Many patients coming to see their plastic surgeons are inquiring as to whether or not they do a deep plane facelift. The term has received a lot of media attention and is often mentioned in Real Self forums and other online patient resources. Many plastic surgeons include this as part of their marketing programs. Let us look at the factors that are important in achieving an excellent facelift result and demystify the concept of the deep plane facelift

Facial aging has many components. There are four main anatomic causes which result in an aged facial appearance. These include the skin, the subcutaneous fat, the muscles, and the bones of the facial skeleton. The aging process in the skin is usually related to photodamage from the sun and other environmental factors. As we age the subcutaneous fat tends to succumb to the forces of gravity and drift from the central portion of the face to the lower portion of the face. The muscles of the face also lose some of their youthful contractility and will tend to sag as well. When patients reach the seventh or eighth decade of life the bony skeleton will begin to resorb.

A facelift can correct the position of the skin, the position of the fat, and the changes that occur in the facial muscles. The earliest facelifts were mostly skin tightening procedures, which did provide good results but there were obvious signs that the patient had a facelift. By just correcting the skin oftentimes patients will have a tight skin envelope overlying sagging fat and muscle which can produce an obvious operative look. In the 1970s, a layer of fascia was identified that was located above the facial muscles. It was called the superficial musculoaponeurotic system, usually referred to as the SMAS. Surgeons began limited dissection of the SMAS in order to elevate and reposition the muscles and the fat of the face. This was a significant improvement in her face lifting technique.

With time, the elevation of SMAS became more extensive. We found that not only could the position of the sagging fat and muscles and the face be improved but the face could be mobilized in multiple vectors which provided a more natural result. Multiple surgeons developed multiple different techniques for elevation and repositioning of SMAS, producing more natural longer-lasting results in facelift surgery.

The SMAS directly overlies the platysma muscle. This is the muscle that causes banding in the neck which patient’s find to be very troublesome. This is where the deep plane facelift technique can produce even better results than previous techniques. By extending the SMAS dissection towards the center of the neck and creating an operative plane below the platysma muscle, the SMAS- platysma complex can be elevated as a unit, rotated in multiple vectors, and secured to the underlying facial anatomy. This is the essence of the deep plane facelift-creating a dissection plane underneath the muscle and elevating and repositioning the muscle. There are also multiple techniques to elevate the cheek fat using an extension of the deep plane technique. By using this technique, excellent results can reproducibly be achieved in rejuvenating the neck, jawline, lower part of the face and the cheek region. When properly done, a deep plane facelift will produce a more youthful and more natural longer-lasting result than most other techniques. When properly done, the recovery from a deep plane facelift is the same as other techniques, but in my opinion, the results are superior.

It is easy to combine other procedures with a deep plane facelift. Very often patients will have eyelid surgery (blepharoplasty), laser resurfacing and or fat injections at the time of their facelift. There is usually very little pain after a deep plane facelift. The swelling and bruising is usually mild, and patients can usually return to work and normal activities within 7-10 days.

The goals of face lifting surgery are to make the patient look youthful and natural and restore their appearance to the way looked about 15 years prior to having the procedure. A deep plane facelift is an excellent option and perhaps the best method to achieve this goal.