The Ultimate Facelift: Is It Talent or Technique?
Are Deep Plane and SMAS Facelifts More Different or More Similar?
Facelift Techniques Explained by Board Certified Plastic Surgeon, Dr. Sam Gershenbaum in Miami
Patients researching facelift surgery today are often confronted with competing claims surrounding deep plane facelift, SMAS facelift, and other named techniques.
Dr. Sam Gershenbaum, a board-certified plastic surgeon in Miami with over 30 years of experience performing facial rejuvenation surgery, explains that outstanding facelift outcomes depend less on market named techniques and more on surgical judgment, anatomical understanding, and meticulous execution.
In today’s aesthetic world, facelift marketing often centers around technique.
Deep plane.
SMAS.
Extended SMAS.
High SMAS.
Patients naturally ask:
Which one is best?
At the final Baker Gordon Stuzin Cosmetic Surgery Symposium in 2026 — long regarded as one of the World’s most respected meetings in aesthetic surgery — this question was heavily discussed. There was even review of a case where two different techniques were used on the same patient, an excellent result, and in general, no one could tell that two different techniques were used.
The consensus was clear:
The best facelift results are determined less by the name of the technique and more by the experience, judgment, and execution of the surgeon.
Understanding the SMAS and the Deep Plane
SMAS stands for the Superficial Musculoaponeurotic System, the fibromuscular layer beneath the skin that plays a central role in facial rejuvenation.
There is no single “SMAS facelift.” Variations include:
• SMAS plication
• SMASectomy
• Standard SMAS flap elevation
• Extended SMAS
• High SMAS
• Stacked SMAS techniques
Deep plane techniques are equally variable in:
• Depth of dissection
• Ligament release
• Extent of skin undermining
• Fixation strategy
• Vector control
When simplified into “SMAS versus deep plane,” the reality of surgical overlap is often lost.
Are They More Similar Than Different?
Both SMAS and deep plane techniques recognize a critical principle:
Meaningful midface elevation requires release of retaining ligaments — particularly the zygomatic retaining ligaments.
In extended SMAS techniques, when dissection progresses from the fixed lateral SMAS into and beneath the mobile medial SMAS, the surgeon effectively enters the deep plane.
At that point, the anatomical territory overlaps significantly with what is described as a deep plane lift.
Surgeons for both techniques agreed that the extent of dissection and release will vary for each patient and is determined during the surgery. Dissection and release continues until appropriate mobilization is evident.
The distinction often lies not only in whether the deep plane is accessed, but in:
• How the tissues are mobilized
• How far the dissection is extended
• The direction of midface structural lift
• The fixation method
• The amount of skin undermining
• Vector of skin closure
The foundational anatomical goals are frequently aligned.
Vector and Skin Management Matter
One world reknown facelift expert lecturing and performing live surgery at this last Baker Gordon Stuzin Aesthetic Meeting in 2026 made note that the deep plane facelift often moves midface and skin in a more lateral vector or direction and insists that the mid face deep tissue elevation should be in a more vertical direction.
Hence, there is a debate over the extent of skin dissection and vectors of the midface deep tissues and skin.
Some approaches limit skin undermining to maintain adherence between skin and deeper tissues.
However, more extensive skin dissection allows independent control of:
• Deep tissue elevation (often more vertical)
• Skin re-draping (often more lateral)
That independence can be essential in restoring natural midface projection without creating a lateral “wind-swept” appearance.
Differences in outcome often relate as much to vector control and tissue handling as to the name of the operation.
Volume Restoration: The Overlooked Factor
Facial aging involves not only descent, but volume loss.
A facelift repositions tissue. It does not replace lost fat or restore skeletal support.
The most natural results frequently combine:
• Appropriate structural lifting
• Release of retaining ligaments when indicated
• Thoughtful vector control and fixation
• Selective volume restoration
Ignoring volume can create tightness without youthfulness.
Overfilling can create distortion.
Balance is key
The Detail That Separates Good from Undetectable
Regardless of technique, refinement determines whether a facelift looks natural.
The difference between a good result and a truly undetectable one often lies in details such as:
• Invisible or well-concealed scars
• Tension-free skin closure
• Preserving natural hairline position
• Maintaining earlobe anatomy
• creating an appropriate pre-tragal hollow separating the ear from the face
• Careful redraping without distortion
A facelift should restore — not advertise — itself.
Technique provides structure. Meticulous execution provides refinement.
The Real Determinant of Outcome
All plastic surgeons agree that no single facelift technique is ideal for every patient.
Experienced surgeons do not perform every procedure identically. The degree of mobilization, ligament release, volume restoration and skin management is tailored to the individual face as are ancillary procedures.
The true determinants of an excellent result are:
• Individualized planning
• Appropriate depth of mobilization
• Proper vector control and fixation
• Appropriate volume restoration
• Precise tissue handling and attention to detail
• Execution of ancillary procedures such as temporal brow lift, eyelid surgery, lip lift surgery… just to name a few
• Surgical experience
What has truly been shown at this meeting is that it may not be possible to tell what technique was used in an expertly and well performed facelift. Hence choosing a surgeon by what technique he markets may not be the best approach.
In the end, the ultimate facelift is not defined by its procedural label, but rather by the execution of an undetectable and fabulous result.