Is a SMAS lift the same as a deep plane facelift?
No. The two names are often used as if they meant the same thing, but they describe different operations. At RNWOOD Plastic Surgery in Seoul, Dr. Min-Hee Ryu defines a deep plane facelift in one sentence: the retaining ligaments are fully released in the sub-SMAS layer, while unnecessary dissection of the skin is kept to a minimum. Where the surgeon works, and whether those ligaments are released, is what separates the two.
This article explains that difference, the five concepts Dr. Ryu uses to describe his deep plane facelift, what the operation can and cannot address, and the situations in which he does not recommend it.
Where does each operation work?
SMAS stands for the superficial musculoaponeurotic system, one of the layers beneath the skin of the face. The two names sound alike because both refer to that layer, but they describe different places to work.
The term "SMAS lift" is used for techniques that work on the SMAS layer itself. A deep plane facelift, as Dr. Ryu performs it, goes beneath that layer. The dissection is carried out in the sub-SMAS plane, and the key retaining ligaments are released there. The skin is lifted only to a limited extent.
Why release the retaining ligaments?
Retaining ligaments, including the zygomatic ligaments, are anatomical points of fixation that hold the deeper tissues of the face in place. When they are released, the deeper tissues can move freely and be repositioned. This is the first of the five concepts in Dr. Ryu's approach, and it is the reason the operation does not depend on the skin alone. The aim is to restore the underlying tissues to a more natural position.
Dr. Ryu has written about these structures in the academic literature, including "Considerations of Facelift Methods and Facial Retaining Ligaments in Asian" (Archives of Aesthetic Plastic Surgery, 2014) and "High Superficial Musculoaponeurotic System Facelift with Finger-Assisted Facial Spaces Dissection for Asian Patients" (Aesthetic Surgery Journal, 2015).
What are the five concepts behind Dr. Ryu's deep plane facelift?
RNWOOD describes Dr. Ryu's deep plane facelift through five concepts. They are not a branded technique; they explain why each step is done.
| Concept | What it means |
|---|---|
| 1. Releasing the retaining ligaments | Key retaining ligaments, including the zygomatic ligaments, are released so the deeper tissues can move and be repositioned. |
| 2. High SMAS | Working at a higher level of the SMAS layer gives more comprehensive control of the midface and lower face, so the cheek, nasolabial region, jawline and neck are treated as one continuous area rather than as separate parts. |
| 3. Composite / preservation | Existing tissues are preserved and repositioned rather than removed unnecessarily. Skin, SMAS, fat compartments and deeper soft tissues are treated as connected layers, and undermining of the skin is kept to a minimum to protect its blood supply. |
| 4. Extended deep plane | The release goes beyond a limited central dissection. For Dr. Ryu, the point is not a larger dissection but releasing the specific structures that restrict movement. |
| 5. Repositioning of the buccal fat | Rather than routinely removing buccal fat, Dr. Ryu may move it into hollow or flattened areas of the midface, when this is appropriate for the patient. |
The third concept also explains a point about recovery. RNWOOD's own description says that less disruption to the skin can contribute to less tissue stress and a smoother recovery. That is a possibility, not a promise, and recovery still differs from one patient to another.
What can a deep plane facelift address?
It can address midface descent, jowls, lower-face laxity and selected folds. How much change is possible depends on each patient's anatomy and tissue quality. A deep plane facelift does not include a neck lift. A neck lift or a submentoplasty is added only when the consultation identifies a need for separate treatment of the neck.
The operation itself takes about four to five hours and is mostly performed under IV sedation. RNWOOD's in-house anesthesiologist remains present throughout the entire procedure, continuously monitoring each patient's condition. General anesthesia is also available for patients who prefer this option. Overnight hospitalization is not required, and a drain is used after surgery.
When does Dr. Ryu not recommend a deep plane facelift?
Dr. Ryu does not recommend a deep plane facelift when sagging is not significant and the skin still has enough elasticity that a surgical lift is not needed. He does not use age alone as the deciding factor. He looks at the actual degree of sagging in the skin and soft tissue, the structure of the face, previous surgery and procedures, and the area the patient wants to improve.
