What is Deep Plane Facelift?

One of the most frequent questions I hear at consultations is: "How can I look younger without anyone noticing I've had something done?" That is precisely the goal of modern facelift surgery — and exactly what the Deep Plane technique, when performed correctly, can achieve.

How the Face Actually Ages

Facial ageing is far more complex than the appearance of wrinkles. Over time, deep soft tissues gradually descend under the influence of gravity. The fat pads of the cheeks migrate downward, definition of the lower jaw is lost, so-called jowls appear, and the neck gradually loses its contour.

At the same time, there is a loss of volume in subcutaneous fat and changes to the facial skeleton — which is why the face looks not only more lax but also less full than in younger years.

From Skin Facelift to Deep Plane Technique

The earliest generations of facelift were based on skin tightening. Such procedures could offer temporary improvement, but frequently produced an unnatural appearance because surface layers bore all the tension — and within months the face would relax again.

SMAS techniques followed, representing a significant advance by incorporating deeper facial structures. However, SMAS is treated separately from the skin — the surgeon tightens one in one direction, the other in another — which still does not address the ligaments around which ageing actually occurs.

Deep Plane facelift went a step further. Rather than separate tightening, it releases the natural restraints preventing tissue movement, and returns the entire tissue complex to the position it occupied before the ageing process began.

What is the SMAS?

The SMAS (Superficial Musculo-Aponeurotic System) is a firm fibromuscular layer situated between the skin and the mimetic muscles. It is the mechanical connection between muscle and skin, and plays a critical role in the shape and movement of the face.

Modern facelift techniques all manipulate this layer. The difference between techniques is not whether the SMAS is addressed — but how and at what depth.

What Does "Deep Plane" Mean?

In Deep Plane facelift, the surgeon enters below the SMAS, into the natural anatomical space between the superficial and deeper facial structures. This technique was popularised in the early 1990s by Dr. Sam Hamra and subsequently further developed by numerous surgeons, including Dr. Andrew Jacono.

Within this space, key retaining ligaments are released — the fibrous structures that firmly anchor soft tissue to the facial skeleton. Only after their release does the tissue become sufficiently mobile to be repositioned to a more natural location — without excessive skin tension.

Which Ligaments Are Released?

• Zygomatic ligaments — anchor cheek tissue to the cheekbone; their release enables elevation of descended cheeks and restoration of volume to the midface
• Masseteric ligaments — responsible for the formation of jowls, the lax tissue along the lower border of the jaw
• Platysma and its fascial attachments — addressing these achieves better definition of the neck and mandibular line

After releasing these structures, the skin, fat and SMAS move together as a single anatomical unit — upward and backward, to the position they occupied in younger years.

Why Results Look Natural

A natural result does not come from less tightening — it comes from a different distribution of tension. When tissue is elevated in the direction it naturally descended, there is no tension. No "pulled" appearance. No artificial skin sheen.

The skin adapts gently on its own because it does not need to bear the load of elevation — the deeper structures have already done that. Personal identity and facial expression are not altered — what is restored are the contours that gradually disappeared over the years.

How Long Do Results Last?

Because the procedure addresses the cause of tissue descent rather than just the symptoms, Deep Plane facelift results last significantly longer than surface techniques — in most patients, 10 to 15 years.

Ageing continues, of course. But from a much more favourable starting position. A patient who undergoes the procedure at 55 will, at 70, look as they did at 55 — not as though they have stopped time.

Who Is a Candidate?

The most common candidates are people between 40 and 70 who notice:

• Descended cheeks and loss of midface volume
• Loss of jawline definition and pronounced jowls
• A lax neck and platysma
• A tired facial appearance that can no longer be resolved with non-surgical treatments

For younger patients with early signs of tissue descent and no significant skin excess, endoscopic facelift is often more appropriate. The choice of procedure always depends on the individual patient's anatomy — not age alone.

What Deep Plane Facelift Cannot Do

Realistic expectations matter. Deep Plane facelift can return descended tissue to a more natural position, but it cannot stop the ageing process, eliminate fine lines, or significantly improve skin quality.

For this reason, certain patients combine the procedure with lipofilling, laser treatments, chemical peels or other treatments that improve skin texture and quality.

Risks

Deep Plane facelift is a technically more demanding procedure than standard techniques because it is performed in close proximity to the facial nerve, which controls the mimetic muscles. Surgeon experience directly determines the safety of the procedure.

• Temporary facial nerve weakness: ~1–2% (almost always transient)
• Haematoma: 1–3% (higher rate in men)
• Asymmetry: rare, generally correctable
• Visible scarring: minimal with correctly planned incisions
• Dissatisfaction with results: possible even after a technically successful procedure — most often due to mismatched expectations. This is why the quality of the consultation is as important as the surgery itself
• Psychological aspects: motivation for aesthetic surgery should come from personal reasons and realistic expectations. Part of the pre-operative assessment is a conversation about what the patient wishes to achieve — and why

How to Identify a Surgeon Who Truly Performs Deep Plane

The term "Deep Plane facelift" has become widely used in clinic marketing — but genuinely performing this technique requires specific training and an in-depth understanding of deep facial anatomy, including safe work in proximity to the facial nerve.

At any consultation it is worth asking specific technical questions: What is the surgeon's experience with the facial nerve and its dissection? How do they address the neck and platysma? Where is the Deep Plane entry point placed, and how is it adapted to individual anatomy? A surgeon who genuinely performs this technique will answer precisely and without hesitation.

Our Approach

No two faces are the same, and no two procedures are identical. During consultations we assess the position of the brows, cheeks and neck, skin quality, soft tissue volume and the anatomical relationship between all structures.

In many patients, Deep Plane facelift is combined with neck lift, endoscopic brow lift, blepharoplasty or lipofilling so that the entire face looks harmonious and natural.

Read also: Endoscopic vs. Classic Deep Plane Facelift — which technique is right for you? · Facelift Zagreb — Cost and What's Included