Question 1

What is a deep plane facelift?

Accepted Answer

A deep plane facelift is a type of facelift surgery (aka rhytidectomy) that tightens and lifts the middle and lower areas of the face by targeting the muscular and soft tissue layer, known as the SMAS (superficial musculoaponeurotic system), a deeper layer than that which is addressed in a skin-only facelift.

The procedure addresses sagging skin and facial muscles, and smoothes wrinkles and folds, while maintaining a natural appearance. Deep plane facelifts usually include a neck lift, because the two areas are closely connected “By lifting the face, the neck also gets lifted, resulting in a more comprehensive and powerful face and neck rejuvenation than just about any other procedure,” explains Dr. Vu Ho, a board-certified facial plastic surgeon in Plano, Texas.

“Deep plane facelifts lift not only the jowls and neck areas, but also release the cheek ligaments and elevate the cheek fat pads and muscles,” says Dr. Andrew Jacono, a board-certified facial plastic surgeon in New York City. “When the malar fat pad is lifted, it reduces the nasolabial folds and gives the face a youthful heart shape.”

While facelift techniques are often pitted against one another—deep plane versus SMAS—the deep plane is actually a type of SMAS facelift (the modern standard for facelifts), with one key difference: during a deep plane facelift procedure, the skin and the SMAS are lifted together, rather than separately. Some doctors claim this creates more natural results.

Deep plane facelifts can be combined with other procedures, such as a brow lift or forehead lift, eyelid surgery (blepharoplasty), face and neck liposuction, fat transfer, facial implants, laser skin resurfacing, or a chemical peel, for full face and neck rejuvenation.

“I often include skin-rejuvenating treatments, such as RF microneedling, chemical peeling, and laser resurfacing, to further enhance the results of my facelifts,” explains Dr. Ho. “A deep plane facelift result looks great, but transforming the skin envelope at the same time really knocks it out of the park.”

For the most youthful appearance, you may also need a platysmaplasty (neck lift). This procedure rejuvenates the neck and improves the jawline by tightening the platysma muscle (to smooth out banding) and removing excess fat (to reduce a double chin or jowls) and excess skin (to smooth wrinkles and contour the area).

Discuss your goals and a personalized treatment plan with your board-certified plastic surgeon during your initial consultation.

Question 2

What are the pros and cons of a deep plane facelift?

Accepted Answer

Pros

A deep plane facelift provides more natural-looking facial rejuvenation results than less effective skin-only facelifts of the past.
Many facelift surgeons believe the deep plane lift can offer more substantial, natural-looking results than a SMAS lift, in certain cases.
The deep plane facelift technique can lift drooping cheeks and treat skin laxity of the lower face, jawline, and neck.
Because it addresses deeper tissues in a comprehensive way, results can last a decade or more. “Bear in mind, however, that the aging process cannot be stopped, nor can the constant effects of gravity be avoided. The body continually ages, regardless of what treatment is done,” notes Dr. Ho.
It can also improve marionette lines and nasolabial folds, which can reduce or eliminate the need for injectable fillers.
The incisions for a well-executed deep plane facelift procedure are discreetly placed around the ears and within the hairline.
Because the skin is not separated from the SMAS, this technique maintains the natural blood supply to the skin, which can lead to less post-operative pain and faster healing.

Cons

Most people need two weeks or more of recovery time after this plastic surgery procedure. “Keep in mind that everyone is different, and some require more or less time for healing,” says Dr. Ho.
The deeper nature of this technique may carry a higher risk of potential nerve damage than less invasive lifts do. "The risk of facial nerve injury in any surgery is very much related to the specific surgeon's experience with that procedure," says Dr. Mark Glasgold, a board-certified facial plastic surgeon in Princeton, New Jersey. "You should not hesitate to ask a surgeon how often they've had this complication and how many of the surgeries they have done."
A deep plane facelift procedure requires a high-level technique, which takes more training and time to perform than standard facelifts. This usually means that it costs more.
While the procedure treats many signs of aging, it won't improve skin quality. “A facelift alone does not change the skin’s elasticity, sun damage, or textural issues,” explains Dr. Ho. Because of this, facelift surgery is often combined with skin rejuvenation procedures, to achieve even better results.

Question 3

How much does a deep plane facelift cost?

