“People believe—probably as a result of its name—that the deep-plane facelift is major surgery.”

Dispelling Myths of the Deep-Plane Facelift

A deep-plane facelift repositions the deep soft tissues of the face. It lifts the whole face, accentuating the jawline, neck and cheekbones. It produces long lasting, natural looking results, without giving you a ‘done look’. The deep-plane facelift is not major surgery. It requires less time for healing than a skin only or a standard facelift. Only a small group of highly skilled surgeons perform this procedure worldwide.

Posted: 9 October 12

Cosmetic surgery has been around for a few generations. Back in the 1940s when Norma Jean began her transformation into Marilyn Monroe, cosmetic surgery was a primitive field. In the past seven decades it has evolved to a point where the sophisticated new-generation procedures are nothing like their primitive versions. They are performed differently, using new techniques and new knowledge of anatomy and physiology. Today’s procedures look and feel different and produce vastly better outcomes.

First generation facelifts, which pulled the skin in an attempt to make it look younger, distorted facial expression and resulted in a plastic or ‘done look’. Today, thankfully, that look is out. Instead, most people want to turn back a few pages of time. They want to look the way they feel inside, but with subtle changes, not dramatic transformations.

And facelifts today are not just for the celebrity crowd; they help people from all walks of life gain confidence, both at work and in their private lives. Men and women alike feel more confident when they know they look good.

Skin only facelifts are a thing of the past. Modern surgical techniques can now make facelifts look more natural and last longer.

The standard facelift these days is the SMAS facelift. This technique gets its name from the superficial musculo aponeurotic system, a sheet or layer of fibrous connective tissue that lies beneath the facial fat layer.

“The SMAS layer of the face separates the deeper facial structures, facial movement muscles, nerves and other structures that are not as affected by the ageing process as the soft tissue of the face,” explains Dr Neil A. Gordon, a Facial Plastic and Reconstructive Surgeon, internationally recognised as an expert in facial rejuvenation and rhinoplasty.  He is the Director of Head and Neck Aesthetic Surgery at the Yale University School of Medicine.

“The SMAS facelift is sometimes also referred to as a ‘muscle pulling lift’, because surgeons often describe it to their patients as tightening the muscle (SMAS) layer. It is clearly an improvement over skin only facelifts, but a SMAS facelift has only a minor effect on the deeper tissues of the face. It can still require skin pulling to achieve results.”

Gordon, whom we met during the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS 2012) conference in Washington DC, is one of a group of elite surgeons around the world who perform the deep-plane facelift. After completing his Internship in General Surgery and Residency in Otolaryngology/ Head and Neck Surgery at Yale University School of Medicine, he went on to hone his skills under the supervision of the world-renowned facial plastic surgeon, Calvin M. Johnson, M.D.

According to Gordon, the SMAS lift helped the cosmetic surgery community to appreciate the benefits of pure deep tissue repositioning, which then led to the more sophisticated technique of the deep-plane facelift.

Both Dr Johnson and Dr Gordon influenced Sydney Facial Plastic Surgeon Dr George Marcells. He performs the deep-plane facelift. According to Marcells, a deep-plane face and neck lift essentially repositions facial soft tissues below the SMAS layer by releasing them from underlying muscles and reattaching them at higher anchor points. “This means that the whole face can be lifted” he says, “creating a more defined jaw, neck and cheekbones.”

The deep-plane facelift involves limited dissection under the skin, preserving the lymphatics and minimising swelling. During the operation the surgeon dissects below the SMAS layer, releasing it from the underlying muscles completely. “Even the mid-face fat is freed up by dividing the cheek ligaments which tether it to the cheekbones beneath”, says Marcells, “allowing the face to be lifted more naturally. The operation is completed by solidly re-anchoring the released SMAS layer at a higher level.”

Dr Gordon adds that we shouldn’t be confused by the term “deep plane”. Although it refers to the fact that the dissection of facial tissues occurs deeper than a SMAS procedure, he emphasises that a better name would be the “correct plane facelift”. He says, “Imagine a banana. When you peel it, the skin comes off easily. When you work at the deep plane level this is the correct plane to be working at. A SMAS based facelift is akin to pulling on the skin of the banana. A deep-plane facelift is more like dissecting the skin of the banana and reattaching it in a new position. Because the deep plane is the correct plane to dissect facial tissues and reposition them, the results are much better, longer lasting and there is much less trauma of the tissues and therefore a faster and more painless recovery takes place”.

“In that sense, traditional facelifts are rather limited because they require wide undermining of the skin, separating it from the underlying lymphatics. This separation often leads to delayed swelling. This standard facelift may not last long and requires revisions. Tension on the skin can lead to poor wound healing, resulting in lumpy red stretched scars. The standard lifts also offer limited scope for improvements in the mid-face area which can end up with a mismatch of healing often causing that abhorred ‘pulled’ look.”

Due to the inherent limitations in standard facelift surgical techniques, undesirable outcomes are possible even in the hands of the best surgeons.

The deep-plane facelift procedure offers superior results. “The lift is more powerful, creating long-lasting improvement of the jawline, neckline and cheekbones,” says Marcells. “There is no ‘pulled’ appearance, since the whole face is evenly lifted. The look is very natural. Also, there is no tension on the skin, which helps incisions heal very quickly. Unsightly scarring is also extremely unlikely.”

Marcells prefers the deep-plane facelift to other techniques because its results are longer lasting, more natural looking and because it leaves no telltale signs to show that you have had a facelift.

In our discussion with Dr Gordon, he was emphatic about dispelling a number of myths associated with the deep-plane facelift: “People believe—probably as a result of its name—that the deep-plane facelift is major surgery. They imagine that it requires a long recovery period. But in reality it is far less painful and requires much less time for healing, because the technique tightens soft tissues deeper than the SMAS and skin layer and involves no pulling of the skin.”

According to Gordon, “People also have this misconception that the face loses volume over time and that they need to fill their faces with dermal filler and other products”. However, facial surgeons understand that the volume in our faces remains the same over time. “What really happens is that the ‘box’ carrying this volume—our skin—becomes bigger as a result of sagging” explains Gordon. “This is why the face looks as though it’s lost volume.” He further stresses this point by saying that he actually removes skin and volume from the lower face area when performing the deep-plane facelift.

While traditional facelifts aimed to produce dramatic transformations in older people, the deep-plane facelift also helps a younger group, often still in their 40s, to slow and soften the facial ageing process. This does not mean that you cannot have the deep-plane facelift if you are older and your face shows significant signs of ageing—you can. But it opens up opportunities for younger people to delay and arrest the signs of ageing by having early treatment. Because these people are having facelifts at a relatively young age, the results are not dramatic. These patients just look refreshed for their age.

Gordon promotes his patients’ recovery during the post operative period by offering a nurturing environment replete with post surgical care, freeing them of uncertainty, fears or doubt. “Knowing you are being watched over and cared for by professional staff in a private secluded location—the Retreat at Split Rock—helps patients to focus fully on their recovery,” he says.

Typically you should expect to pay in the range of $20,000 (AUD) to $30,000 (AUD) for a deep-plane facelift. The healing process will continue for several months, but you should be able to return to normal activities in a couple of weeks.

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