Pro and con for ligaments/deep plane facelift

Deep plane increases the exposure of facial nerve branches during surgery and hence the risk of injury goes up. SMAS might not pull the nasolabial fold as much but safer. Rest is all the same. RegardsDr. J

I have been doing facelifts for thirty years and I have wrestled with the question as to whether the extra risk to the facial nerve is worth it when performing a deep plane facelift.  I have transitioned to the deep plane facelift having found that the results are just better - there is a real elevation of the malar fat pad and even some improvement in the lower lid cheek junction (without necessarily performing a blepharoplasty).  In addition, there is less pulling effect as once the ligaments are released the SMAS layer can be placed in the elevated position.  I also feel that  a more vertical lift can be achieved in the face further enhancing a natural look.  There are other advantages such as decreased elevation of the skin only flap minimizing the vascular compromise.  If your surgeon is well versed in the deep plane facelift then the risks to the facial n are decreased (as in any operation the risks are there but minimized by a good surgeon).  This is not to say that you cannot achieve good results with a SMAS plication lift but the deep plane lift is more likely in my mind to give you a great result.  

Understanding the anatomy for any operation is a must for
any surgeon.  The deep plane facelift is
no exception.  The advantage of the deep
plane facelift is that key ligaments are released to allow maximum lift without
looking tight, stretched, or strange. 
Out of the 3 facelifts I offer, the skin lift, the standard lift, and
the deep plane facelift, the majority of the patients choose the deep plane
facelift since it has a natural look and is long-lasting.  Those are the pros. The cons include a longer
operating time, some increase in risk, and the cost.  When done well, the deep plane facelift is a
wonderful procedure.


Grant A. Fairbanks, MD