Deep plane facelifts carry a significantly higher risk of facial nerve injury compared to SMAS facelifts.
"The reason why I don't do a deep plane is because it does have a very high learning curve, and there's a risk of nerve injury with that that you don't get nearly with the SMAS facelift." (said at 0:17:30)
Published meta-analyses directly comparing deep plane and superficial musculoaponeurotic system (SMAS) facelift techniques demonstrate comparable safety profiles, with no statistically significant increase in the risk of facial nerve injury for deep plane procedures. In a systematic review and meta-analysis of 47 studies (10,766 patients), nerve injury rates did not differ significantly between deep plane and SMAS approaches; most injuries were temporary and resolved spontaneously, while permanent facial nerve damage was exceedingly rare across both methods. Similarly, a meta-analysis of 183 surgical studies showed that the risk of permanent facial nerve injury does not differ significantly across various facelift techniques.
- contradicts: A Meta-Analysis of Complication Rates Among Different SMAS Facelift Techniques. (Aesthetic surgery journal 2019)
"Risk of permanent injury did not differ among techniques." (abstract, results, passage verified)
pubmedfull study (doi) - contradicts: Comparing the Safety and Efficacy of Superficial Musculoaponeurotic System and Deep Plane … (Annals of plastic surgery 2025)
"Nerve injury rates were similar between groups; most reported nerve injuries were temporary and resolved over time, while permanent nerve injury was rare... Both SMAS and deep techniques demonstrate comparable safety profiles, although limited comparative data and heterogeneous outcome measures preclude definitive conclusions about relative efficacy." (abstract, results and conclusions)
pubmedfull study (doi)