Deep Plane Facelift vs. Traditional Facelift: What Is the Difference?

From the outside in, the face is made up of skin, subcutaneous fat, a muscle-and-fascia layer called the SMAS (superficial musculoaponeurotic system), the muscles of facial expression, and bone. The structure that actually sags with age is not the skin but the SMAS beneath it and the fat pads attached to it. The skin merely follows that movement.

The retaining ligaments that anchor the SMAS to bone are located at the cheekbone, cheek, and jawline. These ligaments loosen over time but never fully give way; because they keep trying to hold sagging tissue in place, hollows and folds form across the face. The point where facelift techniques part ways is what is done with these ligaments.

In the traditional technique, the surgeon separates the skin from the SMAS over a wide area, then either suspends the SMAS layer upward and backward with sutures (plication) or removes a strip of it and tightens what remains (SMASectomy). The retaining ligaments are mostly left in place; the lifting power comes from the sutures placed on the SMAS.

This method has been used for decades, is predictable, and gives good results along the jawline and neck. Its limitation shows in the midface: because the fat pads below the cheekbone remain tethered to bone by the ligaments, the SMAS being pulled upward lifts this area only to a limited degree. And since the skin is separated over a wider area, part of the tension ends up on the skin.

In the deep plane technique, the skin and SMAS are not separated from each other; the two are lifted together as a single thick flap. The surgeon goes beneath the SMAS, releases the retaining ligaments of the cheek and jawline in a controlled way, and then moves this freed composite flap to its new position, securing it at the deep layer.

Because the ligaments have been released, the fat pads of the midface also rise back up over the cheekbone, and the nasolabial fold softens from deep within. Since the tension is carried by the deep layer rather than the skin, the skin incision bears less load and the risk of a widened scar in front of the ear is reduced. On the other hand, the technique requires working in a plane closer to the branches of the facial nerve; experience and anatomical knowledge are decisive.

The 'pulled' or 'windswept' look appears when the skin is carrying tension and the outline of the face is being drawn backward. In the deep plane technique, the tissue is moved not backward but in the direction opposite to aging, that is, upward and slightly forward, so the expression around the mouth and under the eyes is preserved.

The traditional technique also gives natural results in the right patient when applied with restraint; the problem arises less from the method than from placing too much tension on the skin. With either technique, volume loss in the face does not come back through lifting alone. That is why most plans add fat injection to the temples, cheekbones, and under-eye area in the same session.

Another measure of a natural result is how the face looks in motion. When smiling or talking, the cheeks should rise naturally, the corners of the mouth should not be pulled sideways, and the skin in front of the ear should not look tight. Showing the surgeon your pre-operative photos alongside photos from your younger years makes it clear that the goal is your own earlier face, not a new one.

With both techniques, swelling and bruising are noticeable during the first week; sutures are usually removed within 7–10 days. In the deep plane technique, because the skin is not widely separated, fluid collection under the skin and bruising tend to be more limited in most patients; on the other hand, the swelling that forms in the deep tissue may be felt a little longer.

Returning to social life generally takes 2–3 weeks with either technique; numbness fades over months and the final shape settles after 3–6 months. For patients traveling to Istanbul for treatment, a stay of about 10 days is planned after a facelift; this allows time for suture removal and the first follow-up.

• First 3 days: sleeping with the head elevated, cold compresses, chin strap
• Week 1: suture check, light walking, no makeup
• Weeks 2–3: bruising fades, return to work and social life
• Month 3 and beyond: remaining swelling subsides, scars fade

With both techniques, the incision starts at the hairline at the temple, follows the natural crease in front of the ear, and continues behind the ear to the hairline at the nape. The length of the incision depends not on the technique but on how much excess skin needs to be addressed in the neck. The main factor that determines the scar is not the location of the incision but the tension on its edges during healing; because the deep plane technique keeps the tension in the deep layer, the scar in front of the ear usually stays finer and the risk of the earlobe being pulled downward is reduced.

Both operations are performed under general anesthesia, usually with one night in the hospital. The traditional technique generally takes 3–4 hours; the deep plane technique takes somewhat longer because the surgeon proceeds more carefully in the deep layer. The difference in duration does not noticeably affect recovery; for anesthesia safety, the total operating time and any additional procedures are evaluated together.

The deep plane technique offers an advantage in patients with pronounced midface sagging, deep nasolabial folds, and a descending jawline. It may also be preferred for revision in patients who have had a traditional facelift before and whose midface did not improve enough. In patients with thin skin and little fat, lifting the skin and SMAS together provides a safer blood supply than separating the skin alone, so this technique is often recommended for them.

In younger patients whose sagging is limited to the jawline and neck and whose skin quality is good, a traditional SMAS technique or a neck lift alone may be sufficient. Blood thinner use, smoking, uncontrolled blood pressure, and certain connective tissue diseases are reasons to postpone either technique. Only the surgeon decides which technique is suitable, after an in-person examination and assessment of the skin and tissue; a preliminary opinion given over photos is not a final plan.

The cost of a facelift is determined less by the technique itself than by the overall scope: adding a neck lift, eyelid surgery, or fat injection, the operating time, the type of anesthesia, and the number of nights in the hospital all change the plan. With the deep plane technique, the operating time is usually somewhat longer.

For that reason, quotes for two different techniques can only be compared when the scope is the same. The most reliable approach is to clarify together during the consultation which areas will be addressed, how long you will stay, and the follow-up schedule.