Deep Plane Facelift has become a hot topic in facial rejuvenation, and many patients are asking what makes it distinct from other facelift techniques. Is it truly a revolutionary approach or just a new spin on established methods? Could it be better than a traditional facelift for a more natural-looking result? And are there patients for whom a deep plane facelift might not be the best choice? This article will answer these questions and clarify what the deep plane facelift really entails. Everyone wants a youthful yet natural look, and understanding facelift techniques can help you see how the right approach contributes to that goal.

Facelift Anatomy and the “Deep Plane” Technique

To understand the deep plane facelift, it helps to know a bit about facial anatomy. The face is arranged in layers: the skin is the outer layer; beneath it lies a layer of fat (the subcutaneous fat). The third layer is a layer of connective tissue called the SMAS (superficial musculo-aponeurotic system) which covers the facial muscles. The forth layer consists of the facial muscles that allow us to smile and the final layer are the nerves which enter the muscles on their deep surfaces. In a facelift, surgeons work in two primary tissue planes:

• Superficial plane: the plane just under the skin, within the subcutaneous fat (above the SMAS layer).
• Deep plane: the plane beneath the SMAS and sometimes deep to parts of the muscles (avoiding the areas where the nerves enter them)

All modern facelift techniques involve lifting and tightening tissue in both of these planes to some extent. The difference between various facelift techniques (for example, a standard SMAS facelift vs. a deep plane facelift) is how much dissection and lifting is done in each plane. The names of the techniques indicate the emphasis: a High SMAS facelift involves more extensive work separating the skin and SMAS (two separate layers), whereas a Deep Plane facelift involves minimal skin separation and more release and lifting of the deeper layer as one unit with the skin. It is probably more accurate to describe the deep plane lift as a single plane procedure and to describe the SMAS-manipulation procedures as dual plane procedures.

In other areas of plastic surgery, whether it is in the breast, body or face, it is generally true that no single procedure is best for every patient. It stands to reason that the same is true for facelift techniques.

It is also true that facelift techniques are more similar than they are different. If two patients have a surgical procedure on the face and one has a deep plane lift, the only area where the two patients may have had a different procedure is the cheek; the brow, eyelids and neck may have undergone the same procedure but the implication is that the two patients have had different procedures. Both procedures all aim to address the jowl area and yield a clean, well-defined jawline.

This brings up an important question: Does the technique matter and, if it does, which patients are best treated with which procedure? This author believes that the best technique in a given patient depends on the individual patient’s features such as age, facial shape, skin quality, degree of wrinkling or sun damage, and facial anatomy.

How Is the Deep Plane Facelift Different from Other Facelifts?

The deep plane facelift was originally described by a Swedish surgeon, Tord Skoog, about 50 years ago. So the deep plane lift actually came before the dual plane lifts. It is ironic that we think of the deep plane lift as new and the two-layer lift as “traditional” since it is really the other way around. The deep plane procedure does have some advantages, however, so it has enjoyed a renaissance in recent years. Here is how the deep plane facelift differs, both anatomically and theoretically:

• Less superficial dissection: In a two-layer facelift, the surgeon will lift the skin and the SMAS layer separately creating two layers. For example, in a high, extended SMAS facelift, the surgeon undermines (separates) a large area of skin from the underlying SMAS and then separates the SMAS from the tissues under it. The two layers are tightened separately. In a deep plane facelift, by contrast, the surgeon makes a more limited dissection in the subcutaneous plane and then enters the deep plane, the plane under the SMAS. The skin remains attached to the SMAS, and both are lifted together as one layer. This is why the deep plane facelift has been called a “composite” lift because the two layers are left attached. Tension is then placed on the SMAS layer, which is carrying the overlying skin and fat.
• Less tension on the skin: Because the skin and SMAS are moved together in a deep plane technique, the tension of the lift is placed on the sturdy deeper layer, not on the skin. Lifting the face as one unit can reduce tension on the skin, which can lead to a more natural result and avoids the overly “pulled” look.
• Quicker healing for the skin: With less extensive undermining of the skin, the skin’s blood supply is better preserved. This can lead to faster healing and less risk of skin complications.
• Less risk of hematoma.  The more limited skin separation from the underlying tissues leaves less of a space for blood to collect and decreases the risk of such a collection, known as hematoma, the most common complication of a two-layer facelift.
• Good for younger patients. Patients who are at the younger end of the facelift spectrum (age 35-50) who do not have abundant loose skin may be better served by the deep plane lift.

