When patients ask why the deep plane facelift is often described as a structural lift, the answer sits below the skin. Deep plane facelift anatomy is built around layers that age in predictable ways, and once you understand those layers, the differences between facelift techniques start to make sense. The deep plane technique works underneath the SMAS, releases the ligaments that hold descended tissue down, and respects the deep fat pads that give the face its forward projection. In other words, the lift happens where the ageing happens.
This article walks through the layers, ligaments, and fat compartments that matter and explains how a deep plane approach treats each. It is written for patients who want to understand the why, not just the what.
The Five Anatomical Layers of the Face
The face is built in five layers, and they sit in roughly the same order from cheek to forehead, despite changes in thickness from one region to the next. Most modern facelift techniques are described in terms of how each layer is treated.
Layer 1: Skin
The skin is the outermost layer. With age, the dermis becomes thinner, the body produces less collagen, and the skin loses a degree of its elasticity. Sun exposure over the years tends to speed this up. Sagging skin is often the first thing people spot in the mirror, even though the skin itself is usually among the last layers to move. This is worth understanding, because pulling the skin alone often gives a tight, drawn look instead of a natural lift.
Layer 2: Subcutaneous fat
Below the skin sits a continuous layer of fat between the skin and the SMAS. Its thickness changes from one part of the face to another, and it gives the cheeks and jawline much of their softness. Most superficial facelift dissection runs through this layer.
Layer 3: The SMAS (Superficial Musculoaponeurotic System)
The SMAS is a fibromuscular layer. It connects the muscles of facial expression to the overlying skin, forming a sheet of fibrous tissue that runs through the face, carrying muscle fibres and lending it much of its structural strength. Further down, this same layer continues into the neck, where it becomes the platysma muscle. Because of that, the anatomy of a facelift and a neck lift overlap closely.
Layer 4: The mimetic muscles and deep fat pads
Beneath the SMAS sit the mimetic muscles, which are the muscles we use to make facial expressions, and the deep fat compartments. These structures move the face and help push the cheek forward. The facial nerve branches also travel through this layer or just below it, so any work in this plane depends on a careful, detailed understanding of the anatomy.
Layer 5: Periosteum and bone
Deepest of all is the bony skeleton, which is covered by periosteum. The retaining ligaments attach to this periosteum and hold the soft tissues to fixed points. Bone does change with age, though the process is slow, so most of what you notice is how the soft tissue drapes over the bone rather than any change in the bone itself.
What is the SMAS, and why is it Central to Modern Facelift Surgery?
The SMAS, or Superficial Musculoaponeurotic System, was first described in the surgical literature in the 1970s and changed the way facelifts were planned. Before then, most facelifts addressed only the skin. Once surgeons recognised that the SMAS was a continuous structural layer carrying the weight of the face, the focus shifted to treating it directly.
How the SMAS changes with age
The SMAS thins, loosens and descends over time, much like the skin above it. As it descends, the cheek tissue carried by the SMAS slides downward and forward, contributing to jowling along the jawline and to deepening of the nasolabial fold. Because the SMAS is connected to the platysma in the neck, descent in the face is often mirrored by laxity in the neck.
SMAS plication vs SMAS imbrication vs sub-SMAS dissection
Different facelift techniques approach the SMAS in different ways. In SMAS plication, the SMAS is folded on itself and stitched. In imbrication, a strip is removed, and the remaining edges are sutured. In sub-SMAS dissection, the surgeon works underneath the SMAS to mobilise the deeper composite of tissues. The deep plane facelift is a form of sub-SMAS dissection that goes a step further by releasing the retaining ligaments that tether the deeper tissues. For a longer discussion of how these approaches compare in practice, the existing article on SMAS facelift vs deep plane facelift covers the differences in more detail.
The Facial Retaining Ligaments: The True Anchors of Ageing
The retaining ligaments are short, fibrous bands that anchor the skin and superficial fascia to the underlying bone or deep fascia. They were mapped in detail by Bryan Mendelson and colleagues, and their anatomy is now standard reference material for facial surgeons. Ligaments do not stretch significantly with age. What changes is the soft tissue around them. As tissue descends, it folds and bunches at the ligament points, which is why the visible signs of ageing tend to appear in predictable locations.
Releasing these ligaments is what allows the deep plane facelift to reposition tissue without relying on skin tension. Skin pulling produces visible scars and a tight, operated appearance. Ligament release allows the deeper layers to move as one unit, and the skin is then redraped without load.
Zygomatic (McGregor’s) ligament
Often called McGregor’s patch, the zygomatic ligament anchors soft tissue to the zygomatic arch in the upper cheek. With age, tissue gathers above and below this point. Release of the zygomatic ligament is part of what allows the mid-face to be lifted in a deep plane technique.
Masseteric cutaneous ligaments
Running in a vertical line, these ligaments hold the cheek skin onto the masseter muscle beneath it. They help create the line you can see between the firmer cheek and the looser lower face. When tissue slips down past them, that is what starts to form the early jowl.
Mandibular ligament
The mandibular ligament anchors soft tissue to the jawline near the chin. Tissue descending around it produces the marionette line and the appearance of jowling near the chin. This ligament is typically addressed during the lower portion of a deep plane dissection.