A younger patient can need surgery if soft-tissue sagging is clear. An older patient whose sagging is not severe may not need a facelift at all. He also does not recommend surgery when the change a patient hopes for is something a facelift cannot easily improve, or when the burden of surgery would outweigh what it can achieve.
Frequently asked questions
Q1) Is a SMAS lift the same as a deep plane facelift?
A1) No. A SMAS lift works on the SMAS layer itself. Dr. Ryu's deep plane facelift releases the retaining ligaments in the sub-SMAS layer and keeps skin dissection limited.
Q2) What can a deep plane facelift improve?
A2) It can address midface descent, jowls, lower-face laxity and selected folds. The possible change depends on your anatomy and tissue quality.
Q3) Does a deep plane facelift include a neck lift?
A3) No. A neck lift or submentoplasty is added only when the consultation finds a need for separate treatment of the neck.
Q4) Is my age the main factor in deciding?
A4) No. Dr. Ryu looks at the actual sagging, skin elasticity, soft-tissue condition and facial structure. Age alone is not treated as an absolute criterion.
Q5) Will my buccal fat be removed?
A5) Not routinely. When it is appropriate, Dr. Ryu may reposition buccal fat into hollow or flattened areas of the midface instead of removing it.
Q6) What kind of anaesthesia is used?
A6) The operation is mostly performed under IV sedation. RNWOOD's in-house anesthesiologist remains present throughout the entire procedure, continuously monitoring each patient's condition.
Q7) How long do the results last?
A7) No duration is guaranteed. Aging, gravity, sun exposure, illness, lifestyle and weight change continue to affect the face.
The cost is explained at your consultation after Dr. Ryu's assessment.
About the Author
Dr. Min-Hee Ryu is the Chief Director of RNWOOD Plastic Surgery in Seoul and a plastic surgery specialist certified in Korea (2008). He has been Faculty of the Mendelson Advanced Facial Anatomy Course (MAFAC) since 2016, an Editorial Board Member of the Aesthetic Plastic Surgery Journal since 2019, and an Educational Council Member of the International Society of Aesthetic Plastic Surgery (ISAPS) since 2024.
Deep Plane Facelift — Deep plane facelift involves extensive dissection beneath facial tissues. Risks include anesthesia reactions, bleeding, hematoma, infection, seroma, delayed healing, wound separation, persistent pain, and visible scars. Swelling, bruising, tightness, and numbness can last for months, and hair loss or distortion of the hairline or ear position can occur. Poor blood supply can cause skin loss or tissue death. Nerve injury can cause temporary or permanent weakness, an altered smile, or numbness, and injury to the parotid gland or salivary duct can cause salivary leakage. A postoperative hematoma can require urgent drainage or another operation. General risks include thrombosis or embolism, and a complication can require emergency treatment or additional surgery. No result, symmetry, scar quality, or duration can be guaranteed, and sagging can recur. Necklift — Neck lift can require extensive dissection beneath neck tissues. Risks include anesthesia reactions, bleeding, hematoma, infection, seroma, delayed healing, wound separation, persistent pain, and visible scars, as well as prolonged swelling, tightness, numbness, contour irregularity, and asymmetry. Nerve injury can cause temporary or permanent weakness, including lower-lip weakness, or altered sensation, and injury to the parotid gland or salivary duct can cause salivary leakage. A large neck hematoma can obstruct the airway and require immediate emergency treatment. Platysmal bands can remain or return. General risks include thrombosis or embolism, and a complication can require emergency treatment or additional surgery. No result, symmetry, scar quality, or duration can be guaranteed, and revision surgery can become necessary. Submentoplasty — Submentoplasty can cause anesthesia reactions, bleeding, hematoma, infection, seroma, delayed healing, pain, and scarring, as well as asymmetry, dents, waviness, loose skin, discoloration, and persistent numbness. It can injure deeper structures, and platysmal bands or neck fullness can remain. Bone structure and deep-neck anatomy limit the possible change. General risks include thrombosis or embolism, and a complication can require emergency treatment or additional surgery. No result, symmetry, scar quality, or duration can be guaranteed, and revision surgery can become necessary.