High SMAS & Extended Deep Plane Facelift is a surgical approach to lifting the midface and lower face by repositioning deeper facial tissues associated with the SMAS (Superficial Musculoaponeurotic System) and supporting facial structures, rather than relying solely on skin tightening.
This approach may be considered for individuals with sagging involving the midface, nasolabial folds, jawline, and lower face. The surgeon evaluates the degree of laxity, tissue position, SMAS layer, facial anatomy, and skin quality to develop an individualized surgical plan.
At Dr. Gorn Aesthetique, facelift planning emphasizes facial anatomy and the direction of tissue repositioning to ensure that the lifting approach complements the overall facial structure.
What Is a High SMAS Facelift?
The SMAS is a layer of tissue located beneath the subcutaneous fat and connected to the facial muscles and supporting structures.
A High SMAS Facelift involves lifting and repositioning the SMAS at a higher level to address laxity across multiple facial regions rather than focusing only on the skin around the jawline.
The surgeon may consider this approach to address:
- Sagging cheeks
- Midface laxity
- Nasolabial folds and surrounding tissues
- Jowls or sagging along the jawline
- Lower facial laxity
- Loss of facial contour definition
What Is an Extended Deep Plane Facelift?
An Extended Deep Plane Facelift is a surgical approach that accesses and repositions tissues within a deeper facial plane. Selected retaining structures may be released according to the surgical plan to allow the tissues to be repositioned.
The term Extended refers to expanding the surgical dissection into areas that require correction, such as the midface and lower face, depending on individual anatomy.
The central principle is to reposition deeper facial tissue units rather than creating tension through the skin alone.
What Is the Difference Between High SMAS and Deep Plane Facelift?
Both techniques aim to address structures beneath the skin, but they differ in how the surgeon accesses and manages the deeper tissue layers.
High SMAS Facelift focuses on lifting and adjusting the SMAS at a higher level to address changes in the midface and lower face.
Deep Plane Facelift, on the other hand, operates in a plane associated with the underside of the SMAS and the facial retaining structures, allowing tissues to be repositioned together according to the surgical plan.
In practice, facelift techniques and their applications vary between surgeons and according to individual anatomy. The choice should therefore not be based solely on the name of the technique.
Why Address the Deeper SMAS Layer?
Facial sagging does not result from skin changes alone. Aging can affect several components, including:
- Skin and elasticity
- Facial fat
- SMAS and facial muscles
- Retaining ligaments
- Changes in cheek tissue position
- Facial bone structure and underlying support
Therefore, tightening the skin alone may not address all the factors contributing to facial laxity.
Deep Plane and SMAS Facelift planning places emphasis on adjusting the supporting structures while also managing excess skin.
Which Areas of Facial Sagging Can Be Addressed?
High SMAS & Extended Deep Plane Facelift may be considered to address laxity involving:
- Midface
- Tissues surrounding the nasolabial folds
- Lower cheeks
- Corners of the mouth and surrounding areas
- Jowls
- Loss of jawline definition
- Lower face
- The transition between the cheeks and facial contours
The extent of surgery varies according to each patient's concerns.
Can a Deep Plane Facelift Improve Nasolabial Folds?
Nasolabial folds develop due to several factors, including natural anatomy, changes in cheek tissue position, facial fat distribution, skin, and bone structure.
Lifting the midface and deeper tissues may reposition the tissues surrounding the nasolabial folds, but this does not mean that the folds will disappear completely.
The goal is to improve the relationship between facial tissues rather than attempting to eliminate all natural facial folds.
How Can a Facelift Improve Jowls and Jawline Definition?
Jowls refer to sagging or accumulated tissue along the sides of the chin and jawline, which can disrupt the smooth contour of the lower face.
Repositioning the SMAS and deeper tissues may help refine the lower face and jawline. The surgeon also considers fat volume, skin laxity, and the structures of the chin and neck.
If neck laxity is also present, additional Neck Lift or Platysma Surgery may be considered.
Who May Be Suitable for High SMAS & Extended Deep Plane Facelift?
Individuals with the following concerns may consider a surgical assessment:
- Beginning midface sagging
- More prominent nasolabial folds associated with tissue descent
- Jowls along the jawline
- Loss of jawline definition
- Lower facial sagging
- Excess skin accompanied by laxity of deeper supporting structures
- A desire to address tissue sagging beyond skin tightening alone
- Previous facelift surgery with concerns requiring assessment for a revision facelift
Will a Deep Plane Facelift Make the Face Look Too Tight or Different?
The goal of a facelift should not be to pull the skin as tightly as possible, but to reposition displaced tissues in a way that complements the patient's facial anatomy.
The degree of change depends on the existing laxity, direction of lifting, amount of skin adjustment, and surgical technique.
Surgical planning should therefore respect the patient's distinctive facial characteristics and avoid unnecessarily changing their natural appearance.
Where Are High SMAS & Deep Plane Facelift Incisions Located?
Facelift incisions are typically placed along areas associated with the hairline, around the ears, and behind the ears, depending on the extent of surgery.
Incision placement and length depend on individual anatomy, surgical technique, the amount of excess skin, and the regions requiring lifting.
All surgical procedures can result in scarring, and the appearance of healed incisions varies between individuals.
Can High SMAS & Deep Plane Facelift Be Combined with a Neck Lift?
These procedures may be considered together, particularly for individuals with both lower facial and neck laxity.
Combining a Face & Neck Lift may allow the surgeon to plan the contours of the lower face, jawline, and neck as a continuous anatomical unit.
However, not everyone undergoing a facelift requires a neck lift. The platysma muscle, skin, submental fat, and neck anatomy must also be evaluated.
How Long Is Recovery After a Deep Plane Facelift?
Temporary swelling, bruising, tightness, or changes in skin sensation may occur after surgery. The severity of these symptoms and recovery time depend on the extent of the procedure.
Swelling gradually subsides, and facial contours continue to change as the tissues heal.
Patients should avoid strenuous activities, physical exertion, and actions that increase pressure on or place stress on the face for the period recommended by their surgeon.
