Understanding Facelift

by Hisham Fansa

What is what- Facelift terminology

Some patients then come to me wanting a deep plane facelift rather than a SMAS facelift. However, the SMAS-facelift is a deep plane lift. In the deep plane lifting, the SMAS layer (the subcutaneous/connective tissue layer located on the muscle) is detached from the muscle and the facial nerve branches running on the muscle and lifted upwards. So technically it is exactly the same. You tighten the deep subcutaneous layer (SMAS) and do not pull on the skin. If you only pull on the skin, it looks unnatural. With the tightening of the subcutaneous layer, i.e. the SMAS, you can work much more naturally.

There are then different techniques for "entering" the deep plane, i.e. where to cut and pull to tighten the deep plane (not where we cut into the skin, the incision is always the same). There are also different techniques for "draping" the skin: you can leave it attached to the deep plane/SMAS layer, in which case it is called composite, or you can separate the skin from the subcutaneous tissue in certain areas, in which case you have two layers, which we call bi-lamellar. In the end, which technique you should choose depends on the actual excess skin and the elasticity of the skin. For a 75-year-old smoker with sun-exposed skin, you have to use a different technique than for elastic skin where it's just a matter of getting rid of mild "sagging cheeks".

So, as always in medicine, it is a matter of an individual, patient-adapted approach. You can recognise good plastic surgeons by the fact that they advise you individually without marketing phrases.