By Charles H. Thorne, MD
Deep plane facelift candidacy depends on your specific facial aging patterns and anatomical needs rather than age alone. In my practice I have found that patients who are at the younger end of the facelift spectrum (age 35 to 50) who do not have abundant loose skin may be better served by the deep plane lift.
Every patient is unique, and a deep plane facelift may be fantastic for some and less ideal for others. A consultation with a knowledgeable plastic surgeon is essential to determine if the deep plane approach is the best match for you. To schedule a consultation, contact my office at (212) 794-0044 or arrange a meeting in person at 812 Park Avenue or by virtual consultation.
Key Takeaways
- Patients with severe systemic diseases or patients taking blood thinners are not candidates for facelift procedures.
- Individual assessment during consultation determines whether the deep plane approach matches your specific facial anatomy and aging concerns.
What Makes Someone a Good Deep Plane Facelift Candidate?
Deep plane facelifts are designed to address specific anatomical changes: malar fat pad descent, nasolabial folds, jowling and descent of the SMAS just posterior to the mandibular retaining ligaments. These are the visible signs of aging that occur when the deeper tissue layers of the face descend over time.
In my practice, patients are categorized into groups based on facial aging patterns and anatomical needs, including brow lift, midface lift, lower facelift, and neck correction. This classified approach allows tailoring of the deep plane facelift to the individual patient’s pattern of aging.
Facial Aging Patterns That Benefit
The facial tissues are arranged in distinct layers. The superficial plane is the anatomic dissection plane just below the skin. The deep plane is the anatomic dissection plane below the SMAS layer. Both deep plane lifts and SMAS lifts involve dissection in the deep plane. The difference is how much dissection and lifting is done in each plane. In the traditional SMAS lift the superficial plane (skin) and the deep plane are dissected and lifted separately. In the deep plane lift, the skin dissection is much more limited so the two layers are not fully separated. All modern facelift techniques involve lifting and tightening tissue in both of these planes to some extent.
The deep plane procedure does have some advantages, so it has enjoyed a renaissance in recent years. The deep plane lift is generally faster to perform and because there is less dissection under the skin, there may be less bruising.
Age and Skin Quality Considerations
Age is not the only factor. The quality of your skin, the degree of tissue descent, and the specific anatomical changes you seek all play a role. The older patients with looser, more wrinkled skin often benefit from the more extensive skin mobilization and lifting achieved with the SMAS lift. The younger patient with less skin changes is often a better candidate for the deep plane lift.
Who Is Not a Candidate?
Patients with severe systemic diseases, and patients with uncontrolled high blood pressure and patients who take blood thinners may not be candidates for facelift surgery. Additionally, patients with skin disorders, such as Ehlers-Danlos Syndrome, progeria and elastoderma can experience severe wound healing issues and, therefore, are not candidates for rhytidectomy.
The decision about candidacy follows an examination of the individual and a review of the complete medical history.
Smoking and Healing
The medication list and any tobacco use are reviewed together during the consultation. Nothing prescribed is stopped without that review involving both you, me, and the prescribing physician. Any factor that affects healing is discussed individually, and the decision to proceed follows that assessment.
How Deep Plane Differs from Other Facelift Techniques
To understand candidacy, it helps to know how the deep plane facelift differs from other approaches. In a deep plane facelift, the skin and the SMAS (the fibrous layer beneath the skin) are lifted together as one unit. This is different from a standard SMAS facelift, where the skin is separated from the SMAS and each layer is lifted independently.
Lifting the skin and the SMAS as one unit has the advantage of being faster to perform and involves less dissection overall. The more limited skin separation from the underlying tissues leaves less of a space for blood to collect and the risk of hematoma is probably less in deep plane lifting. The disadvantage of the deep plane lift is that there may not be as much improvement in patients with abundant loose skin. Also, when the two layers are dissected separately, the surgeon is free to reposition them in slightly different directions and to a slightly different degree. I have written previously about the difference between the deep plane facelift and other facelift techniques. The choice between approaches depends on the individual’s anatomy, the degree of tissue descent, and the areas that need the most correction.
What the Technique Addresses
The composite facelift (deep plane lift) may reduce malar fat pad descent, nasolabial folds, jowling and descent of the SMAS just posterior to the mandibular retaining ligaments. I personally have not detected these differences between the two techniques.
What to Expect During Recovery
Recovery from a deep plane facelift is very similar to recovery from other facelift techniques. Cleveland Clinic reports that after facelift surgery, you will experience bruising and swelling that will last for about two to three weeks. Most patients can return to work in two to three weeks.
Many surgeons, including myself, have patients spend the first night after a facelift under the care of a registered nurse in a hotel. This allows close monitoring during the immediate postoperative period when bleeding or other complications are most likely to occur.
Timeline for Healing
After facelift surgery, sutures are typically removed, swelling begins decreasing noticeably, bruising fades, and light walking is allowed while facial expression feels somewhat restricted. I tell my patients that they can return to unrestricted physical activities after 3 weeks. The NHS reports that it takes about 2 to 4 weeks to fully recover from a facelift, you need to take this time off work, bruising is visible for at least 2 weeks, and it could take up to 6 to 9 months to see the full effect of the facelift.
