The deep-plane facelift is a longer lasting alternative to standard facelift techniques. During a deep-plane facelift, the surgeon repositions soft facial tissues by lifting the whole face rather than just the superficial layers of skin, accentuating the jaw, neck and cheekbones.

This results in a more natural looking outcome, without the stretched ‘done look’ that is fast going out of fashion. Although the deep-plane facelift is not considered major surgery, only a few surgeons have the expertise to perform the procedure with success. A deep-plane facelift also requires less healing time compared to a skin only or a standard facelift.

The deep-plane facelift is currently the gold standard in facelifts. As a result, a deep-plane facelift can be more expensive than a traditional skin-only facelift or the standard facelift.

While skin-only facelifts focus on the outmost skin layers, giving rise to that ‘done look’ most people associate with facelifts, the standard facelift today goes a bit deeper to the submusculoaponeurotic system or the SMAS layer. The SMAS layer lies beneath the facial fat and is made up of fibrous connective tissue. It separates the deeper facial structures like the muscles that control facial movements, nerves and other structures of the face from the superficial layers of the face.

Although the SMAS facelift is an improvement over skin-only facelifts, it has only a minor effect on the deeper tissues. For this reason, some degree of skin pulling is necessary to achieve a satisfactory final result. Sometimes the SMAS facelift is referred to as a ‘muscle pulling lift’.

In contrast, a deep-plane facelift repositions deep facial soft tissue that lies beneath the SMAS layer, allowing the whole face to be lifted. The result accentuates the jaw, neck and cheekbones and produces longer lasting, natural enhancement without giving you the plastic, ‘done look’, which is fast going out of fashion. The ability to produce longer lasting results and avoid the pulled effect is due to the fact that the deeper layers are more fibrous and inelastic compared to the elastic nature of our skin.

Both men and women have deep-plane facelifts, but in general it is more popular among women. This technique is very suitable for older people with a lot of sagging and loose skin, but surgeons report many clients in their early 40s requesting this procedure.

As with other facelifts, the deep-plane facelift can be combined with eyelid surgery, a forehead lift (brow lift), neck lift and non-surgical cosmetic procedures such as lip enhancement.

Reasons for choosing to have a deep-plane facelift

Anyone who is a candidate for a standard facelift is a candidate for a deep-plane facelift. People choose deep-plane facelift surgery over a skin-only or standard facelift for a number of reasons.

You are a good candidate for a deep-plane facelift if any of the following apply:

• You have severe sagging or loose skin on the face.
• Your facial features show you as looking tired, upset or angry when you are not.
• You do not want a dramatic transformation that comes accompanied by pulled skin, stretched features and the resulting ‘done look’. You prefer subtle changes that make you look younger and refreshed, helping you to ‘look how you feel’ instead.
• You value a procedure with long lasting results and few revisions. Typically you can expect the effects of a deep-plane facelift to last between 10 and 15 years.

Scientists believe that a deep-plane facelift is more suitable for smokers than any other facelift. Smoking significantly reduces the body’s ability to absorb oxygen, and the deep-plane tissue has a better supply of blood than the more superficial layers of the face. You can read more about how smoking increases your level of risk in our article on smoking and surgery.

The deep-plane facelift is the preferred technique of surgeons for secondary or revision facelift surgeries because most first-time facelifts have been standard facelifts. There is also a limit to how far the face can be ‘pulled.’

According to many surgeons, the deep-plane facelift is the most effective way to restore the mid face and the creases from the nose to the mouth, otherwise known as the nasolabial folds. This is because the procedure lifts and repositions the fat pads in the cheeks, restoring the cheekbone shape and removing any facial hollows.

Surgeons modify the deep-plane technique to include only the midface—from under the eyes to the jawbone—thereby accomplishing a significant result in a limited region. In this way, it can be an alternative to the previously popular minilift. This is suitable for younger people who have not yet shown signs of ageing around their necks.

What to expect

A deep-plane facelift is performed in a hospital and usually requires an overnight stay.

This type of facelift surgery is performed under general anaesthesia. Your deep-plane facelift may take several hours to complete depending on how extensive the procedure needs to be.

The incisions in a typical facelift are placed in front of and behind the ears. Your incisions may extend into the scalp as well.

