What is a Deep Plane Facelift
The deep plane facelift avoids the problem of the tight overfilled look of many modern facelifts. The main tenet of the deep plane facelift is that it lifts only under the muscle layer, leaving the skin attached to the muscle layers, so it can never look tight. It also lifts the cheeks by releasing the tethering points of the face in the deep plane so that addition of fat or filler is unnecessary.
The "deep plane" is the term used to describe the anatomic plane that exists between the SMAS-platysma complex (which is muscle and fascia) and the deeper layer of muscles responsible for facial expression. The deep plane facelift focuses on release and movement of muscle and fat layers instead of skin pull and removal. The extended deep plane facelift that Doctor Jacono has developed incorporates release of the ligaments tethering the deep plane layer to achieve tension-free movement so that no tightness can be created by the facelift procedure. There are four ligaments that he releases with corresponding natural lifting throughout the face and neck.
The first ligament released is the zygomatic ligaments that tether the cheek so that drooping cheeks can be elevated superiorly. This restores the cheek shape and volume recreating the heart shaped face of youth avoiding the need to add filler, fat or cheek implants to the face. It also will improve the nasolabial folds (creases from our nose to the corner of the mouth), and hollowing and shadowing seen under the lower eyelids by restoring volume that is lost by gravitational descent associated with aging. Doctor Jacono has published research in the Aesthetic Surgery Journal that this restores cheek volume equivalent to adding 3 vials of injected filler or fat in the face and that this effect is permanent. He releases the masseteric and mandibular ligaments that tether the jowl so that it can be lifted creating a smooth and crisp jawline appearance.
Deep Plane Facelift Patient Before and After 1: This middle aged woman had a deep plane facelift procedure performed by Dr. Jacono to lift her cheeks, jowls, and neck line. Minimal incision techniques were used to create a natural facial rejuvenation with no visible scarring.
Doctor Jacono was the first surgeon to describe the release of the cervical retaining ligaments that tether the platysma muscle in the neck and is the basis for his technique that is the extended deep plane facelift. This extension of the deep plane into the neck allows for more significant redraping of the platysma and rejuvenation and refinement in the neck and jawline is more natural and longer lasting. This part of the technique also improves the definition along the angle of the jaw, which is often blunted by bunching that is created in SMAS techniques.
Also unique to Doctor Jacono's technique is the vector or direction the face is lifted after the deep plane facelift release is accomplished. Traditional facelift tightens the face horizontally or towards the ears and making the face appear stretched and the cheeks flattened. This can also cause the corner of the mouth and eyes to look pulled. To avoid these problems a vertical vector or redraping is utilized. By lifting the facial more vertically a smoother more natural appearance is created, the cheeks are restored, and the corners of the mouth that sag with age is elevated. Doctor Jacono performed clinical research that was published to better define the angle of the proper vertical vector or direction of the lift. Dr. Jacono found the ideal vertical facelift "Angle for Maximal Rejuvenation" to be 60 degrees for patients with a mean age of 60 years old. As the age of the patient increases, the angle decreases. Conversely, patients younger than 60 years old will require a greater more vertical facelift angle.
Another innovation in deep plane facelifting Dr. Jacono has introduced to the plastic surgery literature is the ability to perform a deep plane facelift through a smaller incision. Often referred to a short scar or S-lift type incision, Dr Jacono's hybrid deep plane facelift is called a M.A.D.E. "Minimal Access Deep Plane Extended" facelift. This approach has a deep plane facelift scar that is half the length of a typical facelift scar. It is hidden inside the tragus and behind the ear so it cannot be visualized even when the hair is pulled back or placed in a ponytail.
Depending upon the degree of neck drooping and heaviness that occurs, the deep plane facelift may be combined with a midline platysma tightening called a platysmaplasty. Through a small hidden incision under the chin, vertical cords and bands in the neck can be tightened and chin fat that accumulates with age can be removed. Because Dr. Jacono's extended deep plane facelift more significantly lifts the platysma than other facelifting techniques, the additional midline surgery, trauma, and recovery can be avoided in a majority of cases.
Since the deeper layer utilized in a deep plane facelift is fibrous and inelastic, unlike the skin which is very elastic, the deep plane facelift procedure has the most long lasting result of any facelifting techniques. Because it works on the structural elements of the face, the deep plane facelift is more durable than SMAS type facelifts often lasting 10 years and beyond.
Over the course of almost two decades, Dr. Andrew Jacono has developed and pioneered the most advanced and comprehensive deep plane facelift that helps create natural results lifting drooping cheeks, jawline and neck without the appearance of the stigmata of tightness that can occur with other facelifting techniques. Doctor Jacono has published multiple hallmark research studies on his extended deep plane facelift technique in the Aesthetic Surgery Journal, the leading peer-reviewed plastic surgery publication of the American Society of Aesthetic Plastic Surgeons.