Cervical retaining ligaments
Down in the neck, the cervical retaining ligaments hold the platysma and the overlying tissue in place. The peer-reviewed literature on platysma suspension in deep plane surgery explains what it involves and why a deep plane facelift can improve the neck, not just the face.
The Deep Fat Pads: Volume Loss as a Driver of Ageing
We tend to talk about ageing as sagging, but losing volume counts every bit as much. The deep fat of the face is not one smooth cushion. It comes in separate pads, each with its own edges, and they empty out at their own pace. Once a pad deflates, the tissue resting on top of it has less to lean on, so some of the sagging we see is really the result of that missing support underneath.
Malar fat pad (mid-cheek)
The malar fat pad sits over the cheekbone and gives the mid-face its forward projection. As it descends and partially deflates, the cheek looks flatter, and the nasolabial fold deepens. Repositioning the malar fat pad, rather than simply adding volume to it, is one of the goals of a deep plane lift.
Buccal fat pad
The buccal fat pad sits deeper, in the lower cheek. It changes shape with age and can contribute to a heavier lower face in some patients. It is rarely the primary target of a facelift, but it is part of the anatomical picture.
Sub-orbicularis oculi fat (SOOF)
The SOOF is a deep fat compartment beneath the orbicularis oculi muscle around the eye. Loss of SOOF volume contributes to a hollowed appearance of the lower eyelid and the upper cheek junction. Repositioning the SOOF can soften the transition between the lid and the cheek.
Deep medial cheek fat
This is the deepest of the cheek fat compartments, sitting close to the bone. It is often the first compartment to deflate, and its loss contributes to the appearance of a tear-trough deformity and a flattened mid-face. Restoring projection in this area is a key part of mid-facial rejuvenation.
How the Deep Plane Facelift Works on These Structures
With the anatomy in view, the deep plane technique becomes easier to describe. The dissection plane sits underneath the SMAS, above the mimetic muscles. The skin and SMAS are lifted together as a single composite unit, rather than being separated.
Where the dissection plane sits
Operating in the sub-SMAS plane keeps the surgeon above the facial nerve branches and above the deep fat compartments, while staying under the structural layer that actually needs repositioning. It is a real, defined space within the face, and a surgeon trained in the technique works through it with care.
Why composite tissue movement gives a more natural appearance
Because the skin and SMAS move together, the relationship between them is preserved. The skin is not stretched independently of the deeper layer, which is part of why deep plane results tend to look like the patient rather than like a lifted version of someone else. The vectors of movement also matter, which is where the next point comes in.
The vertical lift vector and why it matters
Older facelift techniques often pulled tissue backwards, towards the ear. The deep plane technique typically uses a more vertical vector, repositioning tissue upwards along the line of natural descent. A vertical lift restores cheek projection without producing the swept-back look that earlier techniques sometimes produced. For a longer discussion of how the deep plane compares with a traditional facelift, the article on whether a deep plane facelift is better than a regular face lift is a useful next read.
Surgical Risk Considerations Tied to This Anatomy
The deeper you go, the more anatomical knowledge the work requires. In experienced, well-trained hands, the deep plane technique is not considered riskier, though it leaves less room for imprecise dissection. The published surgical literature, including the StatPearls reference on deep plane rhytidectomy and the technical work by Hamra and Iacono, outlines the anatomical landmarks that guide the approach.
The facial nerve branches and surgical danger zones
The branches of the facial nerve travel in defined corridors close to the deep plane dissection. The frontal branch, the zygomatic branch and the marginal mandibular branch each have known danger zones where they sit closer to the surface. Surgeons trained in the deep plane technique work with these anatomical maps in mind. Temporary weakness can occur if a nerve is stretched during dissection, and it almost always recovers. Permanent injury is uncommon when the technique is performed by an experienced surgeon.
Why surgeon training and experience are particularly important in deep plane surgery
It calls for familiarity with sub-SMAS anatomy, ligament release, fat pad behaviour, and nerve protection, all within a single operation. That is why surgeon selection matters, and why the deep plane facelift is generally undertaken by a surgeon who performs facelift surgery regularly and holds formal plastic surgery qualifications. The durability of deep plane results also rests on this technical foundation.
What This Anatomy Means for Your Consultation
A useful facelift consultation does not look only at skin. The anatomy described above informs every part of the assessment, and it shapes which technique is likely to suit which patient.
Why a facial assessment looks at more than just skin
Loose skin is the obvious sign, but it really just reflects what is going on below the surface. When a surgeon looks at your face, they are weighing up where the malar fat pad sits, how deep the nasolabial fold runs, the line of the jaw, how toned the platysma is in the neck, and how far the mid-face has dropped. Two people with the same amount of loose skin can have quite different anatomy underneath.
How Dr Hunt evaluates which anatomical layers are driving your concerns
In consultation, Dr Hunt walks through the layers in person, often using a mirror, to identify which structures are contributing to the changes you have noticed. For some patients, the dominant issue is volume loss in the deep medial cheek; for others, it is descent through the SMAS and ligament zone; for many, it is a combination. Understanding which layers are driving the appearance allows the surgical plan to be matched to the anatomy, rather than the other way around. Some patients with milder concerns are better served by a SMAS facelift, a mini facelift, or non-surgical options.
