Deep-Plane Face and Neck Lift

Dr. McInnes has spent years learning advanced deep-plane facelift and neck lift techniques because he believes they provide superior results compared to other facial rejuvenation methods. He has learned these directly by many of the best face and neck lift surgeons in the world. Due to it’s more complex nature, extended deep-plane surgery is not a technique offered by many other plastic surgeons in BC. The goal of deep-plane face and neck lift surgery is to provide patents with a refreshed, significantly more youthful appearance that looks natural (with a nicely contoured jawline!). Keep in mind, a face and neck lift alone does not lift the eyebrows, nor does it tighten loose skin around the upper or lower eyelids. It rejuvenates primarily the neck and lower third of the face, and secondarily the middle of the face (ie. the cheeks).

Deep-Plane Face & Neck Lift FAQs

What is a deep-plane face and neck lift? How does it compare to "simple" facelift?

Face and neck lift surgical techniques vary much like the build quality of any object. Some of these techniques are quick, easy, and provide modest improvements that are short-lived. Others, such as extended deep-plane face and neck lift surgery, are more complex, require more expertise, more surgical patience, and have potential for better jawline definition, cheek elevation, and longer lasting results. Much like home renovations where the build quality and effort made by a contractor varies, the same applies to surgical rejuvenation of the face and neck.

Extended deep-plane surgery involves a release of multiple tethering points throughout the face and neck, and is performed “deeper” in the face. The ligaments of the face are much more extensively release vs. simple facelift techniques. The advantage of this is it allows the deep structures of the face to be re-elevated farther and with less tension than could be achieved with simpler techniques. Another advantage is it allows the skin to simply “come along for the ride”, because the pull is placed only on the deep tissues of the face that are free and mobile. As a result, there is essentially zero tension on the skin, which makes the outcome look more natural and is theoretically longer lasting. 

Finally, and perhaps most importantly, the ability to confidently work on the deep structures in the neck and sculpt them appropriately is often necessary to achieving a nice result and contoured jawline. Without this ability, many necks will be under-corrected.

If deep-plane surgery is supposedly better, why is it offered by only a select few surgeons in BC?
I personally believe there are many reasons for this. First of all, it’s more complex, more time consuming, it is cost-prohibitive for some patients, has a much higher learning curve for the surgeon, and finally it requires a much more detailed and thorough understanding of facial anatomy. Dr. McInnes has studied deep-plane face and neck surgery extensively. He has trained with master surgeons throughout North America to understand the surgical anatomy in great detail.

Are all deep-plane face and neck lift techniques created equal?

Absolutely not, and that is quite important to consider. In fact, because the term “deep-plane” has become somewhat trendy, surgeons may falsely advertise what they are really doing. For example, a 1cm dissection below the SMAS layer of the face is technically in the “deep-plane”, but does not release the ligaments of the face in a meaningful way or provide any physical advantages to a simple facelift.  Equally, any slightly deep neck dissection could be branded as “deep-plane” surgery, which is technically true, but certainly not the same as advanced open neck sculpting. 

Deep neck surgery requires the surgeon to be confident and capable of advanced neck dissection, including dealing with structures such as large digastric muscles, deep sub-platysmal fat, and reducing (not removing) submandibular glands. If the neck lift surgeon is not able to manage all of these structures individually, they will not be able to correct the neck fully in each case, and may actually cause secondary aesthetic problems. Most surgeons are comfortable enough to release the skin of the neck and sew the central muscle (the platysma) together which will improve the neck contour to some degree. Many surgeons are not comfortable managing some of the deeper structures which limits the jawline contour in most cases. Gaining experience with these procedures requires dedication from the surgeon to learn them in their own time as it is not adequately covered in standard surgical residency.

Please also note, many surgeons use terminology to brand their surgery in a unique way which is confusing to patients (this is particularly common in the USA and on social media). Despite differences in name, most are performing established facelift procedures such as a SMAS plication, SMASectomy, or deep-plane surgery.

Explain the SMAS anatomy in relation to deep plane surgery

There are multiple layers of the face. The skin, a thin layer of fat below the skin, followed by a deep supportive layer of interwoven muscle and connective tissue called the SMAS (superficial musculoaponeurotic system). Below the SMAS lies the facial nerves, deep fat, glands and deeper muscles. A deep-plane facelift requires a dissection below the SMAS (but above the nerves), releasing tethering points and allowing it to easily re-drape. Fortunately, there are “spaces” right below the SMAS that can be carefully entered so the ligaments can be released. A simpler option is to dissect above the SMAS, then pull it upwards tightly with sutures without releasing it (eg. SMAS plication). 

A commonly used analogy is that of a tree. Think of the leaves as the skin, the small branches as the thin fatty layer right below the skin, and the SMAS layer as the upper part of the tree trunk. If the lower part of the trunk gets released, and we pull on the upper trunk, the leaves (i.e. skin) come along for the ride without tension. Conversely, if we just cut the small branches near the leaves (right below the skin) and then pull on the trunk without releasing it, it is harder to get sufficient movement without tension.

Can I still get good results without deep-plane technique?
Yes, this is possible. There are good surgeons who don’t employ deep-plane techniques. Most surgeons agree, a well performed simple facelift can give better results than a poorly performed advanced facelift. Equally, there can be certain situations encountered intra-operatively that prevent a full-deep plane release from being performed, and sometimes only a partial deep-plane release can be performed by Dr. McInnes (this is a great question to bring up at your consultation). Despite these statements, there must be a reason why the majority of the top facial rejuvenation surgeons in the world employ deep-plane techniques.

