Deep Plane Facelift vs. Skin Only Facelift vs. SMAS Facelift

Dr. Shashi Kusuma talks about the myths and misconceptions about the various types of Facelifts. Deep Plane, Skin Only & SMAS (Superficial muscular aponeurotic system) and what he uses and why some are better than others for his practice.

[@charlottemoore9467]

Oh gosh, I’m getting ready to have a deep clean facelift in five days I hope I’m making the right decision. But my goodness you had the best explanation and very detailed I honestly did not know the difference between a SMAS and a deep plain facelift and now I do. Thank you so much.

[@facesbykusuma]

Good luck with your operation.

[@bonnykowaski]

It's "Deep Plane", not "Deep Clean". Just to be clear. Good luck.

[@ranesmakhalil4364]

How is now result facelift ?

[@julieann4616]

@@bonnykowaski lol

[@julierubin9711]

Best explanation ever! Thank you!

[@californiatravelnurse318]

does this also apply to a platysmaplasty (Where you tighten the muscles of the neck like a corset)

[@PYC000]

Now I know. I thought deep plane and SMAS were the same. Thanks for the clarity.

[@VintageVixen2020]

You are an excellent professor, thanks, loved the detailed drawing and explanation.

[@gilbertjaramillo8735]

Wow, great comparisons and details. Sounds like SMAS is the clear winner in my book.

[@ursulamuga2737]

Great explanation . Thank you!

[@texannadeb5005]

I just had a deep plane lower facelift/necklift with an endoscopic brow lift 13 days ago. Can’t say why my surgeon chose that method, but so far so good. Still have a bit of swelling but I have to say I’m looking good! No issues with nerve damage. I well researched my surgeon and trusted his judgement. Honestly, I probably would’ve gone with whatever method he felt was best. Also, for anyone considering a facelift, my experience was virtually painless.

[@dhanwantieseeram8147]

Who is your doctor and which country and cost plz

[@texannadeb5005]

@@dhanwantieseeram8147 My doctor is Dr. Marcelo Antunes in Austin, TX USA. He is double board certified in facial plastic surgery and otolaryngology. He specializes in facial surgery only. Does not do tummy tucks or breast augmentation or that kind of thing. I like that he solely focuses on facial surgery. He is very honest about what can or cannot be accomplished with your surgery. Sets realistic expectations and I have not been disappointed in any way. Also has a very nice personality and a nice staff. I trust him completely and would not hesitate to recommend him to anyone.

[@texannadeb5005]

@@irenepolikoff5526 Thanks for the background info! They also say that there is a less pulled, more natural look with deep plane vs SMAS because there is less tension on the skin. At only 18 days out I still have a ways to go but, so far, I can say my lift has a very natural look. P.S. You mentioned less fat grafting needed. I had hollows under my eyes but after he repositioned the ligaments in my cheeks it somehow did away with the hollow look under my eyes with no fat grafting needed. I guess that’s another plus for the deep plane lift.😊

[@shashidharkusuma6494]

Hello Texanna, I am board certified in ENT/Otolaryngology as well. I trained in that at Vanderbilt. As you said, if the surgeon makes sense, has good results and consistent results, and you trust the surgeon, that is more important. I am glad you are doing well.

[@shashidharkusuma6494]

@@irenepolikoff5526 It is not true that only plastic surgeons trained in Otolaryngology and facial plastic surgery do deep plane. I am an otolaryngologist and also did the full plastic surgery training after. The technique is a technique that surgeons use and are comfortable with.

[@PattyHellman]

Thank you so much for this explanation. The internet is currently really promoting the Deep plane lifts, at three times the price of the SMAS. I can only afford the smas, but my surgeon has been doing them for decades. I have confidence in his ability and now thanks to your video, I also believe my treatment will be just as effective as any. Thank you!

[@ldraxx]

Great description. Very logical. Thank you

[@michaelpallagi3206]

Wow I never understood all of this until now. Great explanation

[@biankajacobs1663]

Thank you Dr. for your explanation. Excellent!!!

[@enoraparisi3457]

Why isn't the skin-only facelift not done these days? I have minimal sagging because of a jaw angle reduction procedure and buccual fat removal, and i don't want to take the risk with the nerves. What should be my option. Sagging is mainly in cheeks, i want to push the skin on cheeks back and maybe even the temple skin. I dont necessarily need lower face lifted.

[@shashidharkusuma6494]

skin only doesn't hold up to time and skin is not designed to hold tension long term. the sagging also is of the deeper tissues as well that have to be elevated and tightened.

[@margerykirner5604]

I agree the smas technique is safe, and the same outcome with this technique

[@reneeborjas1877]

The surgery of only the skin gives you an artificial look and won't even give you 5 years of duration of the surgery...

[@carolynlee460]

Amazing doctor I wish I had him to do my face lift

[@teresalehtonen8499]

I disagree Dr. SMAS only there are many ligaments in various positions ( deep plane) that prevent the SMAS layer to move effective enough to give dramatic yet natural and long lasting effect. In deep plane you cut the ligaments and are able to move much more effective the whole unit. This also gives less tension to the wound area etc.