Accepted Answer

According to RealSelf reviewers, the average cost of a deep plane facelift is type: embedded-entry-inline id: 6aTOuvi443nRPfQzwP6tIP, while some say they’ve paid up to type: embedded-entry-inline id: 3TqRgTEUtEO0futq5cEvbi. That may seem high, but it's a relative bargain next to the $100,000 or more charged by some of the most in-demand surgeons, a trend that's been accelerated by social media.

Your deep plane facelift cost will depend on:

your facial plastic surgeon's level of experience
their practice location (which impacts overhead costs)
whether your procedure is performed in a hospital operating room or, more affordably, in a private surgery center
the credentials of your anesthesia provider (an anesthesiologist will charge more than a nurse anesthetist; the deep plane lift is rarely done under local anesthesia)
whether you have any complementary procedures at the same time

Most plastic surgeons include a neck lift with the deep plane facelift procedure, but be sure to confirm this with your surgeon during your initial consultation. After you discuss the details of your treatment plan, ask for a personalized price quote that includes all related costs, not just their surgeon's fee.

Insurance doesn't cover elective cosmetic procedures, but many providers offer payment plans or accept various forms of cosmetic surgery financing.

Question 4

Deep plane facelift before and after pictures

Accepted Answer

The deep plane facelift photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

Question 5

Deep plane facelift vs. SMAS facelift: What’s the difference?

Accepted Answer

In recent years, the deep plane facelift and the surgeons who’ve pioneered the procedure, have become somewhat of a social-media phenomenon. This has led to a heightened curiosity about the facelift as well as skyrocketing costs, with some Instagram-famous plastic surgeons commanding six-figures for their signature lifts.

With so many surgeons putting their own spin on the deep plane and promoting trademarked techniques, it's important to understand what qualifies a facelift as a deep plane and what advantages the technique offers.

As we mentioned, a deep plane facelift is a type of SMAS facelift. Both surgical procedures tighten the lower two-thirds of the face, via slightly different surgical techniques.

“A main difference is that the SMAS facelift is more of a two-layer dissection (skin and SMAS separately), and the deep plane operation is more of a ‘composite’ procedure (skin and SMAS together),” says St. Louis facial plastic surgeon Dr. Brock Ridenour.

Because the skin and SMAS stay together, the natural blood supply to the skin is preserved during a deep plane facelift.

Ligament release is another hallmark of the deep plane. This maneuver is thought to allow for a more pronounced lift, especially in the midface, without creating a pulled appearance. Repositioning the midface—putting fallen muscles and fat pads back where they used to be—can also have a volumizing effect, minimizing the need for fat grafting during surgery.

That said, certain landmark studies have found no major differences in the outcomes of SMAS facelifts vs. deep plane facelifts in patients under 70 years old, even after comparing the results over a 10-year period.

The type of facelift technique a surgeon recommends will depend on a variety of factors, so it’s important to thoroughly discuss your goals with your board-certified surgeon to determine which type of facelift you’re a good candidate for, if any. “An experienced surgeon should be comfortable with a variety of techniques, so that each individual patient’s needs are met, as one size does not fit all,” says Dr. Ho.

Question 6

Who's a good candidate for a deep plane facelift?

Accepted Answer

The best candidates for this procedure are typically in their 40s, 50s, or 60s, with deep nasolabial folds and sagging skin in the midface, along the jawline, under the chin, and on the neck.

All facelift patients should be nonsmokers (or willing to quit for a few weeks before and after surgery), in generally good health.

People with uncontrolled high blood pressure, as well as those taking blood thinners and certain herbal medications and supplements are at increased risk for complications, like hematoma (a pooling of blood under the skin).

Question 7

How does a deep plane facelift work?

Accepted Answer

This procedure is performed on an outpatient basis, either in an accredited operating suite at your surgeon’s office or at an outside surgical center.

Unlike less invasive facelifts, which are sometimes done under local anesthesia, deep plane facelifts, due to their complexity, typically require general anesthesia, so you’ll be asleep throughout the surgical procedure, which typically takes three or more hours. Here’s how it works:

Your surgeon will make small incisions around the ear and back into the hairline, making sure they are as imperceptible as possible.
They will then lift the skin and SMAS layer together, as one unit; release key retaining ligaments in the cheek, jaw, and neck; and reposition deeper tissues to eliminate sagging skin.
They will carefully trim off any excess skin.
Finally, they’ll close the incisions with small sutures (stitches), being careful not to apply too much tension to the skin flap.
In some cases, they may also insert thin drain tubes, to help prevent any buildup of excess fluid during the healing process.

