Why Everyone’s Talking About the Deep Plane Facelift
The Celebrity Coverage, Decoded
The “deep plane facelift” is the technique behind much of the current celebrity facelift coverage but the term is older, and far less settled, than the headlines suggest. First described more than three decades ago, it now means different things in different hands. Here, Dr Peter Callan explains where the technique comes from, what the research says about it, and how he approaches facelift surgery.
Dr Peter Callan on what the term really means, what the evidence shows, and how he approaches facelift surgery.
Where does the deep plane facelift come from?
The deep plane facelift is not a new concept. It was first described by Sam Hamra in Dallas in 1990. This worked well on the neck and lower face but failed to lift the midface and nasolabial area unless a large amount of tension was used. Hamra attempted to improve this by incorporating the muscle around the eye with the deeper structures, but this had the effect of weakening this muscle. Others have modified the technique by incorporating the fat of the midcheek but staying above the muscle.
Regardless of all of this, “deep plane” is more of a marketing term these days. One that has as many variations as there are surgeons. My friends and colleagues Rick Warren from Vancouver and Tim Marten from San Francisco feel (rightly so, I believe) that it is important to lift the fat of the midface to improve the area around the mouth, under the eyes and the nasolabial fold.
What is a deep plane facelift, in plain English?
A deep plane facelift has become a term often used but not always well understood. Unfortunately, many claims have been made about so-called “deep plane techniques” that are not based on any evidence. In fact, a recent paper in the main plastic surgery journal found no difference between techniques that lift the SMAS (deep plane) and techniques that tighten the SMAS.
The SMAS is the deeper layer of the face, under the fat. The part of the face that ages the most is the skin and the fat — and this is the most important part of the face to address. If you address it from below, that is deep plane. If you address it from above, that is a SMAS technique. Both work in certain hands, and good surgeons get good results no matter which technique they use.
So is the buzz right or wrong?
The buzz about deep plane is just that, a lot of noise in a complex field. The important thing is to address the skin and the fat. How the surgeon does it comes down mainly to how he or she has been trained and how they think about the face.
There is also no evidence that one technique lasts longer than another, despite the marketing hype. As long as a technique properly repositions the skin and the fat it can work well, with the result mainly dependent on surgeon experience and skill.
Some techniques, however, do not give significant results. Beware of terms such as minilift, s-lift, thread lift and liquid lift.
How do you do your facelifts?
I prefer to address the skin and fat directly and extensively, so I can position the skin and the fat where I want them, which is essentially back to where they were when the patient was younger. My facelift is therefore multivector: I move the skin and fat under the eyes and on the cheek upward and inward, the lateral cheek vertically, and distribute the skin around the lateral cheek, especially around the eye, to give smoothness at rest and a normal wrinkle pattern when the face animates with expression.
The neck is both tensioned and contoured to refine the jawline and neck angle. I also like to address all of the ancillary areas — the upper and lower eyelids, the forehead and the length of the upper lid — as well as the volume of the face using fat transfer.
The aim is to return the structures of the face to where they were, maintaining a person’s character, smile and eye shape. The surprising thing is how little tissue is removed in many people, as it is mostly redistributed back to its original position.
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Frequently Asked Questions
What is the SMAS?
The SMAS is the deeper layer of the face that sits under the fat. Most modern facelift techniques address it in some way — either by lifting beneath it (deep plane) or by tightening it from above (SMAS techniques).
Is a deep plane facelift better than a SMAS facelift?
There is no evidence that one is better than the other. Recent research in the leading plastic surgery journal found no difference between techniques that lift the SMAS and techniques that tighten it. What matters most is properly repositioning the skin and fat — and the experience and skill of the surgeon.
Do deep plane facelifts last longer than other facelifts?
There is no evidence that one technique lasts longer than another, despite the marketing hype. How a result holds over time depends on the individual and the quality of the surgery, not on the name of the technique.
What facelift terms should I be cautious about?
Be wary of terms such as minilift, s-lift, thread lift and liquid lift. Some techniques marketed under names like these do not give significant results. If in doubt, ask a Specialist Plastic Surgeon to explain exactly what a procedure involves and what it can realistically achieve.