Disadvantages of Deep Plane Facelift

• Flexibility. Proponents of the two-layer facelift techniques believe that this method allows greater flexibility because the fat and skin can be tightened to different degrees and in different directions. This allows more customization and allows the surgeon to do slightly different things on the two sides of the face to improve asymmetry.
• Older patients. Older patients with fair skin may have very loose, wrinkled skin. In these patients the more extensive undermining of the skin is probably advantageous and these patients are probably not as well suited for the deep plane procedure.

Where traditional facelifts and deep plane facelifts are the same:

• Longevity of results: A common question is whether a deep plane facelift lasts longer than other facelifts. The truth is that any well-performed facelift, deep plane or otherwise, should provide results that last on the order of ten years or more. Aging is a continuous process, so no facelift is permanent, but if done properly you can expect about a decade of improvement before the effects of gravity and time might make you consider another lift or other touch-ups. Longevity comes down to skin type, age and genetics more than facelift technique.  
• Incisions and scars. The incisions and scars for the two different types of facelifts are the same.
• Complications. There is no proven difference in complications. Two-layer facelifts may have a higher risk of hematoma requiring evacuation and the Deep plane procedure may have a higher risk of nerve injury.

Bottom line: Surgeons who only know one procedure will tend to do that procedure. You know the expression “if you have a hammer the whole world looks like a nail”? The ideal scenario is a surgeon who is familiar and skilled at all the available techniques so that he/she can recommend the procedure that is best for the particular patient.

Who Should Consider a Deep Plane Facelift?

Every patient is unique, and a deep plane facelift may be fantastic for some and less ideal for others. In general, deep plane facelifts tend to be favored for patients who are younger (35-50) with early aging changes, good skin elasticity.  Younger patients typically have better skin quality, although this depends on skin type, ethnic group and sun damage, and may not need extensive skin undermining; lifting the deeper layer gives them the subtle yet significant improvement they want, and many will experience long-lasting results with no signs of having had a facelift.

On the other hand, older patients or those with very lax, sun-damaged skin might sometimes benefit more from a traditional two-plane facelift approach. When the skin has a lot of looseness or damage (for example, in someone in their 60s or 70s with heavy wrinkles or very thin, inelastic skin), separating the skin and tightening it in addition to the deeper layers can provide more dramatic smoothing of the neck and jawline skin.

That said, age alone is not a strict determinant—many patients in their 60s have undergone deep plane facelifts with beautiful outcomes. The choice of technique comes down to the individual’s anatomy and goals. A consultation with a knowledgeable plastic surgeon is essential to determine if the deep plane approach is the best match for you. It is the surgeon who should recommend the particular procedure and then the patient can decide to choose that surgeon or not. If the patient is committed to one type of facelift but the surgeon he/she chooses is not skilled in that area, then the results may not be ideal.

Recovery and Healing After a Deep Plane Facelift

Recovery from a deep plane facelift is very similar to recovery from other facelift techniques. Even though the deep plane method can reduce skin trauma, you should still expect a recovery period before you’re “camera-ready” or back to intense activities. Most patients need about 3 weeks before they feel comfortable resuming unrestricted exercise and major social engagements. Here’s an overview of what to expect:

Immediate Postoperative Care: Right after surgery, you will have dressings on your face and sometimes a small drain to prevent fluid build-up. Many surgeons, including Dr. Thorne, have patients spend the first night after a facelift under the care of medical professionals (either in a hospital, surgical facility, or a hotel with a private duty nurse). The day after surgery, the drain is typically removed and you’ll be able to go home. You can shower and wash your hair on the first day after surgery once dressings and drains are removed, which helps you feel more refreshed. Dr. Thorne visits the patients in the hotel early in the morning to make sure all is well before he begins his day. Initial swelling and bruising will be present, but pain is usually moderate and well-controlled with medication. Stitches (sutures) are removed in stages, starting around five days post-op (depending on the type of sutures, some may stay in a bit longer, up to 10 days).

