What is a deep plane facelift?
A deep plane facelift releases selected retaining ligaments beneath the SMAS, the support layer under the skin. This allows the skin and SMAS to move together as a connected, or composite, layer. Dr. Smith uses relatively limited skin undermining: only a modest area of skin is separated from the tissues beneath it.
The technique name describes part of the operation. Your facial anatomy, skin quality, neck contours and goals determine the full surgical plan.
Why Dr. Smith selects a deep plane approach
Dr. Smith often favors a deep plane approach when there is significant cheek descent, pronounced jowling, marionette folds or substantial laxity. Releasing the retaining ligaments gives him more freedom to reposition the descended tissues, particularly through the cheek and lower face.
For a patient with lighter aging changes, a standard SMAS lift or plication may provide the needed correction with a shorter operation. Dr. Smith chooses the release and lift around the anatomy. A deep plane label by itself does not promise a better result or a longer-lasting one.
What happens during a deep plane facelift
The incision plan is designed for each patient's anatomy, including hairline, sideburn position, ear shape and, in men, the beard. Dr. Smith marks it with the patient before surgery. It generally runs from the temple area, along the natural contours in front of the ear, around the earlobe and into the crease and hairline behind the ear.
After a limited area of skin is elevated, Dr. Smith enters the plane beneath the SMAS. The zygomatic, masseteric and mandibular retaining ligaments, which tether the cheek and jawline to the underlying bone, are released in a controlled way. This lets the skin, fat and SMAS of the cheek move together as one composite layer instead of being pulled from the surface. The released tissue is then repositioned, with the direction and amount of lift chosen for each face, and secured to stable structures near the ear. The goal is to restore the cheek and jawline contours the patient had earlier in life, not to create a new shape.
When the neck is part of the plan, Dr. Smith treats it through a small incision beneath the chin. The approach depends on each patient's anatomy and goals. It can include repairing the platysma muscle bands (platysmaplasty), removing fat above or beneath the muscle, and, when indicated, reducing the digastric muscles or the submandibular glands. Some fat beneath the skin is deliberately left in place, because removing too much can leave the neck looking hollow or older. Excess skin is then trimmed conservatively and the incisions are closed in layers. Because the lift is carried by the deeper tissues, the skin closure is designed to be under little tension, which helps the scars settle.
A deep plane facelift with a neck component usually takes about four hours. It is performed under general anesthesia or IV sedation, depending on the details of the procedure and the patient's preference. A board-certified anesthesiologist gives the anesthesia, and surgery takes place in the practice's accredited on-site surgical facility. Every patient spends the first night in the practice's private overnight surgical suite at the Ritz Tower, cared for by Dr. Smith's nursing team. The next day, patients return home or to their hotel. A private nursing service is available at home or at the hotel for patients who want extra support.
Deep plane and SMAS plication: what changes for you
Both operations treat the SMAS, so the difference is mechanical, not just a matter of name. In a plication, the SMAS is folded and stitched to tighten it while the skin is lifted separately over a wider area. In a deep plane lift, the SMAS and skin stay attached to each other and are moved as a unit after the ligaments beneath them are released.
For a patient with significant cheek descent and deep nasolabial folds, releasing those ligaments can let Dr. Smith reposition the midface more effectively than tightening the SMAS from above. For a patient with mild jowling and good skin, the extra dissection may add operative time and swelling without adding benefit, and a plication or a mini facelift can be the better operation.
Published studies show that both techniques are safe and give high patient satisfaction. Few studies compare them directly, and none has shown that one technique is better for every patient. Results depend as much on choosing the right operation for the face, and on the surgeon's experience, as on the technique itself. So the honest answer to "which is better" is "better for whom," and that is what the consultation settles.
Where the scars go
Facelift scars are permanent, but they are planned so that hair, the ear's own folds and the natural creases of the face hide them. The portion in front of the ear follows the ear's natural contours. Its exact course, including whether it runs inside or just in front of the tragus, depends on the patient's anatomy. The portion behind the ear sits in the crease and then the hairline. A small scar beneath the chin is used when the neck is treated.
Scars are usually pink for the first few months. They generally lighten by around four to six months and keep maturing for up to a year. A small number of patients develop thickened scars, which can usually be improved with treatments such as steroid injections or laser.
Dr. Smith designs the hairline portion of the incision to preserve the sideburn and the hair behind the ear rather than shifting them upward. A displaced or missing sideburn is one of the giveaways of an obvious facelift.
A plan shaped around your face
Dr. Darren Smith is board-certified by the American Board of Plastic Surgery and has completed fellowships in both craniofacial surgery and aesthetic surgery. This combination brings training in the underlying facial framework together with a focus on aesthetic refinement.
