Overview
The deep plane facelift is a cervicofacial facelift technique that repositions the skin, SMAS, and deep facial fat as a single unit after releasing the ligaments that hold the tissues in place. Unlike facelifts that tighten the skin or crease the surface muscles, it acts directly at the source of the sagging.
First described by American surgeon Sam Hamra in the early 1990s, the deep-plane technique has been significantly refined thanks to a better understanding of the anatomy of the facial fasciae and retentive ligaments. It is now considered by many facial surgery specialists to be the gold standard for achieving deep, natural, and long-lasting rejuvenation.
Specifically, the deep plane allows for the simultaneous correction of:
- Sagging of the cheekbones and the middle third of the face
- Nasolabial folds (the lines between the nose and the mouth) and marionette lines
- Jowls and loss of facial contour definition
- Relaxation of the neck and the cervico-menton angle when a cervical movement is involved
Why Does the Face Sag? Understanding the Cause to Better Correct It
The face ages deeply before it ages on the surface. It is composed of several overlapping layers: the skin, the superficial fat layer, the SMAS (superficial musculoaponeurotic system—a fibro-muscular sheet that envelops the facial muscles), and then the deeper layers attached to the bone by retaining ligaments.
Over the years, due to the effects of gravity and thousands of daily muscle contractions, the fat in the cheeks slides along this deep plane. It descends until it is held in place by the ligaments: this phenomenon creates the nasolabial fold, marks the marionette line, and causes jowls to appear. The skin simply follows suit.
It is precisely for this reason that a facelift that merely tightens the skin yields results that are temporary—and sometimes look unnatural—because it treats the symptom (excess skin) without correcting the cause (the sagging of the deep tissues). The deep-plane facelift does the opposite: it lifts what has sagged, right where it has sagged.
Explanation of the technique
Three key steps define the deep-plane facelift and set it apart from other techniques.
A localized skin sloughing
The skin is detached only over a short distance and remains attached to the deeper tissues. This allows it to retain its blood supply, which promotes better-quality healing and reduces the risk of bruising and hematomas compared to extensive subcutaneous detachment.
Release of the retaining ligaments
This is the key step in the procedure. The zygomatic ligaments (at the cheekbones) and masseteric ligaments (along the cheeks) anchor the soft tissues to the bone and prevent them from shifting. By releasing them in a controlled manner, the surgeon makes the tissues mobile, making it possible to lift them without exerting any excessive traction on the skin.
A block-wise repositioning along a vertical vector
The skin, SMAS, and deep fat are lifted together—as a single anatomical unit—along an axis close to vertical—that is, in the exact opposite direction from which the tissues had sagged. This vertical vector restores volume to the cheekbones, smooths the nasolabial fold, and redefines the facial contour, whereas an oblique backward pull (typical of skin lifts) produces the “pulled” appearance that patients dread.
According to the analysis conducted during the consultation, the procedure can be extended to the neck (extended deep plane): treatment of the platysma muscle and redefinition of the cervico-mental angle, for a harmonious result from the eyes down to the base of the neck.
Deep plane, SMAS lift, or mini-lift: What's the difference?
The fundamental difference lies in the surgical plane: a mini-facelift primarily targets the skin; an SMAS facelift tightens the muscle layer by creating folds after lifting the skin; and a deep-plane facelift repositions all the tissues beneath the ligaments as a single unit.
None of these techniques is “superior” in an absolute sense: each has its own indications. A clinical examination determines which technique is best suited to your anatomy—mild sagging in a 45-year-old patient is not treated the same way as marked sagging of the face and neck in a 60-year-old.
Are you a good candidate for a deep-plane facelift?
The deep plane facelift is intended for women and men with moderate to severe sagging of the face and/or neck who desire visible yet strictly natural-looking rejuvenation. The typical age range is between 45 and 70, but the suitability of the procedure depends more on an individual’s signs of aging than on their chronological age.
