Making sense of face and neck lifts

There are a lot of terms used around face and neck lifting that can be confusing to prospective patients. Many of you now do plenty of research and are aware, amongst surgeons, there are certain techniques we feel work well and others that do not have longevity. One of the current trending terms is ‘deep plane’. Many patients seek me out because we have been performing this procedure for many years.

So its important to nail down certain concepts first;

1. Just skin removal can look good for a few weeks, but never gives and meaningful lasting effect because skin doesn’t ‘recoil’ like an elastic band and remain in that tight stretch when this is done.
2. In order to get lasting effects surgeons manipulate a particular layer under the skin of the face called the SMAS (sub-muscular aponeurotic system). This is best thought of as an internal layer that connects to the overlying skin, and the deep muscles. A bit like the underlay beneath a carpet, where in certain portions the carpet and underlay and very tightly linked (not completely separate).
3. Also, the jaw and neck has a thin muscle called the platysma that is a continuation of the SMAS from the face into the neck. This thin sheet of muscle runs all the way down to our collarbones. So when we move the platysma we can also effect changes to the overlying skin like with SMAS.
4. The playsma muscle is also the reason many of us get central bands in our neck. They are the edges of the muscle under the chin that sag over time and start to become prominent as we age.

So what do the surgeons do to these layers??

Well – this is where the fun starts. There are many ways to manipulate the SMAS and Platysma. Which is the best?? NO ONE TRULY KNOWS. There is almost no research to compare versions of face and neck lifts. However, such studies would be really hard to do, because we can’t do one side of a face in one way, and the other totally different – this wouldn’t be ideal!

BUT surgeons who perform high volumes of facelift surgery know which patients tend to get longer lasting results versus others. In general, many surgeons agree the SMAS and platysma need to moved in some fashion. This involves cutting into the SMAS layer and lifting it from beneath (imagine we lift the underlay off the floor boards so it isn’t stuck to them and pull it tight). The variation in what surgeons do is often where they stitch this mobile layer to, and how high/lo those cuts are.

So terms like high SMAS, deep plane and composite are all similar terms and similar operations. Many surgeons prefer to plicate the SMAS and playtsma. Plicate in surgical speak means putting stitches in it to tighten it – a bit like pulling a purse string, or putting stitches into clothing to create a hem. This in principle can look good and lift things – but the procedure is reliant on the stitches having a continuous effect. The reason I and many others prefer deep plane techniques is because actually moving the SMAS to a new position and allowing it to scar into that position is more powerful that leaving it in its native position and tightening it with a stitch alone.

So, when you hear a SMAS lift and deep plane lift – they could actually mean the same thing. Lifting the SMAS is exactly what a deep plane face lift does. Similarly, some surgeons may refer to a SMAS plication (stitches to tighten the SMAS) as a SMAS lift.

So if you want to understand what your surgeon is proposing ask these specific questions;

1. Do you enter the deep plane to move the SMAS and Platysma muscle?
2. Do you fixate a SMAS ‘flap’
3. Is the deep plane released and ligaments released?

Based on the answer to these questions you may be able to understand what procedure is being done.