Bring photographs of yourself from earlier years and describe the features you want to preserve. The most useful conversation is about your goals and proportions, as well as the technique.
Dr. Smith is also a named co-inventor on a U.S. patent for predicting how facial soft tissue moves when underlying bone is repositioned—a contribution to the simulation of craniofacial surgery.
A patient’s facelift experience
Hear a patient describe her facelift and neck lift experience with Dr. Smith.
Deep plane, SMAS, preservation and mini facelift
SMAS describes an anatomical layer, not just one operation. Plication tightens that layer by folding and securing it; a deep plane approach releases selected attachments beneath it so connected tissues can be repositioned together. The facelift selection guide explains how Dr. Smith chooses the scope of treatment.
Dr. Smith’s preservation facelift is a refinement of the deep plane approach with even less skin undermining. It works in the same deeper plane. A mini or MACS facelift is a more limited option for early jowling, mild neck looseness and good skin elasticity.
Is a deep plane facelift right for you?
The degree of cheek descent, skin laxity and jowling matters more than age alone. Dr. Smith may also favor a deep plane or preservation approach for thin or fragile skin, because it limits how much skin is separated from the underlying tissues. Your health, nicotine use, previous surgery and other treatments remain part of the assessment.
The quality of the SMAS and any previous surgery can change the plan. The neck also needs its own assessment: a heavy neck or pronounced bands cannot be fully described by the words deep plane facelift. Dr. Smith will explain the facial and neck components proposed for you.
Plan your recovery around real life
Plan for swelling, bruising and a period away from demanding activities. Looking comfortable in public, returning to work and resuming exercise are different milestones; the timing also depends on any combined procedures.
Discuss upcoming events, travel and the physical demands of your work before choosing a surgery date. Your plan should include follow-up visits, help during early recovery and individualized instructions for activity and incision care.
Recovery, week by week
The first two or three days are the most uncomfortable: the face feels tight, and a soft dressing is worn. Swelling often builds through the first week before it begins to subside, so the end of week one does not show the final result. Drains are used in some cases, depending on the extent of surgery. When they are used, Dr. Smith decides when to remove them based on how each patient is healing.
Pain is managed mainly without opioids. Dr. Smith uses a long-acting local anesthetic during surgery, and afterward acetaminophen and suzetrigine (Journavx), a newer non-opioid pain medication. A prescription opioid is available if it is needed, but many patients use little or none.
Sutures in front of the ear are removed at five to seven days. The sutures behind the ear and in the scalp are absorbable and do not need to be removed. Bruising tends to drift down toward the neck as it fades. Visible bruising and most of the early swelling usually settle over two to four weeks. Many patients are comfortable in public with light makeup at around two weeks, which is also when desk work is often realistic, but some need longer.
Light walking is encouraged from the first days. Light cardio can usually resume at two to three weeks, and strenuous exercise and heavy lifting at four to six weeks, with Dr. Smith's clearance. Numbness around the ears begins to recede over the following weeks. The new contour of the cheek and jawline is usually evident by about three months, and the final result is judged at around six months to a year, once the deeper tissues have fully settled.
Patients must stop all nicotine before and after surgery. This includes cigarettes, vaping, nicotine pouches, patches and gum, because nicotine from any source is linked to a much higher rate of wound-healing problems after facelift surgery. Dr. Smith requires patients to be completely nicotine-free for at least four weeks before surgery and four weeks after. Nicotine testing is done before surgery to confirm.
Combining a deep plane facelift with other procedures
A facelift repositions tissue. It does not change skin texture, eyelid skin or lost facial volume. For that reason Dr. Smith often discusses companion procedures: upper or lower blepharoplasty for the eyes, a brow lift when the brow has descended, fat grafting to restore volume in the temples, cheeks or lips, a lip lift, chin augmentation with an implant, buccal fat reduction, earlobe reduction, and laser resurfacing to improve skin texture. These can be performed in the same operation when it is safe to do so, or staged. Combining procedures lengthens surgery and modestly increases the risk of complications, so the decision is made for each patient individually.
Energy-based skin tightening such as FaceTite can help early, mild-to-moderate laxity and small fat deposits along the jawline and neck. It does not replace a facelift once the deeper tissues have descended.
Risks of a deep plane facelift
As with every facelift, the most common significant complication is a hematoma, a collection of blood under the skin that sometimes needs to be drained. The risk is higher in men, in patients with high blood pressure and in those taking blood-thinning medications or supplements. This is why Dr. Smith controls blood pressure carefully before, during and after surgery and reviews every medication and supplement beforehand.