You’ll leave with bandages wrapped around your face. You will feel groggy from the anesthesia, so make sure you have someone you trust there to take you home safely and assist you overnight.

Question 8

How long does deep plane facelift recovery take?

Accepted Answer

You can expect to need two to three weeks or more of recovery time post-surgery.

“There are many variables that contribute to healing. Genetics, lifestyle/diet, and age can all play a role,” explains Toronto facial plastic surgeon Dr. Philip Solomon. “Generally, patients can return to work feeling confident within two to three weeks following deep plane facelift surgery. Residual swelling and numbness may still be a factor—however, both will dissipate over time, [within] anywhere from one to three months on average.”

Prior to your procedure, your board-certified facelift surgeon will walk you through detailed post-op care instructions, including follow-up appointments to remove your stitches and any surgical drains.

Here's what that may look like:

You’ll probably keep your bandages on for two days after surgery.
Stitches and drains are usually removed at a follow-up appointment about a week after surgery.
You can expect bruising, swelling, and discomfort for the first two to three weeks. Your surgeon will prescribe pain medication to help keep you comfortable.
You'll have some residual swelling for up to three months or longer post-op, though some patients experience swelling for up to six months.
Meticulously executed deep plane facelift incisions in patients who heal well are generally minimal and well-hidden. They also tend to fade over time.

If you experience anything unusual during your healing process, be sure to immediately reach out to your surgeon.

Question 9

How soon will you see deep plane facelift results?

Accepted Answer

You will see immediate results once your bandages are removed, but it takes three months or longer for all the facial tissues, muscle, and skin to settle and swelling to fully subside. That's when you'll see your final results.

In general, healing is complete within six months and scars will continue to mature for a year. “Again, it is worth noting that everyone is unique, so healing times and results are different for each person,” says Dr. Ho.

See deep plane facelift before and after photos

Question 10

Is a deep plane facelift safe? What are the risks?

Accepted Answer

This cosmetic procedure is considered safe in the hands of an experienced, board-certified plastic or facial plastic surgeon.

During your initial facelift consultation, your doctor should talk you through these potential risks and side effects:

The most common complication of any facelift is a hematoma, a collection of blood under the skin; overall, it occurs in less than 2% of cases. (According to a recent review of the procedure, up to 8% of men are likely to experience hematoma.) You can lower your risk by avoiding situations that can raise your blood pressure, such as strenuous activity and heavy lifting during the first few weeks of healing.
Infection is possible—and avoidable, if you keep your incisions clean. Your surgeon may also prescribe antibiotics to reduce the risk of infection.

Some surgeons and studies say that deep plane facelifts carry a slightly elevated risk of nerve injury. “A deep plane facelift involves dissection below the facial nerve, which puts the nerve at risk for injury,” explains Seattle facial plastic surgeon Dr. William Portuese. However, according to the aforementioned 2022 review, facial nerve injury “occurs in less than 1% of cases (similar for standard facelifts).”

When nerve injuries occur, they typically resolve on their own within three to six months. Still, “this reinforces the importance of seeing a surgeon who has substantial experience doing this type of procedure to not only avoid complications, but also to be able to deal with problems that could arise,” Dr. Ho adds.

Question 11

How long does a deep plane facelift last?

Accepted Answer

Deep plane facelift results typically last many years, but it varies by individual.

“The main advantage of the deep plane technique is not necessarily in the longevity, but in the aesthetic outcome,” explains Dr. Frank Fechner, a facial plastic surgeon in Worcester, Massachusetts. “[The] release of tethering facial ligaments allows for a more wholesome repositioning of the face, leading to a better look.”

You can enhance the longevity of your results by:

using medical-grade skin care
minimizing the effects of sun exposure by regularly using sunscreen with SPF 30+
avoiding smoking
maintaining a healthy diet
exercising regularly

Nonsurgical skin rejuvenation treatments like laser resurfacing and microneedling, which stimulate new collagen production, can also slow down the development of new skin laxity.

DEEP PLANE FACELIFT

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