What Is A Deep Plane Facelift?
A deep plane facelift is one type of facelifting technique, considered one of the most powerful techniques in facial rejuvenation. Originally described over 40 years ago, the deep plane facelift was thought to address the nasolabial folds and marionette lines in a more dramatic fashion. Over the last few years, as the popularity of the facelift has made a resurgence, more people are discussing the various techniques – whether deep plane or extended SMAS or SMAS lift.
Anatomy And Physiology Involved In Deep Plane Facelift
The anatomy and physiology of deep plane facelifts are to address the sagging tissues of the face and neck and reposition them back to where they used to be found. In other words, picking up the soft tissues of the face and putting them back where they used to be located. The difference between a deep plane facelift and other techniques is that the attachments to the SMAS layer are all released prior to moving the SMAS layer. This allows for more mobility.
How Does a Deep Plane Facelift Work?
As opposed to traditional facelift procedures that may move skin only or use sutures to tighten the SMAS (Superficial Musculoaponeurotic System), a deep plane facelift moves the sagging fat pads by lifting them and repositioning them to their natural positions.
Equipment, Personnel, And Preparation
This is a surgical procedure performed in the operating room and using sterile techniques. Dr Rihani and his team of professionals perform facial cosmetic surgery exclusively. By performing these facelifts on a regular basis his team understands your objectives and goals, making the operation a streamlined process for both patient and staff.
Technique Or Treatment
A skin incision is made in carefully concealed areas around the ear. The length of the incisions varies based on the amount of skin removed. The skin is then elevated, and the underlying tissues are visualized, allowing accessibility to the deeper tissues. This underlying tissue is known as the Subcutaneous Musculoaponeurotic System or SMAS. The SMAS is then incised and elevated. By freeing the attachments of the SMAS, the skin and SMAS are able to be moved as a unit. The amount of release of the SMAS is the determinant of whether a deep plane lift is performed. A deep plane lift releases the zygomatic, masseteric, mandibular, and cervical retaining ligaments. These ligaments are deep attachments that run from deeper structures up into the SMAS/skin complex. By performing a full release of these, Dr. Rihani is able to get the most lift from these tissues. This also allows minimal tension on the skin when the incisions are closed. The results are a full lift of the face and neck with a tensionless closure on the skin.
Enhancing Healthcare Team Outcomes
A deep plane facelift is a procedure that needs a coordinated team in order to be performed safely. A surgeon cannot monitor the patient while performing surgery, so we rely on anesthesiologists and nursing staff to focus on those aspects so Dr Rihani can focus on the surgical outcome.
Interventions by Nursing, Allied Health, and Interprofessional Teams
By working closely with our colleagues, we are able to maintain a high standard of safety and optimize outcomes. Beginning with our initial consultation, we will review your health history to ensure that you are a good, safe candidate for your procedure. Communication with your primary physician allows us to ensure that our patients are safe to undergo anesthesia for their procedure.
Monitoring by Nursing, Allied Health, and Interprofessional Teams
During surgery, an anesthesiologist delivers anesthesia with continuous monitoring. By allowing anesthesiologists to focus on the anesthesia, Dr Rihani is able to focus on making your result a great one.
Deep Plane Facelift Complications
Complications are similar for all surgical procedures, including a risk of bleeding, scarring, bruising, swelling, and numbness of the surgical area. Although the risk is extremely low, the risk of nerve damage (facial weakness) is considered a risk of the procedure.
Benefits Of A Deep Plane Facelift
Patients who undergo a facelift see improvement in their neck and jawline definition to minimize the signs of aging. Addressing the jowls, nasolabial folds, and excess skin under the neck are common concerns that patients want to be addressed. This surgery is usually combined with other procedures to improve other areas as well – including eyelid and brow lifts, fat transfer, laser resurfacing, etc – to maximize the amount of facial rejuvenation achieved.
Fat Redistribution
One of the benefits of face lifting is that I am actually taking the fat pads that have dropped and repositioned them back to where they were. This redistribution of fat restores volume to areas that have lost it – effectively adding back cheek volume. We see this same phenomenon in the jawline where we lose volume along the back of the jaw and instead have heaviness in the front – creating “jowling”. By repositioning these jowls, the volume is redistributed upward to create a sharp, smooth jawline.
Smooth Skin
Removing excess skin can create facial skin that is smoother with fewer wrinkles. Most notable is the area around the mouth, known as the “smile lines”. We generally say that these improve by around 80%, marionette lines improve by 70%, and nasolabial folds improve by 30%.
