Deep Plane Facelift

What is a deep plane facelift?

A deep plane facelift is a facelift technique used to correct sagging of the lower face and neck. Its name comes from the fact that the surgery is performed not just beneath the skin, but beneath the supporting layer of muscle and connective tissue in the face, known as the SMAS, in a deeper anatomical plane.

With age the cheek tissues descend, the jawline loses its definition and the neck becomes lax. In a deep plane facelift, the ligaments that hold these tissues down are released and the skin and supporting layer are then lifted together as a single unit. The aim is to bring the tissues closer to where they were years ago without making the face look stretched.

Head and neck surgery requires close familiarity with the course of the facial nerve and the anatomy of the neck. Because a deep plane facelift involves working near the branches of the facial nerve, Dr. Özlem Yüksel Coşar places particular emphasis on careful anatomical planning.

What does a deep plane facelift correct?

A deep plane facelift is planned for patients in whom ageing is most visible in the lower half of the face and the neck:

• Sagging along the jawline (jowls)
• Deepened nasolabial folds between the nose and mouth
• Deepened marionette lines running from the corners of the mouth to the chin
• A jawline that has lost its sharp contour
• Neck laxity, neck bands and fullness under the chin

This operation is not designed for the upper face, such as the forehead, brows and eye area. If your ageing signs are mainly around the brows, eyes and cheekbones, an endoscopic facelift may be the more appropriate choice.

SMAS vs deep plane: what is the difference?

Facelift techniques differ mainly in the layer in which the tissues are lifted:

Placing the tension on the deeper layer rather than the skin helps to avoid a "wind-swept", overly tight look and supports better scar healing. That said, there is no single right technique for everyone; the choice depends on your facial structure and on what needs correcting.

Who is a good candidate?

A deep plane facelift is usually considered for people who:

• Have noticeable sagging of the jawline and neck, most often between the ages of about 45 and 70
• Are in good general health, with blood pressure and blood sugar well controlled
• Do not smoke, or are willing to stop several weeks before surgery
• Have had a stable weight for some time and have realistic expectations

A facelift does not by itself improve skin texture, fine wrinkles or sun spots. At the consultation we discuss openly what surgery can and cannot change.

Consultation and planning

At the first consultation we assess skin quality, the degree of sagging in the cheeks and jawline, the neck muscles, fat under the chin and any differences between the two sides of the face. Facial nerve function is examined and documented. Previous facial surgery, fillers or thread lifts are taken into account.

International patients can send photographs and medical information in advance for a preliminary assessment, but the final plan is always made after an in-person examination in Izmir. Before surgery:

1. Blood thinners, certain painkillers and herbal supplements are reviewed and, if necessary, adjusted together with the prescribing doctor.
2. Blood pressure must be well controlled, as high blood pressure increases the risk of bleeding after surgery.
3. Routine blood tests and an anaesthetic assessment are carried out.
4. Smoking impairs the blood supply to the skin and can cause wound-healing problems, so you must stop before and after surgery.

How is a deep plane facelift performed?

The operation is carried out under general anaesthesia and usually takes 3–6 hours, depending on whether a neck lift is included.

Incisions

The incision starts at or within the temple hairline, follows the natural contours in front of the ear, curves around the earlobe and continues behind the ear and along the hairline at the back of the neck. If the neck is also treated, a small incision is made under the chin.

Working in the deep plane

After the skin has been lifted over a short distance, the surgeon passes beneath the SMAS layer. The ligaments that hold the cheek and jawline down are released, and the skin and SMAS are moved upwards and backwards together and secured to the deeper tissues. The branches of the facial nerve are protected throughout. Excess skin is then removed without tension.

Neck lift

In patients with neck laxity, the neck muscles (platysma) are brought together in the midline through the incision under the chin in the same operation, and excess fat under the chin is reduced if necessary. This helps to define the angle between the jaw and the neck.

Thin drains and a light compression dressing are usually applied at the end of the operation. Most patients stay in hospital for one night.

Recovery after a deep plane facelift

Recovery depends on the individual and the extent of surgery. In general:

• Days 1–2: Drains and dressing are removed. You will be asked to rest with your head elevated and to avoid sudden head movements.
• First week: Swelling and bruising are at their peak; tightness and numbness in the face and around the ears are normal. The stitches in front of the ear are usually removed towards the end of this week.
• Days 10–14: The stitches behind the ear and in the scalp are removed.
• Weeks 2–3: Most bruising has faded and most patients return to desk work and social life. Remaining mild swelling can be covered with make-up.
• Weeks 4–6: Exercise and sport can be resumed gradually.
• Months 6–12: Residual swelling and numbness largely settle, the scars mature and the final result becomes visible.

We see patients in the first days, at 1 week, 1 month, 3 months and 1 year. After you return home, follow-up can continue by video call, and our team can be reached in English throughout your recovery.

Risks and things to be aware of

A deep plane facelift is a major operation and carries certain risks:

• Haematoma (a collection of blood under the skin): the most common early complication of a facelift; high blood pressure increases the risk, and it sometimes requires a return to theatre.
• Facial nerve weakness: usually temporary and resolves over weeks to months; permanent injury is rare.
• Numbness: numbness of the cheeks, ears and earlobes is common and usually improves over several months.
• Wound-healing problems: particularly in smokers, the blood supply to the skin around the ear can be compromised.
• Scar-related issues: thickened or widened scars, a change in the shape of the earlobe, a shift in the temple hairline or hair thinning near the incisions.
• Infection, asymmetry, contour irregularities and, occasionally, the need for a touch-up.

Before surgery we go through all the risks and any factors specific to you during the written consent process. Following aftercare advice carefully, especially keeping blood pressure under control and avoiding smoking, reduces these risks considerably.

Combining it with other procedures

If only the lower face is treated, it can end up out of balance with the upper face. For this reason, in some patients a deep plane facelift is planned together with:

• An endoscopic facelift for descent of the brows and mid-face
• Eyelid surgery for excess eyelid skin and bags
• A lip lift if the distance between the nose and upper lip has lengthened
• Fat grafting, using your own fat, to areas that have lost volume

Combining procedures can lengthen both the operation and the recovery, so the decision is made by considering your general health and expectations together.