Deep Plane Facelift vs. High SMAS: Which Is Better for Asian Facelift?

Facelift surgery, also known as rhytidectomy, is a cosmetic surgical procedure designed to reverse the signs of facial aging, such as sagging skin, facial wrinkles, and loss of skin elasticity. The primary goal of a face lift procedure is to tighten sagging skin, jowls, nasolabial folds, facial muscles, and underlying tissues, restoring a more youthful and rejuvenated appearance. There are various face lifting procedures, including Dual Plane SMAS facelifts, Deep Plane facelifts, and Mini facelifts, each with its unique approach and benefits. Dr. Nk Park, a board-certified plastic surgeon in Korea, explains the most suitable facelift procedure for the Asian face

Why Are Asian Facelift Results Often Poorer Than in Caucasian Patients?

One key reason for varying face lift outcomes between Asian and Caucasian patients lies in facial anatomy. 

Wide Face

For an Asian patient, the face tends to be wider, requiring deeper and more medial dissection for effective rejuvenation. This makes achieving visible results more technically demanding.

Thick Skin

Additionally, the presence of thicker and heavier tissues in Asian patients necessitates careful support during surgery to achieve durable and natural-looking rejuvenation while minimizing scarring and downtime.

Facelifting Techniques Explained

Which face lift technique is superior? This question has fueled debate among plastic surgeons for decades, particularly when comparing SMAS methods. Some studies argue there’s minimal difference among techniques(Is there a difference? A prospective study), while others suggest otherwise. Less invasive methods are often highlighted as alternatives to traditional face lift surgeries, catering to diverse patient preferences. Meanwhile, long-term studies on identical twins using different face lift techniques show nuanced outcomes without a clear winner(Identical Twin Face Lifts with Differing Techniques). Yet, most experts agree: surgeon skill matters more than the technique itself. 

Here are popular face lifting methods preferred by Korean plastic surgery doctors today, including both less invasive and more invasive methods tailored to individual needs.

Lateral SMASectomy

• This method involves making an incision in only part of the SMAS layer and pulling it to secure it, rather than detaching the entire SMAS layer.
• Compared to traditional SMAS facelifts, it is relatively less invasive and requires less time, making it a procedure that even less experienced surgeons can attempt.
• Results vary depending on the surgical design, so achieving good outcomes requires extensive, long-term skill development.

Extended SMAS / High SMAS

• The method primarily performed at Noonopi Plastic Surgery requires time-consuming and skillful dissection of both the Skin and SMAS layer “separately”.
• Considering the width and structure of Asian faces, dissection of the cheekbone to mid-face area must be performed more extensively than in Westerners to achieve visible changes.
• Because the skin and SMAS are dissected separately, a major advantage is the ability to adjust the direction of tension.

Composite or Deep Plane  Facelift

• This procedure involves dissecting the SMAS and skin as a single layer as you move deeper.
• It reduces operating time and minimizes concerns about postoperative complications.
• Dr. Hamra first coined the term ‘composite facelift,’ though Jacono later adopted the term ‘extended deep plane face lift’, which includes various marketing. 

Is Composite Facelift the Ideal Solution for Asians?

Some surgeons like Dr. Chin-Ho Wong and Dr. Taek Keun Kwon argue that the composite face lift is particularly well-suited to Asian facial structure. In fact, it seems like growing numbers of Korean plastic surgeons at Gangnam are adopting this approach. 

My Perspective: The Surgeon's Skill Matters More Than the Surgical Technique

Personally, I prefer the dual plane High SMAS approach over the deep plane technique for facelifts.

• The dual-plane method produces more natural-looking results because the SMAS and the skin can be pulled in different directions.
• The results of a facelift depend on the patient's own skeletal type rather than the technique itself.

However, before insisting on a specific method, it is more important to consider the doctor's skill and aesthetic sense.

Characteristics of a Failed Facelift: Pulled Ear Appearance

• Regardless of the method used, an attached earlobe deformity is one factor that diminishes the results of facelift and is often seen in before-and-after photos.
• At Noonopi, we consider the development of attached earlobes post-operatively to be a surgical failure.
• Some surgeons take photos with earrings to hide this in postoperative pictures.
• Looking at celebrities or public figures who have had facelifts, it's common to see cases where they accept the risk of pinched ears to achieve a better frontal appearance by pulling the skin excessively tight. However, the surgical approach for ordinary people, who cannot conceal such results with makeup or accessories, should differ from the methods used for celebrities.

What the World’s Best Facelift Surgeons Say About non-Caucasian Facelifts

Dr. Bruce Connell—often called the Michelangelo of facial rejuvenation surgery—was a master of dual-plane SMAS facelift rather than composite lifts.

However, East Asian case studies are underrepresented in early Western literature, necessitating the adaptation of these techniques in Korean surgical practices. In particular, Asian face lifts focus on nasolabial folds, and specific techniques have been developed to enhance their appearance.

Fat grafting is commonly used to enhance facial aesthetics during or after a facelift, adding volume to areas such as the nasolabial folds and cheeks to achieve more natural-looking results and improve long-term outcomes.

How Noonopi Approaches the Asian Patients

Dual-Plane High SMAS

We combine precise skin and SMAS dissection with tension-free closure for natural and youthful results. Additionally, the technique involves carefully designed and marked skin incisions to ensure effective access to deep anatomical planes, particularly in facial and neck areas, which is crucial for safety and optimal outcomes. These incisions are strategically placed to make any resulting scars nearly invisible after the recovery period.

Hyperbaric Oxygen Therapy for Recovery

Because High SMAS face lifts require more delicate dissection, we support healing with HBOT (Hyperbaric Oxygen Therapy). Our premium, single-patient chamber enhances skin flap survival and accelerates facelift recovery for optimal outcomes.