What is deep plane face and neck surgery?

Our focus on surgical rejuvenation of the face and neck is what is called ‘Deep plane’ face and neck lift. This is definitely a buzz word/term these days in facial aesthetic surgery. 

There are many terms and versions of a face and/or neck lift, and patients quite rightfully do some pre- consult research. This can be confusing, and so we hope this page helps de-mystify some concepts.

Today the term deep plane facelift was popularised by Andrew Jacono in New York, and he and many others across the world described what we feel are the current versions of face and neck lift that afford maximal longevity and natural results.

Actually deep plane facelift surgery was originally coined by a surgeon called Sam Hamra many years ago and was a major innovation at the time. The reason terminology has morphed over time is because most things go full circle, and although Sam hamra’s deep plane differs from today, it is important to acknowledge his major contribution in this area.

What is the SMAS and why all the fuss?

Many patients have heard of the SMAS, here are some points about the SMAS, and our fascination with it as facelift surgeons;

• SMAS stands for sub muscular aponeurotic system
• It is like a flexible plastic sheet that largely sits under the facial skin, and has connections to the skin – there are many ways to try modify the position of the SMAS in face lifting surgery
• These connections are complex and are stronger in certain parts of the face
• Some surgeons (like me) like going under it – the Deep plane – and lifting it from its attachments to allow it to be moved – because moving the SMAS, if done correctly, moves the skin above it without creating abnormal appearances
• Moving the SMAS in the deep plane permanently changes the position of the SMAS meaning it likely gives you the best chance of longevity in the lift
• The SMAS is the same layer as the sheet muscle we have in our neck called the Platysma – which is also best lifted when going under it and releasing it to pull it tight

There are a number of small refinements that add to expertise in this procedure, and we advise seeking a surgeons that performs a high volume of these procedures.

What should your deep plane face/neck lift consult include?

• A comprehensive assessment of your whole face and neck
• A skin assessment
• Images to highlight where the scars are placed and why 
• Indicative results for this procedure in patients with anatomy like yours
  • We all come in different shapes and sizes so there is no value in showing you pictures of patients that have totally different starting points to you
• Your surgeons should be comfortable disclosing how many procedures they do / have done, definitions are helpful here
  • Primary deep plane = patients having it for the first time
  • Revision surgery = The surgeon revises a patient of his own due to dissatisfaction
  • Secondary / Tertiary surgery – the surgeon is revising a patient of someone else’s, or simply performing a second time/third time (and so on) face/neck lift on a patient previously operated on years before
• Indicative results at different time points in healing process and many months/years after surgery
• The surgeon should explain their complication rates
• The surgeon should describe their revision rates – how often are they revising a patients face or neck
  • This should be very low – but every surgeon worldwide has failures and if you are told they do not – please be very wary, any surgeon and any technique is fallible, and every surgeon without exception encounters dissatifactory results early post-operation.
• The surgeon should explain their ‘tuck up’ or tweak rates
  • Surgeons cannot fully control internal scarring so certain minor issues with contour, lumpiness or such like can require a small touch up procedure should the patient want it

What to look for in an expert?

• Do they have a particular interest / high volume in the procedure(s) you are seeking an opinion on?
• What is their education? Many surgeons in the UK would typically have;
  • Fellowship (dedicated) training in aesthetic surgery
  • Are on the specialist register for a surgical discipline related to aesthetic surgery. Plastic surgeons get comprehensive training in a variety of aesthetic surgery and other specialists in ENT, OMFS, Ophthalmics and Breast surgery also provide aesthetic treatment/surgery. (Some are not on the register but are still excellent surgeons with excellent training from other countries, different training paths)
  • Is there evidence they are seen as an expert by their peers?
    • Invited lectures
    • Invited teaching
    • Visits from other surgeons who observe them
    • Educational roles in aesthetic surgery
• Are they affiliated with national bodies / royal colleges that have an interest in patient safety, and education/training in aesthetic surgery.

Surgeons may have different combinations of the above and so crucially – Do you get on with, and trust your surgeon are the key things before you embark on a surgical journey.