By Dr Scott J Turner, Specialist Plastic Surgeon (FRACS) | Bondi Junction, Sydney
There’s a lot of confusion out there about facelift terminology. Patients come into my Bondi Junction rooms having read about “High SMAS,” “deep plane,” “extended deep plane” — and understandably, they’re not sure what any of it means for them. Some terms get used interchangeably online. Others get thrown around as marketing rather than meaningful surgical descriptions.
So let me cut through that noise.
What I want to explain here is how two well-established surgical approaches — the High SMAS facelift and the deep plane facelift — can be combined with strategic retaining ligament release to address facial ageing at a structural level. Not skin tightening. Not surface pulling. Actual repositioning of the tissues that have descended.
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A Quick Look Back at How Facelifts Have Changed
For decades, facelift surgery was a skin operation. Surgeons would undermine the skin, pull it tight, trim the excess, and close. The problem? Skin stretches. It’s elastic by nature. So those early results faded within a couple of years. Worse, the tension on the skin closure led to that windswept, pulled look. Distorted earlobes. Wide scars.
Everything shifted in 1976 when Mitz and Peyronie described the SMAS — the superficial musculoaponeurotic system. This fibromuscular layer sits beneath the skin and fat, and it’s the structural framework of your face. Once we understood that the SMAS was responsible for supporting facial contours, it became clear that any lasting facelift needed to work at that deeper level.
That was nearly fifty years ago. And the techniques have continued to evolve since.
What Is the SMAS, and Why Does It Matter So Much?
Think of the SMAS as a continuous sheet of tissue running from the platysma muscle in the neck up through the face, connecting to the facial muscles and skin. When it’s well-supported, your facial contours stay defined. When it weakens and drops — which it does with age — you get jowling, cheek flattening, deeper nasolabial folds, and laxity through the lower face and neck.
Here’s a detail that doesn’t get discussed enough in patient-facing content: the SMAS isn’t uniform in thickness. It’s thickest laterally, close to the ear and along the zygomatic arch. As you move toward the centre of the face, it thins out considerably — becoming quite attenuated over the midface muscles. That variation matters a great deal when you’re planning where and how to engage the SMAS surgically.
The High SMAS Approach — and What It Gets Right
A standard SMAS facelift typically works in the lower cheek and jawline area. Good for jowls, reasonable for jawline definition, but it has a ceiling — literally. Because the dissection stays low, the midface and upper cheek don’t get much correction. For a lot of patients, that’s the area they’re most bothered by.
The High SMAS technique solves this by taking the SMAS elevation higher — along and above the zygomatic arch — where the tissue is thicker and better able to support a lift. By engaging the SMAS at this level, you capture the midface within the same flap. One structural unit, lifted together, rather than treating the midface and lower face as separate problems.
The other advantage? A more vertical vector. Gravity pulls everything downward. A lateral-only pull — which is what many older techniques relied on — fights against the wrong direction. A vertical lift from the zygomatic arch directly counteracts descent and tends to produce a more natural result. You get better cheek elevation, better nasolabial fold correction, and a cleaner jawline without that horizontally-stretched appearance.
The Deep Plane Facelift — a Different Philosophy Entirely
The deep plane facelift works on a fundamentally different principle. Rather than lifting the SMAS as its own separate layer (which is what all standard SMAS techniques do), the deep plane approach dissects beneath the SMAS — into the space between it and the deeper facial muscles.
Why does that matter? Two reasons.
First, because the skin stays attached to the SMAS throughout the dissection, it moves as a single composite unit. Blood supply is preserved. And the tension of the lift sits on the deeper structural layer, not on the skin surface. That’s a big part of why deep plane results can look smooth and unforced — there’s genuinely less pull on the skin.
Second — and arguably more important — the deep plane is where the retaining ligaments live. You can’t release them properly from above the SMAS. You need to be underneath it.
Retaining Ligaments: The Anchors That Limit Your Lift
This is where a lot of patients (and, frankly, some surgeons) don’t pay enough attention.
