Picture two consultation summaries side by side. One surgeon recommends a SMAS facelift. The other recommends a deep plane facelift. Both promise to address the jowls and the softened jawline, and the fees and recovery notes differ.
The gap between those recommendations comes down to depth, meaning which layer of the face the surgeon plans to move. A Houston practice’s guide to the deep plane technique, together with its general facelift guidance, lays out those layers in enough detail to help a patient compare the two plans.
The practice is led by Leo Lapuerta, MD, FACS, a triple board-certified plastic surgeon with more than 30 years of experience. This guide tracks its descriptions layer by layer, from the surface down.
Layer one: the skin
A facelift ends with the removal of excess skin. The practice’s position is that the skin should not do the lifting. Once internal support is restored, the remaining skin is redraped and the excess trimmed so it sits over better support, and the point, as the practice puts it, is not to pull hard.
The practice links lifting by skin tension to a windblown or surface-pulled look. Both the SMAS and deep plane approaches exist to move the work below this layer.
Layer two: the SMAS
The SMAS, short for superficial musculoaponeurotic system, is a layer of fibrous tissue and muscle beneath the skin that supports the face. A SMAS facelift tightens and repositions this layer rather than the skin alone.
The practice credits that approach with more natural facial contours and a lower risk of a surface-pulled appearance, and it notes that the SMAS layer is often central when surgeons talk about durable support. It describes the SMAS facelift as suited to moderate laxity that needs deeper support than skin-only lifting can give.
The practice also names its limit: a SMAS facelift may not mobilize as much tissue as a deep plane lift.
Layer three: beneath the SMAS
A deep plane facelift releases tissue below the SMAS and repositions the deeper structures as a unit. The practice lists descended fat pads, lower-face tissue and deeper support structures among what moves back into position.
That reach suits a specific pattern of aging. The practice lists heavier jowls, midface descent and deeper folds as the best fit for the deep plane approach. Its limit is the flip side of that reach: more involved surgery and a more involved recovery.
The practice’s deep plane timeline shows swelling and bruising affecting appearance through the first one to two weeks, better definition in weeks 3 to 6, a more stable result by months 2 to 3 and ongoing softening and scar maturation from six months on. Every facelift, at any depth, carries surgical risks.
Reading two different recommendations
The practice states that a deep plane facelift is not better by default than a SMAS facelift. For some patients the SMAS lift is enough, and the deeper operation comes into consideration when laxity and descent are more advanced. Two surgeons can look at the same face and reach different readings of its descent, which is how two honest recommendations end up one layer apart.
Fees can differ for the same reason. The practice says facelift pricing reflects surgical complexity, anesthesia, the facility and whether a neck lift or other procedures are part of the plan. A deeper, longer operation and a combined neck lift both change that equation.
These questions help line the two plans up:
- Ask each surgeon to name the layer they will work in and the features of your face that led them there.
- Confirm whether the plan includes a neck lift, eyelid surgery or fat transfer.
- Ask whether a lighter lift would undercorrect your jowls and folds, or a deeper one would exceed what you need.
- Find out the surgical setting and the credentials of the person giving anesthesia.
- Request a count of this specific technique performed, and the years behind that count.
Dr. Lapuerta’s own answers on setting and experience are on record. He owns and operates a QuadA (AAAASF) accredited surgical facility, works only with physician anesthesiologists and has performed more than 30,000 surgical and non-surgical procedures. In his view, experience with a procedure in both cases and years, together with board certification, is the best determinant of an outcome patients judge as good.
His practice keeps more than 3,000 before-and-after images on file. If two quotes differ by a layer, asking each surgeon for results from the technique they recommended, on faces with heaviness like yours, gives you a direct way to compare.
This article is for general information only and is not medical advice. Results vary from patient to patient. Consult a board-certified plastic surgeon or your physician about your own situation. Written in partnership with Joseph Lambert, a publicist working with Leo Lapuerta, MD Plastic Surgery.
