Pre Operative FaceLift Information

You can download this information above as a printable .pdf file here: Deep Plane Facelift pre-op

Deep Plane Facelift

The deep plane facelift

The facelift is the operation that can truly reverse the changes of ageing in a significant and permanent
fashion. Unlike injectables, which can make the face appear full, paralysed or just unnatural, a well
performed facelift can remove 10-15 years of ageing or more from a face and neck.

The facelift operation has evolved significantly over time. Early facelifts were done by tightening skin
alone. This led to a ‘tight’ appearance in the face that often looked unnatural. The results also tended
not to last for more than a couple of years.

Further research determined that a more permanent and natural result could be obtained by tightening a deeper layer in the musculature of the face, known as
the superficial muscular aponeurotic system or SMAS. The SMAS lift is a commonly practiced
facelift procedure with good results. The Deep Plane Facelift is the next evolution.

The deep plane facelift lifts a layer of tissue which is fibrous and inelastic. Unlike the skin which is
very elastic and has a tendency to re-stretch over time, the deep plane facelift is durable. Results
should last 10 years of longer, far longer than a traditional SMAS lift. The deep plane facelift creates
natural results and avoids the stigmata of tightness that occur with other facelifting techniques.

What is a deep plane facelift?

The key distinguishing feature of a deep plane facelift is that it lifts only the muscle layer (the
SMAS), leaving the overlying skin attached. This means that the skin never looks tight or unnatural. It
also releases important tethering points in the cheek area and along the jawline. This allows the
muscle layer to re-drape in a very smooth fashion so that the addition of fat or filler is unnecessary.
The “deep plane” is a term used to define the tissue layer between the SMAS and the muscles of facial
expression which lie deep to it. The muscles of facial expression are covered by a thick layer of fascia
so in a properly trained surgeon can be identified very easily. The deep plane facelift releases the
SMAS muscles with their attached skin and fat and repositions them. This avoids pulling on the skin
or removing excessive amounts of skin.

Four ligament groups need to be released in order proper movement of the droopy structures of the
face and neck.

1. The zygomatic ligaments connect the cheek skin to the underlying bones. In order to elevate
the cheeks, they need to be released. A youthful face appears “heart-shaped”. Once the
zygomatic ligaments are released, tissue can be moved upwards to restore this heart-shape.
Additional filler, fat or cheek implants are not necessary. Releasing these ligaments also helps
to elevate tissue into areas of hollowing under the eyes and lift the nasolabial folds.
2. Mandibular retaining ligament. This ligament tethers the tissues along the jawline near the
chin. When it is released marionette lines around the chin as well as the anterior jawline are
improved.
3. Masseteric cutaneous ligaments. These ligaments tether tissues along the angle of the jaw.
Once they are released they allow the entire jawline to becomes much smoother and tighter.
4. Cervical retaining ligaments. The deep plane facelift is extended down into the neck to allow
re-draping of the neck tissues in continuity with the facial tissues. This produces an
appearance to the neck which is youthful and long lasting. Traditional SMAS lifts can
sometimes cause tissue to be bunched up around the back of the jawline. By lifting tissues
back up into the face rather than at the back of the jaw this problem is avoided

Vertical lifting

Traditional facelifts often focused on stretching skin backwards towards the neck and ears. This
sometimes gave the face a very stretched appearance. This could flatten the cheeks. Even the corners
of the eyes or the mouth would sometimes be pulled sideways giving the mouth a “fish-like” look. A
deep plane facelift uses a vertical vector to lift tissues upwards rather than backwards. This creates a
much more natural facial contour. The cheeks become volumised, sagging corners of the mouth are
altered from downward pointing to slightly upward. The actual best angle that tissues need to be lifted
tends to become more vertical as we age more than 60 and needs to be customised to each patient.

A deep plane facelift may need to be combined with a procedure in the midline of the neck called a
platysmaplasty. The free edges of the platysma muscle often sag down into the neck creating two
vertical lines an inch or so apart from the midline. A small incision may need to be made just under
the chin to identify these muscle bands and suture them together. This creates a type of muscle sling
that can be used to lift up any loose fat in the neck. The incision under the chin is very well hidden. In
the majority of patients, the deep plane facelift creates such a wonderful lift in the neck that the
platysmaplasty is not necessary.

Deep plane facelift vs SMAS

The SMAS facelift remains the most common facelift technique performed around the world,
particularly in the United States. Typically, a type of SMAS lift called a “SMAS plication lift” is
performed. This is not a deep plane facelift. In this surgery, the skin is completely lifted off the SMAS
and then sutures are placed within the SMAS to tighten it. This can give a very easily spotted look
“like you had a facelift” and is readily seen in celebrities and newsreaders. Pulling on the SMAS gives
better results than lifting the skin alone but a SMAS facelift can create a very tight look in the skin.
A SMAS facelift can really only effectively treat the lower face and jaw well. Drooping cheeks are
often not well addressed. This means that some surgeons then perform fat grafting at the same time.
This can make the cheeks seem overfilled as the underlying problem of descent of tissues has not been
corrected. The deep plane technique repositions the saggy muscle and fat of the face back into it’s
proper position as a continuous unit.

Deep plane facelift recovery

You can expect some bruising of some areas of the facial and neck skin for the first week after a deep
plane facelift. Swelling of the face occurs the morning after surgery. The swelling will be significantly
improved by 2 weeks but will continue to decrease in size over around 6 weeks.

The bruising and swelling from a deep plane facelift is much less than with a standard SMAS facelift.
This is because the deep plane technique is performed in a natural tissue plane layer that does not
usually have many blood vessels within it. In addition, the attachments from the skin to the SMAS
layer underneath it are left undisturbed for most of the face, again leading to less skin bruising and
swelling. SMAS facelifts typically disrupt the attachments between the skin and SMAS.

Typically, patients feel little to no pain after surgery. Head elevation and cold compresses can be
helpful to assist with reducing swelling.

Deep plane facelift scars

The deep plane facelift leaves the most hidden scars of any facelift surgery. Due to the fact that tissues
are lifted in a deep layer, little to no tension is placed on the skin. This allows the skin edges to close
together with almost no visible scarring. Scars will appear as very fine lines which are nearly
imperceptible. Another key benefit is that this technique prevents the earlobes from being pulled
downwards which can create a “pixie ear” deformity.

Advantages of the deep plane facelift

• More natural results by repositioning the SMAS and platysma layer
• Restoration of natural volume an elevation of the cheeks (no need for fat grafting or facial
  implants)
• Shorter recovery time
•  Better scars
• Longer lasting result
• Improved nasolabial folds
•  Smoother skin

Am I candidate for a deep plane facelift?

A deep plane facelift is helpful in both men and women who display sagging face and neck skin. This
includes jowls along the jawline, platysmal vertical bands in the neck and other areas of droopy skin
around the midface and mouth. In some patients these changes can being to occur in their 20’s and a
deep plane facelift may still be the best solution. Patients should be non-smokers and be in good
physical health. During your consultation with Dr Roth he will be able to advise if you are a suitable
candidate for a deep plane facelift.