Enhanced Confidence
After undergoing this surgery, patients are more happy with their overall appearance after their healing is complete. This generally takes about 2-4 weeks. Their improved neck and jawline definition allows them to have a more youthful appearance, reducing signs of facial aging, which some believe makes them look 10-15 years younger! Improvement in eyelid appearance and brow position can also be achieved at the same time, which may also provide functional improvement.
Where Will I See Results Of A Deep Plane Facelift?
Patients typically see improvement from Dr Rihani’s procedure from the neck, lower cheek, midface, and outer brow. The position of the outer brow, the jawline, and the neckline are noticeably improved.
Deep Plane Facelift Before And After
This lovely patient came to us to address the heaviness of her upper eyelids as well as neck laxity and jowling. We wanted to address some of the asymmetry of the upper eyelids as well as restore her beautiful, natural neckline and jawline through a deep plane face and necklift.
Recovery After Deep Plane Facelift Surgery
Most patients have a smooth, predictable recovery after surgery. In general, the first few days of recovery are followed by a slow, gradual improvement over the next 2 months. Here are a few more details that may give you an idea of what to expect.
The First Few Days
Following surgery, patients wear a neck and face wrap overnight. There are also two drains that remain in place during that time. The next day after surgery, the dressing and drains are removed. You are actually able to shower the next day after your surgery. Swelling will typically increase the first 3 days prior to getting better. Most patients may feel some sense of discouragement after the first days with the swelling that is present.
The First Two Weeks
Usually around days 7-10, there is a rapid improvement in the swelling and appearance. There may still be some bruising present, but patients have a sense of improvement and they can actually see some jawline definition at this time. The neck looks better than before surgery and you may be able to get out and about without obvious signs of surgery.
Weeks 2 and 3
We generally say that 80% of the swelling is gone at week 2. It is a gradual process at this time. Bruising may still be present and will go away gradually. Cool compresses may still be used in the evening if the neck and face feel tight. Patients begin driving at the 2-week mark.
Weeks 4-6
Resuming normal activity, patients start to feel like they are getting their routines back and feel overall better. Activities like golf and tennis should be delayed until the 2 month/8 week timeframe. But walking and lower body exercises are okay to begin.
How Long Does It Take To Recover From A Deep Plane Facelift?
The typical recovery time for a facelift is 2 weeks. At the end of 2 weeks, one may still have some bruising present. As bruising is different for everyone, the return to normal social situations may vary. We do our best to minimize any bleeding during surgery, but many patients may develop bruising 2-3 days after their surgery from increased activity.
How Long Before I Can Return To Work After A Deep Plane Facelift?
We recommend 2-3 weeks of time off following your surgery. Some patients return sooner to virtual meetings and work from home, which is up to the patient. Some patients do not mind a little bruising present when they return to work, and some patients are face-to-face with clients and want no signs of previous surgery.
How Long Do The Results Of A Deep Plane Facelift Last?
A facelift is a permanent solution to an ongoing process. In other words, the aging will continue, but a patient who has undergone the surgery will generally look better than before. Some patients may elect to undergo a second procedure after 10-15 years or so.
Cost Of A Deep Plane Facelift
The average costs of a deep plane facelift vary based on geography and the market and the experience of the surgeon. Additional procedures performed at the time of a lift will also, obviously make the surgery more expensive. Average costs are typically in the $30,000-$50,000 range.
Indications For A Deep Plane Facelift
Typical indications for surgery include skin laxity, excess fat under the chin, and sagging of neck and lower face tissues (including the jowls). Correcting the upper cheek and outer brow is also part of Dr Rihani’s deep plane facelift surgery.
Premature Wrinkles
Some patients have a genetic predisposition for loose skin or excess wrinkles around the lower face and neck. When decided the correct treatment plan, a deep plane facelift is able to correct many of these issues with adding unnatural volume. This lends itself to a more natural looking result.
Decreased Skin Elasticity
As we all age, the elasticity of the skin begins to decrease. This means that the skin sags, fat pads drop, and the face shape changes. The current devices on the market to restore elasticity unfortunately fall short of tightening the skin. The most procedure to reduce excess skin and tighten the neck and jawline remains the deep plane facelift. Unlike other facelift methods, the deep plane technique avoids unnecessary tension on the skin to avoid the stretched or pulled look.
Good Overall Health
All patients undergoing an elective surgical procedure must be in good overall health. Uncontrolled hypertension, diabetes, smoking, and heart disease are all contraindications for undergoing this type of procedure. If you are interested in any of these procedures and have these comorbidities it is important that you work with your primary care physician prior consult in order to optimize your overall health.
