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?

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.

Kerem Sami Kaya, MD · Answer

Hello, 
Yes, it is mechanically possible to achieve significant repositioning of the midface, lower face and early jowls with a deep-plane facelift without a submental incision or midline platysmaplasty.
The amount of facial improvement lost by omitting central neck surgery is usually not large, provided the main problem is descent of the facial tissues rather than significant central neck pathology. A well-executed deep-plane facelift can substantially improve the cheek, jowls and jawline while accepting some residual neck laxity.
Central neck surgery becomes more important when the remaining deformity is caused by significant medial platysmal laxity/banding, central fat or deeper neck structures that cannot be adequately repositioned from the lateral approach. At that point, further traction on the face mainly tries to compensate for a problem that is actually in the central neck.
So, in selected patients, I would consider a deep-plane facelift alone a very reasonable trade-off if the patient prioritizes facial rejuvenation and is willing to accept an intentionally less-corrected neck.
Kind regards

Mert Demirel, MD · Answer

Yes, it is mechanically possible to improve the midface, lower face, and early jowls with a deep plane facelift without a submental incision or midline platysmaplasty. The facial component of the lift can still reposition descended cheek and lower-face tissues and improve the jawline from a lateral approach.
The tradeoff depends on the anatomy. If the patient has good neck skin, minimal platysma banding, little submental fullness, and only early jowling, omitting central neck work may sacrifice only a small to moderate amount of improvement. In that case, the face can still look meaningfully better while the neck is simply left less corrected.
If there is central neck fullness, visible platysma bands, a heavy submental area, deep fat, digastric fullness, or loose central neck skin, then the limitation becomes larger. The lateral facelift can improve the jawline, but it cannot fully correct what is happening in the midline neck.
Central neck surgery becomes necessary when the central neck structures are preventing the jawline from being defined. In other words, if the jowl and lower face blend into a heavy submental/platysma problem, continuing to pull from the sides will not create a clean contour and may risk an over-pulled or unnatural result.
So the answer is not that submental surgery is always required for facial improvement. It is required when the central neck anatomy is the limiting factor. For early jowls with a good neck, a deep plane facelift without central neck work can be reasonable. For moderate neck laxity or banding, skipping it may significantly compromise the final balance.
My advice would be to ask your surgeon what specifically limits your result: cheek descent, jowls, platysma bands, submental fat, skin laxity, or deep neck anatomy. If the limitation is mainly facial descent, central neck work may be optional. If the limitation is the central neck, omitting it will likely mean accepting a noticeably under-corrected jawline/neck transition.

Sudeep Roy, MD · Answer

This is a fantastic question. As a double board certified facial plastic surgeon who specializes in deep plane surgery, I would generally tell you that a properly performed deep plane lower facelift should achieve the same results in mid and lower face when performed with or without a central neck intervention. The only caveat to that is if a patient has a really heavy neck with either significant amount of deep fat prominence, large digastric muscles and large, ptotic submandibular glands as this is essentially weight on the center of the hammock you are trying to elevate. In these cases, by accessing the central neck and reducing these deep structural prominences, you allow for less gravitational pull down on the SMAS/lateral platysmal work, if that makes sense. Otherwise, should be very similar results. A platysmaplasty alone does NOT effect the results on the mid and lower facelift, in my experience. Thanks for this very insightful question.

Keshav Magge, MD · Answer

Thank you for your question.  As someone who does a lot of Deep Plane Facelifts, I think the submental incision is essential for the best result in terms of getting the best neck.  That being said, I think you can have a great result on the jowls, midface and lower face without the submental incision.  As you mentioned, that submental incision is really about getting the best neck possible.

Vikram Mookerjee, MD · Answer

In the right candidates, it is possible to achieve significant rejuvenation of the face without a submental incision. A well executed deep plane facelift can still significantly lift the midface, lower face, and jowls from the lateral approach alone. Sometimes this is paired with a little bit of submental liposuction under the chin. Typically, these are patients that are thinner, on the younger side, and have less overall signs of aging. Forgoing central neck surgery starts to impact facial improvement more if the patient has a heavier neck with more significant aging. An in person consultation with a plastic surgeon will help you determine which plan is best for you, based on your goals. Hope this helps, and good luck!

Anil R. Shah, MD · Answer

Hello!

It would be helpful to see you in person so that your issues can be better addressed and we can come up with a plan! Please call 312-944-0117 to book a consultation!

Stephen Prendiville, MD · Answer

For a patient with clear indications that need to be addressed via deep neck work and platysmaplasty, omitting the neck is a clear mistake.  There are circumstances where it can be omitted; I refer to this as a mini-lift.  Only a consultation will help make the decision as to whether this is appropriate for you or not.

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?

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 (10)

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