On a Deep Plane Facelift...is Facial Nerve Injury Risk Very High?

It is important that the surgeon understands the relationship of the facial nerve to the anchoring ligaments and the anatomy of the SMAS and subSMAS tissue spaces accurately to perform a safe and successful surgery. Actually, extended techniques such as deep and composite plane facelifts while identifying and preserving the anatomy often leads to lower complication rates than blindly working around vital structures.

    The rate of facial nerve injury is not high in deep plane facelift but is higher than in other facelift variants.   Kenneth Hughes, MD Los Angeles, CA

Dear Lacey,

The risk of permanent facial nerve injury is generally very low with any facelift technique. A deep plane facelift does involve surgery closer to certain branches of the nerve, but in experienced hands the chance of injury is still far less than 1%. It is important to discuss the benefits of different techniques for your individual case. Aside from weighing the risks of surgery, it is also important to consider which form of facelift will give you the best, long-lasting result.

Best wishes,

-Dr. Jamil Asaria, FACE Cosmetic Surgery, Toronto, Ontario

In experienced hands the deep plane face lift is quite safe and has very risk of nerve injury.  if a nerve injury occurs, it is almost always temporary.

Whether it is a deep plane or a superficial plane facelift, the risk of injury to the facial nerve is directly related to the skill and experience of the surgeon who performs the surgery.  Do your homework and select an experienced board-certified plastic surgeon.

It is highly unlikely that the facial nerve will get injured in a deep plane facelift, provided that the surgeon has skills, talent and lots of experience.  Since the deep plane dissection exposes the nerves, at least in theory the chance of injury is higher, but practically speaking this rarely happens.  Much more important it the selection of appropriate technique for each unique face.  In my practice, I custom tailor facial procedure based on the patients individual anatomy and aging.  This could include deep plane dissection, short scar with plication, etc. Make sure your surgeon discusses with you his plan for you and explains to you why he/she chose this technique in your case. 

in unexperienced hands - yes.  fortunatley most people who do not have sufficient expereince with this technique offer a different type of face lift.  many plastic surgeons now are getting extra training in these advanced techniques in cosmetic surgery fellowships.  get to know your surgeon and his/her expreince.  generally abps certified plastic surgoens are going to be honest with you and theirselves and not offer you something beyond their skill level.

I explain risk of facial nerve injury verbatim to patients in the following manner:  The Florida power and light engineer knows where your power line is near your house and he stays away from it; we exercise the same caution with the facial nerve.  Having performed numerous Facelifts in my career and from having performed many parotidectomies with facial nerve dissection in my training, I can assure you that the facial nerve is a consistently deep structure with very few exceptions.  The plane of dissection in a deep plane facelift is typically over the parotido-masseteric fascia, with several of  the facial nerve branches resting safely beneath this layer.  In the hands of an experienced Surgeon, your risk of facial nerve injury should be no greater with a deep plane technique than any other Facelift technique.

Facelifts have evolved from simple tugging on the skin to more 3-D shaping by elevating deeper tissue layers for a more natural and lasting result. However, there are several variations of this, and the deep plane involves more disseection around important nerve branches so the risk of injury is higher, though still low overall. Because of the deeper dissection, the swelling lasts longer. It is also not well proven that the deep plane procedure gives more lasting results than more limited dissection versions but most facelifts do involve some degree of work on layers under the skin.

I disagree with the previous responder. The "Deep Plane" facelift is a technique that uses a dissection beneath the SMAS well into the middle portions of the face and even further forward. The SMAS is lifted directly above a certain "plane" of separation which is directly above the branches of the facial nerve. Eventually the Deep Plane facelift developed into the Composite Facelift, both of which have been developed and described by Hamra. While the branches are certainly at risk, injury should be very rare when performed by experienced surgeons. A subperiosteal lift is the "deepest" level of dissection and is a completely different technique.