[@shashidharkusuma6494]

No worries about the disagreement. As i said in the video there are those who do things one way, others who do differently. As long as the surgeon gets consistent and reproducible and good results, that is what matters at the end of the day. There have been publications that have shown no long term differences when these techniques are used by experienced surgeons.

[@erika8884]

@@shashidharkusuma6494 I have been doing my own research for 6 months. Based on photos of various surgeons and searching for the top FACES doctors in the world, SMAS looked better and the most highly respected surgeons didn't even offer the deep plane. Lifting as one unit didn't appeal to me because the small details and changes seemed limited based on the surgeries that I have watched. When I asked about an appointment with two well-known Facial Plastic Surgeons who only perform SMAS facelift, the consultations offered were 5-8 months out, and surgery was six months from there. There were two lesser known doctors, but were well liked who offered the deep plane, and the consultations were available that same week, surgery 4-6 weeks out. I have witnessed a more dramatic and pleasing result from those who have had the SMAS. Molding the entire face from a small pocket doesn't give much room to sculpt the face.

[@shashidharkusuma6494]

@@erika8884 Hello Erika, there has been publications that showed that in good hands with experiences, as long as the issues of the patient are corrected thoroughly and safely, the outcomes are good. Glad to hear that you are doing such research and the patient base is so informed and educated on the subject. It becomes very difficult for patients and also doctors sometimes to fully understand the differences as there is so much content around. Moreover, if you think of a golfer, some use a driver, some use an iron, some use a hybrid all various types of clubs to get to the hole to get an eagle or a birdie. That is the goal.

[@shashidharkusuma6494]

please check out @doctor.kusuma to check out some results.

[@michaelshannon9169]

Very interesting and informative. Could you do a vid on fat transfer to face? Thank you.

[@facesbykusuma]

Working on it . I do a lot of facial fat transfer. Working on very new techniques. We’ll share content soon.

[@michaelshannon9169]

@@facesbykusuma Thank you so much. I have been wanting to do this procedure but I never feel I have done enough research, I always feel I need to do more, find out more, see which practitioner is most qualified etc. Really looking forward to your assessment on this. Thanks :-)

[@facesbykusuma]

@@michaelshannon9169 please watch the latest video series on fat grafting

[@wildehilde9695]

Very well explained, thanks heaps!

[@dancingbird7225]

Thanks for such a clear explanation

[@rozsakimable]

Excellent explanation. Can a smas lift be done with local anesthetic

[@facesbykusuma]

Yes, do it every week. Can be done safely, thoroughly, comfortably

[@aabbarin3506]

Excellent explanation . Thank you .

[@ellens5183]

That’s so weird I just watched Williams Center Deep plane FL and others and they all make subcutaneous dissection first to separate skin from SMAS and then go to deep plane and also make flaps or dissect SMAS but not pull SMAS together with skin

[@facesbykusuma]

Hello Ellen, nothing weird about it at all. As I mentioned surgery and surgical techniques vary from surgeon to surgeon. Opinions and experience of surgeons vary from surgeon to surgeon. And results hence may also vary. As I always said, as long as you’re comfortable with the surgeon, explanation, the track record, the outcomes, the safety, and other components that are important to you then it should be perfectly reasonable and fine. An experienced surgeon should be able to do all of the techniques based on the situation that’s called for. That would include the deep plane lift when needed, smas resection and tightening as needed, smas elevation as needed, and other components such as removal of glands in the neck if needed to make a sharper neck.Just like a golfer who does things differently on the fairway of the green on the putting green etc. but ultimate goal is to get to the hole.

[@ellens5183]

@@facesbykusuma Thanks for reply doctor I am watching these videos because I want to address my mid face especially cheeks and that’s what I figured out the deep plane is the most appropriate surgery for that. Some Dr also do soof lift. I think it’s another great addition to it. But not many can do that

[@facesbykusuma]

@@ellens5183 After nearly 40 to 50 years of collective experience with facial rejuvenation surgery at large, and more recently with non surgical options, most experienced facial rejuvenation surgeons would offer combination treatments that include surgery that include volume restoration that include skin rejuvenation to get the most long lasting natural and safe and effective results.

[@peggycartmill8019]

There’s no contact information. In what state are you?

[@facesbykusuma]

Plantation, Florida and Boca raton Florida

[@evaelizabeth6186]

Thank you dr 😀

[@D8099.]

Most SMAS surgeons have no clue about how to address the neck which is all deep muscle work. I see alot of shinny people with old necks. But not I 😂

[@yvonnewhite1987]

Very good explanation thank you

[@cleaningdreams]

Amazing video

[@juliegray9972]

ive had 2 consultations. one offered a smas with a platysmal band procedure and the other doctor wants to do skin only. The doctor for the skin only said he has patients that will do skin only 3-4 times over 10-12 years and that they are happy with that until they’ll eventually need the smas. i have very minimal sagging (mostly jowel and neck) and he says the skin only procedure will be effective. Its all so much to think about already at just 48 years old.

[@facesbykusuma]

Without seeing you hard to say, however, I prefer doing SMAS tightening in all cases. Skin only in my opinion is not enough.

