What is a Deep Plane Facelift?

Deep Plane face lifts lift not only the jowls and neck areas, but also release the cheek ligaments and elevate the cheek fat pads and muscles. This is called the malar fat mound, and when lifted reduces the nasolabial folds and gives the face a youthful heart shape.

A deep plane facelift lifts the skin and muscle in one layer. Because it is performed underneath both the skin and muscle, it avoids, particularly in patients with thin skin, telltale facelift lines that occur when the muscle lift line can be seen under the skin.  Because it is deeper, it has a better blood supply, so that there is less worry about skin loss. It also provides better access to the ligaments and muscles of the cheek, so that it is easy to produce uniformity of "structure lift", resulting in a natural, non-facelift appearance. Having said all of this, good, experienced surgeons produce excellent results, regardless of technique.  Trust your face to an experienced facial plastic surgeon.

A deep plane facelift is not significantly
different other than the recovery takes several weeks longer, but the long-term
results are no different.

A deep plane face lift is similar to a sub-SMAS face lift with dissection beneath the muscle-fascia layer, however, only limited dissection is performed above the muscle-fascia layer. Proponents claim that the minimal dissection between the skin, fat, and muscle-fascia layer gives the skin an even smoother appearance and faster recovery time while still providing dramatic, longer lasting results than with a standard skin-only face lift.

The deep plane facelift is an advanced surgical technique that achieves a natural looking and long lasting result. This technique represents the state of the art in facelift surgery. Rather than just tightening the skin, this procedure lifts and tightens the underlying muscle while repositioning fat to achieve a three dimensional rejuvenating result. This procedure is best performed by an experienced facial plastic surgeon who performs facelift surgery as a routine part of his or her practice.

Best of luck,

Dr, Clevens

The deep plane facelift involves disscting in the tissue layer (the SMAS) that contains the muscles and some of the inelastic tissue of the face.  The SMAS is then pulled "up and back," helping restore a more youthful appearance to the face.  Although its use has decreased in popularity over the last few years due to the risks of nerve damage and the fact that some of the benefits of the lift can be achieved through other techniques (such as fat grafting), it remains a valuable tool for facelift surgeons.

There are many different types of facelifts, each one having a different take by different surgeons.  I use a variant of a deep plane facelift and find it provides the most robust changes while still keeping the face looking natural.  Some things to consider when discussing deep plane facelifts:

Anatomy- This facelift is not for every surgeon.  It requires much more knowledge of facial anatomy.  However, an experienced facelift surgeon can perform this lift with little risk to the facial nerves.  A surgeon's knowledge of anatomy is more critical to avoiding damage to nerves than technique.

Results- A deep plane facelift is a results driven procedure.  Patients wanting the best results will want to have the more robust changes to the face while still looking natural. 

Downtime- The deep plane facelift has a reported longer period of recovery.  However, I have found the opposite to be the case.   I vary my technique to minimize postoperative edema so that patient's have the benefits of a more robust lift without the downtime.  Dissection below the platysma muscle (see article, yes it is in the face) is a natural embryologic glide plane which is bloodless and can expedite recovery.

Incisions and Longevity of Lift- Several biomechanical studies have looked at the strength of tissues being held.  Deeper plane tissues is a stronger flap and has less chance of sliding back to original position

Overall, deep plane facelifts (which is a large category of lifts) can provide excellent rejuvenation in the right hands.  There are risks with any facelift, so pick a rejuvenation procedure by surgeon not by technique.  Not all deep plane facelifts are the same.

While there are a dizzying number of Facelift techniques described, all are a variation on the way the SMAS layer is effected.  Generally, the "deep plane" is that plane of facial tissues below the SMAS layer.  In the original description by Sam Hamra, he discussed cutting through the SMAS layer just in front of the ear and elevating the SMAS all the way past the nasolabial fold.  The benefits:


You can really smooth out every wrinkle on the face

The results last a very long time

You are able to free the SMAS from some of the suspension ligaments of the face


The downside:


The muscles of facial expression are enveloped in the SMAS layer.  The nerves that go into these muscles come from below.  When lifting the SMAS, those nerves are at extreme risk of injury, both temporary (some weakness in every deep plane Facelift) or permanent (small percentage).

The risk of having a final result that is wind swept and somewhat unnatural is high.  This is in part due to the fact that the suspension ligaments of the face have been mobilized.


Although in the right patient the deep plane face lift may be the right choice, I feel the risks outweigh the benefits.  I do a SMAS imbrication, where a strip of SMAS in front of the ear is excised and the SMAS layer is elevated an inch or so out and then sutured back and up.  This allows for many of the benefits of the deep plane Facelift (longevity, excellent tightening) without some of the risks.

I use a particular technique, called the "composite rhytidectomy" for face-lifting. "Rhytidectomy" is the clinical term for facelift. "Composite" refers to a specific technique which will now be discussed. The evolution of the technique began in the mid-1980's and is now a well defined operation with predictable results.
Conventional techniques for face-lifting begin by lifting the skin off the cheek and neck. The deeper layers are accessed by this dissection and are available for manipulation. However, much of the blood supply to the skin is supplied by networks of blood vessels within these deeper layers that nourish the skin by small perforating vessels. Lifting the skin requires division of these "perforators" thus compromising the blood supply.
The "composite" technique lifts both the skin and the deeper layers (which will be discussed later) as a unit, preserving both the network of blood vessels in the deeper tissue as well as the perforators. The resulting flap of tissue is maneuvered to reposition sagging areas of fat, muscle, and skin to their more natural youthful position. The skin remains well nourished by attention to the blood supply anatomy.
Many conventional techniques rely on pulling the skin to effect changes in the neck, jowl, and cheek. Remember that the pulling is directed behind and above the ear, a significant distance from the center of the neck and the medial cheek. To sharpen the neck angle and flatten the jowl, a significant amount of tension needs to be generated at the level of support around the ear. This commonly will leave the patient with the appearance of being "pulled too tight." The patients have an "operated upon" look.
The composite rhytidectomy bases all support for the facelift on a deeper inelastic layer. As stated, the skin remains attached to the deeper connective tissue and muscular layers during dissection. As the flaps of tissue are redraped, the sutures of support are placed through the deeper inelastic layers of connective tissue. The attached skin accompanies these deeper layers in redraping and are not required to support the lift. The skin is closed almost tension free with the most delicate of sutures. As a result, the patients look more natural, the incisions heal better, there is little risk for hair loss, and the lift probably lasts longer.Management of the Deeper Plane

The original deep plane facelift reported by Dr. Hamra describes elevating only a short area of skin flap around the ear before focus is directed to dissecting and elevating the SMAS flap over the zygomaticus muscle and to a point near the nasolabial folds.
We believe, in order to get the best result, the SMAS flap should be repositioned. However, in our experience and opinion, the small amount of skin flap elevation limits the refinement achievable. The extended SMAS-plasty technique consists of elevating a formal facial skin flap followed by elevation of a SMAS flap similar to that described by Dr. Hamra. The SMAS elevation is also extended inferiorly to the platysma.
After all the flaps are elevated, excellent redraping can be performed to achieve a natural and long lasting refreshed look. There is a slight increase risk of injury to the facial nerve due to the extent of dissection, but in experienced hands, the risk is very low and not higher than that reported in less involved facelifts.