Deep Plane Facelift
The deep plane facelift is the most effective type of procedure providing the best results with longevity. The term 'deep plane' refers to the SMAS layer of the face which is a deeper layer under the skin of the face which supports the facial fat compartments and the underlying muscles.
There are also deeper ligaments which attach this SMAS layer to the facial skeleton to provide additional support. This SMAS layer is the main layer which is lifted during a facelift in order to provide the rejuvenating and lifting effect. The main area of tension and lifting occurs with the SMAS layer and not the skin. Although some excess skin is removed during a facelift the tension on the skin closure should be minimal otherwise adverse scars can result. The SMAS lift therefore provides reduced tension on the skin closure.
A deep plane facelift is simply a variant of a SMAS technique which involves dissecting more extensively under the SMAS layer and releasing the supporting ligaments to enhance the lifting effect. This also allows a more effective mobilisation of the sagging tissues along the jawline, neck as well as the cheek so that they can be freely lifted and restored to a more youthful position. This often provides a more effective and longer lasting result in many patients.
In an extended deep plane facelift the SMAS layer is even more widely undermined and lifted until it allows the tissues to be freely repositioned in different vectors . For example, the SMAS layer in the cheek can be elevated upwards to lift the tissues of the cheek and jowl. At the same time the SMAS layer can be lifted in contiuity with the neck muscle and tightened along the jawline to aid the contouring and provide definition along the jawline. This versatility helps achieve the most effective and yet natural results. However, very few surgeons will perform a true extended deep plane facelift since the surgery is more technically demanding.
Advantages of a deep plane facelift are:
- It reverses but also stabilises the signs of facial ageing
- It provides a restoration of your true younger anatomy by elevating the deeper tissues rather than just the skin
- It allows contouring of multiple parts of the face including the malar region, midcheek , jawline and just below the jawline
- It provides good definition to the jawline
- It has excellent long term results
- If used in younger patients it significantly delays facial ageing - an effect called pre-juvenation
Mr Chana routinely performs deep plane facelift surgery in the majority of his patients and is well known for his experience. He is well regarded by his peers and most importantly his patients. You can learn more about this technique in the sections below and view the remarkable results of the patients Mr Chana has treated in photographs and real life videos.
How is the deep plane facelift performed ?
The incisions made around the ear are the same as a standard face lift . The skin is elevated in order to gain access to and dissect under the SMAS layer. The SMAS layer is usually elevated together with the platysma muscle in the neck. During this dissection some of the ligaments attaching the SMAS layer to the facial bones are released in order to more effectively mobilise the tissues. This can help to accurately position the tissues and help provide volume in areas such as the mid cheek and the cheekbone area at the same time.
There are multiple deeper stitches which are used to position and lift the SMAS layer. The exact vector of lift can be varied in the cheek compared to the neck in order to specifically enhance the rejuvenating effect in different parts of the face.
After the deep layer surgery has been completed the skin is redraped and the excess skin which has been drawn upwards with the SMAS lifting is then trimmed and carefully stitched in a manner that hides the incision in the natural curves in front of and behind the ear.
Where are the scars and how do they heal after surgery ?
The scars are well concealed around the curves both in front of and behind the ear and along the hairline. The video of my patient below shows the stitch line the next day after surgery and how well these scars heal a few weeks after surgery.
Watch this video explaining where the scars are located from a deep plane facelift and the recovery:
How long does the procedure take to perform ?
Since the surgery involves more dissection the procedure takes longer than a standard SMAS facelift and is usually perfomed under general anaesthesia. This may take approximately 2 and a half hours. It should be remembered that this surgery is not rushed and that all the necessary time that is required is taken to ensure a meticulous technique is employed to obtain the best results with the time taken varying from person to person. Many patients are usually undergoing additional procedures which may involve chin liposuction , platysmaplasty (neck lift) or eyelid surgery which add extra time to the overall length of the procedure.
Am I suitable for a deep plane facelift ?
You are suitable for a deep plane facelift if you have the following features of facial ageing :
- Laxity and wrinkles in the cheek
- Jowl formation
- Heavy lower face with laxity along the jawline
- Laxity under the jawline in the upper neck
- Prominent nasolabial and marionette lines may benefit in some cases
What is the recovery from a deep plane facelift ?
There is very little discomfort after the procedure and usually only mild painkillers are required. There may be some mild bruising along with swelling which tends to subside by about two weeks. The modern techniques of anaesthesia and meticulous surgery significantly reduce the level of bruising and swelling.
You will see in the video above that there is in fact very little bruising even at the first day after surgery. There is very little pain with patients normally experiencing discomfort and a sensation of tightness which gradually subsides over a week or two.
During the first few days it is important to be gentle with movements, avoid heavy lifting and sleep upright. These measures help to reduce the swelling.
In the first week there will be stitches to be removed from around the ear and if neck surgery has been performed at the same time there will be stitch to remove from under the neck.
After two weeks the swelling and bruising should have subsided to the extent that it would not be too noticeable in public.
It is advisable to refrain from exercise for about 6 weeks.
The scars may be a little red in the first few months especially behind the ears but will slowly settle aided with massage and silicone scar cream.
There is some loss of sensation which slowly improves over a period of about a year. This is usually of little concern since this does not affect the front of the face. The nerves recover and the areas of skin near to the ear may take several months to a year regain full sensation. During the recovery there may be some temporary tingling or pins and needle type sensations.
There may be some thickenings or mild lumps under the skin but these slowly soften and settle down over a few weeks.
In general, you will be acceptable to appear in public after 2 weeks and be back to full activity after 6 weeks. You will look your best at 3 months.
What is the typical result from a deep plane facelift. ?
The result of the surgery aims to address the laxity in the cheeks and jawline. It is important to remember that if there is laxity under the chin and in the neck it is best to perform a necklift and tighten the playsma muscle at the same time to achieve the best result. For this reason many patients will be advised to have necklift at the same time which works in conjunction in contouring the area under the chin but also adding a further element of contouring to the adjacent jawline. The example of the video below demonstrates exactly such a patient:
Watch the video below of the real life result of my patient and her deep plane facelift result
How long does a deep plane facelift last ?
The effects of a deep plane procedure are likely to last 8 to 10 years. However, it is important to remember that the surgery restores the youthful anatomy and it is not just a skin tightening. Therefore, it slows down and stabilises the ageing process. This means that in 10 years time after the surgery you will still look better than if you did not undergo surgery. When performed in younger patients this effect is called pre-juvenation in order to slow down the ageing process.