After several weeks, bruises, scars and changes to your skin color should have faded. The timeline varies from person to person, and individual healing patterns affect how quickly you see the final result.
When to Call Your Surgeon
Contact the office immediately if you experience any concerning symptoms during recovery. Certain symptoms require prompt attention:
- Sudden increase in swelling on one side of the face
- Severe pain that worsens rather than improves
- Active bleeding that soaks through dressings
- Fever or changes in the appearance of the wound edges
The office number is (212) 794-0044, and staff are available during business hours Monday to Friday, 9 AM to 5 PM. After hours, an answering service provides contact information for urgent concerns.
Choosing the Right Surgeon
Make sure your plastic surgeon is board-certified (by the American Board of Plastic Surgery, or an equivalent certifying board) and has extensive experience specifically with facelift surgery. A surgeon who specializes in facial rejuvenation or has done many deep plane facelifts will be familiar with the anatomy and techniques to avoid complications.
I am the Editor-in-Chief of Grabb and Smith’s PLASTIC SURGERY, 7th Edition, and served as President of the American Society for Aesthetic Plastic Surgery. With more than thirty-five years of experience in plastic surgery, I focus on helping patients understand which approach best matches their individual anatomy and goals.
Risks and Complications
The only complication that I have seen in the immediate post op period is a collection of blood called a hematoma. This occurs in approximately 1 percent of patients and it is just an inconvenience. Usually the patient or the nurse notices a fullness in the cheek or neck. It is not dangerous and would eventually go away, but it would take months to disappear. We take the patients back to the operating room, remove some sutures, milk out the blood and re-suture the area.
I discuss these in more detail in my article on complications after facelifting. In the longer term, the potential complications are rare but include:
- Unsightly scars
- Delayed wound healing behind the ear
- Nerve injury. This is the most dreaded complication of facelifting. In experienced hands it occurs in approximately 0.1% of cases and is usually temporary. Permanent nerve injury creating facial asymmetry is slightly more common in the deep plane facelift but in experienced hands, it is very rare.
Frequently Asked Questions
What age range is typical for deep plane facelift candidates?
In my practice I have found that patients who are at the younger end of the facelift spectrum (age 35 to 50) who do not have abundant loose skin may be better served by the deep plane lift, as facial aging patterns matter more than chronological age.
Can I have a deep plane facelift if I had previous facelift surgery?
The simple answer is sometimes. Candidacy for revision surgery depends on individual factors including tissue quality, healing from the previous procedure, and current anatomy, which require examination to assess. Plastic and Reconstructive Surgery – Global Open reports that the deep-plane series it reviewed excluded patients who had undergone previous face lift surgery. In my experience, many patients who are having a secondary facelift have skin redraping issues from the first procedure that are best approached using a two-plane operation. (Which raises another interesting point; I think skin redraping problems are less common after deep plane procedures.)
What medical conditions prevent deep plane facelift candidacy?
Patients with skin disorders such as Ehlers-Danlos Syndrome, progeria and elastoderma can experience severe wound healing issues and are not candidates for rhytidectomy. Individual assessment determines candidacy.
How long does recovery take after deep plane facelift?
Cleveland Clinic reports that after facelift surgery, you will experience bruising and swelling that will last for about two to three weeks. The NHS reports that it takes about 2 to 4 weeks to fully recover, though it could take up to 6 to 9 months to see the full effect.
What makes deep plane different from other facelift techniques?
The difference between various facelift techniques is how much dissection and lifting is done in each plane. In a deep plane facelift, the skin and the SMAS are lifted together as one unit. The more limited skin separation from the underlying tissues leaves less of a space for blood to collect, less chance of skin irregularities but less benefit from abundant excess skin.
How do I know if deep plane is right for my facial aging?
StatPearls describes that deep plane facelifts address malar fat pad descent, nasolabial folds, jowling and SMAS descent. In my practice, patients are categorized based on facial aging patterns and anatomical needs. Individual consultation determines whether your specific concerns match this approach.
Next Steps
Determining whether you are a candidate for a deep plane facelift requires individual assessment of your facial anatomy, aging patterns, and personal goals. The consultation is where you and I discuss your concerns, examine your facial structure, and determine which approach offers the best match for your situation.
My office is located at 812 Park Avenue, New York, NY 10021. Office hours are Monday to Friday, 9 AM to 5 PM. You can reach us at (212) 794-0044 to schedule an appointment. We also offer in person at 812 Park Avenue or by virtual consultation options for your convenience.
Sources
- Critical Review of a Series of 78 Surgical Facial Rejuvenation Procedures with a Deep-Plane Face Lift Associated with Neck Correction (Plastic and Reconstructive Surgery – Global Open (PMC))
- Deep Plane Facelift – StatPearls – NCBI Bookshelf (StatPearls / NCBI Bookshelf (NIH))
- Facelift (Rhytidectomy): What Is It, Recovery & What to Expect (Cleveland Clinic)
- Facelift (rhytidectomy) – NHS (NHS (UK National Health Service))
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