A deep plane facelift does not reposition the skin, but rather the deeper tissue layers of the face. This text explains what that means, how the technique differs from a classic facelift, and what the recovery process entails. <\/p>
When looking in the mirror and noticing that the cheek is lower, the fold between the nose and the corner of the mouth is becoming deeper, and the jawline is fading, one often encounters the term deep plane facelift when searching for information. This is a surgical technique in which the aged position of the deeper tissue layers is corrected, rather than merely tightening the skin. <\/p>
Facial aging is not just a matter of the skin. Beneath the skin lies a layer of fat pads and supporting tissue that shifts downwards and inwards over the years. This results in a loss of volume at the level of the cheekbone, a deeper nasolabial fold, a less defined jawline, and sometimes the onset of a double chin. <\/p>
In a deep plane facelift, work is performed through an incision in front of and behind the ear into a deeper plane. This entire unit of skin, fat, and supporting tissue is released as a single entity and subsequently secured in a higher, more natural position. The skin is not placed under tension separately, which contributes to how natural the result looks. <\/p>
From the outside in, there are roughly four layers: the skin, a layer of subcutaneous fat, the SMAS, and beneath that, the deeper structures containing fat pads, the masseter muscle, and the branches of the facial nerve.<\/p>
SMAS stands for Superficial Musculo-Aponeurotic System: a thin sheath of connective tissue and muscle fibers that runs like a hammock over the cheek and neck and is connected to the mimetic muscles. When this sheath slackens, everything attached to it sags as well. This is why almost every modern facelift technique intervenes at this layer. <\/p>
“Deep plane” refers to the plane beneath the SMAS. Instead of separating the SMAS from the skin and repositioning both layers separately, work is performed beneath that layer, keeping the skin, fat, and SMAS connected to each other. The fibrous ligaments that anchor the cheek to the underlying bone are also released in a controlled manner, so that the tissue can truly be repositioned instead of merely being stretched. <\/p>
In a classic SMAS facelift, the skin is first separated from the underlying tissue. Then, the SMAS is separately tightened, folded, or partially removed, and the skin is subsequently draped over it. This is a proven and safe technique that provides a beautiful and refreshed result for many patients. <\/p>
The difference lies in the way the tissue moves. Because the layers remain attached to each other in a deep plane facelift, the entire cheek pad moves along in the desired direction. Consequently, the correction is situated more in the midface and in the transition to the nasolabial fold. Furthermore, the tension is placed on the deep tissue and not on the skin. <\/p>
Which technique is indicated depends on the anatomy, skin quality, the degree of sagging, and the patient’s wishes. Both approaches have their place. <\/p>
A MACS lift, short for Minimal Access Cranial Suspension, and variants of the so-called mini-lift, work through a shorter incision, usually only in front of the ear. The SMAS is vertically suspended with sutures to the fixed connective tissue at the level of the temple. <\/p>
These techniques generally require a shorter recovery and are suitable for limited to moderate sagging, often in a younger face. In cases of pronounced sagging of the neck or a significantly descended midface, their reach is more limited. It is therefore not a question of more or less, but of which technique suits which face. <\/p>
Less suitable are situations with a history of poor wound healing, active smoking, untreated high blood pressure, or coagulation problems. Smoking significantly increases the risk of wound healing problems; quitting well before and after the procedure is a prerequisite. <\/p>
The procedure is performed under general anesthesia or under deep sedation with local anesthesia, depending on the extent. The duration is usually several hours. <\/p>
The incision runs in the hairline at the level of the temple, follows the natural folds in front of the ear, goes around the earlobe, and continues behind the ear into the hairline. Through this access, the deep plane is released and the tissue is re-secured with sutures to the fixed support points. Excess skin is removed without tension. Often, a small drainage system is placed, which is removed the following day. <\/p>
Week 1.<\/strong> Swelling and bruising, especially around the jawline and neck. A bandage or compression garment is worn. Pain is usually limited and is described as tension or numbness rather than sharp pain. Sutures are generally removed between day five and ten. <\/p> Week 2 and 3.<\/strong> The bruises change color and largely disappear. Many patients are socially presentable after two to three weeks, possibly with some camouflage makeup. Light office work is usually possible again by then. <\/p> Week 4 to 6.<\/strong> Sports and physical exertion are generally resumed after four to six weeks, in consultation. Sensation in the skin in front of the ear and in the earlobe gradually returns; a numb feeling that persists for several months is normal. <\/p> After three to twelve months.<\/strong> The final result is assessed when the last of the swelling has disappeared and the scars have matured.<\/p> The scars follow the natural folds and the hairline and are therefore generally discreet. They are pink to red and firmer in structure during the first few months, and then gradually fade over about a year. Scar massage, silicone gel or patches, and consistent sun protection support this process. <\/p> A facelift does not stop aging. What the procedure does is return the tissues to an earlier stage; the aging process then continues at the same pace. Lifestyle, sun exposure, weight fluctuations, and genetic predisposition play a role in this. There is an obligation of means and not an obligation of result. <\/p> The face ages as a whole. Therefore, a facelift<\/a> is often combined with a neck lift<\/a> for loose skin or vertical neck bands, with an upper<\/a> or lower eyelid correction<\/a> when the eye area makes the gaze look tired, with facial lipofilling<\/a> to replenish lost volume, or with a brow lift<\/a>. <\/p>Scars and durability<\/h2>
Combination with other procedures<\/h2>