He has given lectures on deep plane facelift at Harvard Medical School, Yale University, Stanford University and the University of Pennsylvania, as well as delivered over 100 lectures on his extended deep plane facelift at the most important national and international plastic surgery symposia of the American Academy of Facial Plastic and Reconstructive Surgeons, European Academy of Facial Plastic Surgeons, and the International Society of Aesthetic Plastic Surgeons. He is considered an international expert in deep plane facelifting, and was recently selected as one of the 20 best facelifting surgeons worldwide to contribute to a textbook comparing their expert methods in facelift surgery. He has performed over 1500 deep plane facelifts and continues to teach his techniques performing live demonstration deep plane facelift surgery all over the world. Hundreds of surgeons from 6 continents have traveled to observe Dr Jacono perform a deep plane facelift.
Deep Plane Facelift vs SMAS
Most patients are concerned about "looking like they had a facelift" or looking pulled after surgery because they see so many celebrities, newscasters, and people in their communities looking like they had work done. The reason for this is that the most commonly performed facelift surgery in the United States is a superficial facelift called a SMAS plication lift, not a deep plane facelift. This facelift technique involves simply elevating the skin followed by placing sutures to lift SMAS-Platysma complex. The SMAS (Superficial Musculo-Aponeurotic System) is the muscle of the lower cheeks and jowl, and the platysma is the muscle that drapes across the neck and lower third of the face. Pulling this SMAS-Platysma layer is better than lifting the skin alone, but separating the skin from the underlying muscles as is performed in a SMAS facelift creates a tight look to the skin. This surgery only treats the lower third of the face and jawline and does not lift drooping cheeks. As a result, many surgeons will perform fat grafting to the cheeks at the same time. Fat grafting is performed by liposuctioning fat from the abdomen or thighs and injecting it into the face, often making the cheeks look overfilled because they are not lifted as they droop simply inflated. Unlike a SMAS facelift where the skin is separated from the deeper muscles and soft tissue, the deep plane technique repositions under the loosened saggy muscles and fat of the face as a unit leaving the skin intact.
Deep Plane Facelift Patient Before and After 2: Unhappy with her sagging jawline, neck, and eyelids, this patient opted for a deep plane facelift combined with a lower blepharoplasty with Dr. Andrew Jacono. Her before and after photos show her stunning jawline and tight neck area. It is also apparent that her cheeks have been lifted and her lower eyelids no longer look droopy and tired. Her overall facial rejuvenation shaved years off of her age and she looks beautiful and refreshed.
Deep-Plane Facelift Recovery
Recovery following a deep plane facelift usually involves some bruising and swelling around the repositioned areas for the first few days. These symptoms will gradually disappear on their own. Because the deep plane technique is accomplished in the layer that naturally exists in our face there is minimal bruising and minimal pain after the procedure. Deep plane surgery also maintains more of the natural blood supply to the skin by not severing blood vessels between the muscle and skin allowing for more rapid healing. SMAS type facelifts lift under the skin disrupting blood vessels. Because of this bruising is greater in non-deep plane facelifts.
Some pain medication may be prescribed to help the patient to feel more comfortable during the healing process. Patients will also be encouraged to apply cold compresses to help alleviate swelling and elevation of the head will be recommended as well. It is important to get plenty of rest during the recovery
Deep-Plane Facelift Scars
Deep plane facelift incisions heal with minimal to no visible scarring. Because the deep plane facelift does not separate the skin and the lift is supported under the muscles, there is no tension or pulling on the incision lines once closed. This tension free closure allows the incision to heal like imperceptible fine lines. It also prevents pulling of the earlobe after facelift which can create a "pixie ear" deformity where the earlobes elongated and are pulled down after facelift surgery.
Advantages of the Deep Plane Facelift
There are many advantages to having Dr. Jacono perform your deep plane facelift. As a pioneer and teacher of this surgical procedure, Dr. Jacono has developed improvements that his patients benefit from. To begin with, Dr. Jacono uses local or twilight anesthesia to perform the deep plane facelift and this allows him to keep the surgical time around 1 ½ to 2 hours long. Often patients will have an awake deep plane facelift with just numbing shots in the face using medication like novocaine you get at the dentist. A standard facelift procedure involves general anesthesia and surgical time that can last up to 5 hours. There is also less trauma caused to the facial tissue so the recovery time is also shorter.
An overview of some benefits includes:
- Shorter surgical time
- More natural results by repositioning the SMAS, platysma
- Restoration of natural volume and elevation of the cheeks
- Excess skin is removed leaving smoother skin
- Nasolabial folds are softened
- Quicker Recovery
- Better Facelift Scars
- Longer Lasting Result
Am I a Candidate for a Deep Plane Facelift?
Good candidates for a deep plane facelift are men and women who are showing signs of aging in their face that includes sagging and drooping skin. Candidates should be in good physical health and have a realistic expectation of the surgical outcome. During your consultation with Dr. Jacono, he will be able to determine if a deep plane facelift is a right procedure for you.
Deep Plane Facelift Patient Before and After 3: Unhappy with her wrinkles, sagging cheeks, jowls, and turkey neck, this woman in her mid 60's wanted to look refreshed and younger. Dr. Jacono performed a deep plane facelift combined with an upper blepharoplasty and co2 laser resurfacing. This patients before and after deep plane facelift photos show her looking radiant and 15 years younger.
To learn more about this procedure or to schedule your deep plane facelift consultation, contact Dr. Jacono today at 516-773-4646.>