Are the ligaments that are cut re-attatched during a Deep Plane Facelift?

Question

With a deep plane facelift, are the ligaments that you cut then re-attatched? Can the face sag worse after ligaments are cut? What is left to support the smas? Can this type of facelift alter your appearance? Cause scarring or asymetrical face shape. Thanks!

Randal Haworth, MD, FACS · Answer

In a deep plane facelift, the surgeon detaches the skin and soft tissues of the face from the underlying muscles and ligaments before repositioning them to create a more youthful appearance. The ligaments are not cut and re-attached, but rather released and repositioned to achieve a natural-looking lift.

The SMAS (superficial musculoaponeurotic system) is a layer of muscle and connective tissue that lies beneath the skin of the face and provides support to the soft tissues. In a deep plane facelift, the SMAS is also repositioned and tightened to provide additional support and lift to the face.

It is possible for the face to sag after a facelift, regardless of the technique used. However, a skilled and experienced surgeon can minimize this risk by properly supporting and repositioning the underlying tissues and using appropriate techniques to tighten and re-drape the skin.

In terms of scarring, any surgical procedure can result in scarring. However, with a deep plane facelift, the incisions are typically well hidden within the hairline and natural contours of the face, and scarring is usually minimal and fades over time.

As with any cosmetic surgery, there is a risk of asymmetry or changes to your appearance after a deep plane facelift. However, by choosing a skilled and experienced surgeon and carefully discussing your goals and expectations, you can minimize this risk and achieve a natural-looking result.

It's important to have a thorough consultation with your surgeon before undergoing any facial rejuvenation procedure to ensure that you fully understand the risks and benefits and have realistic expectations for the outcome.

Best of luck !

Lucian Ion, FRCS · Answer

Thank you for your question. There is a technique that aims to restore the characteristic impact of the ligaments released during a deep plane facelift. It has been described by Prof Bryan Mendelssohn from Melbourne. It is not the most common approach.

After the SMAS layer is mobilized and secured in a higher position, the scar tissue typically takes over and produces the suspension. This seems to be a reliable effect, and long-term results after a deep plane facelift support the hypothesis that scar tissue is an adequate substitute for the original ligaments.

In terms of risks, any intervention on the facial features can alter the appearance and produce scarring or asymmetry. The data available regarding risks related to the deep plane facelift intervention indicates that it is the type of surgery with the lowest risk level compared to other techniques developed over the years.

In the hands of a skilled surgeon, many techniques can produce good results. I suggest that you examine these options with several surgeons to reach a decision regarding what you feel suits your needs best.

Stephen Prendiville, MD · Answer

When the facial "ligaments" are released in deep plane facelift, the SMAS is tightened and anchored by long lasting absorbable monofilament sutures (PDS), which stay in place while your body lays down collagen.  This natural healing process is most robust in the first 3 months, but reaches a steady state at 1 year.

Jacob Tower, MD · Answer

Hello, hope you are well. The zygomatic cutaneous and mandibular cutaneous ligaments are released as a part of deep plane facelift surgery. These ligaments are not re-attached; instead, the face is supported by re-suspending the SMAS (superficial musculoaponeurotic system) in a superolateral vector with sutures deep underneath the skin. This type of facelift not only addresses the lower third of the face (treatment of jowling and jawline), but also the midface which is where other facelift techniques may fall short. Thus, it (and extended deep plane) is considered the most powerful surgical approach to the aging face and neck. If well-executed, your appearance in terms of your essential qualities generally remains unchanged, but rejuvenated and natural appearing. That is because this technique can reverse many of the anatomical changes that occur with aging without 'pulling' on the skin itself. It does not address the upper third of the face (hairline, temples and brow), eyelids, or skin texture. Hope this helps.
Cheers,Dr. Tower

Brian M. Harmych, MD, FACS · Answer

That is a great question!  During deep plane facelift surgery, the retaining ligaments that retained the soft tissues of the neck and face are divided.  This allows adequate mobility of the SMAS tissues and advancement of those tissues without tension.  The SMAS tissues are gently supported with sutures.,  The important thing in deep plane facelift surgery is that there is limited or no tension on the SMAS tissues.  Eventually, as healing progresses, a layer of normal scar tissue or fibrosis remains to support the tissues of the deep plane. By lifting the soft tissues in a mostly vertical direction, this type of facelift absolutely alters the appearance of the face. However, unlike traditional SMAS facelift surgery, the deep plane (if performed correctly) yields a much more significant and much more natural results that typical SMAS facelift. Asymmetry is a risk of any facelift operation, regardless of the type.

Ronald J. Edelson, MD · Answer

Those are all very good questions. Every surgeon dies something slightly different in facelift surgery. I don’t cut the ligaments or muscle at all whereas others do. So it’s a question to ask when you go for a consult.

William Portuese, MD · Answer

In our practice, we do not perform a deep plane facelift procedure for multiple reasons. We perform a high SMAS lower face and neck lift procedure which accomplishes tightening the facia layers in addition to tightening loose skin, and removing fat deposits in the neck, lifting the jowls and tightening the platysma muscle in three locations in the neck to improve the jawline.

Are the ligaments that are cut re-attatched during a Deep Plane Facelift?

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