Deep Plane, SMAS, Mini/Open Facelift: What are the differences?
Facelift surgery has evolved from simple skin tightening to techniques that reposition deeper facial structures. Today, three commonly discussed approaches are:
SMAS facelift
Mini/open facelift (limited incision facelift)
Deep plane facelift
All aim to improve facial aging, but they differ significantly in depth, technique, and outcomes.
A key structure in modern facelift surgery is the superficial musculoaponeurotic system (SMAS), a fibrous layer connecting facial muscles to the skin. The SMAS was formally described by Mitz and Peyronie in 1976.As this layer descends with age, it contributes to:
Sagging cheeks
Jowls
Loss of jawline definition
SMAS Facelift
The SMAS (traditional) facelift is widely used and produces reliable improvement in the lower face and jawline.
Technique: Skin separated from the SMAS layer, SMAS is tightened or repositioned, Skin re-draped with reduced tension
Results: Strong improvement in jawline and lower face, Moderate improvement in midface
Longevity: Typically 5-10 Years
Safety & Complexity: Moderate complexity, Well-established and widely performed
Mini / Open Facelift
The mini facelift (often called a mini open facelift) uses shorter incisions and limited dissection.
Technique: Superficial or limited SMAS involvement, Minimal tissue dissection
Best for: Early signs of aging, Mild jowling
Results: Subtle improvement in lower face, Minimal effect on midface
Longevity: Shorter duration compared to SMAS
Safety & Complexity: Lower complexity, Less invasive
Deep Plane Facelift
The deep plane facelift, introduced by Dr. Sam Hamra in 1990, lifts the skin and SMAS together as a single unit by dissecting beneath the SMAS. This technique allows the release of retaining ligaments and a more effective repositioning of the midface. A more ‘vertical' restoration of the face is achieved, versus a stretched look in a traditional SMAS.
Technique: Dissection below the SMAS, Skin and SMAS lifted as one unit, Release of facial retaining ligaments
Results: Strong improvement in cheeks and nasolabial folds, Natural-looking lift with less skin tension
Longevity: Typically 10-15 years and more, due to deeper structural repositioning
Safety & Complexity: Higher complexity, Requires advanced surgical expertise, Operates closer to facial nerve branches
Evidence From Comparative Studies
A 2024 systematic review (21 studies, 2,896 patients) reported:
94.4% satisfaction (deep plane facelift)
87.8% satisfaction (SMAS facelift)
Both techniques showed high satisfaction and low complication rates. Mini facelift data is less standardized due to variation in technique.
Key Takeaway
Mini facelift → limited, early-stage correction
SMAS facelift → reliable lower face improvement
Deep plane facelift → deeper structural repositioning with stronger midface results
Outcomes depend heavily on surgeon experience and technique. The main difference between these techniques is the depth of dissection and how facial tissues are repositioned. All can produce effective results, but outcomes depend heavily on surgical expertise.
References
Mitz V, Peyronie M. The superficial musculoaponeurotic system (SMAS) in the parotid and cheek area. Plastic and Reconstructive Surgery. 1976.
Hamra ST. The deep-plane rhytidectomy. Plastic and Reconstructive Surgery. 1990.
Stuzin JM. Anatomy of the SMAS and deep plane facelift surgery. Aesthetic Surgery Journal.
Stuzin JM, Baker TJ. Deep plane facelift techniques and facial ligament release. Aesthetic Surgery Journal.
Rohrich RJ, Pessa JE. Facelift techniques and long-term outcomes. Plastic and Reconstructive Surgery.
Aesthetic Surgery Journal Open Forum. Systematic review of facelift techniques, 2024.