The deep plane facelift gets a lot of attention, and it’s easy to see why. It’s a sophisticated technique with decades of refinement behind it.
But when your primary concern is the lower third of your face and neck — jowls, a softened jawline, loose neck skin, marionette lines — the deep plane isn’t always the better answer.
Beneath your skin sits a layer of fibrous, interconnected tissue called the superficial musculoaponeurotic system — SMAS for short. Think of it as your facial scaffolding. It connects to the muscles that control facial expression and keeps everything where it belongs.
As you age, this layer gradually descends. That descent is what creates jowling along your jawline, looseness in your neck, and deepening lines around the corners of your mouth. Gravity pulls it downward, so correcting these changes means lifting it back up.
The name of this technique describes exactly how it works. Entering the SMAS at a higher point — near your cheekbone — gives the lift more reach through the lower face. Moving that tissue upward in a vertical direction counteracts exactly how it fell.
Imbrication is what separates this technique from a simpler tuck or fold. Dr. Koch removes a small portion of the SMAS, overlaps the edges, and sutures them together in the lifted position.
The areas this technique addresses directly include:
For patients with significant neck skin laxity, Dr. Koch may add a submentoplasty — a procedure targeting the area under the chin — to get the best possible result.
The deep plane goes beneath the SMAS entirely, releasing the ligaments that anchor your facial tissue to the bone and lifting everything below as one unit.
If your main concern is volume loss or deep folds in the cheek area, that deep release has its place. But if you’re focused on your jawline, jowls, and neck, the SMAS approach is more direct, with less risk.
Going deeper means working closer to your facial nerve branches. A recent review of nearly 2,900 facelifts found the deep plane carried a higher complication rate than SMAS techniques, including a greater chance of blood pooling under the skin and temporary nerve effects.
The SMAS approach also lends itself well to an in-office setting. Dr. Koch performs this procedure under twilight sedation, without general anesthesia. That means a faster recovery and none of the grogginess that typically follows a hospital procedure.
If you’re considering a facelift and want to understand which approach is right for you, schedule a consultation with Dr. Koch. He’s trained more physicians in awake facelift techniques than any other surgeon in the country.
Contact us today for an appointment at 669-279-3663, text the office, or book online at drkochfacialplasticsurgery.com.
