A deep plane facelift is a facelift approach that works in the plane beneath the SMAS. The surgeon releases the ligaments that hold the face (retaining ligaments). The midface and jowls are then repositioned together with the skin. This page explains what the deep plane is and how it differs from SMAS and high-SMAS techniques. It also covers the neck, what studies report and how to plan surgery in Istanbul, Turkey.
| In brief | Details |
|---|---|
| What is done | The ligaments holding the face are released in the plane beneath the SMAS; the midface and jowl tissue are repositioned together with the skin |
| Target areas | Midface, nasolabial fold, jowls and jawline; the neck if needed |
| Duration | Usually 3–5 hours; varies with the neck and added procedures |
| Anaesthesia | General anaesthesia |
| Where | Hospital operating room (Memorial Göztepe Hospital, Istanbul); consultation at the practice in Ataşehir |
| Back to daily life | Gradual; for most people 10–14 days, varies individually |
| Scars | A scar remains along the planned incision line around the ear and hairline |
Contents— 15 sections
What Is a Deep Plane Facelift?
The face is built in layers: skin, the fat beneath it and the SMAS (the muscle-fascia layer). Between these layers and the deeper structures run ligaments that hold the face in place (retaining ligaments). With age these structures loosen and the cheek tissue descends. The nasolabial fold (from the side of the nose to the corner of the mouth) deepens. Jowls form and the jawline becomes less defined.
In the deep plane approach the surgeon works not on top of the SMAS but in the plane beneath it, and releases these ligaments. The midface and jowl tissue can then be repositioned as a single unit together with the skin and the SMAS. The technique was first described in 1990 to improve the correction of laxity in the nasolabial area (Hamra, 1990).
For a general overview of facelift surgery (techniques, scars, recovery and preparation): facelift in Istanbul, Turkey.
What Is the Difference Between Deep Plane, SMAS and High SMAS?
Facelift techniques differ in which plane the support tissue is treated in, and how far. The table introduces the options; it does not rank them.
| Technique | Plane | How it is done |
|---|---|---|
| SMAS plication / imbrication | On top of the SMAS | The SMAS is folded or partly removed to tighten it; the surgeon does not go beneath it. |
| SMAS flap / high SMAS | Beneath the SMAS (limited) | The SMAS is lifted and moved as a separate flap; in high SMAS the flap starts higher, above the level of the cheekbone. |
| Deep plane | Beneath the SMAS, with release of the facial ligaments | Skin and SMAS are moved together as one unit; the midface can be included in the plan. |
| Mini / MACS lift | Limited SMAS suspension | A suspension over a smaller area through a shorter incision. |
Which technique suits you depends on where and how much the face has descended, your skin, previous treatments and your general health. This is decided at the consultation. The deep plane combined with an endoscopic approach: endoscopic deep plane facelift. Related reading: preservation facelift, mini facelift.
Can the Face and Neck Be Lifted Together With a Deep Plane Facelift?
Sagging in the jowls and jawline often comes with laxity in the neck. In that case the face and neck can be planned in the same operation. The plan then includes the platysma muscle of the neck and, if needed, a small incision under the chin.
Not every patient needs a deep procedure in the neck. If the neck is already well defined, the plan can focus on the face and loose skin. The decision depends on your neck anatomy and skin laxity at the examination. Op. Dr. Ali Çetinkaya explains this in the video below. For the neck in detail: deep plane neck lift; for persistent jowls: when jowls won’t go away.
Who Is a Deep Plane Facelift Considered For?
It may be considered for
- Descent of the midface and a deepened nasolabial fold
- Marked jowls and loss of jawline definition
- Sagging of both the face and the neck
- People in good general health who do not smoke or can stop
It may need to be postponed or another option considered
- Uncontrolled chronic illness or a bleeding disorder
- Active smoking (risk to wound healing)
- Only mild skin changes; surgery may be too early
- The main concern is volume loss or skin quality
A deep plane facelift is not needed for every kind of sagging; suitability is assessed at the consultation together with your health. What a facelift can and cannot correct: results and limits; how it differs from non-surgical options such as fillers, threads and devices: non-surgical alternatives.