Contraindications
Patients are not candidates for surgery if they have health conditions that make them at high risk for undergoing surgical procedures. Also, people who smoke or use nicotine products are on anticoagulants, immunomodulators, or other medications, which can increase the risk of adverse outcomes.
Where Are The Scars Located?
All incisions are concealed along natural creases around the ear and behind the hairline in the brow. There is also a small incision under the chin when performing any work on the front of the muscles of the neck.
Will My Scars Be Visible?
Scars are typically red and lumpy for the first 2 months after surgery. After this, the scars begin to flatten and fade. Dr Rihani performs meticulous closures with small sutures on his incisions to ensure the best closure possible.
Deep Plane Facelift Vs. Facelift Technique
Marketing buzzwords and “innovative techniques” in facelifting can sometimes be misleading and confusing. There are differences in some of these techniques, however. Here is a brief introduction to some of those techniques and how they differ.
What Is A SMAS Facelift?
A SMAS (Superficial Musculoaponeurotic System) facelift may include a few different types of techniques that mobilize the SMAS layer without releasing all of the ligaments to the SMAS. The SMAS facelift can provide a nice, effective lift for some patients but may not provide as dramatic or long lasting of a result compared to a deep plane technique.
What Is A Ponytail Lift?
This type of lift is described as a deep plane lift while minimizing incisions or incision length. This procedure is nice for a limited number of patients who are experiencing some sagging of soft tissues but do not have a need for skin excision or need a limited amount of skin removed. When skin excision is not needed, the scars can be much shorter. Again, most patients need some form of skin removal unless they are performing this surgery in their 40s. Talk to your surgeon about whether you are a candidate for this procedure. Most patients will need some skin removed so this procedure may not have as long of a lasting result as a true deep plane facelift with skin removal.
What Is A Mini Facelift?
A mini facelift is not actually a facelift “technique.” We consider it as a descriptor of the scar length and downtime. Typically, a mini lift implies less downtime and short scars. Since this is not a technique description, facial plastic surgeons do not typically talk about this term between colleagues. If a surgeon is offering a “mini facelift,” you should ask them exactly what they mean by this marketing term and what technique they are actually using. Depending on which technique is used.
What Is A Liquid Facelift?
Liquid facelift is not a true facelift, it adds volume to the face using artificial fillers (hyaluronic acid, calcium hydroxylapatite, etc) in a way that can conceal some of the signs of an aging face. This relatively quick procedure provides instant results but is short-acting – typically 9-12 months.
What Does It Address?
| Liquid facelift | SMAS plication | Mini Facelift | Ponytail facelift | Deep plane facelift | |
| What does it address | Volume loss of the face | Neck and jowls | Varies | Jowls, nasolabial folds | Nasolabial folds, neck and jowls |
An Important Technical Point
| Liquid facelift | SMAS plication | Mini Facelift | Ponytail facelift | Deep plane facelift | |
| Important technical point | Performed with fillers, no surgery | Folding of tissues under skin | Implies a short incision but techniques vary | Hidden incisions mean that skin excision is minimal | Involves release of the 4 deep SMAS attachments |
How Long Does It Last?
| Liquid facelift | SMAS plication | Mini Facelift | Ponytail facelift | Deep plane facelift | |
| How long does it last | 9-12 months | 1-5 years | Variable | 5-10 years | 10-15 years |
What Is The Recovery Time?
| Liquid facelift | SMAS plication | Mini Facelift | Ponytail facelift | Deep plane facelift | |
| Recovery time | 1 week | 2 weeks | 2 weeks | 2 weeks | 2-3 weeks |
Risk of Complications
| Liquid facelift | SMAS plication | Mini Facelift | Ponytail facelift | Deep plane facelift | |
| Complication Risk | Low risk of vascular occlusion and irregularity | Low risk of scarring and nerve damage, bleeding | Low risk of scarring and nerve damage, bleeding | Low risk of scarring and nerve damage, bleeding | Low risk of scarring and nerve damage, bleeding |
What Is The Difference In Cost And Recovery Time?
| Liquid facelift | SMAS plication | Mini Facelift | Ponytail facelift | Deep plane facelift | |
| Cost | $$ | $$$ | $$$ | $$$$ | $$$ |
Why Choose A Deep Plane Facelift Over A SMAS Facelift?
