Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney
The deep plane facelift is not new, and if you are reading this you likely already know how it differs from an SMAS lift. What has changed is the detail. Over the past five years a body of published work has put precise, measurable data behind the finer points, where to enter the deep plane, how much skin to lift, which direction to pull, and how to hold the neck. I have brought several of those refinements into my own practice. If you want the operation itself set out step by step, my deep plane facelift page covers it, and the broader facelift overview places it next to the other techniques I use.
My own technique has been shaped by the work of many facelift surgeons around the world, and I will write about others in time. Among them is Dr Ben Talei, a facelift surgeon in Beverly Hills, USA who has published a steady run of papers on deep plane technique since 2021. I have followed his work closely and have seen him present at conferences around the world. A number of the techniques I use in my own facelift practice have been influenced by it, and where the anatomy and the evidence are sound, I have adopted what he has shown.
I am Dr Scott J Turner, a Specialist Plastic Surgeon (FRACS). I consult in Bondi Junction and Manly, and I operate at Bondi Junction Private Hospital and Delmar Private Hospital in Dee Why. What follows is the part of his work that has changed how I plan and perform a facelift, technique by technique.
The one idea underneath all of it
If there is a single thread running through the last five years of deep plane work, it is this. The gains have come from release, not from pulling harder. Free the retaining ligaments properly and the deeper tissue can be repositioned and held at depth, with the strain kept off the skin. Almost every refinement below is a different answer to the same two questions. How completely do you release, and once the tissue is free, which direction do you move it.
Reading the vector before I lift
The direction of the lift sounds like a small thing. It is one of the most important decisions in the whole operation.
Talei and his colleagues did something most surgeons had not. They measured the actual direction each layer was moved during surgery, across a series of their own cases, and published the numbers. The deeper layers wanted to travel close to vertical. The skin sat on a gentler angle. The lesson underneath the data was that there is no single correct direction. It follows each patient’s own pattern of descent.
Two further findings shaped how I assess a face. Primary facelifts, where the tissue has never been operated on, tend to lift in fairly consistent directions. Revision facelifts do not. Old scar tissue pulls unevenly, so each suspension point has to be angled on its own rather than to a single template. And the two sides of a face rarely match. Years of driving with one cheek to the window leave more sun-related change on that side, so I plan the left and right separately rather than mirroring one onto the other.
So before I lift, I read the face in front of me. Where the descent is mostly vertical, the Vertical Restore planning I offer lifts the tissue against the direction it has fallen, rather than back toward the ears. That single choice is the difference between a face that looks rested and a face that looks pulled.
A more lateral entry, and lifting less skin
For a long time the assumption was that a bigger facelift meant raising more skin. Talei has been part of a group of surgeons challenging that.
In a large multi-surgeon review he contributed to, covering close to four thousand cases across the authors’ combined series, the deep plane is entered more to the side, and only the skin needed to reach that entry point is lifted. The real work happens underneath, on the deeper layer. Talei calls the shape of that lateral entry the “sailboat” design. The point of it is restraint.
Why does it matter how much skin comes up? Skin carries its own blood supply through small vessels that run up into it from the tissue beneath. Lift a large sheet of skin off the face and you divide a lot of those connections, which is what drives prolonged swelling, discolouration, fine surface vessels and slower healing. Raise less skin and more of that supply stays intact. In the authors’ series, the limited approach was associated with low rates of those skin problems, without giving up the depth of the correction underneath.
This is the basis of the preservation deep plane facelift I perform. I lift only as much skin as I need to reach the deeper layer, enter it laterally, and keep the connection between skin, SMAS and the underlying fat where I can. The structural change is the same. The skin is left better supplied, which is the whole point.
Holding the neck deeper: the mastoid crevasse
The neck is where facelifts are won or lost. It is also where one of Talei’s most useful contributions sits.
The angle of the jaw, the corner where the jawline turns down toward the neck, is held by where you anchor the neck muscle. Traditionally that muscle is stitched onto the surface of the firm tissue behind the ear, near the bony prominence you can feel below the earlobe. That is a surface hold, and a surface hold can stretch and loosen over time.
Talei’s mastoid crevasse uses a deeper pocket in that region as the fixation point instead. Anchoring into the deeper pocket turns the bone and the jaw angle into a kind of pulley, which gives a more stable, three-dimensional hold and a crisper line where the jaw meets the neck. Opening that pocket can also ease pressure on the tail of the salivary gland that sits nearby, which in my experience helps slim the back of the jawline. In his published series of 79 patients, the jaw angle sat an average of about 8 millimetres deeper with crevasse fixation than with the older surface method.
When a neck needs that kind of lasting hold, this is the fixation I use. A neck held only at the surface can soften again as the stitches settle. A deeper, more stable anchor is far less inclined to, and a well-built neck is a large part of what makes a facelift still read as solid years later rather than months.
The platysma and the neck bands
Under the skin of the neck sits a broad, thin sheet of muscle called the platysma. With age its front edges can stand out as two vertical bands, and how those are managed matters as much as the lift above them.