How do we age?
As humans age there are multiple changes which affect our facial appearance, including descent of facial fat pads, decreased facial volume, loose and inelastic skin, loose neck muscles, and even changes in our bone structure. All of these changes contribute to a less youthful appearance over time, such as jowls and loose neck contours. In order to fully rejuvenate the face, all of these changes need to be considered and addressed.

Which “add-on” and “upkeep” procedures are common?
Eyelids, eyebrows, facial fat grafting, skin resurfacing, and anti-wrinkle injections are common. These aren’t always done at the same time, but really help balance the entire face. Humans lose facial fat as we age, and therefore fat grafting is often important and recommended. Upkeep includes staying healthy, avoiding smoking, using sun protection, and some upkeep with neuromodulators (anti-wrinkle injections).

What medication will I be given or prescribed after surgery?
Dr. McInnes believes in multi-modal pain treatment as it has shown to be the most effective and decreases the use of narcotic pain medications. He will commonly treat his patients with a combination of acetaminophen (Tylenol), and a short course of low-potency narcotic. In combination with the numbing (freezing) medication injected at the surgical site, many patients are surprised by just how little narcotic medication they use after face and neck surgery.

When can I resume normal activity and exercise?
Following facelift surgery, it’s important to take it easy for 4-6 weeks. Over-activity can cause bruising and put tension on the incisions. Many patients are socially presentable after 2-3 weeks and able to return to work after about 3 weeks. Dr. McInnes will provide you with a detailed post-operative form to review before and after surgery.

What are the risks of surgery?
There are risks associated with your surgery. Please download the consent form designed by the American Society of Plastic Surgeons (ASPS) for a detailed list and description of the risks involved. Risks of surgery will be discussed in detail prior to your consent. It is important to address all your questions directly with Dr. McInnes.

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What Training Does Dr McInnes Have in Advanced Face and Neck Lift Procedures?

In addition to 5 years of dedicated plastic surgery residency training in Canada, Dr. McInnes completed a fully accredited 1-year fellowship in complex plastic surgery techniques at Washington University in Saint Louis. He is extensively trained in nerve surgery, which are the anatomic structures facelift surgeons worry about the most, and also the structures that prevent most surgeons being comfortable with deep-plane surgery. Since being in practice, he has also sought out extensive additional aesthetic training with many of the best facial rejuvenation surgeons in the world. He has spent time with over 12 different surgeons, actively analysing their techniques and outcomes. He has also participated in multiple, advanced deep-plane cadaver courses to learn the surgical anatomy from experts in North America and Australia. Facial rejuvenation is one of his passions and something he actively studies and chats about with colleagues on a daily basis.

What Can Affect My Surgical Outcome?

A well-done facelift surgery can often make patients look 10-15 years younger, and should continue to age at a normal pace afterwards. However, the reality of any rejuvenation procedure is that sometimes the results aren’t as striking as intended or don’t last as long as hoped.  The SMAS layer of the face is the “workhorse” for supporting the changes made to rejuvenate the face. Unfortunately, sometimes the SMAS itself is very thin and weak, and doesn’t hold up as much as we would like. Sometimes we don’t know about patient soft tissue quality until we’ve started the surgery.  Things that can affect the integrity of the SMAS include large changes in weight, being overweight, prior smoking, or simply genetics. Equally, patients who put too much strain on their face too early after surgery can cause some of the deep sutures to fail. Abnormal bleeding during surgery can make the dissection more difficult and limit the surgeon’s ability to effectively release the SMAS safely (which is why blood pressure control and avoiding medications or supplements that can lead to bleeding is so important). There are alrso genetic neck structures that are quite difficult to effectively modify, such as the position of the hyoid bone. Much like the building materials used in a home renovation impact the outcome, the quality of the facial skin and connective tissue will impact the final outcome following facial rejuvenation surgery.

Face and Neck Lift Recovery

Recovery is a gradual process and is different for each patient. Dr. McInnes continues to work with his anesthetists to keep the anesthesia “light” in order to facilitate recovery. You will also be given a “getting ready for surgery” document to help plan for surgery. If you decide to proceed with surgery, Dr. McInnes will ask that you come back to the office for a second visit 2-4 weeks before surgery. At this second visit he will discuss the post-op course with you in greater detail, and give you any prescriptions so they can be filled before surgery. His goal is to make the experience as seamless as possible. Most patients still have some minor bruising at two weeks, and most are socially presentable after 2-3 weeks (it’s a gradual, ongoing process). Blood pressure needs to stay on the low side for at least 4 weeks. 

What Happens At My Consultation?

Dr. McInnes will review your medical history and ask you about your aesthetic concerns. He will then perform a detailed facial assessment and discuss different treatment options with you. Afterwards, your surgical quote will be provided by the office staff.  Book your consultation by filling out the form above, or contacting our office.

How Much Does a Facelift and Neck Lift Cost in Vancouver?

The cost of an extended deep plane facelift starts at $25,000. An extended deep plane facelift with open neck contouring and minor facial fat grafting starts at $30,000. Prices for face and neck lift surgery are based on your individual surgical requirements, the exact procedures you require, and will be provided after your assessment. If comparing prices between surgeons, please remember that facelift techniques vary greatly and that deep-plane surgery is more time consuming, requires more expertise, and is more expensive to perform. Financing plans are available and are an increasingly popular option.