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.

Simple, tension-based facelift techniques can also work and give nice results, but in general, tension is the enemy of nice scars, full correction, and lasting results. One of the main reasons Dr. McInnes switched to deep-plane surgery is he found simpler techniques often lead to under-correction, and he wanted to achieve the nicest results he could for his patients. A simple facelift is usually done with suture tension placed into the deep facial structures, without releasing them.

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.

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.

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.

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.

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. As discussed, 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 also 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.

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 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.