The advantages of sub SMAS and deep plane facelifts include:

1. Natural appearing result
2. Less chance of a “pulled” look vs. a traditional facelift
3. Long term durability
4. Addresses laxity near the jawline
5. Great for neck laxity
6. Can be modified with high SMAS modification to achieve a mid face lift

All of these advantages come with only a few drawbacks. Patients will need at least 10 to 12 days of downtime, which is a bit longer than a traditional facelift. In addition, there will be some amount of lymphatic swelling that will require postoperative massage.

Dr. Raghu Athré is an expert in deep plane face lifting techniques for his Houston patients. Dr. Athré’s advanced anesthesia techniques allow the deep plane face lift to be performed under local anesthesia with oral sedation to minimize bruising and swelling, and minimize down time experienced by patients.

The deep plane facelift is the hardest lift with respect to technical expertise required and the hardest lift to achieve perfect local anesthesia. Because of these reasons, many surgeons shy away from deep plane or sub-SMAS facelifts. But if you want to maximize the longevity of your facelift, a deep plane facelift is likely your best option. Seek out a surgeon with experience in this technique.

The face has many layers, just like an onion. As you go through the layers from superficial to deep, you will see the skin, followed by a small amount of subcutaneous fat, followed by the superficial musculoaponeurotic system (SMAS), the parotid masseteric fascia, and finally the parotid gland, and various muscles, nerves and blood vessels.

For any lasting effect, a facelift must readjust the SMAS layer, which essentially provides a scaffolding for the surface layers of skin.

Many surgeons offer a type of facelift called something like a “Band-Aid Lift” or “Lunchtime Lift.” This can be done in under 40 minutes per side, with the facelift patient under anesthesia near the incision sites only. By lifting the skin from the underlying layers, pulling the skin back, trimming the skin, and closing the incision, the immediate results can look quite good. However, skin-only lifts rarely withstand the test of time.

This is because the skin itself has no inherent strength. Skin is like a rubber band. If you take a rubber band that is 5 inches long and keep stretching it all day, the rubber band may end up being 7 inches by nighttime. If you trim 2 inches off the end of the rubber band, you’ll be back to the original length, but if you stretch it again, it will elongate again. This is how skin behaves – with gravity and connective tissue pulling it down over time.

The real strength layer is actually in the SMAS. The SMAS layer is a tough, fibrous layer that envelopes the face and runs into the platysma muscle of the neck. This continuous layer is what wraps the face, and any type of lifting procedure that will stand the test of time will address this layer.

There are several options to address this layer:

1. The surgeon can use permanent suture to put a stitch through this layer and sew the layer over itself – like pleated pants. This is called privation.
2. The surgeon can make a cut in the SMAS, lift up the SMAS for a short distance, pull the SMAS over the proximal SMAS, and sew the overlapped edges. This is called a sub-SMAS umbrication.
3. The surgeon can make a cut in the SMAS, undermine the SMAS, shorten the SMAS, and attach the SMAS to fixed points on the skull – aka, a Deep Plane Facelift.

The above lifts are listed in order of increasing difficulty, but also increasing longevity. A woman with thin tissue and minimal aging may do fine with a subSMAS umbrication, but significant aging along the jawline, and neck requires a deep plane lift to achieve reliable, natural, and long-term results.