The deep-plane facelift has become a buzzy catchphrase, with proponents praising its ability to address multiple layers of tissue and provide a longer-lasting lift. However, other experts have raised concerns about the procedure, highlighting the potential risks and lack of evidence for superior, natural-looking results. Here, we explore this trending technique’s popularity and examine if the “Ferrari of Facelifts” is worth all the hype.
PROS
01. A “Deeper” Lift
According to New York facial plastic surgeon Matthew White, MD the power of the deep-plane facelift is its ability to achieve optimal rejuvenation. “The deep-plane facelift can be likened to making a bed in the morning,” he says. “Just as you straighten the wrinkles and tuck the blanket, we adjust the skin and connective tissue canvas of the face, pulling it taut for a fresh, youthful look. I can tailor the surgery to work harmoniously with the patient’s unique facial structure, ensuring an enhanced yet natural appearance.”
02. Elevating Foundational Structures
As time passes, facial tissue descends, notes Newport Beach, CA plastic surgeon Jonathan Zelken, MD. Both traditional and deep-plane facelifts use SMAS manipulation techniques to restructure the tissues, muscles and ligaments. “With the deep- plane technique, the tension and pulling is directed at the deeper structures, like the muscles and ligaments, rather than the skin.”
03. Bringing in the Reinforcements
“Facial ligaments loosen over time,” adds Dr. White. “This technique repositions the cheek, the mandible angle and jawline ligaments at a deeper level, which help blend the face and neck.”
04. Addressing Fat Pad Descent
As the natural fat pads in the cheeks break down and descend, the face can lose its youthful plumpness. New York facial plastic surgeon Edward S. Kwak, MD says that repositioning the tissue using a deeper surgical technique can minimize the need for excessive fat transfer in some patients. “With this approach, the midface contours are rejuvenated and fuller-looking in a natural manner, which prevents the need for additional volume replacement with fillers or fat grafting,” he explains. Although, even with a deep-plane lift, judicious amounts of micro or nano fat grafting may be necessary.
CONS
01. Skepticism + Concerns
One expert who doesn’t buythe hype is La Jolla, CA plastic surgeon Robert Singer, MD, who has utilized various facelift techniques throughout his career. Expressing his reservations about the marketing surrounding the deep-plane lift, he questions if it has only achieved household name recognition because of social media. “While you might see before-and-after cases that show good results, what you’re not seeing is the unnecessary risks that patients are put under. You also don’t see follow-ups after a year or two or three to ensure the results are what they claim to be. It’s incorrect to say one technique is better than the other when it comes down to the skill, experience and artistry of the individual surgeon.”
02. Accounting for Differential Aging
Dr. Singer believes that the deep-plane facelift does not adequately account for the differential aging of tissue layers. “Older patients with significant skin laxity may not benefit from this approach, as it lifts all tissues together without separately addressing skin laxity. This can result in unnatural-looking creases and lines, particularly if there is existing sun damage,” he says.
03. Risk of Nerve Injury
There are also concerns about the higher risk of nerve injury associated with the deep-plane technique. “The procedure involves operating near the facial nerve branches, which increases the likelihood of permanent or temporary nerve damage,” says New York facial plastic surgeon Lee Ann Klausner, MD. While there is always a risk of nerve injury in any facelift, the deep-plane technique carries a higher risk in this regard, she notes.
04. Recovery Time + Natural-Looking Results
Contrary to popular belief, Dr. Klausner suggests that deep-plane facelifts have historically required a longer recovery period. “Additionally, there is no evidence to support the claim that the deep-plane results in a more natural appearance,” she says. “In a study published in 2004 in the Archives of Facial Plastic Surgery, board-certified facial plastic surgeons examined photos of 20 patients who had undergone facelifts to examine the results. Of those who were in the ‘best’ category, there were more SMAS placation facelifts, and the ‘average’ category had more deep-plane facelifts. The conclusion was that deep-plane did not seem to offer superior results in patients younger than 70 years old.”
05. No Superior Techniques
“I look at great facial surgeons like I look at great chefs,” says Dr. Singer. “They cook different ways, but they still can end up with great meals. It all depends on what works in their hands.” While he acknowledges the potential benefits for some, he believes other techniques like the bi-lamellar facelift, which partially involves the deep-plane but focuses on freeing up the skin, can also yield good results. “Artistic, natural-looking results are a result of elevating sagging tissue, removing excess skin, and replacing deficient volume or removing excess volume. Every patient is unique, and there is not one technique that produces good results in everyone. The artistry is individualizing the procedure based on the patient’s anatomy,” he adds.