How Is a Deep Plane Facelift Performed?
Planning and incision line
The incision plan is individual; it usually uses the temple hairline, the front of the ear, around the earlobe and behind the ear.
Releasing the ligaments
After the skin is lifted a short distance, the surgeon moves into the plane beneath the SMAS. The ligaments holding the face are released and the tissue is moved together.
Removing excess skin and closure
Excess skin is removed in a measured way so that tension sits in the deep tissue rather than the skin; the layers are closed with sutures.
Planning and marking
Anaesthesia
Incision and entry beneath the SMAS
Releasing and repositioning
Removing excess skin
Closure and dressing
A facelift needs incisions, so scars remain; how visible they are differs from person to person. Details: facelift scars.
Recovery After a Deep Plane Facelift
This timeline is a general guide; recovery depends on the scope, your skin and lifestyle. Return to work, driving, showering and exercise, and the check-up plan are covered in facelift recovery and follow-up.
What Are the Risks of a Deep Plane Facelift?
A deep plane facelift is a planned operation and, like any operation, carries risks. Knowing them in advance helps you notice warning signs early:
- Haematoma (blood collecting under the skin): the most common early complication; it may need to be drained. In a large meta-analysis, major haematoma was reported in 1.22% of deep plane facelifts, slightly more often than with SMAS plication (Jacono et al., 2019).
- Nerve effects: temporary weakness of facial expression or changes in sensation can occur and usually recover. In the same meta-analysis the risk of permanent nerve injury did not differ between techniques.
- Scars and hairline: rarely, a noticeable scar or thinning of hair along the incision line.
- Wound healing problems: healing at the skin edge can be delayed, especially in smokers.
- Asymmetry and infection: small differences between the two sides are possible; infection is rare.
When to call immediately, including emergency number 112 in Turkey: warning signs after surgery. If you smoke or use nicotine, discuss a plan to stop with your doctor; blood thinners are adjusted only with your doctor’s approval.
What Do Scientific Studies Show?
- Origin of the technique: the deep plane approach was described in 1990 to correct laxity of the nasolabial area better than earlier methods. The first series reported 403 patients (Hamra, 1990).
- Complications: a meta-analysis of 183 studies found no difference between techniques in the risk of permanent nerve injury. Temporary nerve effects were more frequent with high SMAS and composite techniques. Major haematoma was more frequent with deep plane and SMAS imbrication than with SMAS plication. The authors recommend choosing a technique by the quality of results, not by its complication profile (Jacono et al., 2019).
- Satisfaction: in a review of 21 studies and 2,896 patients, patient satisfaction was 94.4% with the deep plane and 87.8% with SMAS techniques. Overall complications were 17.2% and 10.3%, respectively. The authors conclude that both techniques give long-lasting results with high satisfaction (Khoury et al., 2025). These studies are not head-to-head comparisons; definitions and follow-up differ between studies.
These findings are general information; which technique suits you is decided at the consultation. Full references are at the end of the page.
Planning a Deep Plane Facelift in Istanbul, Turkey
If you are travelling to Istanbul, plan the consultation, the possible operation and the post-operative check-ups with the surgeon before you book flights. How long you stay depends on the scope of surgery and how your recovery progresses.
- Before you travel: photos or a video call give preliminary information only; suitability and technique are decided at a face-to-face examination.
- In Istanbul: examination at the practice in Ataşehir; surgery under general anaesthesia in a hospital operating room (Memorial Göztepe Hospital), usually with one night in hospital.
- Flying home: plan your return flight only after the surgeon has checked you and confirmed that you can travel.
- After you return: agree in advance how follow-up will continue and how to reach the clinic if you notice a problem. In an emergency, contact local emergency services first.
- Language: consultations are available in English, German and Turkish.
More on travelling for a facelift: planning a facelift in Turkey.
