The Evolution of the Facelift: From SMAS to Deep Plane

Facelift surgery has come a long way since its beginnings more than a century ago. What began as a simple skin-tightening procedure has evolved into a highly sophisticated surgery designed to restore youthful contours while maintaining a natural look. Today’s techniques focus not just on lifting, but on preserving facial structure, circulation, and long-term results.

Let’s take a closer look at how facelift techniques have developed and why the most advanced approach, the Preservation Deep Plane Facelift, represents the next generation in facial rejuvenation.

Early Facelifts: The Beginning of Modern Facial Surgery

Facelifting is nearly as old as facial plastic surgery itself. The first known facelift was performed in 1901, when surgeons lifted and trimmed away excess skin to reduce visible sagging. These early procedures were limited to the surface, surgeons separated the skin from the deeper tissues, tightened it, and removed the excess.

While this offered temporary improvement, the results often looked tight or “pulled,” and the effects did not last long. For decades, this simple skin lift remained the standard until new anatomical discoveries transformed the field.

The SMAS Facelift: A Deeper Understanding of Facial Anatomy

In the 1970s, surgeons began to explore the deeper structures of the face. In 1974, Dr. Tord Skoog described working in the “deep plane” to lift and reposition the platysma muscle, a key component of the neck and lower face. Around the same time, Drs. Mitz and Peyronie identified an important fibromuscular layer known as the SMAS (Subcutaneous Musculo-Aponeurotic System).

The SMAS facelift became the new standard for nearly two decades. By tightening this layer, surgeons could create smoother jawlines and necks with more natural results than skin-only lifts. However, this technique was not without its drawbacks.

Because the skin was lifted and re-draped with tension, patients sometimes developed visible scars around the ears, downward-pulled earlobes, or shifted hairlines. Over time, as the SMAS stretched again, patients could develop unnatural creases along the jawline or hollowing in the neck. Even in expert hands, results varied widely.

The Deep Plane Facelift: A More Natural Lift

By the late 1990s, Dr. Sam Hamra refined Skoog’s work and introduced what he called the deep plane facelift, before later evolving it into his composite lift technique, which also addressed the eyelids and eyebrows.

Unlike the SMAS lift, the deep plane facelift releases the SMAS and skin together from the deeper facial ligaments that anchor them in place. By freeing these strong attachments, the surgeon can reposition the deeper structures of the face and neck without excessive pulling on the skin.

This method allows the entire facial unit (skin, fat, and muscle) to move together, producing a smoother, more youthful appearance. Because the skin is not stretched tightly, scars are finer and more discreet. Patients benefit from a more natural result, with improved definition along the jawline and neck.

The Preservation Deep Plane Facelift: The Latest Advancement

The newest innovation is the Preservation Deep Plane Facelift, which takes the advantages of deep plane surgery even further.

In this approach, surgeons still perform the same deep release beneath the SMAS and platysma but preserve the natural connection between the skin and underlying tissue. This key difference maintains much better blood flow to the skin, reducing swelling and speeding up recovery.

For patients, the benefits are significant:

• Less swelling and bruising
• Faster healing and recovery
• Lower risk of wound complications
• More natural, longer-lasting results

Because blood circulation to the skin is preserved, healing occurs more quickly, and the need for advanced wound treatments such as hyperbaric oxygen therapy is dramatically reduced.

A Century of Progress

From the earliest skin lifts of the early 1900s to today’s Preservation Deep Plane Facelift, each innovation has brought surgeons closer to the goal of natural rejuvenation without visible signs of surgery.

Modern facelift techniques now emphasize precision, safety, minimal downtime, and preservation, producing results that are both beautiful and enduring, helping patients look refreshed, not “done.”

Dr. Minas Constantinides is a board-certified Facial Plastic Surgeon at Westlake Dermatology & Cosmetic Surgery in Austin, Texas. He is on the Executive Committee of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) and is a Senior Advisor of the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS).

Disclaimer: The contents of the Westlake Dermatology website, including text, graphics, and images, are for informational purposes only and are not intended to substitute for direct medical advice from your physician or other qualified professional.