Your surgeon will provide detailed postoperative instructions. It’s crucial to follow all your care instructions to ensure a smooth recovery. Some common early post-operative guidelines include:

• Keep your head elevated (especially when resting or sleeping) to help reduce swelling. Use extra pillows or a recliner to keep your head above heart level.
• Manage discomfort with medication: Take Tylenol (acetaminophen) regularly (e.g. every 4 hours) as recommended for pain control. You may be prescribed a stronger pain reliever for the first day or two; use it only if needed. Often, patients find that after 48 hours Tylenol is enough to stay comfortable.
• Take short walks as you feel up to it: Gentle activity like walking around your home or a brief walk outside helps maintain good circulation and can actually aid healing. Just ensure you have someone with you initially, as you may feel weak right after surgery. Do not walk for exercise; just stroll to get fresh air and break the monotony of recovery.
• Avoid heavy lifting or strenuous exercise for at least three weeks. Even though you might feel better much sooner, your body needs time to heal internally. Straining too soon can increase swelling or risk bleeding. Your surgeon will clear you when it’s safe to resume workouts, usually around 3 weeks post-op for vigorous activity.
• Watch for any concerning symptoms: Some swelling and bruising is normal, but if you notice a sudden bulge or a rapid swelling in any area of the face or neck (which could indicate a hematoma), or have severe pain on one side, contact your surgeon right away. It’s always better to be cautious and have your surgeon check anything you’re unsure about during recovery.

The first week after surgery is when swelling and bruising peak. You will likely feel tightness in your face and neck, and some areas of numbness — these sensations gradually improve over a few weeks to months. By the end of the second week, most patients look much better, with bruises turning yellow and fading, and swelling starting to come down. By three weeks, you’ll typically be comfortable being seen in public without it being obvious you had surgery (with some concealer makeup if needed). Subtle swelling can persist for several months, but it’s usually only noticeable to you and your surgeon.

Remember that healing is a process; you’ll see improvements week by week, but sometimes it is hard to see improvement day to day.

Possible Complications of a Deep Plane Facelift

Facelift surgery is very safe when performed by an experienced, board-certified plastic surgeon. However, like all surgeries, a deep plane facelift comes with some potential risks and complications. It’s important to be aware of these (and discuss them with your surgeon), even though serious complications are fortunately rare.

General facelift risks: All facelift patients will experience some bruising and swelling—that’s a normal part of the healing process, not a complication. Temporary numbness of the skin is also common due to small sensory nerve branches being stretched; sensation usually returns over time. The main complications to consider for any facelift are bleeding (hematoma), poor wound healing with noticeable scarring, or injury to the facial nerves.

Deep plane vs. SMAS facelift risks: Each facelift technique has its nuances. In a deep plane facelift, the surgeon works closer to the facial nerve branches as they release and lift the SMAS layer. Because of this, there may be a slightly higher risk of nerve injury in inexperienced hands – typically this would manifest as weakness in certain facial movements (for example, a crooked smile if a buccal branch of the facial nerve is affected). The good news is that such nerve effects are usually temporary, resolving over a few weeks as the nerve bruising recovers; permanent nerve damage is uncommon in facelifts performed by seasoned surgeons. On the other hand, in a more traditional two-plane facelift (with extensive skin undermining), there is a higher volume of raw surface under the skin, so the risk of a hematoma (a collection of blood under the skin that might require a drainage procedure) can be slightly higher compared to a deep plane lift. Surgeons who perform wide skin undermining often use something called a hemostatic net which eliminates the risk of hematoma reducing even further any difference between deep plane and two-layer facelifts. Skin flap issues (like areas of delayed healing at the incision) are also a bit more common when a lot of skin has been lifted, especially in smokers or patients with weaker skin. Since the deep plane lift keeps much of the skin attached to deeper tissue, the skin’s blood supply is well-preserved, potentially reducing the risk of skin-related healing problems.

Bottom line on safety: In the hands of a qualified surgeon, both deep plane and traditional facelifts have low complication rates. The differences in risk profile are small, but they exist. Your surgeon should explain all the possible complications and their approach to minimizing those risks. You, as the patient, also play a role in ensuring safety (for example, by not smoking and following instructions, as we’ll discuss next).

