Deep-Plane Face and Neck Lift

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.

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.

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.

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.

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.

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.

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).

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.

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.

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.