Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney
Facelift surgery has changed substantially over the past 15 to 20 years. Not in dramatic new procedures, but in surgical philosophy. The traditional approach involved extensive skin undermining, aggressive dissection, and skin tension to deliver a result. The modern approach takes a different view. Respect the natural anatomy. Do more of the structural work at the deeper level. Use the skin as a covering rather than a load-bearing element. The result is a face that looks more like itself and ages more gracefully over time.
This guide explains three technical developments shaping modern facelift surgery: the preservation approach, limited skin undermining, and partial submandibular gland reduction. As a Specialist Plastic Surgeon (FRACS) practising from clinics in Bondi Junction and Manly, I incorporate these techniques into facelift surgery where individual anatomy and goals make them appropriate. By the end of this article, you’ll understand what these terms mean, why they represent a meaningful shift in surgical thinking, and what they may mean for the result you can expect. If you’re already considering surgery, the deep plane facelift procedure page covers the surgical detail and consultation process.
In short: Modern facelift technique has moved away from extensive dissection and tight skin pulls toward an approach that preserves natural anatomy, undermines less skin, and addresses deeper neck structures (including the submandibular gland in selected patients). The aim is a result that looks unoperated and ages more naturally.
What’s Changed in Modern Facelift Surgery
For decades, the standard facelift centred on lifting the skin and tightening it under tension. Surgeons separated the skin from the underlying tissue across a wide area, redraped it, and trimmed the excess. The technique worked, but it had inherent limitations. Tight skin closures caused that “pulled” appearance. Wide undermining stressed the skin’s blood supply, increasing complication risk in revision cases and smokers. The neck was often a weak point because the structures responsible for neck contour (the platysma muscle, the digastric muscles, the submandibular gland) were rarely addressed properly through superficial work alone.
Modern facelift surgery flips that logic. The structural work is done at a deeper level, beneath the SMAS layer or within the deep plane itself. The skin is moved less, undermined less, and closed without tension. Where the deep neck contributes to fullness or poor contour, the surgeon addresses those structures directly rather than working around them. The three developments covered in this article (preservation technique, limited skin undermining, and submandibular gland reduction) are interconnected expressions of this shift in thinking.
The Preservation Approach
Preservation is a relatively new term in facelift surgery, borrowed from rhinoplasty where it has been a major movement for the past decade. In rhinoplasty, preservation means working with the existing nasal anatomy rather than removing and rebuilding it. The same philosophy now applies in facelift surgery, with adaptations.
In a preservation deep plane facelift, the surgeon performs targeted release of the retaining ligaments and repositions the deep tissue composite without unnecessary disruption of surrounding anatomy. The facial nerves, the deeper fat compartments, and the structural framework that holds the face together are respected, not dissected widely or repositioned aggressively. The skin envelope is barely undermined. The work happens at the level where it actually matters, which is beneath the SMAS layer.
What this looks like in practice. Older techniques often elevated skin flaps over wide areas of the face to gain access. The modern preservation approach uses smaller skin elevations and works through the deep plane itself, releasing only the specific ligaments (zygomatic, masseteric, mandibular) needed to allow tissue repositioning. The result is more efficient surgery and less collateral disturbance to surrounding tissues.
Why this matters for patients. Less collateral disturbance means a face that recovers more predictably and looks more like itself afterwards. Patients who’ve had aggressive traditional facelifts sometimes report that they look “different” rather than refreshed. The preservation approach reduces that risk because it doesn’t reshape the face dramatically, it simply repositions tissue that has descended back to where it used to sit.
The preservation approach also tends to age better. When you respect the underlying architecture, future facial change happens within a more natural framework rather than within a face that has been heavily modified. For a deeper discussion of preservation principles applied to the neck specifically, see Preservation Deep Plane Neck Lift.
Considering modern facelift surgery? The deep plane facelift procedure page covers the surgical detail and consultation steps. To arrange an assessment in Bondi Junction or Manly, contact the practice.
Limited Skin Undermining
Skin undermining is the surgical step where the skin is separated from the tissue underneath it. In a traditional facelift, this dissection extended widely across the face and neck. The surgeon would lift large skin flaps to gain access to the SMAS, then redrape and trim them at the end of the surgery. It was effective for getting access, but it came with a cost.
