Extended Deep Plane Facelift
Drooping of the cheeks and jowls may become more noticeable as we age. There may even be a loss of definition at the back corner of the jawline, which can begin to blend in with the neck. The extended deep plane facelift can address these areas of concern. Dr. Harmon can provide exceptional results with the extended deep plane facelift through the release of multiple tension points and lifting of both the skin and muscle layers of the face at the most natural anatomic angle, neither too vertical nor too horizontal. This tension-free approach significantly improves healing and eliminates the risk of a “pulled” look. Unlike other facelift techniques, the extended deep plane facelift can restore and enhance natural volume to the cheeks and redefine the entire length of the jawline (1). This reduces the need to place additional volume in the cheeks and jaw with fat or hyaluronic acid filler. The overall effect is more natural and longer lasting. Its safety has been well-documented by a meta-analysis published in the prestigious Aesthetic Surgery Journal (2). The technique does, however, require extensive training to perform. Dr. Harmon is the only surgeon in the region - and one of the few in the world - trained in this procedure by the surgeon who developed the technique, Dr. Andrew Jacono.
Original Research Published in Major Surgery Journal
Dr. Jeffrey Harmon has published original research with his former American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) fellowship director and colleagues. Titled “Effect of a Novel Platysmaplasty Hammock Flap During Extended Deep Plane Facelift on Signs of Aging in the Neck,” the paper investigates the effects of one component of the extended deep plane facelift to restore youthful qualities to the neck in a natural, long-lasting manner (3). This paper was published in Aesthetic Surgery Journal, one of the most prestigious publications in plastic surgery.
The purpose the platysma hammock flap during the extended deep plane facelift as described in the publication is not only to improve the appearance of the facelift – partially by lifting and supporting drooping glands under the jawline – but also to avoid the quick redevelopment of neck bands and skin looseness. This paper assessed the longevity of the platysma hammock flap and assessed post-operative satisfaction with the technique. A statistically significant improvement in neck banding, skin looseness, and gland visibility after surgery was found, strongly supporting the benefits of this procedure.
Extended Deep Plane Facelift Before & After
Am I a Good Candidate?
Individuals develop signs of facial aging at different rates and to a different extent. The extended deep plane facelift can address aging of the cheeks, jowls, jaw, and neck comprehensively in a natural and long-lasting manner.
Most candidates for an extended deep plane facelift range in age from 40s to 70s. A consultation is recommended to determine candidacy for the procedure, because there may be factors that preclude this procedure for certain individuals. Reasonable expectations must be established about what an extended deep plane facelift can and cannot accomplish as with all plastic surgery procedures. As with all facial plastic surgery procedures, results can vary.
Recovery from an extended deep plane facelift is specific to the individual. The duration of recovery will vary from person to person. The recovery time for this procedure is approximately 10 to 14 days for most individuals. Dressings are removed the day after surgery. Sutures are removed in a staged, progressive manner from day 5 to days 10 to 12 after surgery. Makeup can usually be applied to the healing incision sites starting approximately 14 days after surgery. The healing process does not end at 14 days, however. For example, the incisions continue to heal for months after surgery.
Some swelling and bruising are expected after an extended deep plane facelift. Post-operative swelling and bruising generally improves significantly by 10 to 14 days after surgery. Swelling and bruising are expected to continue to improve and resolve in the ensuing days and weeks.
What to Expect in a Consultation
Expect a detailed, informative conversation with Dr. Harmon about your concerns and aesthetic goals regarding your face. He will assess your anatomy and develop a personalized treatment plan to address your concerns and aesthetic goals.
Frequently Asked Questions
- What type of anesthesia is required?
- The extended deep plane facelift can usually be performed under IV sedation. Some individuals may require general anesthesia.
- Can a facelift be performed without a neck lift?
- The face and neck are considered together because the anatomical structures blend together. Therefore, a facelift is almost never performed without a neck lift. The approach to the neck lift does depend on each individual’s specific anatomy.