The branches of the facial nerve that move the cheek and mouth lie beneath the layer that is lifted in a deep plane dissection. Temporary weakness of one of those branches can occur and usually recovers over weeks to months. Permanent injury is rare. Large reviews have not found a consistent difference in nerve injury rates between deep plane and SMAS facelifts.
Other risks include infection, numbness around the ears, hair loss near the incisions, asymmetry, wound-healing problems and unfavorable scarring. Dr. Smith reviews these in relation to each patient's health before a decision is made.
Deep plane facelift cost in NYC
Your quote depends on the extent of facial and neck treatment, anesthesia and any additional procedures. Ask for an itemized plan that makes the surgical scope and fees clear.
A $500 fee secures your consultation and is credited toward your procedure. The consultation is where you can compare the proposed changes, recovery plan and financial details with your priorities.
Care and safety
Facelift surgery carries risks, including bleeding, infection, nerve injury, scarring and asymmetry. Dr. Smith reviews the considerations relevant to your health and surgical plan before you decide. Healing and results vary.
Your Manhattan consultation
Dr. Smith sees facelift patients at his practice on the ground floor of the Ritz Tower, 111 East 57th Street, New York, NY 10022, between Park and Lexington Avenues in Midtown Manhattan. The office is a short walk from the Lexington Avenue/59th Street station (4, 5, 6, N, R, W trains).
Surgery takes place in the practice's on-site surgical facility, accredited by QUAD A (formerly AAAASF). Out-of-town patients can begin with a video consultation, followed by an in-person visit before surgery. To arrange a consultation, call 212-633-0627 or use the online request form. A $500 consultation fee is credited toward surgery.
Your questions, answered
Is a deep plane facelift the same as a SMAS facelift?
The SMAS is a supportive anatomical layer addressed by several facelift techniques. A deep plane facelift works beneath it and lifts connected tissues together. Other SMAS approaches treat this layer differently; the technique should be explained in relation to your anatomy.
Does a deep plane facelift include a neck lift?
Dr. Smith includes neck work when looseness or fullness beneath the chin or through the neck is a concern you want to address. He includes platysmaplasty for vertical bands or significant platysma laxity, and selects fat treatment or other deeper steps according to your anatomy. The neck lift guide explains those choices. The deep plane label alone does not specify which neck steps you need.
Will a facelift treat my eyelids or skin texture?
A facelift primarily addresses tissue descent and facial contours. Eyelid concerns, sun damage and fine surface lines may call for separate treatments, which can be discussed as part of a coordinated plan.
How long do deep plane facelift results last?
Dr. Smith favors deep plane release for selected patients because he believes it supports a lasting correction of significant cheek descent. That is a reason for his technique choice, not a guarantee that it will outlast every SMAS lift. Continued aging, tissue quality, the full operation and healing all affect durability.
What anesthesia is used for a deep plane facelift?
Either general anesthesia or IV sedation, chosen with each patient based on the extent of surgery and their preference. All anesthesia is given by a board-certified anesthesiologist.
Am I too young, or too old, for a deep plane facelift?
There is no fixed age. Studies of facelift patients, including those older than 75, have not found age alone to raise the risk of complications when patients are carefully screened. Overall health, blood pressure, medications, nicotine use and healing capacity matter more than the number.
Does a deep plane facelift look "pulled"?
A pulled or windswept appearance usually comes from relying on skin tension or lifting in an unnatural direction. The deep plane technique moves the deeper tissues and is designed to keep tension off the skin, which supports a natural result when the direction and amount of lift are chosen well. A well-executed SMAS facelift can also look natural. The surgeon's judgment matters as much as the technique.
What is the difference between a deep plane and a preservation facelift?
Both move the deeper tissues as a unit. Dr. Smith's preservation facelift undermines even less skin and keeps more of the native attachments intact. He describes it on the preservation facelift page.
Can a deep plane facelift be revised?
Yes. Previous surgery changes the anatomy, so revision planning starts with what was done before. Published series report similar complication rates for secondary and first-time facelifts. Dr. Smith sees patients who had surgery elsewhere and discusses what a secondary facelift can and cannot correct.
Will I need to stay in New York after surgery?
Out-of-town patients usually stay in the city for one week, so that early follow-up visits and suture removal can take place in the office. Most hematomas appear within the first 24 hours, which is why every patient spends the first night under the care of the practice's nursing team.
How do I arrange a consultation?
Contact the Manhattan practice to discuss an appointment with Dr. Smith. A $500 fee secures the consultation and is credited toward your procedure.