In the 1980's and 1990's plastic surgeons started performing deep plane or sub-SMAS facelifts that elevated the deep tissue connective tissue plane under the skin. "SMAS" is an acronym for superficial musculoanoneurotic system. It is a wordy term that describes the connective tissue layer under the skin that is continuous with the frontalis muscle in the forehead and the platysma muscle in the neck. Sometimes it is called the "muscle layer," although it is made up of inelastic connective tissue in the face. In deep-plane facelifts, the tension is applied to this deeper tissue, which is relatively strong and inelastic. This avoids tension on the skin. The skin comes up with this deeper layer and the fat layer is sandwiched in between.

The subperiosteal facelift was introduced in the 1990's. Often these lifts were performed using an endoscope and referred to as "minimally invasive," another catchphrase. However the plane of dissection, just over the bone, did not make sense anatomically. There was not enough movement of the more superficial facial tissues. Not surprisingly, this technique did not become popular. Suture-suspension techniques were tried and found to be ineffective- there was too much distance between the fixation point and the tissue being elevated.