Once the incisions are made, various degrees of undermining of the skin are performed, and the deeper layers of the face are ‘lifted’. Muscle tightening as well as liposuction of the neck and jowls may be performed, and excess skin is either removed or repositioned. The results are a reversal of the effects of gravity and a tightening of soft tissues of the face, restoring a more youthful contour to the face

Expect photos to be taken both before and after surgery for the purpose of “before and after” comparisons.

Before and after surgery

There are several things you can do to prepare for any surgery and these apply to the deep-plane facelift as well.

If you have short hair, you may want to let it grow out a bit before the surgery so that it can cover your surgical incisions during the recovery period. If you dye, bleach or chemically treat your hair, you may want to have this done ahead of the surgery. It will be at least a month before you can safely treat your hair again.

Make arrangements for someone to drive you home after your hospital stay. It’s also a good idea to have someone stay overnight with you on your first night home.

After the surgery your face will be bandaged. Sometimes drain tubes are inserted beneath the skin to remove fluids. Many people report surprisingly little pain after the deep-plane facelift procedure. Any discomfort you may experience can be controlled with pain medications.

Expect some level of swelling and bruising, especially in the first week. Unlike a standard facelift, which requires the skin to be separated from the deeper tissues to achieve the lift, the deep-plane technique works by repositioning the entire loose soft tissue of the face as one unit, causing less tissue trauma. This is why healing is generally faster with a deep-plane facelift.

Your facial bruising will fade away within a couple of weeks, but you may still have some puffiness. Your surgeon will guide you on what medications and remedies you can use for reducing discomfort during this period. Cold compresses on the face may help limit swelling and bruising.

There are general steps that can speed up the healing process after surgery. Follow these and your surgeon’s instructions carefully to ensure speedy healing and a good outcome.

Here are a few tips to ensure proper healing after your facelift surgery:

• Keep your head elevated, using extra pillows as you sleep or when lying down.
• Sleep on your back during the recovery period. Use pillows to prevent yourself from rolling over in your sleep.
• For at least one week after your facelift, avoid excessively turning your head or flexing your neck.
• Follow your surgeon’s instructions to the word on what you can and cannot do during the recovery period. You will be given an idea of when it is safe to resume normal activities and how long you should refrain from engaging in strenuous activities. Usually you are expected to avoid strenuous activity for four to six weeks.
• In general, you should not strain, bend or lift anything immediately after facelift surgery. These activities can induce bleeding.
• After two days, you can wash your hair.
• Don’t use concealing makeup for at least a week after surgery.
• Avoid smoking as well as second hand exposure to smoke. Both can increase your risk of poor wound healing, skin death, raised and red scars and wound separation.
• Stay out of the sun during the healing process. Exposure to the sun can lead to prolonged swelling and to discolouration of the scars.

Most people can return to work after two weeks. It is important to remember, however, that different people heal differently. So discuss this with your surgeon, and you will be given the go ahead if your wounds are healing normally.

Possible risks and complications

As with any surgical procedures there are risks involved in a deep-plane facelift. You should be fully aware of potential risks and complications involved in any surgical procedure before you elect to go through with it.

Specific complications that may occur during or after a deep-plane facelift include:

• Facial pain, bruising and prolonged swelling: bruising, swelling, numbness and some level of pain are to be expected for about one to two weeks. Talk to your surgeon if they last significantly beyond two weeks.
• Injury to facial nerves that result in numbness or loss of sensation.
• Facial asymmetry or an irregular or lopsided appearance on the face: some people experience facial asymmetry during the healing process. This is normal and typically resolves on its own without any intervention. Continuing asymmetry may have to be treated with revision surgery.
• Dissatisfaction with the results.
• Hair loss around the incision sites.
• Skin loss, contour irregularities and discolouration.
• Some people experience depression or other emotional changes after their facelift surgery.
• The need for revision surgery of a minor or major nature.

Just as you would discuss potential benefits before surgery, it is always advisable to ask your surgeon to address the potential risks as they apply to you. They can also advise you on how to avoid or minimise some types of risk.

Rough costs involved

The cost of a deep-plane facelift will vary depending on the surgeon you choose, the facilities used and the exact procedure that must be performed. Your surgeon will help you estimate potential costs after a consultation.

Expect the surgery to cost in the range of $20,000 and $30,000 (AUD) including the surgeon’s and assistant surgeon’s fees, anaesthetist’s fee, hospital facilities and services and the cost of follow up visits.

Read our article What Does A Facelift Cost in Australia for more detailed information on all costs associated with facelift.

This information is correct as of 2019.