Your face isn’t a curtain draped over a skull. It’s tethered at specific points by dense fibrous bands called retaining ligaments. Four are surgically significant: the zygomatic ligaments (holding the cheek fat pad to the cheekbone), masseteric cutaneous ligaments (along the jawline), mandibular ligaments (along the jaw), and cervical retaining ligaments (in the neck).
In youth, they keep everything firmly positioned. But they weaken at different rates as you age, and soft tissue slides downward unevenly over them. That uneven descent produces jowls, the pre-jowl sulcus, deep nasolabial creases, and that blunted jaw-to-neck angle.
Now, if you try to lift the SMAS without releasing these ligaments, you hit a wall. The tissue can only go so far before those tethers stop it. Push harder, and you don’t get a better lift. You get distortion, dimpling, or tension in the wrong spots.
Releasing the ligaments allows the whole composite flap to move freely. The cheek fat pad slides back up over the cheekbone. Jowl tissue elevates properly. And the correction distributes evenly, which is what makes the final result look like you, just less tired.
Why “Deep Plane” Alone Doesn’t Tell the Full Story
Not every operation labelled “deep plane” includes comprehensive retaining ligament release. And not every High SMAS lift captures the midface adequately. The label on the technique matters far less than what actually happens in theatre — how much tissue gets mobilised, which ligaments get released, and whether the surgical plan matches your specific anatomy rather than a marketing description.
Putting It Together: Why the Combined Approach Works
Neither technique is perfect in isolation. They each have strengths. The combined approach draws on both.
The SMAS gets engaged high along the zygomatic arch — where it’s thick enough to provide a solid structural foundation. The dissection then transitions beneath the SMAS in the midface, entering the deep plane so the retaining ligaments can be identified and divided. With those tethers released, the entire composite flap moves as one piece, repositioned vertically to directly counteract gravity.
Skin gets redraped gently — no pulling, no excess tension. That’s the bit patients care most about. They don’t want to look “done.” And this is the mechanical reason they don’t have to.
The neck gets addressed in the same operation because the SMAS is continuous with the platysma. Depending on what’s needed, that might involve platysmaplasty, deep neck work, or liposuction.
Who’s Suited to This Type of Procedure?
Broadly, patients with moderate to advanced ageing across the midface, lower face, jawline, and neck. Where changes aren’t confined to one area but affect the whole lower two-thirds of the face. Traditional SMAS techniques on their own often can’t provide enough correction in these cases — especially in the midface.
Not everyone needs something this comprehensive. Earlier or more localised changes may respond well to a short scar facelift or ponytail facelift. Some patients benefit from adding blepharoplasty, brow lift, fat grafting, or lip lift. All of that gets sorted out during your consultation.
Modern Facelift Surgery in Bondi Junction, Sydney
At FacePlus Aesthetics in Bondi Junction, Dr Turner performs structural facelift surgery with a focus exclusively on the face. Patients from across Sydney’s Eastern Suburbs, the North Shore, Inner West, and interstate seek consultation for advanced High SMAS and deep plane techniques with retaining ligament release. All facelift surgery is performed in accredited private hospitals in Sydney with specialist anaesthetic care.
What Recovery Looks Like
Swelling peaks around days three to four. Bruising varies but settles over two to three weeks. Most people feel comfortable socially by week three or four, earlier with makeup and clever hair styling.
Because the structural work is deeper, final settling takes longer than you might expect. Three to six months for contours to fully refine. Scars sit in natural creases around the ears and within the hairline, fading over six to twelve months. There’s a more detailed timeline on our facelift recovery page.
Risks Worth Understanding
All surgery carries risk — facelift surgery included. Haematoma, infection, nerve injury (most often temporary), skin healing problems, asymmetry, unfavourable scarring. Your individual risk profile depends on your health, whether you smoke, and the extent of the procedure. Operating in an accredited hospital with a qualified anaesthetist and choosing a Specialist Plastic Surgeon (FRACS) are non-negotiable safeguards. See our risks and complications page for a full discussion.