- Will I look “pulled” or unnatural after a facelift?
- The extended deep plane facelift can prevent the appearance of being “pulled” through the release of multiple tension points in the face and neck through the deep plane approach. This can result in a natural and tension-free lifting of drooping tissue.
- Will the extended deep plane facelift distort my hairline?
- No, the extended deep plane facelift utilizes a minimal-access approach that preserves the hairline. This can be done because there is no tension on the skin with an extended deep plane facelift, allowing the incision to be hidden at the hairline without distorting it.
- Do men benefit from the extended deep plane facelift?
- Absolutely. Men experience similar age-related changes to their face as women. As a result, they experience similar benefits from the extended deep plane facelift as women.
- Will I have long, visible incisions?
- Dr. Harmon utilizes a minimal-access approach to the extended deep plane facelift that hides incisions around the ear and along the hairline. The fact that the extended deep plane facelift results in no tension on the skin allows these incisions to heal significantly better than other facelift approaches which place undue tension on the skin.
- Will the extended deep plane facelift get rid of my wrinkles?
- The extended deep plane facelift, unique among facelift techniques, can significantly improve the deep folds between the cheek and the lip, also known as the melolabial folds. However, fine facial wrinkles that are a result of changes to the top layers of the skin and not loose, drooping soft tissue and fat is better treated with laser resurfacing (CO2 laser). Fortunately, laser resurfacing (CO2 laser) can be performed at the same time as an extended deep plane facelift, which enhances the results of the facelift.
- Will the extended deep plane facelift get rid of my smoker’s lines (peri-oral rhytids)?
- No. While the extended deep plane facelift can significantly improve the severity of melolabial folds, peri-oral rhytids require a dual-pronged approach independent of a facelift. Dr. Harmon utilizes the patient’s own fat, refining it into a fine injectable called nano-fat, to fill the deepest lines around the mouth. He then utilizes an advanced laser, called a fractional CO2 laser, to resurface the skin. The action of the laser as well as the fat cells (adipocytes) from the nano-fat enhance the healing of the skin, allowing more organized, youthful collage to form around the mouth, thereby reducing the appearance of smoker’s lines.
- Will the extended deep plane facelift treat my deep tear troughs?
- The tear trough is a ligament extending from the facial bones to the skin. A youthful face demonstrates a smooth curve and transition from the lower eyelid to the cheeks. The tear troughs can become more visible with the drooping of cheeks and the development of lower eyelid bags, both of which breaks that smooth transition. The extended deep plane facelift can improve the appearance of the interface between the lower eyelid and cheeks. However, lower eyelid bags are the primary contributor to deepened tear troughs. Therefore, one should not expect the extended deep plane facelift to treat their deep tear troughs. Lower eyelid surgery (blepharoplasty) is generally the best treatment for deep tear troughs.
- Will my nasolabial folds and marionette lines improve after extended deep plane facelift surgery?
- The nasolabial folds and marionette lines develop as a result of superficial fat pads drooping and exposing ligaments surrounding those fat pads. They are important areas of the face that delineate different subunits. As a result, they are essential. However, they often become more pronounced with age. The extended deep plane facelift can often, though not always, improve both the nasolabial folds and marionette lines because the release of tension points in the cheeks and jawline allow a lift of the deep tissue away from these ligaments.
- Will the presence of dermal filler in my face prevent me from having a facelift?
- Not necessarily. The extended deep plane facelift can generally be performed with dermal filler in the face.
- What is the best age to get a facelift?
- The best age for a facelift is entirely dependent on the individual, their aesthetic goals, as well as their anatomy and medical history. It also depends on how early a patient would like to enjoy the results! The age range in which most patients undergo a facelift is late 40s to late 60s.
- How long does the extended deep plane facelift last?
- The extended deep plane facelift, like every other facial plastic surgery procedure, does not stop the aging process. The primary goal of the extended deep plane facelift is to make an individual look like themselves, only younger. That being said, the extended deep plane facelift can last much longer than other facelift approaches, which often need to be “revised” within a few years. The extended deep plane facelift can last 12 – 15 years, which is quite a long time compared with other approaches.
