A deep plane facelift is a type of facelift surgery (aka rhytidectomy) that tightens and lifts primarily 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 traditional facelift procedure.
It’s the most effective procedure to address significant sagging and smooth deep wrinkles and folds, while still maintaining a natural appearance.
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. When the malar fat pad is lifted, it reduces the nasolabial folds and gives the face a youthful heart shape.
It’s a type of SMAS facelift (the modern standard for facelifts), with one key difference: during a deep plane facelift, the skin and the SMAS are lifted together, rather than separately—which some doctors claim creates more natural results.
The main advantage of the deep plane technique is not necessarily in the longevity, but in the aesthetic outcome. The release of tethering facial ligaments allows for a more wholesome repositioning of the face, leading to a better look.
Deep plane facelifts can be combined with other facial procedures, such as a brow lift, rhinoplasty (nose job), and eyelid surgery for full facial rejuvenation. Not all facelifts address the neck, so be sure to discuss your goals with your provider.
You may also need a platysmaplasty (neck lift), a procedure that rejuvenates the neck area and improves the jawline by tightening the platysma muscle (to smooth banding) and removing excess fat (to reduce a double chin or jowls) and excess skin (to smooth wrinkles and contour the area).
. Many facelift surgeons say a deep plane facelift provides more natural-looking facial rejuvenation results than the skin-only facelifting of the past.
. Deep plane lifts can offer more substantial, natural results than an SMAS lift, in certain cases.
. Results are durable, lasting several years.
. The deep plane facelift technique can lift drooping cheeks and treat skin laxity of the lower face, jawline, and neck.
. It can also improve marionette lines and nasolabial folds, so less injectable fillers are needed, if any.
. The incisions for a well-executed deep plane facelift are hidden around the ears and within the hairline.
. Because the skin is not separated from the SMAS, deep plane facelifts maintain the natural blood supply to the skin, which can lead to less post-operative pain and faster healing.
. Most people need approximately two weeks of recovery time after this plastic surgery procedure. “Keep in mind that everyone is different and some require more or less time.
. The deeper nature of the deep plane technique carries a higher risk of potential nerve damage than skin-only lifts do. The risk of facial nerve injury in any surgery is very much related to the specific surgeon's experience with that procedure. 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 is a complicated technique, which takes more time 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.
The best candidates for this procedure are healthy nonsmokers, typically in their 50s or 60s, with deep nasolabial folds and sagging tissue in the midface, along the jawline, and under the chin.
A hematoma, which is a collection of blood under the skin, is the most common complication of any facelift; about 1% of patients experience it. 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 also possible—and avoidable, if you keep your incisions clean. Your surgeon may also prescribe antibiotics to reduce the risk of infection.
Deep plane facelifts carry a slightly elevated risk of nerve injury due to the deeper dissection. A deep plane facelift involves dissection below the facial nerve, which puts the nerve at risk for injury. Most facial nerve injuries resolve on their own within three to six months. This reinforces the importance of seeing a surgeon who has substantial experience doing this type of procedure.
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.
Deep plane facelifts require general anesthesia, so you’ll be completely asleep throughout the surgical procedure, which typically takes three or more hours.
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 and tighten the skin and the SMAS layer together, as one unit. Once these tissues have been lifted and repositioned to eliminate sagging, your surgeon will trim off any excess skin before closing the incisions with small sutures (stitches). In some cases, your surgeon may also insert thin drain tubes, to help prevent any buildup of excess fluid during the natural 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 and assist you overnight.
You can expect to need up to two 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. Generally, patients can return to work feeling confident 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 surgeon will walk you through detailed post-operative 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 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 deep plane facelifts are more prone to prolonged swelling even beyond this time frame.
. Scars are generally minimal and tend to fade over time.
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 completed in about six months.
Deep plane facelift results typically last many years, but the specific time varies for each individual.
You can enhance the longevity of your results by using medical-grade skin care. It’s also paramount to minimize the damaging effects of sun exposure with regular use of sunscreen with SPF 30+. Making certain lifestyle changes can help prolong your results—namely, avoiding smoking and maintaining a healthy diet with regular exercise. Nonsurgical skin rejuvenation treatments like laser resurfacing and microneedling, which stimulate new collagen production, can also slow down the development of new skin laxity.
A deep plane facelift is a type of SMAS facelift. The 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). Because the skin and SMAS stay together, the natural blood supply to the skin is preserved during a deep plane facelift.
Multiple 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.