Most patients who come to me for a facelift consultation ask some version of the same question: "What is the difference between deep plane and SMAS facelift, and which one do I need?" It is a good question, and the answer matters more than most patients realise. The technique determines not just how long the results last, but how natural they look — and whether the face moves freely afterwards or appears operated on.
I perform both techniques. My honest assessment is that deep plane facelift produces superior outcomes for the majority of patients with moderate to significant facial aging. But I also perform SMAS facelifts in specific clinical situations where the anatomy calls for it. This article explains why — and how to think about which approach fits your situation.
— Dr. Umut Zereyak
The anatomy: what each technique actually lifts
The face ages in layers. The skin is the outermost layer. Below it sits the subcutaneous fat. Below the fat lies the SMAS — the Superficial Musculoaponeurotic System, a fibrous layer that connects the skin above to the muscles below. And connecting the SMAS to the bone are the retaining ligaments — dense, fibrous structures at specific anatomical locations across the face.
A traditional facelift tightens only the skin. This produces results that look operated on and do not last. SMAS facelift — the most widely performed modern technique — goes one layer deeper, tightening or repositioning the SMAS along with the skin. This is an improvement, but the SMAS remains tethered to the bone by the retaining ligaments, which limits how far it can be moved and how natural the result appears.
Deep plane facelift goes one layer further. It releases these retaining ligaments — specifically the zygomatic ligament, the masseteric ligament, and the mandibular retaining ligaments — allowing the entire composite of skin, fat, and SMAS to be repositioned as a single unified structure, without tension on any one layer. The result is a face that has been moved to where it was, rather than stretched to look younger.
The key technical difference
The single most important difference between deep plane and SMAS facelift is ligament release. When the retaining ligaments are released, the tissue composite moves freely and can be repositioned vertically and superiorly — returning volume to the mid-face, softening the nasolabial folds, and restoring jawline definition — without placing skin under tension.
When ligaments are not released, as in a standard SMAS facelift, the tissue is being moved against resistance. To achieve visible improvement, the skin must be pulled more tightly, which creates the characteristic "windswept" or overly tight appearance that most patients actively want to avoid.
This is also why deep plane facelift produces better mid-face improvement. The mid-face — the area beneath the eye and above the mouth — is directly connected to the deeper facial structures through the zygomatic ligament. A SMAS facelift that does not release this ligament cannot meaningfully lift the mid-face. A deep plane facelift that does release it repositions the entire cheek complex, filling the tear trough and restoring malar volume.
Longevity: 7–10 years vs 12–15 years
The commonly cited longevity figures — 7 to 10 years for SMAS facelift and 12 to 15 years for deep plane — reflect the underlying anatomy. When the retaining ligaments have been released and the tissue repositioned at its natural attachment points, the result is structurally stable. The tissues are held in their new position by their own anatomy, not by skin tension that gradually relaxes.
These figures are not guarantees — longevity depends on individual skin quality, genetics, lifestyle, sun exposure, and weight stability. But in my clinical experience, patients who have undergone deep plane facelift consistently maintain their results significantly longer than those who have had SMAS techniques, and they require revision surgery less frequently. Long-term outcome data supporting these observations has been published in peer-reviewed literature.[1]
[1] Rohrich RJ et al. "The individualized component face lift." Plast Reconstr Surg, 2009;123(3):1050-1063. See also Jacono AA, Ransom ER. "Patient-specific rhytidectomy." Aesthet Surg J, 2012;32(7):804-813.
Side-by-side comparison
| Feature | Deep Plane | SMAS Facelift |
|---|---|---|
| Tissue plane | Below SMAS — composite flap | SMAS surface only |
| Retaining ligaments | Released — key step | Not released |
| Skin tension | None — tissue moves freely | Moderate to high |
| Natural appearance | High — no pulled look | Moderate |
| Mid-face improvement | Significant — cheek repositioning | Limited |
| Nasolabial fold | Directly addressed | Minimal improvement |
| Neck | Combined with platysmaplasty | Combined with platysmaplasty |
| Longevity | 12–15 years | 7–10 years |
| Operating time | 4–6 hours | 2–4 hours |
| Recovery | Similar — 2–3 weeks social | Similar — 1–2 weeks social |
| Surgeon training | Specialist — <15% perform routinely | Standard board training |
| Cost in Turkey | Contact for pricing all-incl. | Lower — consult for quote |
When I recommend SMAS facelift instead
I want to be direct about this: deep plane facelift is not the right procedure for every patient. There are clinical situations where I recommend a SMAS technique, and I think it is important to say so honestly.
Early-stage aging in younger patients
Patients in their early-to-mid 40s with mild laxity and good skin quality may achieve their goals with a less invasive SMAS or high-SMAS technique. The deeper approach has a longer recovery than the improvement warrants in these cases.
Specific anatomical considerations
Patients with thin skin, very minimal soft tissue volume, or specific anatomical factors may be better candidates for a different approach. I assess each patient individually at consultation.
Recovery timeline constraints
Patients with very limited time in Istanbul or specific recovery window requirements may find a less extensive technique more practical. Deep plane surgery typically requires 5–7 days before flying; a SMAS facelift may allow earlier travel in some cases.