- Will I heal at the same rate on each side of my face (symmetrically) after the extended deep plane facelift?
- The healing process differs for each side of the face. That is partially due to the fact that every face is asymmetric. It is not unexpected for one side of the face to heal faster than the opposite side, including more bruising and swelling on one side compared with the other.
- Will I have drains after the extended deep plane facelift?
- Yes. One drain is placed on either side of the neck. Each comes out through a small opening in the hair, which usually heals beautifully after they are removed. The drains are usually removed the morning after surgery unless the drain output necessitates leaving them in for additional time.
- Will my ear be removed and replaced during extended deep plane facelift surgery?
- No, the ear is not removed and replaced during an extended deep plane facelift or any other facelift technique/approach. This is an understandable, common misconception. The incisions for the extended deep plane facelift are simply hidden in the complex curves and crevices of the ears without actual removal of the ear cartilage or earlobe.
- Will my earlobes be altered after extended deep plane facelift surgery?
- One risk of facelift surgery is the stretching and alteration of the lower earlobes, called a pixie ear deformity. This is usually due to excess tension on the skin and an incision carried to far onto the earlobe itself. This risk can be minimized by performing deep plane surgery which eliminates tension on the incision and allowing 1 - 2 mm of skin beyond the earlobe to preserve the earlobe sulcus.
- Where should I expect to swell the most after extended deep plane facelift surgery?
- Some swelling is expected after facelift surgery, regardless of the approach/technique used. As previously stated, the swelling generally improves significantly in 10 to 14 days such that most individuals can return to their normal daily routine with some exercise restrictions. Swelling is expected to continue to improve and resolve over a period of weeks. One possible explanation for this is that the lymphatic drainage system is temporarily affected by facelift surgery. The lymphatic drainage system, located all over the body, removes body fluid from tissue and returns it to the blood. The lymphatic drainage system helps improve and resolve swelling. One small study from Aesthetic Surgery Journal in 2012 evaluated the lymphatic drainage system in 3 patients who underwent a facelift (4). Lymphoscintigraphy was performed prior to surgery and at multiple time points after surgery on these patients. Lymphoscintigraphy involves the use of a material that is injected into tissue and which is absorbed by the lymphatic drainage system and can be detected on imaging. The study demonstrated that the locations for the lymphatic fluid to drain was restricted to areas under the jaw immediately after facelift surgery. The patients realized an improvement in lymphatic drainage by 3 months after surgery and a normalization of the drainage patterns by 6 months. This is a possible explanation as to why swelling in the area under the jaw, called the submental space, can take slightly longer to resolve than in other areas with any facelift approach/technique.
- Can hyperbaric oxygen (HBO) therapy improve healing after extended deep plane facelift surgery?
- Hyperbaric oxygen (HBO) therapy has been used for many years to treat chronic wounds. The procedure has been shown to improve the delivery of oxygen to tissue and reduce tissue injury. Most assume HBO therapy is used only for patients who are experiencing poor blood flow to the skin after a facelift. In fact, there is some evidence that treatment with HBO can accelerate the resolution of bruising after facelift surgery (5). This could potentially benefit patients who would like to return to work or their social lives more quickly. The option for HBO treatment is discussed with patients prior to extended deep plane facelift surgery. People who could potentially benefit from HBO therapy include patients with a recent history of smoking or those who have undergone a facelift or non-surgical face tightening procedure elsewhere, because the blood supply to the tissue of the face, including the skin, is weakened. Patients who pursue HBO therapy undergo a consultation with the physician who administers the therapy where he extensively reviews their medical history and performs a physical exam to determine their candidacy for treatment.
- Is the extended deep plane facelift a painful procedure?