Top recommendations:
- Sagging of the cheekbones and the middle third of the face
- Pronounced nasolabial folds and marionette lines
- Blurred cheeks and facial contours
- Loosening of the neck, loss of the cervico-mental angle
- Patients who have already undergone their first facelift and are seeking a more extensive correction
- Patients who categorically refuse any “tight” or “frozen” appearance
Conversely, certain situations call for a different approach or for postponing the procedure: active smoking that has not been quit (risk of scarring), unrealistic expectations, very early-stage sagging (where cosmetic medicine or a more limited procedure may be sufficient), or a medical contraindication to general anesthesia. These factors are systematically evaluated during the consultation.
Overview of the procedure
The Consultation with Dr. Vairinho
It all begins with a comprehensive morphological analysis: skin quality and thickness, the location of fat deposits, the degree of laxity in the SMAS and neck, and bone structure. Medical photographs are taken. This analysis helps determine whether the deep plane technique is appropriate, which additional procedures would be relevant (blepharoplasty, lipofilling, neck treatment), and to explain to you in detail the expected scar patterns and postoperative outcomes. You will receive written medical information and a detailed estimate, along with a legal cooling-off period of at least 15 days prior to the procedure (Bertranais Law). A second preoperative consultation is always scheduled.
Preparation
A preoperative evaluation is ordered, and an anesthesia consultation is scheduled before the procedure. Patients are required to stop smoking completely at least one month before and one month after the operation—this is an important factor in ensuring good scar healing. Certain medications (aspirin, anticoagulants, anti-inflammatory drugs) must be discontinued according to the anesthesiologist’s instructions.
The Intervention
A deep-plane facelift is performed in a clinic under general anesthesia and lasts an average of 2 to 4 hours—longer if additional procedures are performed (neck, eyelids, lipofilling). The incisions are concealed within the hairline in the temporal region, follow the natural contours of the ear, and end in the scalp. A compression bandage is applied. An overnight hospital stay is typical.
BEFORE / AFTER
Scars: Discreet by Design
Les cicatrices d’un lifting deep plane suivent un trajet entièrement dissimulé dans les zones naturelles : départ dans les cheveux en région temporale, descente le long du bord antérieur de l’oreille, contour du lobe, remontée derrière le pavillon, puis fin masquée dans le cuir chevelu.
Two features specific to the deep plane technique promote optimal scar healing: the skin is closed without any tension (all tension is borne by the deep plane), and its blood supply is preserved due to minimal tissue dissection. Scars gradually fade over 12 to 18 months. Like any surgical scar, they are permanent, but their location generally allows the hair to be pinned back without them being noticeable.
Postoperative Care and Expected Results
Recovery from a deep-plane facelift is gradual and generally not very painful—the discomfort, which is mainly a feeling of tightness, is usually well managed with simple pain relievers.
- Day 0 – Day 1: Overnight stay at the clinic. The compression bandage is removed the next day. You may feel tightness and notice swelling in your face—this is normal and to be expected.
- Days 2–7: Swelling peaks around days 2–3 and then subsides. Bruising varies from patient to patient. Rest at home with the head elevated at night.
- Days 7–10: Stitches are removed. The swelling decreases significantly, and the bruises turn yellow and then fade.
- Days 15–21: A return to social life is generally possible; concealer may be used with a doctor’s approval. Return to work depends on the type of job (2 to 3 weeks on average).
- 1 month: Gradual resumption of light exercise with a doctor’s approval. Temporary sensitivity issues may still occur around the ears.
- 3 to 6 months: Nearly final results: the tissues have softened, and residual swelling has subsided. The scars continue to mature for up to 12–18 months.
Close postoperative follow-up is arranged with Dr. Vairinho at each key stage to monitor healing and answer your questions.
The results of a deep-plane facelift become apparent as early as the third week, continue to refine over the course of 3 to 6 months, and are characterized by a rested appearance, repositioned cheekbones, a reshaped facial contour, and a redefined neck—without altering your facial expressions or your identity. The repositioning of deep structures gives this technique a longevity that is generally superior to that of more superficial facelifts: the benefits are usually observed for many years—the literature commonly cites about ten years—with the understanding that natural aging continues and that longevity varies depending on each individual’s skin quality, lifestyle, and sun exposure. No results can be guaranteed: these factors are discussed honestly during the consultation, supported by photographs.