The cost was vascular. Skin flaps rely on a delicate network of small blood vessels for their survival. The wider the undermining, the more reliant the skin becomes on a smaller pool of vessels at the flap’s edge. In healthy non-smoking patients, this usually heals fine. In smokers, in revision cases, in patients with prior radiation or scarring, or in older patients with thinner skin, the risk of skin necrosis (tissue death from inadequate blood supply) goes up.
Limited skin undermining flips this calculus. Instead of broad skin elevation, the surgeon uses targeted access through smaller dissection windows. The deep plane release does most of the work of repositioning tissue, so the skin doesn’t need to be lifted as widely. The skin that is moved is moved less far. The blood supply remains largely intact across most of the face.
The clinical advantages add up. Lower risk of skin necrosis, particularly in smokers and revision cases. Less compromise of skin lymphatics, which can mean less prolonged swelling. Closure with less tension, which typically produces finer, less inconspicuous scars. Faster overall healing because less tissue has been disturbed.
Limited undermining also pairs naturally with deep plane technique. When you release the retaining ligaments at the deep plane and reposition the tissue composite as a single unit, you don’t need to elevate large skin flaps. The repositioning happens beneath the skin rather than by repositioning the skin itself. This is one of the technical reasons deep plane facelift has become the modern standard for patients suitable for that approach.
The trade-off, where one exists, is that limited undermining suits some patients better than others. Patients with very loose skin and substantial excess to remove may still need wider undermining for the redraping step. Individual surgical planning is essential.
Submandibular Gland Reduction
This one needs careful explanation because it’s more advanced than the other two and not appropriate for every patient.
The submandibular gland is a salivary gland that sits beneath the jawline on each side, in the upper neck. In some patients, particularly those with thin necks, prominent jawlines, or significant ageing changes, the gland becomes visible as a fullness or bulge in the lateral neck area below the jaw. The traditional response in facelift surgery was to leave the gland alone, accept the limitation, and tell the patient that this was the contour they’d be left with.
Modern deep neck lift technique, performed by surgeons trained in deeper anatomical access, can address this. The procedure involves partial removal of the superficial portion of the gland that contributes to the visible fullness. The deep portion of the gland (which produces saliva) is preserved. Done well, this can substantially improve neck contour for patients who have prominent gland issues that other techniques cannot address.
Who this suits. Submandibular gland reduction is considered when the patient has visible gland fullness in the lateral neck below the jawline, when other contour issues (platysmal banding, fat excess, skin laxity) are also being addressed during the same procedure, and when the patient understands the additional risks involved. It is not a routine part of every facelift. For most patients, addressing the platysma muscle, the deep neck fat, and the digastric muscles provides adequate neck contour without touching the gland.
The risks deserve direct mention. Marginal mandibular nerve injury (the nerve that controls lower lip movement) is a specific concern because the nerve runs near the gland. Salivary leak or fluid collection (sialocele) can occur. Some patients experience temporary dry mouth or altered saliva production, though the deep portion of the gland typically maintains function. Bleeding risk is higher than in standard facelift work because the gland is well-vascularised. These risks are why the procedure requires specialist surgical training and is performed selectively.
The clinical trade-off comes down to this. For patients with prominent submandibular glands, leaving the gland alone produces a known neck contour limitation. Addressing it surgically introduces additional risk but may deliver substantially better neck definition. Whether the trade-off is worth taking depends on individual anatomy, the prominence of the gland, the patient’s general health, and the patient’s tolerance for the additional surgical complexity. This is a consultation conversation, not a default offering.
For more on deep neck anatomy and the techniques that address it, see What Is a Deep Neck Lift?.
How These Three Techniques Work Together
These developments aren’t separate innovations. They’re three expressions of the same underlying shift toward respecting anatomy and addressing facial ageing at the right level.
Preservation philosophy says: don’t dissect more than you need to. Limited skin undermining is one application of that philosophy at the skin level. Working at the deep plane rather than the SMAS level is another application at the structural level. Addressing the submandibular gland directly when it’s contributing to poor neck contour is the same philosophy applied to the deep neck.