- Facial plastic surgery procedures are generally well-tolerated by patients and typically involve little pain, especially when compared with surgery on other areas of the body. Patients are usually prescribed just a small amount of pain medication for after surgery. In fact, we have found most use only over-the-counter pain medication including acetaminophen and/or ibuprofen after surgery instead. And those who do use the prescribed pain medication usually only use it the first night after surgery. With that in mind, it is important to note that every patient perceives and processes pain differently. Some patients have a high pain tolerance. Others may be more predisposed to be more sensitive to pain. We at Harmon Facial Plastic Surgery are focused on balancing minimizing post-operative discomfort and maximizing safety.
- Is a facelift a common surgical procedure?
- Yes, a facelift is a common surgical procedure. The International Society of Aesthetic Plastic Surgery (ISAPS) releases statistics each year that provide insight into the state of plastic surgery around the world. ISAPS reported 56,084 facelifts were performed in the United States in 2020.
Why Choose Dr. Harmon
- The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good.
- Dr. Harmon values making patients feel welcomed, listened to, and respected.
- Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology.
- Dr. Harmon earned his medical degree from the University of Cincinnati.
- Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati.
- Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City.
- Dr. Harmon posts frequently and covers a wide range of topics, including procedure-specific information, volunteering, general health, and much more. Read more from Dr. Harmon by visiting his blog.
- Harmon Facial Plastic Surgery can be reached here.
1. Jacono AA. A Novel Volumizing Extended Deep-Plane Facelift: Using Composite Flap Shifts to Volumize the Midface and Jawline. Facial Plast Surg Clin North Am. 2020 Aug;28(3):331-368.
2. Jacono AA, Alemi AS, Russell JL. A Meta-Analysis of Complication Rates Among Different SMAS Facelift Techniques. Aesthet Surg J. 2019 Aug 22;39(9):927-942.
3. Jacono AA, Alemi AS, Harmon JJ, Ahmedli N. The Effect of a Novel Platysma Hammock Flap During Extended Deep Plane Facelift on the Signs of Aging in the Neck. Aesthet Surg J. 2022 Apr 21:sjac086.
4. Meade RA, Teotia SS, Griffeth LK, Barton FE. Facelift and patterns of lymphatic drainage. Aesthet Surg J. 2012 Jan;32(1):39-45. Erratum in: Aesthet Surg J. 2012 Mar 1;32(3):368.
5. Stong BC, Jacono AA. Effect of perioperative hyperbaric oxygen on bruising in face-lifts. Arch Facial Plast Surg. 2010 Sep-Oct;12(5):356-8.
- Article - 4 Benefits of the Extended Deep Plane Facelift
- Article - Overview of Facelift Techniques
- Article - Three Procedures to Address the Signs of an Aging Face Comprehensively
- Article - How to Evaluate a Cheek Lift with the Extended Deep Plane Facelift
- Article - Fat Grafting Versus a Cheek (midface) Lift: Which Procedure is the Most Appropriate for Me?
- Article - Why People Seek Revision Facelifts and Why Deep Plane Facelift Surgery is the Best Approach
- Article - Peri-Oral Rejuvenation: An Explainer
- Article - Kludges in Facial Plastic Surgery
- Article - Is it My Buccal Fat or Jowl Fat That Needs Treatment?
- Article - Four Strategies to Reduce Swelling After Deep Plane Facelift Surgery
- Article - What is Lymphatic Massage and What Can it Do After Facelift and Neck Lift Surgery?
- Article - The Importance of Post-Operative Recovery Incision Care and Our Plan
- Article - Is Silicone Gel Effective in Improving the Appearance of Surgical Incisions?
- Article - How Are Drains Cared for After Extended Deep Plane Facelift and Neck Lift Surgery?
- Article - What is Hemostatic Netting and Why Would it Be Used in Facelift and Neck Lift Surgery?
- Article - What Makes a Facial Plastic Surgeon Qualified to Care for Your Face?
- Article - What Facial Plastic Surgery Procedures Do Men Frequently Seek?
- Article - When Should I Consider Undergoing Facial Plastic Surgery Procedures Prior to a Wedding?