Improving the Extended Deep Plane Facelift by Further Emphasizing a Composite Volume Lift

As I have written about previously, the extended deep plane facelift has gradually become a gold-standard technique in facelift surgery. Importantly, the technique was not developed in isolation. Instead, the extended deep plane facelift is an improvement on deep plane facelift surgery which was, itself, first published over thirty years ago (1). The evolution of facelift surgery has been one of gradual, iterative improvements in technique in which the strengths of older techniques are preserved and the weaknesses are improved upon. This process has continued with the extended deep plane facelift (2).

Further Emphasizing a Multi-Layered Volume Lift, Further De-Emphasizing a Skin-Only Lift

Important improvements have been made to the extended deep plane facelift since the technique was first published approximately fifteen years ago (3). They have involved a reduction in the amount of subcutaneous dissection at the cheek and on the side of the neck, thereby reducing the amount of skin-only lift. As a result, a larger percentage of the dissection is in the deep plane, which is the connective tissue (e.g., Superficial Musculoaponeurotic System [SMAS]), and muscle (e.g, platysma muscle) that lies immediately deep to the subcutaneous fat. In effect, this approach further emphasizes the volume lift aspect of deep plane surgery.

There Are Many Potential Healing Advantages to This Approach

The potential advantages of this approach to extended deep plane facelift surgery include (2):

• Possible reduction in bruising
• Possible reduction in swelling
• Reduction of space in which blood can collect, possibly reducing the risk of and/or severity of a hematoma and/or a seroma
• Possible reduction in risk of skin color changes
• Possible improved healing at the incision site

The basis for the above is the fact that a significant portion of blood flow to the skin comes from tissue deep to the skin. Therefore, if less skin is dissected, there is likely improved blood flow to the skin after surgery. Moreover, if less skin is dissected, then there is less space for blood and body fluid – called serous fluid – to collect. I have personally seen less swelling, less bruising, and reduced drain output utilizing these modifications to the extended deep plane surgery technique.

There Is a Potential Results Advantage to This Approach

Less skin dissection means a larger area of deep plane dissection. A larger area of deep plane dissection leads to more volume being lifted. This can provide more natural-appearing results across the cheek and improved results across the neck. First, increased volume immediately in front of the incision can better approach the natural contours of the face in youth. Second, the lift on the side of the neck can capture and lift more volume in the lower, central neck. In contrast, many older facelift techniques that emphasize a skin lift are more likely to result in a pulled, stretched, and/or “windswept” appearance and may have a higher risk of poor healing.

This Modified Approach Remains the Extended Deep Plane Facelift Technique

It is important to emphasize that these modifications preserve the basic idea of the extended deep plane facelift approach. This approach still extends the deep plane facelift into the neck. The modifications are not revolutionary but are important. They reflect a desire among many individuals to continuously innovate by thinking critically about their technique and evaluating ways in which they can improve results for their patients.

References

1. Hamra ST. The deep-plane rhytidectomy. Plast Reconstr Surg. 1990 Jul;86(1):53-61; discussion 62-3.
2. Roskies M, Bray D, Gordon NA, Gualdi A, Nayak LM, Talei B. Limited Delamination Modifications to the Extended Deep Plane Rhytidectomy: An Anatomical Basis for Improved Outcomes. Facial Plast Surg Aesthet Med. 2024 Nov-Dec;26(6):657-664.
3. Jacono AA, Parikh SS. The minimal access deep plane extended vertical facelift. Aesthet Surg J. 2011 Nov;31(8):874-90.