The deep plane facelift.

Why I work beneath the surface

A face ages in layers. Skin is only the outermost of them. Beneath it sits the SMAS, the fibrous and muscular layer that ties the skin to the muscles of expression, and beneath that are the retaining ligaments that anchor soft tissue to bone. Over time those ligaments stretch, the fat compartments of the cheek deflate and slide, and the result is jowling, a deeper fold from nose to mouth, and a neck that has lost its line.

Tightening skin does not answer any of that. The skin simply becomes the thing holding everything up, and it was never built for the job. That is where the pulled, windswept look comes from. The deep plane facelift is my primary technique for facial rejuvenation because it works at the level where the problem actually is.

What happens in the operation

The incisions run in front of and behind the ear and into the hairline. From there I work beneath the SMAS and release the zygomatic, masseteric, and mandibular ligaments, the attachments that tether descended tissue in its new, lower position. Once they are released, the skin, fat, and SMAS move together as one composite unit, and I reposition that unit upward and back toward the cheek, the direction it originally travelled. The skin is then trimmed and closed without having to carry the tension. The operation is done under general anesthesia and generally takes three to five hours.

This is demanding work in anatomy that deserves respect, and I think the more useful question for a patient is rarely which technique, but who performs it and how often. The practice’s page on the deep plane facelift in Newport Beach covers the technique, candidacy, and recovery in more detail.

Not one operation, four

I perform four variations. The standard deep plane treats the midface, jowl, and upper neck together. The extended version adds a platysma release for a neck with more advanced laxity or banding. A preservation approach keeps more of the native ligament attachments and suits people with strong tissue and earlier change. A mini deep plane uses a more limited dissection for aging that is still confined to the lower face and jawline. Choosing among them is a matter of examination, not preference.

Who it is for, and who it is not

Most of the people who benefit are between forty-five and seventy, with real jowling or midface descent, in good general health, at a stable weight, and either non-smokers or willing to stop for at least four weeks on each side of surgery. If the laxity is mild, a less invasive option may serve better, and I will tell you so. Some faces are best treated with a facelift alone; others are better served alongside eyelid surgery, a brow lift, a neck lift, or fat transfer.

I also perform revision facelifts for people whose earlier lift has relaxed, was under- or over-corrected, or healed unevenly. Scar tissue distorts the normal planes, so there is no template for a secondary operation. Each one is planned around the anatomy in front of me and what was done before.

Recovery and what to expect

The first days are for rest with the head elevated. Discomfort is usually described as tightness and pressure more than pain, and most of it passes within the first week. If drains are used they come out at the first visit, around day five to seven, and most sutures are out by the second week. People tend to return to work and social life at three to four weeks. The final contour continues to refine for six to twelve months.

The risks I go through with everyone include bleeding under the skin, temporary weakness of a facial nerve branch, asymmetry, hair loss near the incisions, and, rarely, infection. Results typically last ten to fifteen years; you keep aging, at a normal pace, from a new baseline.

The best compliment a facelift can receive is that nobody mentions it. If surgery is not the right step for you yet, I would rather say that at the first meeting.

Deep plane  ·  Extended  ·  Preservation  ·  Mini  ·  Revision