Which Face Lift Technique Is The Best?

This is a very common question asked by our patients, and the answer is not black and white.

Traditionally, there are three well known face lift techniques: Skin Only, SMAS, and Deep Plane.

The skin only technique is not commonly used as it does not address the aging of the underlying structures of the face. It has limited use and may be appropriate for younger patients (typically 40 years or younger) with only loose skin due to genetics or weight loss.

The SMAS technique has been around for over forty years, as is used by many plastic surgeons. There are many ways to address the SMAS: by imbricating the excess SMAS with sutures, or by cutting a portion of it and approximating the two ends of the SMAS. SMAS (Superficial Musculo-Aponeurotic System) is the tougher layer under the skin and will descent with aging. By elevating the SMAS, one is addressing the aging process, and the face lift result is not dependent on skin excision only.

The deep plane technique starts as a SMAS technique for the first few inches but then goes under the muscles of the face and involves releasing the ligaments which attach the muscles of the face to the underlying structures. It addresses the same aging process as the SMAS.

Proponents of the SMAS technique state that there is less chance of facial nerve injury (as the dissection is above the facial nerves), quicker recover (typically 2-3 weeks compared to 3-4 weeks for deep plane technique) and similar results as the deep plane technique.

Proponents of the deep plane technique state better ability to address the aging face, and longer lasting result (10-15 years versus 5-10 years for the SMAS technique).

Studies have shown no difference in comparing results from both techniques, and both have proven long lasting. One landmark study compared identical twins having face lift using different techniques and the findings were as above.

It ultimately depends on the surgeon, rather than technique. As with any case, I recommend consulting with a board-certified plastic surgeon or facial plastic surgeon (ENT surgeon with additional training in cosmetic surgery of the face) and viewing before and after photos. Every surgeon has a vision of what is attractive, and it is important for the patient to find the results match their expectations.

Michael A. Jazayeri, M.D. is a board-certified plastic surgeon with over 25 years of experience in cosmetic surgery of the face and body. His office is in Orange County, California. If you like to schedule a consultation, please call (714) 834-0101.