Which ligaments are released during a deep plane facelift and what parts of the face do they address?

Question

Hi, Would like to ask what ligaments are or should be released for a deep plane face lift? What ligaments address different parts of the face? Would not releasing all of the necessary ligaments give poor results? What also happens with the SMAS as I have been left questioning if I truly had a deep plane as my SMAS was folded. I did not think this was done/happened for deep plane? Thank you

Roy Kim, MD · Answer

A deep plane facelift is a surgical procedure that addresses sagging and drooping in the mid- to lower-face by repositioning the deeper layers of tissue, including the muscles and ligaments, rather than just the skin. The specific ligaments that are released during a deep plane facelift will vary depending on the patient's individual needs and the surgeon's technique.

In most patients, it's important to release the ligaments AND to do it so that the final result is symmetric. In virtually all cases, it's important to release the ligaments, but HOW MUCH is the artistry involved in a  facelift.

The anatomy is always the same, but each patient is different.

The main ligament that is typically released during a deep plane facelift is the platysma ligament, which runs down the neck and helps to support the lower face. Other ligaments that may be released include the zygomatic ligament, which supports the cheekbones, and the mandibular ligament, which supports the jawline.

Releasing the necessary ligaments is crucial for achieving the desired results in deep plane facelift. Not releasing all the necessary ligaments can result in poor outcomes like asymmetry, unnatural or unnatural look, or not enough improvement.

Regarding the SMAS (superficial musculoaponeurotic system), in a deep plane facelift, the SMAS is lifted and repositioned rather than excised or folded. The SMAS is a layer of tissue that sits beneath the skin and fat, and it helps to support the face and create a more youthful appearance. The SMAS can be lifted and folded/ plication, or lifted and a small portion removed/ SMASectomy.

It is important to note that every surgeon has their own technique, and some may do things differently. If you have any concerns or questions about your surgery, it is best to discuss them with your surgeon. They will be able to explain the specific technique they used and address any concerns you may have about your results.

Christopher David Jones, MBBS, BSc, FRCS (Plast) · Answer

Put simply there are two broad types of facial ligaments: osteocutaneous, connecting bones (such as cheek, orbit and jaw) to skin and fasciocutaneous, connecting glands and muscles to the skin. The SMAS is an anatomical layer in the face, just deep to the skin which encloses the muscles of facial expression. With a traditional "SMAS" face lift, depending on the amount of dissection, the same ligaments are released as those with deep plane. The main difference is that, with SMAS dissection, these ligaments are only released at their insertion into the skin (their origins are not affected), whereas with a deep plane dissection, the ligaments are released at their origin. This enables an improved manipulation of the tissues with deep plane face lifts. Although contentious, some studies report a better cosmetic appearance and longer outcome with deep plane face lifts. In reference to the SMAS with deep plane surgery, the SMAS is lifted as a complete unit which is thought to lessen the tension within the facial muscles (and ultimately the overlying skin) resulting in an improved contour.If you have any ongoing concerns following your face lift, I recommend that you speak with your surgeon.

Stephen Prendiville, MD · Answer

It is important to understand that different experienced Surgeons utilize different techniques.  That having been said, a deep plane facelift calls for release of the zygomatico-cutaneous, partido-cutaneous, and often the mandibular-cutaneous ligaments.  These aren't really ligaments in the same sense as are seen in joints, but dense attachments from the skin to deeper tissues.  Regarding your specific case, best to review with your Surgeon.

Ronald J. Edelson, MD · Answer

You’re making this more complicated than it needs to be. But that’s okay. Plastic surgeon also make this more complicated than it needs to be. You need to find a good, experienced facelift surgeon which might be difficult in a small town. Choose the right surgeon and don’t get mired down in all the different ways surgeons do deep plane facelifts which incidentally are no better than a standard facelift

Which ligaments are released during a deep plane facelift and what parts of the face do they address?

Answers (4)

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