Why Choose Dr Hunt for Deep Plane Facelift in Sydney
Deep plane facelift surgery rests on a foundation of facial anatomy, surgical planning and experience. Each face is shaped by its own history of ageing, volume loss and tissue change, which is why a structured pre-operative consultation matters as much as the operation itself. Dr Jeremy Hunt approaches every facelift assessment with that anatomical detail in mind, mapping the layers and ligaments contributing to your concerns before any surgical plan is discussed.
Dr Jeremy Hunt is a Specialist Plastic Surgeon (FRACS) with more than two decades of experience in aesthetic and reconstructive plastic surgery. He is a Fellow of the Royal Australasian College of Surgeons in Plastic Surgery, with his profile listed on the RACS register (https://www.surgeons.org/Profile/jeremy-hunt-144103). He is a member of the Australian Society of Plastic Surgeons, verifiable at https://plasticsurgery.org.au/doctor/mr-jeremy-hunt/, and a member of the Australasian Society of Aesthetic Plastic Surgeons, verifiable at https://aestheticplasticsurgeons.org.au/surgeon/Jeremy-Hunt/.
Frequently Asked Questions
What is the SMAS in a facelift?
The SMAS is the Superficial Musculoaponeurotic System, a fibromuscular layer that sits beneath the skin and subcutaneous fat. It connects the muscles of facial expression to the overlying skin and is the structural layer that modern facelift techniques work on or beneath. SMAS plication folds the layer on itself; deep plane technique works underneath it and releases the retaining ligaments that anchor the tissues.
What are the facial retaining ligaments?
Facial retaining ligaments are short, fibrous bands that anchor the skin and superficial fascia to the underlying bone or deep fascia. The main groups are the zygomatic, masseteric, mandibular and cervical ligaments. They do not stretch with age. Instead, the soft tissues sag around these fixed anchor points, which is why the visible signs of ageing tend to appear in predictable locations on the face.
Why does the deep plane facelift release the ligaments?
Releasing the retaining ligaments allows the deeper layers of the face to move freely as a single composite unit. Without release, the surgeon has to rely on skin tension to create the lift, which can produce a tight, pulled appearance. With release, the deeper tissues are repositioned first, and the skin is redraped without load. This is also why lower closure tension is associated with finer scars.
Is the deep plane facelift more invasive because it goes deeper?
The dissection is more extensive, yes. Deeper does not automatically mean more risky when the technique is performed by a surgeon experienced in deep plane anatomy, but it does mean a longer operation and a more complex surgical plan. Recovery can involve slightly more swelling in the first weeks. Individual results vary, and suitability is assessed during a consultation that considers your anatomy and your general health.
Does every patient need a deep plane facelift?
No. The deep plane facelift is generally considered for patients with mid-face descent, deeper nasolabial folds and jowling. Patients with milder skin laxity may be candidates for a SMAS facelift, a mini facelift or non-surgical options. The right approach is determined during consultation, based on your facial anatomy, your goals, your general health and what is realistic to achieve through surgery.
Disclaimer: This blog is general in nature and does not constitute medical advice. All surgical and invasive procedures carry risks. Before proceeding with any procedure, you should seek a second opinion from an appropriately qualified health practitioner. Individual results vary depending on anatomy, technique and how the body heals after surgery. AHPRA registration: MED0001151603.
Further Reading
- SMAS facelift vs deep plane facelift: which is right for you: https://www.drjeremyhunt.com.au/blogs/smas-facelift-vs-deep-plane-facelift-which-is-right-for-you/
- Who is a candidate for the deep plane facelift in Sydney: https://www.drjeremyhunt.com.au/blogs/who-is-a-candidate-for-the-deep-plane-facelift-in-sydney/
- The longevity of deep plane face lift: https://www.drjeremyhunt.com.au/blogs/the-longevity-of-deep-plane-face-lift/
- Considering face lift surgery: ten things to know: https://www.drjeremyhunt.com.au/blogs/considering-face-lift-surgery-ten-things-to-know/
Medical References
- Deep Plane Rhytidectomy, StatPearls, National Library of Medicine: https://www.ncbi.nlm.nih.gov/books/NBK545277/
- Complete Platysma Muscle Suspension in Deep-Plane Face-Lift Surgery, PMC: https://pmc.ncbi.nlm.nih.gov/articles/PMC11932438/
- Cosmetic surgery information, HealthDirect Australia: https://www.healthdirect.gov.au/cosmetic-surgery
- Cosmetic surgery hub, Therapeutic Goods Administration (TGA): https://www.tga.gov.au/cosmetic-surgery-hub
- AHPRA cosmetic surgery guidelines: https://www.ahpra.gov.au/Resources/Cosmetic-surgery-hub.aspx
- Facelift overview, Cleveland Clinic: https://my.clevelandclinic.org/health/treatments/8868-facelift-rhytidectomy