Surgeon one says a SMAS lift is all I need, surgeon two says only deep plane will last. Completely stuck

I'm 61, jowls and a soft neck, otherwise reasonable skin for my age. Two consultations done, both surgeons properly qualified, both lovely, both completely certain, and they've recommended DIFFERENT OPERATIONS.

Surgeon one: a SMAS lift with work on the neck muscle. Says for my face it gives an excellent result, shorter surgery, easier recovery, and that in his hands the difference from a deep plane at five years is smaller than the internet thinks.

Surgeon two: deep plane or nothing, says lifting the deeper layer as one piece is the only way my midface improves and the only version that will still be holding at year ten. Longer operation, several thousand more, and he was a bit sniffy about "conventional" lifts which I didn't love.

I've read everything on this site twice. I understand the anatomy as well as a non surgeon can. What I can't work out is whether I'm choosing between two operations or between two salesmen, and I've cancelled one deposit deadline already because I froze. How did anyone here actually decide?

I sat exactly where you're sitting two years ago, down to the sniffy second surgeon. I'll tell you what unstuck me: a nurse friend said "you're not buying an operation, you're hiring a person", and it reframed the whole thing.

I went back over both surgeons and ignored everything they said about technique. Looked only at their healed patients, women in their sixties, photographed at a year, not at six weeks. Asked each how many of MY operation they do a month. Asked what their revision policy was and watched how they reacted to the question. On technique they disagreed; on that audit, one of them was streets ahead.

Had my SMAS lift with him 22 months ago. My jowls have not returned, my neck is behaving, and I've stopped rereading the deep plane forums at midnight. Would the other operation have been 10% better? Possibly. I'll never know and it turns out I don't mind.

Other route here: I chose the deep plane, mostly because my main complaint was the midface, the flat cheek and heavy fold that showed in photos, and both my consultations agreed the deeper lift addresses that part more directly.

Honest ledger of what the extra money and hours bought me. Recovery was real: more swelling than I expected and a face that felt like a mask for a good month. But at fourteen months the cheek is where it should be and the result looks like me on a very good day, nothing tight anywhere. No regrets, AND I think Rosemary's point stands, because I'd have trusted my surgeon with either operation. The technique followed the surgeon, not the other way round.

annelise_k said:

the result looks like me on a very good day, nothing tight anywhere

Can I hijack slightly, because this sentence is the entire reason I'm still only lurking on consultation pages. Both my aunts had lifts in the 1990s and both spent the rest of their lives looking like they were facing into a gale. Family photos from every Christmas since are basically a warning leaflet. The jowls I can live with, looking PULLED I cannot. Is it really just luck of the draw?

Two questions in this thread, and they have connected answers.

Vivienne, your instinct that you may be choosing between salesmen is half right, but it is worth knowing that the disagreement itself is legitimate. SMAS and deep-plane lifts both work on the same deep layer; they differ in how far it is released and how it is moved, and thoughtful surgeons genuinely differ over where the extra dissection earns its cost for a given face. Your pattern, jowls and neck with reasonable skin, is precisely the territory where both opinions can be defended, which is why you have two. I have set out the honest comparison, including what the long-term evidence does and does not show, in SMAS versus deep-plane facelifts. The readers above have given you the practical tiebreak, and it is the right one: judge each surgeon's healed results at a year on faces like yours, ask how often they do the operation they are proposing, and ask each of them directly why the other's recommendation is wrong for you. The answers to that last question are usually very illuminating.

Cheryl, your aunts' era is the reassurance, not the warning. Those tight results came from pulling skin alone against its natural direction. When the deeper layer carries the lift, the skin is laid back without tension, and a face that looks operated on is regarded as a poor result by every surgeon worth consulting. It is not luck; it is technique and taste, and both are visible in advance in a surgeon's photographs.

What neither I nor anyone here can say is which operation your face needs, Vivienne. Both of your surgeons have examined you. Go back better armed rather than choosing under a deposit deadline; a date that cannot wait for your questions is answering one of them.

Reporting back, as promised to myself. I did the audit instead of the agonising: year-out photos from both, revision policies from both, and I asked each surgeon straight out why the other might have recommended differently. Surgeon one talked me through the reasoning on both sides for twenty minutes without a bad word about anyone. Surgeon two repeated his pitch. That settled it more than any anatomy diagram.

SMAS lift with surgeon one, booked for March. I'll come back and add my own honest ledger to the pile when I'm through the other side.