Understanding the Deep Plane Facelift: Technique, Terminology, and Philosophy
The term Deep Plane Facelift has gained popularity in recent years, but the surgical technique it describes is not new. It refers to a method of facial rejuvenation that involves dissection beneath the SMAS (Superficial Musculoaponeurotic System) layer and targets deeper tissues like muscle, fascia, and fibro-fatty structures.
While plastic surgeons have been operating in this anatomical plane for decades, they traditionally didn’t use the term “deep plane lift.” It was ENT facial plastic surgeons who coined and marketed the phrase, leveraging social media and branding to bring it into the public eye. Despite the shared anatomical goals, the two specialties differ significantly in how they approach this surgery.
Here, I will explain these differences to help you determine whether a deep plane facelift might be the right procedure for you.
The Plastic Surgery Approach to Deep Plane Facelift
In the plastic surgery approach to Deep Plane Facelift, the skin envelope and the SMASlayer are first separated. The procedure then enters the deep plane, located beneath the SMAS, using a High SMAS approach, which typically begins across the cheekbone area and extends downward along the face in front of the ear. In some cases, this dissection continues into the neck after the skin has been fully lifted.
During this process, the SMAS is carefully dissected away, resulting in a separation between the skin and the deeper facial tissues. This method is referred to as the Bilamellar (or Bilaminar) High SMAS Approach to the Deep Plane Facelift. This approach enables a full, continuous elevation of both the face and neck through a sub-SMAS dissection, allowing for comprehensive rejuvenation. Although both techniques reach the same anatomical layer, the bilaminar method offers greater adaptability to individual facial structures and aging patterns.
The Differences of the ENT Facial Plastic Surgery Approach
The Monolayer Technique
In the ENT facial plastic surgery approach to the Deep Plane Facelift, there is minimal skin undermining, and entry into the deep plane (sub-SMAS layer) is performed while keeping the skin and underlying tissues attached as a single unit. This technique, known as the monolayer approach, is believed by its proponents to yield superior outcomes due to its preservation of tissue integrity.
However, I strongly disagree with this perspective. The monolayer technique inherently limits the ability to achieve multi-vector elevation and transposition of facial structures. Because the skin and SMAS are not separated, the lift can only be performed in one general direction, reducing the surgeon’s ability to tailor the lift to the individual’s anatomy and aesthetic goals.
Skin Laxity Correction
The ENT facial plastic surgery version of the Deep Plane Lift offers limited correction of facial skin laxity. While both surgical philosophies utilize the deep plane concept for neck rejuvenation via subplatysma dissection, my approach incorporates a composite philosophy. This means I elevate the entire deep plane of the face and neck as a single, continuous sub-SMAS dissection, allowing for comprehensive mobilization of both the SMAS layer in the face and the subplatysma layer in the neck.
This unified elevation enables me to address the jowl through three distinct mechanisms:
- Central neck correction via the Central Cervicoplasty Deep Plane Neck approach.
- Lateral neck contouring through the Lateral Platysmaplasty Deep Plane approach.
- Facial vector manipulation using the Deep Plane Facelift, which allows for multi-directional tensioning, including vertical, oblique, and lateral vectors, to achieve a more natural and tailored result.
My Approach
In my version of the Deep Plane Lift, which utilizes the High SMAS approach, I advocate for the bilaminar technique – a method that separates the skin and SMAS layers to access the deep plane. This approach offers significantly greater versatility, particularly in addressing key areas of facial aging such as the jowls, marionette lines, and the buccal fat pad.
Unlike the monolayer technique used by ENT facial plastic surgeons, the bilaminar High SMAS approach allows for direct visualization and assessment of buccal fat attenuation or herniation through the deep plane. This is a major advantage, as addressing buccal fat through the oral cavity often leads to over-resection, which can compromise facial volume and contour.
Furthermore, the ENT version of the Deep Plane Lift lacks the ability to sculpt or excise excess subcutaneous fat around the jawline and jowls when necessary. The monolayer technique inherently limits access and visibility, making it impossible to accurately assess or treat buccal fat abnormalities. In contrast, the bilaminar High SMAS approach provides the precision and flexibility needed to address all aspects of facial aging in a comprehensive and customized manner.
My Final Thoughts on New Jersey Deep Plane Facelifts
In conclusion, while ENT facial plastic surgeons may have coined the term Deep Plane, plastic surgeons have been performing this same dissection technique, under different terminology, for over a decade prior. The anatomical planes of dissection remain consistent across both approaches; however, the methods of access and execution differ.
I firmly believe that my version of the Deep Plane Lift offers significantly greater versatility, allowing it to be adapted to a wide range of facial types and aging patterns. Though it is a more technically demanding procedure, the results consistently demonstrate its superiority in achieving natural, long-lasting rejuvenation.
Dr. Scott Spiro – New Jersey’s Best Facelift | Neck Lift Plastic Surgeon
For those interested in learning more, I invite you to explore my podcast series on the Deep Plane Face and Neck Lift and browse real patient outcomes on my website.Dr. Scott Spiro is a board-certified plastic surgeon at Spiro Plastic Surgery in West Orange, NJ, specializing in facelift and neck lift surgery. Call us at (973) 736-5907 or reach out online to learn more.
