How much facial improvement from a deep-plane facelift is mechanically possible without central neck surgery?

Question

For surgeons who perform deep-plane facelifts: Is it mechanically possible to achieve substantial repositioning of the midface, lower face, and early jowls without a submental incision or midline platysmaplasty, accepting that the neck itself would be intentionally under-corrected? I'm not asking whether adding neck surgery produces the best overall result—it obviously does. Rather, I'm trying to understand the tradeoff. In your experience, does omitting central neck surgery sacrifice a small amount of facial improvement or a large amount? At what point does central neck surgery become necessary to continue improving the face rather than simply improving the neck?

Christopher T. Maloney Jr., MD · Answer

Yes, it is possible, but the result will generally be less optimal. In my experience, when I decide not to make a submental incision, I often end up regretting it because it limits how completely I can address the neck and can affect the overall result.

While you can achieve meaningful improvement in the midface, lower face, and early jowls without submental incision, there comes a point where the remaining neck tension and platysma position limit how much additional improvement you can achieve in the lower face. The face and neck are closely connected, so treating one without the other can compromise the final outcome.

Is there a particular reason you're hoping to avoid a submental incision?

Philip Wasicek, MD · Answer

Hello, 
You are asking a very interesting question. I am going to tell you something you are probably not expecting based on what you wrote. In my opinion, you can actually get better midface correction/improvement and vertical lifting during a deep plane facelift if you do not open the neck centrally and perform a platysmaplasty. The platysma and SMAS are contiguous. By performing a central corset platysmaplasty, you are limiting the degree of excursion and rotation of the deep plane flap, thereby limiting the improvement in the face. The degree to which this is true is on the more incremental/subtle side. 
Depending on the anatomy of the neck and its appearance, it is frequently a good idea to open the neck and address it. Sacrificing the appearance of the neck for some additional improvement in the midface may or may not be worth it. 
My best advice is to have an in-person consultation with a board certified plastic surgeon who specializes in deep plane facelift/necklift surgery.

Julian De Silva, MD · Answer

Hi Maria, this is a well-framed question. In my experience a deep-plane facelift delivers most of its facial improvement independently of central neck surgery. The lateral deep-plane release repositions the midface, lower face and early jowls by mobilising the deeper layer and re-draping it over the cheek and jawline, and that vector does not depend on a submental incision. So substantial midface and jowl correction is achievable while intentionally under-correcting the neck. What you give up by omitting central work is mostly in the neck itself: submental fullness, midline platysmal bands and the crispness of the cervicomental angle, which are hard to fully address from the lateral approach alone. The lateral lift does tighten the upper neck and jawline somewhat, so a mild neck often looks acceptably improved without going central. A heavy central neck, strong bands or submental fat is where the omission shows. So the trade tends to sacrifice little facial improvement but a variable amount of neck improvement, depending entirely on your starting neck. It is reasonable if your concern is the face and your neck is mild. That line is best drawn on examination. I operate only on faces and would want to assess your neck in person before committing to where it sits for you.

How much facial improvement from a deep-plane facelift is mechanically possible without central neck surgery?

Answers (3)

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