The older instinct was to cinch the bands tightly together down the midline of the neck, like lacing a corset. Talei makes a careful point about this. Pull the midline too tight and you lock the neck in place, which works against the vertical lift you are trying to create everywhere else. He favours suspending the platysma out to the side, into the deeper anchor near the ear, so it acts like a hammock that lifts the whole floor of the neck rather than a drawstring that bunches the middle.
There are traps on both sides of this. Tighten the centre without supporting the sides and the neck can cord or band beneath the chin, one of the clearest giveaways that work has been done. Reduce the centre too aggressively and you can hollow it. I work the sides first, support the platysma laterally, and treat the midline conservatively, because an over-tightened neck is far harder to undo than an under-treated one.
The judgement calls under the chin
A clean neckline is not only about lifting and the muscle. Deeper still there are decisions. The salivary gland that sits under the jaw, a paired muscle band running under the chin called the digastric, and the position of the hyoid, the small bone that sets how sharp a neck can ever be.
Talei’s work on the deep neck is mostly about restraint and good judgement. When the gland or the muscle band is the real driver of fullness, partial reduction can help. He is firm about the limits. You never remove more than about half of either, salivary function has to be protected, and a low-sitting hyoid is an anatomical fact no technique fully overcomes.
That is the approach I take. I assess the gland, the muscle and the bone position on each patient rather than running one routine. I only reduce a gland or a muscle band when the anatomy is the real cause of the fullness, because these steps sit close to important nerves and vessels and carry real risk. And if a low hyoid is going to cap how sharp your neck can become, I would rather tell you that at consultation than promise something the anatomy cannot give.
Planning the male face and neck
Men’s faces are not scaled-up versions of women’s. The skin is thicker, the tissue is denser, the blood supply is higher, and there is often more fullness deep under the chin. The hairline, the sideburns and the beard line also limit where an incision can sit without showing or shifting the beard.
Male ageing also tends to be more about structural descent than lost volume, which usually means repositioning what has fallen rather than adding volume back. Talei has written specifically on the male face and neck and the modifications these differences call for. I plan men along the same lines. The incision is designed to the male hairline so it stays hidden and the beard is not dragged out of position, the deeper work is weighted toward releasing and lifting rather than filling, and the goal is a stronger jawline and a defined neck that still reads as the same man, not a softened version of him. The richer blood supply in male skin also raises the risk of bleeding in the first day or two after surgery, so I plan and watch for that more closely in men.
The upper lip
One contribution sits slightly to the side of the facelift. As the face ages, the skin between the nose and the lip lengthens, less of the lip shows, and the corners of the mouth can turn down, which can leave a resting expression that looks tired when it is not. A facelift pulls sideways and does little for any of that.
Talei took the same deep plane logic to the upper lip, in a lip lift he named the CUPID Lift. The brand is his. The principle is what travels across. Releasing a deeper layer so the lip can be reshaped and shortened without bunching the skin, and so the small scar at the base of the nose sits under less tension than older techniques placed on it, which helps it heal as a finer line. When a lip lift suits a face I am treating, I use that same deep plane principle, because the area around the mouth is part of how a face reads as a whole and is worth assessing alongside a facelift rather than on its own.
Reading the evidence, not the brand names
A word on how I weigh all of this, because facial surgery attracts more branded names than almost any field in medicine. There is a real difference between a technique that has been measured and written up in a peer-reviewed journal, where other surgeons can examine the method and the results, and a trademarked procedure name built mainly for marketing. The advances above earned their place in my practice because the first kind of evidence sits behind them, not because of the names attached to them.
That evidence still has limits, and you should know them. The figures I have referred to come from other surgeons’ series, most of which follow patients to approximately one year after surgery, rather than five or ten. They describe what is achievable in selected patients, not a promise. Surgery is variable by nature, and two people with similar faces can heal quite differently.
How this comes together in my practice
Across the last few years my facelift has changed in specific, traceable ways. I read the lift vector to the individual face, and to each side of it. I enter the deep plane laterally and raise less skin. I anchor the neck into a deeper, more stable point and suspend the platysma out to the side rather than cinching it down the middle. I make conservative, case-by-case calls on the gland, the muscle and the bone position in the deep neck. And I plan men differently from women.
None of that is a guarantee of a particular result. Your outcome depends on your anatomy, your skin, your health and your healing, and every one of these steps carries risks that are discussed in full at consultation. Anyone who promises you a fixed result from a facelift is overselling it.
If you are considering facelift surgery
A facelift is a considered decision, and the process is built for that. You will need a referral from your GP. You will have a minimum of two consultations before any surgery, with time to think in between, and a seven-day cooling-off period after the decision to proceed. Where appropriate, psychological assessment forms part of the planning. The Medical Board and AHPRA requirements also recommend that you confirm a surgeon’s Specialist Plastic Surgeon registration on the AHPRA register before booking.
If you would like to discuss whether a deep plane facelift suits your anatomy, you are welcome to contact us to arrange a consultation in Bondi Junction or Manly.
