21 Sep 2023 | by Leonard Miller, MD, FACS, FRCS

As we age, subtle changes begin to appear. A loss of elasticity, facial volume, and firmness changes the contours of the face, and wrinkles, creases, and excess skin occur. While traditional facelift surgery offers significant benefits, the concern of taunt, pulled skin is a top concern. The deep plane facelift adjusts muscles and tissue to add internal alterations without stretching the outer layer of the skin. 

You are not alone if you are unhappy with changes as you age but are wary of subjecting yourself to a deep plane facelift. But there is another option. The natural facelift at Boston Center for Plastic Surgery combines plastic surgery and dermatology to provide more natural facelift results with reduced downtime.  

What is the difference between a natural facelift procedure and a deep plane facelift? We will compare a deep plane facelift and the natural facelift results here.

The natural facelift at Boston Center for Plastic Surgery combines plastic surgery and dermatology to provide more natural facelift results

Review Popular Facelift Options

Deep Plane Facelift 

The deep plane facelift helps reposition the face’s sagging tissue, including muscle and fat, especially the cheek area. The deep plane facelift procedure exerts less tension on the skin than the traditional SMAS facelift. It alleviates the pulled appearance, especially in areas of the face with many deep wrinkles. 

The results from a deep plane facelift may last longer when compared to traditional facelifts. Because the deep plane procedure involves more complex dissection, there is a risk of injury to motor nerves that may cause muscle weakness and asymmetry. Possible prolonged swelling may be a negative feature that occurs with deep dissection. 

The deep plane facelift lifts the internal layers of the face instead of pulling the skin. Still, Dr. Miller finds that the deep plane facelift can produce a more altered look compared to a patient’s natural appearance due to the over-alteration of the shape of the upper face rather than pulling. 

Traditional SMAS Facelift

The SMAS facelift raises only the SMAS tissue and skin top layer and is less invasive than the deep plane facelift, which elevates the skin, muscles, and SMAS together as one unit. The SMAS technique requires an incision behind each ear that extends from ear to ear, hidden in the hairline. 

When an effective SMAS facelift is performed, the final results elevate and tighten the lower face, jawline, and neck muscle. Incorporating fat injections during the SMAS facelift adds fullness and elevates the cheeks without surgically elevating the deep cheek tissue. A careful directional pull on the skin can prevent an unwanted, tightly-pulled appearance.

The advantages of a subcutaneous lift with SMAS tightening include the following:

  • Tightening sagging skin.
  • Smoothing smile lines.
  • Recontouring the jawline.
  • Lifting jowls.
  • Creating a more youthful appearance.

The SMAS facelift is the most frequently performed procedure today and forms the basis of Dr. Miller’s natural surgical facelift. 

Natural Facelift

Board-certified plastic surgeon Dr. Leonard Miller has developed the natural facelift technique. The natural surgical facelift restores a more youthful appearance without creating a stretched or pulled appearance on the upper part of the face or around the mouth like traditional facelifts.   

Dr. Miller’s natural facelift is safer, better tolerated, and less expensive than the SMAS and deep plane facelift. Patients also prefer the natural facelift because it involves a rapid recovery with minimal incisions.

View more Natural Surgical Facelift before and after pictures

Natural Facelift Benefits Compared to the Deep Plane Lift

Dr. Miller incorporates innovative techniques that are tried and true and have been used for many years during facelift surgery to tighten and sculpt the face, jawline, and neck. But, he has enhanced these techniques and created the natural surgical facelift to ensure that his patient’s results look realistic rather than overly taut or tight.


The natural surgical facelift uses inconspicuously-placed incisions for a more lifted, youthful appearance compared to the deep plane facelift that requires larger incisions behind the ears and in the hairline.

Preserves each patient’s natural appearance

The natural, surgical facelift preserves the natural shape of the face. The deep plane facelift involves lifting the skin, supportive tissue, and muscles together as one unit, reducing the traditional facelift’s stretched appearance. Still, the deep plane technique can alter the shape of the face.

Reduced recovery and downtime

Each natural facelift procedure is customized to match the patient, and Dr. Miller will explain the expected recovery time. The natural facelift recovery is much shorter and less involved than the deep plane facelift recovery. Most patients return to work, school, and regular activities in less than one week and must avoid strenuous activities and heavy lifting for 2 to 4 weeks.

The deep plane facelift recovery is typically more involved. Patients must refrain from work for two weeks and avoid strenuous activities for six weeks.

Deep Plane Facelift Procedure Compared to the Natural Facelift in Boston, MA

Deep Plane Facelift Procedure

The deep plane facelift typically takes 3 to 6 hours to perform. The incisions are placed at the temple, follow the crease behind the ear, and enter the hairline. The surgeon lifts the SMAS layer, skin, and deeper muscles and tissue. Permanent stitches are added within the inner layers to secure the lifted cheeks, jowls, and upper neck tissues. A hospital stay is not usually needed, and most patients return home after the surgery. 

Natural Facelift Procedure

The natural facelift surgery created by Dr. Miller gently sculpts and lifts the face, jawline, and neck. He places several discreetly placed, fine incisions. Depending on the correction level and the individual patient’s goals, most natural facelift procedures take 2 to 3 hours. 

Patients experience a more lifted and youthful appearance with the natural facelift without any visible signs of plastic surgery or a taut or pulled appearance. Sometimes, the doctor recommends combining Botox, fat injections, or dermal fillers for dramatic results. 

The neck may also be improved during the natural facelift using a small incision under the chin, by tightening the muscles. In addition, liposuction could be performed without incisions to enhance the neck and jowls. The natural facelift is an outpatient surgery, and the patient returns home to recover.

See more patients »

Learn More About the Natural Facelift

The natural facelift preserves each patient’s facial characteristics and shape while noticeably reducing signs of aging. Call (617) 735-8735 or visit us online to request a natural facelift consultation with Dr. Leonard Miller, MD, FACS, FRCS, at the Boston Center for Plastic Surgery in Boston, MA.

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