considered when choosing the type of anesthesia.

What to check during your consultation

High patient satisfaction has been reported for both the deep-plane facelift and the SMAS lift ^[3]. However, results vary with each person's facial structure and skin condition, so it is best to have the location and degree of sagging assessed through an examination and to weigh the pros and cons of each method before deciding.

• Which layer the dissection will be performed in, and why
• The evidence for the expected changes and how long they last
• The types of complications and how they are managed
• The type of anesthesia and what recovery involves