总有患者咨询“骨膜下除皱”和“小切口深平面除皱”（ Deep Plane SMAS Lift）的区别。
总结一下:骨膜下除皱创伤较大，恢复期较长，对面神经的损伤风险更大，并不适合大多数人。

Periosteal Facelift vs SMAS Facelift — Which Is Better?

⭐ Short answer:

Periosteal facelift is not universally better than SMAS.
It is deeper, more aggressive, gives longer-lasting lifting, but also has more swelling, longer recovery, higher risk, and is not necessary for most patients.

SMAS facelift is safer, proven for decades, more commonly performed, and usually gives natural, reliable results with less downtime.

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What is a Periosteal Facelift?

A periosteal facelift lifts tissues all the way down to the bone (periosteum), then re-suspends the facial structures higher.

Pros
• Very strong vertical lift
• Long-lasting (because it’s anchored to bone)
• Can significantly elevate:
• midface
• deep nasolabial folds
• cheeks that have fallen
• Often used in younger patients with congenital flat midface or older patients with severe midface descent

Cons
• Much more invasive
• Longer swelling (sometimes 4–8 weeks)
• Risk to nerves is higher
• Can look overpulled if not done by an expert
• Not many surgeons are trained in this technique

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What is a SMAS Facelift?

The SMAS layer is the fibrous layer above the muscles.
Most facelifts today are SMAS, deep-plane, or extended SMAS.

Pros
• Very natural results
• Lower risk to nerves and blood supply
• Faster recovery compared to periosteal
• Works extremely well for:
• jawline
• jowls
• neck laxity

Cons
• Midface lift is moderate, not as dramatic as periosteal
• Results still long-lasting but not as “anchored” as periosteal

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So which is better?

Based on modern aesthetic surgery consensus:

✔ If your main issue is midface flattening or deep nasolabial folds → Periosteal facelift can be stronger.

✔ If your issues are jowls, jawline, and neck → SMAS or deep-plane facelift is usually better and safer.

✔ If you want faster recovery and lower risk → SMAS is better.

✔ If you want the strongest possible vertical vector lift and accept longer downtime → Periosteal can be considered.

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Who is an ideal candidate for periosteal lift?
• Thick skin
• Strong facial bones
• Significant midface ptosis
• Want maximum lift and don’t mind 4–8 weeks recovery
• Someone in their 40s–50s with “fallen cheeks”
• Revision facelift cases needing stronger fixation

Not ideal for:
Thin skin, smokers, older than 65, people who bruise easily, or those wanting subtle/natural results.

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My honest recommendation for most patients

Most people get the best risk–benefit ratio from:

Deep-plane SMAS facelift

This lifts:
• cheeks
• jawline
• jowls
• neck
in one continuous layer, very naturally, with lower risk than periosteal.

Periosteal facelift is more niche and should only be done by surgeons with very strong anatomical experience.