Deep Plane DAO Release - are there any known long term complications?

Question

I'm 55, female with resting mean face. I'm considering a deep plane facelift with DAO release. Botox has previously worked well in this area. Are there any know long term complications for a DAO release? Such a pooching around the mouth area?

Mark Glasgold, MD, FACS · Answer

I have been working on this technique for about 10 years and in a few hundred deep plane facelifts. It has proven to be the most consistent and effective modification I have made to the operation in 25 years. The greatest risks would be more associated with the extended dissection needed to identify the DAO such as facial nerve injury but these are related to surgical skill and experience and not the procedure itself. I avoid doing the procedure in patients who actively engage their DAO when smiling as release can create a "joker" smile in these specific patients. These patients get a similar "off" effect from botox - so this is a good screening procedure. Some patients will get a hard swelling in the buccal region which can take a few months to resolve but has always gone away in my experience. The technique will lead to a very thin appearance in the buccal region - this is best demonstrated through photos during consultation.I don't know what pooching around the mouth area looks like but it is not something I have ever had a patient complain of.When evaluating a surgeon for the procedure you will want to know their experience, their complications and see photos demonstrating correction of the labiomental fold and downturned mouth without using fillers.

Jigar Sitapara, MD · Answer

Good morning CarolinaWren!If by DAO release you mean mandibulocutaneous ligament release, then no, there are no known long term complications. This is the ligament that anchors the marionette region and can cause the dreaded "resting mean face". Just know that there does tend to be bruising in that region after the release. This doesn't always need to be released during deep plane surgery, but it sounds like it may be helpful in your case. I hope that helps!Happy holiday weekend from the nation's capital!Jigar Sitapara, MDChevy Chase Facial Plastic Surgery

Marc Polacco, MD · Answer

Thank you for your question. There are the standard complications, such as bleeding and infection like any surgery. However, the one complication to be aware of in this region is injury to the facial nerve. Weakening the muscle is what you want, but if the nerve in injured, complete paralysis may occur, resulting in asymmetric smile. I hope this is helpful, and I wish you all the best.
-Dr. P

Stephen Prendiville, MD · Answer

The DAO or depressor anguli oris is a muscle which functions to depress the lateral lip and corner of the mouth.  So, in situations of a severe marionette line/ depressed corner of the mouth, such a maneuver can be helpful in improving the aesthetic result.  Usually, there is some degree of muscle re-connectivity in the months after the procedure, so major long term functional or aesthetic  detrimental effects are expected.

Ronald J. Edelson, MD · Answer

At 55 there is a good chance that a facelift would be worthwhile. I’ve never done DAO rri ease and can’t imagine it’s worthwhile. Also deep plane facelifts are no better than standard facelifts. Go on some consults with surgeons in your area. Whatever you do don’t let them talk you into fat transfer to the face. I know it’s all the rage now but it’s an absolute waste of money.

Deep Plane DAO Release - are there any known long term complications?

Answers (5)

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