Ways to Reduce Surgical Risks and Ensure the Best Outcome

While your surgeon will take every precaution to perform a safe and effective surgery, there are several steps you can take to help minimize risks and set yourself up for a smooth facelift experience. Here are some important ways to improve safety and results:

• Choose a highly qualified 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. Don’t hesitate to ask about their credentials and how often they perform facelifts.
• Don’t make cost your only deciding factor. It’s natural to consider the price of a procedure, but beware of discounts or unusually low fees for facelift surgery. By the same token, the most expensive surgeon is not necessarily the best surgeon for you. Price is another marketing tool.
• Be open and thorough about your medical history. In your consultation and pre-op appointments, tell your surgeon everything about your health: any medical conditions, previous surgeries, and all medications or supplements you take. Certain conditions (like high blood pressure or bleeding disorders) and medications (like blood thinners, even fish oil or herbal supplements) can increase surgical risks. Your surgeon needs the full picture to plan safely. They may ask you to get medical clearance or adjust certain medications before surgery.
• Stop smoking well before surgery. Smoking is extremely detrimental to healing. Nicotine (and even nicotine patches/gum or vaping) constricts blood vessels and can impair blood flow to the skin, greatly increasing the risk of tissue healing problems and poor scarring. Most surgeons will require you to quit smoking at least a few weeks (ideally a month or more) prior to a facelift, and not resume during the recovery period. For the best outcome, it’s best if you quit altogether — your body will thank you in many ways, not just for surgery. A smoker who quits still has a higher risk than someone who has never smoked.
• Follow all pre-operative and post-operative instructions. Your surgeon will give you specific guidelines to prepare for surgery (such as which medications to stop, when to start any pre-op washes or antibiotics, and how to arrange your post-op care). After surgery, you’ll receive instructions on caring for incisions, managing drains if any, taking medications, and activity restrictions. Following these instructions to the letter can significantly reduce your risk of complications. For example, properly caring for your incisions can prevent infection, and avoiding strenuous activity as instructed will minimize the chance of bleeding. If you have any doubts or questions during recovery, call your surgeon’s office for clarification rather than guessing. Being an attentive, proactive patient is one of the best ways to ensure a safe recovery and beautiful result.
• Attend all follow-up appointments. These visits allow your surgeon to monitor your healing and catch any potential issues early, even if you feel fine. If you live far from your surgeon, arrange for a local doctor to check on you if needed, but keep your surgeon informed. Don’t skip your follow-ups — they are part of your care plan.

By taking these steps and working closely with a trusted surgeon, you significantly increase the likelihood of a smooth surgery and recovery. Peace of mind comes from knowing you’ve done everything possible to minimize risks.

Essential Questions to Ask During Your Facelift Consultation

A consultation is your opportunity to learn about the surgeon and the procedure, and to make sure the approach aligns with your goals. Dr. Thorne encourages patients to ask plenty of questions — an informed patient can enter surgery with confidence and realistic expectations. Here are some key questions you might discuss during a facelift consultation (particularly if you’re considering a deep plane facelift):

