In Defense of the Deep Plane Facelift

In Defense of the Deep Plane Facelift featured image
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For a complete facial refresh, there’s nothing that compares to the power of a facelift. While there are a handful of different types of facelifts—mini, mid, lower and full, to name a few—there has been some recent chatter questioning the safety of a deep plane facelift, which involves lifting and repositioning the skin and muscle together as a single unit. As such, there is a possibility for nerve damage, but as Nashville, TN plastic surgeon Daniel A. Hatef, MD contends, nerve damage is a well-known risk of any facelift.

“Those questioning the safety of the procedure aren’t plastic surgeons,” notes Dr. Hatef. “What they’re saying is not scientific, it’s just misinformation based on one bad case.” Ahead, we separate fact from fiction with Dr. Hatef, along with everything to know about the popular procedure before going under the knife.

What is the difference between a traditional facelift and a deep plane facelift?

“A deep plane facelift is where we raise what is called the SMAS—the superficial musculoaponeurotic system—of the face, which is basically the resting fascia of the facial muscles that moves your face and help you smile, kiss, all of your facial expressions. There’s a fascial layer that surrounds those muscles, so we lift the superficial aspect of that fascia off of those muscles and we relocate it in a more superior and more youthful position to get a better jawline, to correct the jowls and to improve the neck. The reason we do it is because when you see aging, when you see jowling, those things are a result of that loosening over the muscles and sliding down. So when we reposition that, that’s the best way, in my opinion, to reposition facial fat.”

What makes a deep plane facelift more risky than others when it comes to facial-nerve damage?

“When we do the surgery, we are dissecting very close to the branches of the facial nerve. There’s no doubt that we are getting near them and even touching them and and we see them during this facelift, but to say that it’s unsafe is completely unscientific.

Patients will sometimes smile funny for about two or three weeks after surgery—kissy faces will also be a bit weaker for this period—and that’s partially because you’re stretching the nerves out when you do the dissection, but it’s also because you’re potentially injuring the musculature, especially the platysma, when you’re doing a deep plane facelift. But I’ve never seen any long-term problems from it. Over time, the muscles will strengthen again.”

What should a patient do if they find themselves in this situation after a deep plane facelift?

“It depends on their examination, and that’s why it’s so important to go to a board certified plastic surgeon or board certified facial plastic surgeon who specializes in the surgery and who does it frequently, so that they will have the confidence to have seen it before and understand that it’s going to go away. I think the worst thing you can do is is reopen and explore for nerve injury, when there’s likely no injuries.

Now if someone went to a non board-certified person who calls themself a cosmetic surgeon and their entire face isn’t moving, in this situation we know that either both branches are cut or there’s a suture that’s looping a large branch. That’s different. But when it’s an isolated branch,  that’s generally just from stretching, trauma from surgery and inflammation.”

What is the number-one thing a patient can do to try to avoid these risks?

“Going to a board certified plastic surgeon. Of course there are risks, but these are known risks of facelift surgery. We’re not producing vehicles off the assembly line—it is surgery and things don’t always go well. Most of the time they do, especially in the hands of a great surgeon, but sometimes they don’t. Generally, these things will resolve with time.

Anytime you’re traveling for surgery, you maybe don’t establish as good of a relationship with that surgeon, and so they’re not able to hold your hand as well. When you’re considering a huge surgery like this, you’re probably better off staying in town where you live and finding a board certified plastic surgeon or facial plastic surgeon, not facial cosmetic, not cosmetic—there are only two boards that are acceptable for doing this kind of surgery.”

What does downtime and potential scarring look like after a deep plane facelift?

“For a deep plane facelift like I do where I mobilize a high SMAS, I make my incision where the typical hairline starts and I go down behind the tragus of the ear, under the ear lobe and behind the ear, and then back into the hairline. We do that on both sides. And then I make about a two-inch incision underneath the chin, on the neck.

The downtime is generally about three weeks. If the patient has a lot of subplatysmal fat, I let them know that I’ll be taking more out to give them optimal jawline contouring. But when I do that, I take out the lymph nodes in the neck, and so in that case the downtime is even more, and that’s because they swell so much. When they come in for their first post-op appointment at week one, they look amazing and they’re so happy. And then swelling really kicks in in that area of the neck and so they’re swollen for a good six weeks after that, but when that subsides they end up looking amazing.”

Is there anything the patient can do to reduce the swelling at home?

“Eating a high-protein anti-inflammatory diet, lymphatic massage and compression, compression, compression. Those things help to make it so that we have more even swelling and so that three to six months down the road, they just have a nice flat jawline contour.”

What would you recommend for those looking for significant tightening results but are not ready for a facelift?

“The things that we do in patients who have a little bit of jawline laxity but aren’t ready for the facelift are jawline rejuvenation with filler where we use filler to artistically augment the jawline. So you’re augmenting that area and creating a highlight, and then at the edge of that highlight is a strong shadow. So it’s a little bit of light physics that we’re manipulating when we do that. It’s also just the fact that adding volume to the jawline splits their soft tissues and reduces the laxity. The other option is internal radio frequency in the area.”

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