Video: Op. Dr. Ali Çetinkaya on Planning a Face and Neck Lift
Op. Dr. Ali Çetinkaya explains why a facelift and neck lift should be planned individually; more on our channel:
Op. Dr. Ali Çetinkaya: Specialty and Professional Details
- Specialty: Specialist in Plastic, Reconstructive and Aesthetic Surgery (2017); working in plastic surgery since 2012 (including specialty training).
- Society membership: Turkish Society of Plastic, Reconstructive and Aesthetic Surgeons (TPRECD) — member record.
- Operations: Memorial Göztepe Hospital, Istanbul.
- Consultations: Ataşehir, Istanbul — contact and address.
- Languages: Turkish, English, German.
Full education and career: biography.
What Determines the Cost of a Deep Plane Facelift in Turkey?
The fee for a deep plane facelift depends on the planned scope, anaesthesia and the length of the hospital stay. Added procedures, such as a neck lift or eyelid surgery, also affect it. The fee is given after the examination. Added procedures are not necessary for everyone; you can ask in writing what the fee includes.
Preparation (medication and smoking), choosing a surgeon and travel planning are covered in detail on the facelift page: preparation, choosing a surgeon, planning in Turkey.
Questions You Can Ask at Your First Consultation
- 1Is a deep plane or a SMAS technique more suitable for me, and why?
- 2Will the midface and neck be included in the plan?
- 3Where will the incisions be and how will the scars be planned?
- 4In which hospital and under which anaesthesia will the operation take place?
- 5How is my risk of haematoma and temporary nerve effects assessed?
- 6How will recovery and check-ups be planned, including after I return home?
- 7What can I realistically expect for my face?
Glossary
- Deep plane
- A facelift approach that works in the deeper tissue plane beneath the SMAS.
- SMAS
- The support tissue system beneath the skin and fat of the face (muscle-fascia layer).
- Retaining ligaments
- Connective tissue that anchors the facial soft tissues to bone and deeper structures.
- High SMAS
- A facelift technique in which the SMAS flap starts higher, above the level of the cheekbone.
- Platysma
- The thin, flat muscle under the skin at the front of the neck.
- Nasolabial fold
- The line running from the side of the nose to the corner of the mouth.
Frequently Asked Questions
What is a deep plane facelift?
What is the difference between a deep plane and a SMAS facelift?
Is a high SMAS facelift the same as a deep plane facelift?
How long does a deep plane facelift last?
Is a deep plane facelift riskier?
Can the face and neck be done in the same operation?
How long does the operation take?
When can I return to social life?
Where are the scars?
How long should I stay in Istanbul?
What does a deep plane facelift cost in Turkey?
Medically reviewed by
Specialist in Aesthetic, Plastic and Reconstructive Surgery
- Specialist since 2017
- Member of TPRECD
- Ataşehir, Istanbul
- Türkçe · English · Deutsch
Op. Dr. Ali Çetinkaya is a specialist in Plastic, Reconstructive and Aesthetic Surgery. Member of TPRECD (Turkish Society of Plastic, Reconstructive and Aesthetic Surgeons). He completed his residency in 2017 and practices at his private clinic in Ataşehir, Istanbul, specializing in deep plane facelift, neck lift, rhinoplasty, and eyelid surgery (blepharoplasty). He offers consultations in Turkish, English, and German for international patients.
Last updated:
This page is for information and does not replace medical advice.
Sources
- Hamra ST. The deep-plane rhytidectomy. Plast Reconstr Surg 1990;86(1):53–61. doi:10.1097/00006534-199007000-00008
- Jacono AA, Alemi AS, Russell JL. A Meta-Analysis of Complication Rates Among Different SMAS Facelift Techniques. Aesthet Surg J 2019;39(9):927–942. doi:10.1093/asj/sjz045
- Khoury S, Almubarak Z, Khan H, et al. The Deep Plane versus SMAS Facelift: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2025;49(21):5895–5903. doi:10.1007/s00266-025-05118-x
- TPRECD — Turkish Society of Plastic, Reconstructive and Aesthetic Surgeons