• Do you recommend a deep plane facelift for me, or another technique? Every patient’s needs are different. Understanding why your surgeon recommends a certain facelift technique (deep plane vs. SMAS vs. mini-lift, etc.) will help you feel confident that the plan suits your anatomy and desired outcome. A good surgeon will tailor the approach to you rather than using the same method for everyone.
• Can I see before-and-after photos of patients with similar concerns to mine? Looking at before-and-after images of your surgeon’s facelift patients (especially those around your age or with similar facial features) gives you a realistic idea of the results they achieve. This also helps you gauge the surgeon’s aesthetic style and what “natural results” mean in their hands. Remember, patients have to give specific consent to allow their photos to be shown so the surgeon cannot just show you any patient’s photos.
• How long will it take to recover, and when can I resume normal activities? It’s important to know how much downtime you’ll need after a facelift. Ask about the stages of recovery: when you can drive, go back to work, exercise, or attend social events. Knowing the timeline (for example, that most people are back to daily routines by 2-3 weeks, with full exercise by 3-4 weeks) will help you plan accordingly and arrange for any help at home if needed.
• What are the risks and potential complications, and how do you handle them? Even though complications are uncommon, your surgeon should clearly explain what the possible risks are (such as hematoma, infection, nerve injury, poor scarring) and what steps they take to prevent or address them. This will reassure you that they have a plan for safe surgery and that they won’t abandon you if something unexpected occurs. It’s also fair to ask about the surgeon’s personal complication rates and revision policies.
• How long can I expect my facelift results to last? While no surgeon has a crystal ball, they can give you a general idea of how long the benefits of the surgery typically endure and what maintenance might be needed. For instance, you might learn that patients often enjoy 8-12 years of improvement, and that even as you continue to age, you will likely always look a bit younger than if you hadn’t had the lift. Understanding this helps set realistic expectations. You can also ask how future aging changes might be managed — for example, some patients may opt for minor touch-ups or nonsurgical treatments in the years after a facelift to prolong the effects.
• Will I likely need any additional procedures to get the result I want? Sometimes a facelift alone isn’t enough to address all concerns. Depending on your anatomy, a surgeon might recommend adjunct procedures such as a browlift, eyelid surgery (blepharoplasty), lip lift etc to achieve harmonious results. As mentioned above, the Deep Plane vs Dual Plane lift only involves the cheek and may be a minor part of the overall procedure. In addition, fat grafting to restore lost facial volume or skin resurfacing (lasers/peels) to improve skin texture can be combined with a facelift. Ask if they think anything else is indicated in your case. This doesn’t mean you must do those extras, but it’s good to know the full range of options to meet your goals. A trustworthy surgeon will guide you to the right amount of intervention, not necessarily the maximal. Dr. Thorne’s philosophy is that it is always better to do the least amount of surgery that will achieve the goals, not the maximum amount of surgery possible. This is how you avoid looking like you have had surgery.
• What type of anesthesia will be used for my facelift? Facelift surgeries can be done under general anesthesia or monitored anesthesia care (MAC) depending on the surgeon’s preference, anesthesiologist’s preference, patient anatomy, and the extent of work. It’s important for you to know what to expect. Both methods are safe when properly administered. Dr. Thorne prefers not to have an endotracheal tube to avoid a sore throat after surgery and to limit the amount of anesthesia you get.  If you have any concerns about anesthesia, discuss them. Also ask about the anesthesiologist’s qualifications — for instance, Dr. Thorne works only with board-certified anesthesiologists in an accredited facility.
• How much will the procedure cost, and what does the fee include? Facelift cost can vary widely based on geographic location, the surgeon’s expertise, the number of procedures you are having, and what is included (surgeon’s fee, operating room fee, anesthesia fee, post-op garments, etc.). During your consultation, you should receive a detailed quote. While it’s not advisable to shop purely on price, you do need to understand the financial aspect.

Don’t hesitate to bring a written list of questions to your consultation so you don’t forget anything. A good surgeon will appreciate that you’re taking your procedure seriously. Asking these questions will give you clearer insight into the facelift process and help you make an informed decision that’s right for you. The goal is that you walk away from the consultation with a solid understanding of what will be done, why it’s recommended for you, what the recovery will entail, and what results you can realistically expect.

Conclusion

The modern day facelift is an advanced technique that involves the deeper layers of the face and can achieve beautiful, natural-looking rejuvenation. The exact type of facelift procedure is a matter for the surgeon and the patient to decide. All modern facelift techniques lift the deeper facial layers to restore youthful contours, and in skilled hands it can do so without creating a tight or pulled appearance. However, no single method is “perfect” for everyone. An experienced plastic surgeon will evaluate your facial structure, skin, and aging pattern to determine which approach (or combination of approaches) will give you the best result.

If you’re considering a facelift, don’t get too caught up in the marketing buzzwords. The most important step is to consult with a qualified, board-certified plastic surgeon who has extensive facelift experience. They can explain whether a deep plane facelift, a two-layer facelift, or perhaps a less invasive procedure is appropriate for your situation. In the end, what matters is that you achieve a refreshed, natural outcome and that the procedure is done safely. With the right surgeon and the right technique for you, you can turn back the clock on facial aging by a decade or more and look as youthful as you feel.

About Dr. Thorne

Dr. Charles Thorne has spent over 30 years performing, teaching, and writing about plastic surgery. He is a world-renowned expert in facial rejuvenation and cosmetic surgery. Dr. Thorne is a Past President of the American Society for Aesthetic Plastic Surgery (ASAPS), the only professional society within plastic surgery dedicated exclusively to cosmetic surgery. He has also served as Chairman of the American Board of Plastic Surgery and as President of the Northeastern Society of Plastic Surgeons.

Dr. Thorne’s contributions to the field are extensive: he has published over 50 scientific articles and 23 book chapters, and he is the editor of Grabb and Smith’s Plastic Surgery, the leading single-volume textbook in plastic surgery. He served as the Cosmetic Surgery Section Editor for the journal Plastic and Reconstructive Surgery and is an active member of numerous national and international plastic surgery societies. Patients from around the world seek out Dr. Thorne for his expertise, knowing they will receive honest advice, state-of-the-art techniques, and natural results in a safe, professional environment.