[@joaniekmiller]

Very informative.

[@sheliascott2612]

Which is which is the best for a patient with Bell’s palsy deep plane or smas

[@bonniegarza4775]

Excellent

[@loladivinity2]

Can I get a smas first then later get a deep plane ?

[@margerykirner5604]

I want a smas lift

[@effiemonfared6668]

thank you Dr. sorry we don’t know your name and locations???

[@D8099.]

As you sell yourself. Your forgetting to mention deepplane moves all layers as one unit. Like an island that moved and you just put it back where it was. You do mention at the end when you do SMAS only you create two planes of pull. The SMAS going your direction and the deepplane staying right where is. Creating tension the enemy of natural looking facelifts. Tension creates the traditional plastic like Barbie shinny skin. Unsuitable for males. Great for some females who are ok looking a bit different from themselves.

[@Singlelady1601]

Doesn't the deep plane facelift effects last longer?

[@facesbykusuma]

That is a myth. A week done operation with sound technique and combination approaches with maintenance lasts. skin quality, good skin care all play a role.

[@lepojkaculumovic5819]

Thank you very much doctor. Can you remove buccal fat in SMAS face lift?

[@milliekozary5667]

5 weeks ago I had a deep plane, neck and lip lift. All healing as should but notice that the mouth corners are sloping down more than I like is that because it’s due to the deep plane technique or the lip lift. Can this be fixed in your opinion sooner than later?

[@facesbykusuma]

Is hard to say. In any surgery, the thoroughness of surgery , the extent of dissection, the amount of elevation etc etc are all variable. Be happy to do a virtual consult.

[@Sweetiesplanet]

how did the scar from the lip lift heal. I heard that that is a very gnarly scar

[@tanyts]

What do you think about dr. Amir karam saying he invented a new technique called “vertical lifting” instead of horizontal lifting which everybody else does?

[@facesbykusuma]

I will have to review, but generally again, once you get the lay of the land with proper discretion and dissection of the tissues, you can move and position the way you see it best for the patient. Some need more vertical, some need more oblique, some need more lateral etc. There are a lot of minimal variations that surgeons claim, but again, the positioning of tissues should be fine and can be done optimally for each patient based on the need.

[@tanyts]

@@facesbykusuma thank you so much for answering!💕

[@abebahaile2552]

👍👍👍

[@chem3066]

Can’t read what you wrote need black ink marker

[@yasmeenmalika1031]

You should draw with some prominent marker,red didn't seems right.

[@facesbykusuma]

Thank you for the feedback. Will improve the quality more.

[@lizguenther8675]

What about drains with a lower facelift?

[@facesbykusuma]

I always use a drain. Some surgeons may not.

[@kmartin1550]

The surgeon shouldn't decide the patient should! I know what I want and need, and I know at this stage in my life and how I'm aging, I only need and will only feel comfortable with the skin lift procedure, not the SMAS or deep plan.

[@Sweetiesplanet]

I understand what you're saying but if you're not an expert, you wouldn't know exactly what you need or what would benefit you the best. That's why finding a surgeon that you trust is of optimal importance because he brings his skill, expertise and experience to the table for the benefit of his patient. Your intuition is definitely a powerful tool!!

[@margerykirner5604]

Do you do twilight sleep with smas lift?

[@californiatravelnurse318]

does the SMAS last as long as deep plane ?

[@facesbykusuma]

A well done surgery should last 10 plus yes. There maybe some minor skin loosening but by and large they should last.

[@tanyts]

Wowww what a great video! Because there is so much confusion all over the place! Thank you!🤍

[@facesbykusuma]

Thank you 🙏

[@D8099.]

WRONGGGGGG!!! IM A 42 year old gay male. Ive just had a deepplane and everyone thinks I’ve just lost weight. ALLLL My friends had SMAS lifts because they could not afford deepplane. There’s only a handful of surgeons in the U.S. qualified and confident enough to perform them. My friends all look shinny and OVERLY SMOOTHED OUT, like someone steam ironed the skin until it melted into a smooth wax lol. Also a bit pulled around the eyes almost doll like. My female friends LOVVVVE IT. My male friends have all sunk into a deep depression and told me they wished they had listened to me and saved more money and just waited. The SMAS feminized my male friends and they’ve all grown out thier beards. As much as I want to praise my Doctor I’m afraid if I mention his name too much online it will become to hard to get an appointment and future prices will go up.

[@facesbykusuma]

I am very happy that you had such a great result. Techniques should be chosen based on the need. Deep plane is good, SMAS is good when done for the right reasons and the right way. The surgeon should have the right criteria for what is recommended and done for each patient. A well trained surgeon will do either or other based on the need. Many surgeons in current times also do combination surgical procedures such as fat grafting, skin resurfacing, combining multiple procedures such as eyes, brow etc. There are many patients who are equally happy with techniques other than deep plane as well. So nothing wrong or right, it is right for the right person. As far as training and qualifications, that is a universal recommendation to ensure that the surgeon is consistent, safe, clear with proven evidence of great results.

[@Sweetiesplanet]

boy you're crazy and selfish!!!😅🤣😂