Deep Plane Facelift

A traditional facelift tightens the skin alone, which can produce results that look pulled and fade relatively quickly as the skin relaxes. A deep plane facelift works beneath the SMAS layer, the muscular and connective tissue framework of the face, repositioning the underlying structures that have descended with age. The skin redrapes naturally over this repositioned foundation without artificial tension. Results look more natural, last longer, and age more gracefully.

Both techniques work below the skin and address the SMAS layer. A SMAS facelift plicates (folds and sutures) or implicates (removes a section of) the SMAS to tighten it but does not release the deeper retaining ligaments. A deep plane facelift goes further, releasing the zygomatic and masseteric ligaments that anchor descended tissue, allowing more complete repositioning of the mid-face and better correction of deep nasolabial folds. For patients with significant mid-face descent, the deep plane technique offers superior results.

Yes, for the right candidate who is someone with meaningful facial aging who wants the most natural, durable result available from a single procedure. The deep plane technique delivers improvements that lesser approaches simply cannot achieve, particularly in the mid-face and nasolabial fold area. Patient satisfaction with facelift surgery is consistently among the highest of any cosmetic procedure, and the longevity of deep plane results makes it one of the most cost-effective investments in facial aesthetics over a 10- to 15-year horizon.

With a healthy lifestyle – no smoking, consistent sun protection, a good skincare regimen – results from a deep plane facelift typically last 10 to 15 years or longer. The technique’s durability comes from repositioning the structural foundation of the face, not from stretching skin. Results do not disappear suddenly; they age gradually, and most patients look substantially younger than their chronological age for well over a decade.

Most deep plane facelift patients are between 45 and 65, though the procedure is appropriate across a wide age range depending on the degree of facial aging. The ideal time is when you have meaningful laxity to correct, enough for surgery to deliver a significant improvement, but still have good skin elasticity that allows the skin to redrape well. Younger patients (late 30s to early 40s) with early descent may achieve excellent results with a SMAS facelift. Patients in their 70s with advanced laxity can still be strong candidates; Dr. Shektman evaluates each individual on their own anatomy.

Natural results are the explicit goal of Dr. Shektman’s technique. The deep plane approach allows the skin to fall naturally over repositioned tissue without the tension that creates a stretched or windswept appearance. Patients consistently describe their results as looking like a rested, younger version of themselves, rather than like they’ve had surgery. The more than 800 facelifts Dr. Shektman has performed represent real experience in achieving this outcome consistently.

A facelift addresses the lower two-thirds of the face and neck. It does not improve the upper eyelids, brow, or forehead (which require blepharoplasty or brow lift), skin texture or surface lines (which respond to laser resurfacing), or volume deficits in the lips or perioral area (which are addressed with fat grafting or filler). Many patients combine a facelift with one or more of these complementary treatments for a more complete rejuvenation.

A mini facelift is a shorter, more limited procedure that addresses early jowling and neck laxity through smaller incisions with less tissue elevation. It is a reasonable option for patients with mild, early aging who want a shorter recovery, but it does not address the mid-face, does not work at the SMAS or deep plane level, and produces less comprehensive and less durable results. For patients with moderate to significant facial aging, a mini facelift will not achieve the same improvement as a deep plane procedure. Dr. Shektman will recommend the appropriate approach during your consultation.

The procedure is performed under anesthesia, and patients feel nothing during surgery. Post-operatively, discomfort is typically described as moderate tightness and soreness rather than sharp pain and is well-managed with prescription medication for the first several days. Most patients are surprised by how manageable the recovery is. By the end of the first week, most find they no longer need prescription pain medication.

All surgery carries risk, and a deep plane facelift is no exception. The most commonly discussed risks include hematoma (blood pooling beneath the skin, the most frequent early complication), temporary nerve sensitivity, infection, scarring, and asymmetry. Because the deep plane technique works in proximity to the facial nerve branches, it requires a surgeon with specific expertise in deep plane anatomy – the reason surgeon selection matters enormously. In the hands of an experienced, board-certified plastic surgeon like Dr. Shektman, complication rates are low and serious complications are rare.

Hematoma, a collection of blood beneath the skin, is the most common early complication following facelift surgery. It typically presents within the first 24 hours as sudden swelling on one side of the face. Risk factors include uncontrolled blood pressure, use of aspirin or blood thinners, and post-operative straining. Dr. Shektman takes precautions including careful intraoperative hemostasis, placement of small drains when indicated, and detailed pre-operative instructions about medications to avoid. Blood pressure management in the immediate post-operative period is also a key part of the protocol.

Incisions are placed at the hairline, in the natural contours around the ear, and (if necessary) under the chin – locations specifically chosen to be imperceptible once healed. In the early weeks, incision lines may be visible as pink marks. By six months, most are barely noticeable; by one year, they are typically invisible in normal social settings. Proper wound care and sun protection during the healing period support optimal scar maturation.

Yes, and for many patients, a thoughtful combination approach produces the most complete result. Botox relaxes dynamic lines (forehead, crow’s feet, brow) that surgery does not address. Filler can restore volume in areas outside the facelift zone, such as the lips and perioral area. However, large volumes of filler in the areas being surgically treated are generally discontinued before surgery. Dr. Shektman will advise you on timing and what to pause before your procedure during the consultation.

Initial improvement is visible almost immediately, even through the initial swelling and bruising. As swelling resolves over the first two to three weeks, the results become more apparent. Most patients feel their results are visible and presentable within two to three weeks, enough to return to work and social activities. The final result, with all swelling resolved and incisions fully matured, is typically fully visible at six months.

Facelift surgery is priced individually based on procedural complexity, anesthesia, and whether additional procedures are performed concurrently. A straightforward estimate cannot be given without a consultation. After Dr. Shektman evaluates your anatomy and discusses your goals, a detailed, transparent cost quote is provided. Financing options are available. Patients who compare the cost of repeat filler treatments over a decade often find that facelift surgery is the more economical long-term investment.

Yes, and for a meaningful period, not just a few days. Smoking impairs microvascular circulation, which is essential for wound healing. Patients who smoke face significantly higher risks of skin necrosis, poor wound healing, visible scarring, and prolonged recovery. Dr. Shektman requires smoking cessation for a minimum of four weeks before surgery and throughout the recovery period. Patients who quit permanently prior to surgery maintain their results substantially longer.

Absolutely. Male facelift surgery follows the same anatomical principles, with specific consideration given to the hairline, beard pattern, and the aesthetic goals appropriate for masculine facial structure. The incision placement is adapted accordingly to avoid distorting the hairline or sideburns. Dr. Shektman has experience with male facelift patients and approaches each case with attention to the nuances of male facial anatomy.

The most important questions to ask any facelift surgeon include:

• How many facelifts have you performed?
• Are you board-certified by the American Board of Plastic Surgery?
• What technique do you recommend for my anatomy and why?
• What does your recovery timeline look like?
• Can I see before and after photos of patients with similar anatomy to mine?
• What are your complication rates?
• Will you be performing my surgery personally?

Dr. Shektman welcomes all these questions and more. He encourages patients to use the consultation to evaluate him as much as to learn about the procedure.