Combination with other procedures
When the primary goal is eyelid correction and the facial aging is mild, blepharoplasty with a minimal facelift component may be more appropriate than a full deep plane procedure.
The goal of every facelift I perform is a result the patient is satisfied with 10 years from now. That means recommending the right technique for each person's anatomy and goals, not the most technically complex one.
What about extended deep plane and composite facelift?
The extended deep plane technique takes the standard deep plane approach further by releasing additional ligaments — including the orbicularis retaining ligament — and addressing the lower eyelid-cheek junction in the same procedure. This is indicated for patients with significant mid-face descent and tear trough deformity. I use the extended deep plane approach selectively, combined with fat grafting where volume restoration is needed, to achieve a complete three-dimensional rejuvenation in a single operation.
The composite facelift further incorporates the orbicularis oculi muscle into the flap — an approach that requires specific experience with orbital anatomy. The choice between standard deep plane, extended deep plane, and composite technique is made at consultation based on each patient's anatomy.
Recovery: are there real differences?
The recovery from deep plane and SMAS facelift is more similar than the technical complexity might suggest. Both involve general anesthesia, similar incision patterns, and comparable swelling profiles in the first two weeks.
Deep plane surgery typically produces slightly more swelling in the first week, reflecting the more extensive tissue dissection. In my experience, most deep plane patients are socially presentable by week two and feel confident returning to normal activity by weeks three to four. SMAS facelift patients may reach this point a few days earlier.
For international patients, the practical implication is that deep plane surgery typically requires a minimum of 5–7 days in Istanbul before flying; SMAS facelift patients may be able to fly at 8–10 days in uncomplicated cases. Both require 12 months for complete resolution of all swelling.
Full recovery timeline for Istanbul patients →
Cost in Turkey: deep plane vs SMAS
Deep plane facelift is more expensive than SMAS facelift because it requires longer operating time and more specialised surgical skill. In Turkey, this difference is proportionally smaller than in the United States or United Kingdom, because the baseline cost of care is lower.
Pricing for both deep plane and SMAS facelift is provided during your free video consultation, as the cost depends on the complexity of your case and any combination procedures. All packages are all-inclusive with no hidden fees.
Full cost breakdown and all-inclusive package details →
How to decide which technique is right for you
The honest answer is that this decision should be made in consultation with your surgeon after a direct assessment of your anatomy, skin quality, and goals. No amount of online research can substitute for a surgeon reviewing your photographs and asking the right questions.
What I would suggest for any patient comparing techniques: ask the surgeon to explain, specifically, why they are recommending one approach over another for your face. A surgeon who recommends deep plane facelift for everyone, without assessing the individual, is not giving you good advice. The same is true of a surgeon who never recommends deep plane.
The technique should fit the patient's anatomy. The surgeon's job is to make that assessment honestly.
Further reading
- Deep plane facelift recovery: week by week guide →
- Retaining ligaments in deep plane facelift →
- SMAS anatomy: the foundation of facelift surgery →
- Composite facelift vs deep plane: technical differences →
Discuss which technique is right for you
Book a free 30–45 minute video consultation. Dr. Zereyak reviews your photographs and provides a clear recommendation — deep plane, SMAS, or a different approach — based on your specific anatomy and goals.
Frequently asked questions
What is the difference between deep plane and SMAS facelift?
A SMAS facelift tightens and repositions the superficial musculoaponeurotic system — the fibrous layer beneath the skin. A deep plane facelift releases the retaining ligaments that tether this layer to the bone, allowing the entire facial composite (skin, SMAS, and underlying fat) to be repositioned as one unit. This produces more natural results with longer longevity — typically 12–15 years versus 7–10 years for SMAS — with less tension on the skin surface.
How long does a deep plane facelift last?
Deep plane facelifts typically last 12–15 years, significantly longer than traditional SMAS facelifts (7–10 years). Longevity depends on individual factors including skin quality, lifestyle, sun exposure, and weight stability. The results are permanent in the sense that the repositioned tissues remain elevated — but natural aging continues after surgery.
Does a deep plane facelift look natural?
When performed correctly, a deep plane facelift produces the most natural-looking results of any facelift technique. Because the deeper tissues are repositioned rather than the skin being pulled, there is no "windswept" or overcorrected appearance. The technique preserves natural facial expressions and avoids the distortion of skin-only facelifts.
What is the best age for a deep plane facelift?
There is no universal "best age" — candidacy depends on the degree of facial aging, skin quality, and anatomical structure rather than chronological age. Most deep plane facelift patients are in their late 40s to mid-60s. Some patients in their early 40s with significant laxity benefit from earlier intervention; some patients in their 70s remain excellent candidates. Dr. Zereyak evaluates each patient individually during video consultation.
What is the downside of a deep plane facelift?
The deep plane facelift is a more complex and time-intensive procedure than SMAS or mini facelift techniques, which means: longer operating time (4–6 hours), more extensive initial swelling (peaks at 48–72 hours), and a slightly longer recovery before social presentability compared to minimal-incision procedures. It also requires a surgeon with advanced fellowship-level training in facial anatomy and ligament release — relatively few plastic surgeons perform deep plane facelifts as their primary technique. The tradeoff is more natural results and significantly longer longevity.