Is a deep plane facelift better than an SMAS facelift – the short answer is “not necessarily.” In my hands, I prefer the deep plane facelift technique as it addresses the nasolabial folds more effectively than an extended SMAS technique. It is hard to compare facelift techniques between surgeons. A deep plane facelift may be better than a SMAS lift in my hands, but if a surgeon does not routinely perform deep plane facelifts, then the technique may be more challenging. Surgeons create results that look good in their eyes and adjust their techniques accordingly. That is the art of facelifting. Because of this, the before and afters are the most important factors when choosing your surgeon.
What Is A Deep Plane Face And Neck Lift And How Is It Different From A Deep Plane Facelift?
A facelift in the plastic surgery community refers to simply the cheek component of the lift. A neck lift refers to the neck component of the lift. Most of my surgeries utilize both neck and face components. The original description of deep plane facelifts does not really include a sub-platysmal mobilization in the neck, and so many surgeons create their own variations of a deep plane facelift in combination with a “deep plane neck lift,” meaning the attachments of the platysma are released and mobilized. This may be confusing as many surgeons are now referring to “deep neck surgery” as a way to talk about removing deep muscles and submandibular glands in the front of the neck.
Which Facelift Technique Will My Surgeon Use?
Dr. Rihani performs a deep plane face and necklift, usually in combination with an outer browlift for his facelift techniques. Oftentimes, this is combined with upper and lower blepharoplasty, browlift, fat transfer, lip lift, or laser resurfacing.
Every surgeon has a combination of techniques that they will use so that should be discussed with your surgeon. However, I do emphasize that not all surgical techniques are the same in each surgeon’s hands. Focus on their aesthetic ideals and before and afters as well as their practice focus on the facelift. Experience and volume is also very important.
Additional Procedures And Treatments To Enhance Facelift Results
There are a few procedures that may be beneficial after your surgery to maintain your result, or even enhance it. We discuss a few of those below and whether they are worth the investment or not.
Collagen-inducing Treatments To Further Firm The Skin
Dr. Rihani does not believe in collagen-inducing treatments following surgery. The surgery should address the skin laxity present during surgery. Many treatments that tout “skin tightening” actually can destroy valuable fat below the skin, creating more skin creepiness over the long term.
Surgical Procedures To Complete Your Results
Other surgical procedures performed at the same time as a facelift include upper and lower eyelid surgery, known as upper and lower blepharoplasty, fat transfer (using your own fat to add volume), laser resurfacing, earlobe reduction, lip lift, and brow lift. Many patients opt to perform these treatments at the same time as a facelift in order to make the most of their recovery time.
Injectables To Enhance Facial Features
Some patients require additional volume after a facelift. Dr Rihani performs fat transfer in about 50% of his facelifts in patients that have donor fat (usually from their abdomen or thighs). In patients who do not need much volume or do not have fat to use, we may use fillers after the patient is done with the healing process – usually around 6 months after surgery.
How To Find An Experienced Deep Plane Facelift Surgeon
Many of our patients find us through word of mouth. If you know someone who has had a facelift, it always helps to talk to them about their experience. If you do not know anyone, it always helps to start by seeing who in your area is a board-certified facial plastic surgeon or plastic surgeon. Dr. Rihani is board-certified by the American Board of Facial Plastic & Reconstructive Surgery (https://www.abfprs.org). For any surgeon, you would want to ensure that they are maintaining the proper certifications, that they have good patient reviews (check Google), and that they are doing a high volume of facelifts per year.
Why Choose A Deep Plane Face Lifting Surgeon At Facial Plastic Surgery Institute?
As a facial plastic surgeon specializing in facial cosmetic surgery, Dr. Rihani performs a high volume of deep plane facelifts every year. He has a reputation in his community as a Top Doc – nominated every year since opening his practice – and as a physician who cares about patient outcomes.
Dr. Rihani’s Face Lifting Expertise
After training at UT Southwestern, Dr. Rihani completed a facial plastic surgery fellowship under two excellent facial plastic surgeons – E Gaylon McCollough, MD, and Fred Fedok, MD. He subsequently opened his practice in 2015 and has focused exclusively on facial cosmetic surgery since that time. He is an active teacher of facial injectable techniques and facial aesthetics. He is also a clinical assistant professor at UT Southwestern and teaches both residents and facial plastic surgery fellows on current facial plastic surgery techniques.
Schedule A Deep Plane Facelift Consultation
If you are considering a deep plane facelift, Dr. Rihani offers both virtual and in-person consultations. Simply, fill out the contact form and one of our team members will reach out.