Like any surgical procedure, the deep-plane facelift carries risks—rare but real—which I always explain to you clearly and frankly during your consultation:
- Hematoma: the most common early complication, which may require revision surgery; the risk is reduced by the limited skin elevation characteristic of this technique
- Sensory disturbances around the ears and cheeks: common and almost always temporary (lasting from a few weeks to a few months)
- Injury to a branch of the facial nerve: rare, usually temporary; a precise understanding of the deep anatomy is precisely what allows one to work away from the nerve branches
- Abnormal scars (enlarged, hypertrophic): rare, exacerbated by smoking—hence the need to quit
- Infection, localized skin necrosis, asymmetry: rare
Choosing a surgeon who is qualified in plastic, reconstructive, and cosmetic surgery, is registered with the Medical Board, and operates in a suitable facility with an experienced anesthesia team is the most important factor in reducing these risks.
Deep-plane surgery is a demanding technique: the quality of its execution depends entirely on a thorough understanding of the anatomy of the deep planes of the face. Dr. Alexandre Vairinho, a board-certified plastic surgeon specializing in plastic, reconstructive, and cosmetic surgery and a former Chief Resident (Saint-Louis Hospital, Paris), has made facial surgery one of the main focuses of his practice. His approach combines a comprehensive morphological analysis, meticulous technical execution, and close postoperative follow-up, both in Paris’s 7th arrondissement and at his surgical facilities throughout the Île-de-France region. The decision to proceed with surgery is never automatic: if a less invasive alternative better serves your goals, that is the option that will be recommended to you.
FAQ
Frequently Asked Questions About the Deep Plane Facelift
This is a facelift and neck lift technique that repositions the skin, SMAS, and deep fat as a single unit after releasing the retaining ligaments, rather than simply tightening the skin. It corrects sagging at its source, resulting in a natural and long-lasting outcome.
In an SMAS facelift, the skin is extensively detached, and the muscle is tightened by creating folds. In a deep-plane facelift, the skin and SMAS remain attached and are repositioned together, beneath the ligaments, along a vertical axis. The result: no tension on the skin, a more complete correction of the midface, and a more natural appearance.
The mini-facelift is intended for early-stage, localized sagging; the deep-plane facelift is intended for moderate to severe sagging of the face and neck. It is the clinical examination—not age—that determines whether the procedure is indicated.
There is no set age: the procedure is most often performed between the ages of 45 and 70, but it is the degree of sagging observed during the examination that matters, not the patient’s chronological age.
No, provided the procedure is performed by a surgeon who is thoroughly familiar with the anatomy of the deep plane. The deep plane dissection plane is a natural plane of glide with minimal blood supply, and the limited skin elevation actually reduces certain risks (bruising, hematomas) compared to extensive skin elevation. The risks, which are rare, are discussed in detail during the consultation.
The scars are hidden in the hair and along the natural contours of the ear. Closed without tension, they fade over 12 to 18 months and generally allow you to wear your hair up without them being noticeable.
A deep-plane facelift is performed under general anesthesia: the procedure itself is painless. Postoperative symptoms are characterized more by a feeling of tightness than by actual pain, which is usually effectively relieved by simple pain relievers.
Repositioning deep structures generally offers longer-lasting results than superficial facelifts—the literature commonly cites a duration of about ten years. Natural aging then continues, and the longevity of the results depends on skin quality and lifestyle.
Yes, when clinically indicated: the procedure is then extended to the platysma muscle (extended deep plane) to redefine the angle between the chin and the neck, as a continuation of the work performed on the face.
Yes: blepharoplasty (eyelids), facial lipofilling (volume restoration), or skin rejuvenation treatments can be performed during the same surgical procedure when appropriate. The exact combination is determined during the consultation.
Yes. In fact, this is a common indication: the deep plane approach allows for a deeper and more lasting correction in patients who have previously undergone a more superficial facelift, following an assessment of their existing scars.
Yes. The technique is tailored to men’s specific characteristics (hair and beard distribution, tissue thickness), and its natural-looking results—with no visible signs of surgery—are particularly well-suited to men’s desire for discretion.
>> This page is intended to provide general information. Only a consultation with Dr. Vairinho will allow for an accurate assessment of your situation and the recommendation of an appropriate treatment plan. A personalized quote is provided only during a consultation.
