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 provides 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 restores and enhances natural volume to the cheeks and redefines 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 was 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.
- 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 - Fat Grafting Versus a Cheek (midface) Lift: Which Procedure is the Most Appropriate for Me?
- 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 - What Makes a Facial Plastic Surgeon Qualified to Care for Your Face?
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.
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.
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.
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 gid 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.
- 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 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.
- 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 (3). 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.
4. Meade RA, Teotia SS, Griffeth LK, Barton FE. Facelift and patterns of lymphatic drainage. Aesthet Surg J. 2012 Jan;32(1):39-45. doi: 10.1177/1090820X11430683. Erratum in: Aesthet Surg J. 2012 Mar 1;32(3):368.