A modern facelift may incorporate all three. The deep plane release allows the structural lift. Limited skin undermining preserves vascular supply. Where the patient’s anatomy makes the gland a contour limitation, partial gland reduction is included as part of the deep neck work. The face is repositioned, the skin is closed without tension, and the underlying anatomy that produces the neck contour is addressed properly rather than worked around.
The patient experience reflects this. Recovery tends to be more predictable. The look is more natural because the surgery has worked with the face rather than against it. Long-term ageing is more graceful because the underlying architecture has been respected.
Not sure whether modern technique is right for you? The right approach depends on your facial anatomy, skin quality, and goals. To discuss whether preservation deep plane technique, traditional SMAS facelift, or another approach is appropriate, book a consultation at the Bondi Junction or Manly clinic.
Who Benefits From Modern Technique
Most facelift candidates benefit from modern technique compared with older approaches. That said, certain patient groups benefit substantially more.
Smokers and former smokers benefit from limited skin undermining specifically. The vascular advantages of preserving skin blood supply are most relevant in patients whose skin vasculature is already compromised. Modern technique reduces the complication rate in this group meaningfully.
Revision facelift patients benefit from preservation thinking. Operating in scarred tissue is technically more demanding, and aggressive dissection in previously operated planes carries higher risk. The preservation approach, with its respect for existing anatomy and limited dissection, is often the safer route.
Patients with prominent deep neck anatomy, including submandibular gland fullness, deep neck fat, or strong digastric muscles, benefit from the deeper neck work that modern technique enables. Without this, neck contour outcomes have a ceiling.
Patients in their late 50s or older with substantial facial change benefit because deep plane release and structural repositioning produce better correction of advanced ageing than skin tension alone could ever achieve.
Patients who want to look like themselves rather than transformed benefit from preservation philosophy. If your goal is to look refreshed and to have the result age gracefully, working at the right anatomical level with respect for surrounding structures supports that.
The patients who don’t necessarily benefit. Some patients with mild change and good skin elasticity may be well served by simpler techniques like a short scar facelift. Modern technique is not always the most extensive technique, it’s the most appropriate technique for the individual anatomy and goals.
Risks and Considerations
Modern technique reduces certain risks (particularly skin necrosis from over-undermining) but doesn’t eliminate the inherent risks of facelift surgery. Bleeding, hematoma, infection, scar quality, asymmetry, and nerve injury remain possibilities with any facelift approach.
Submandibular gland reduction adds specific additional risks worth understanding. Marginal mandibular nerve injury can produce temporary or, rarely, permanent weakness of the lower lip on the affected side. Salivary fluid collection can develop and may require drainage. Bleeding risk is higher than in standard neck work. The surgical complexity is substantially greater, so patients should ask specifically about a surgeon’s experience with this aspect of surgery.
Recovery from a modern facelift incorporating these techniques is generally similar to a deep plane facelift overall, with social downtime of around 3 to 4 weeks. Where submandibular gland reduction is included, recovery may be slightly longer due to deeper neck dissection. Individual recovery varies based on age, health, smoking status, and adherence to post-operative instructions.
For a fuller discussion of facelift complications, see Risks and Complications after Facelift Surgery.
Choosing a Surgeon Familiar With Modern Technique
Not every surgeon performs facelift surgery using preservation principles, limited skin undermining, or deep neck work. These are advanced techniques requiring specific training and consistent volume to perform well.
Questions worth asking at consultation include the following. Do you use preservation deep plane technique? How much skin undermining do you typically perform? Do you address the submandibular gland when it’s contributing to neck fullness? Can I see before and after photos at 1 to 2 years post-operation, not just early healing photos? What is your approach in revision cases or in patients who smoke?
A surgeon comfortable answering these questions in detail, with photographs that demonstrate consistent natural-appearing outcomes, is generally one who’s invested in modern technique. A surgeon who deflects or speaks in generalities about “advanced techniques” without specifics may not have the technical depth.
Specialist Plastic Surgeon (FRACS) credentials, AHPRA registration, and specific training in deep plane and deep neck techniques are baseline qualifications. Beyond that, consistent surgical volume and demonstrated outcomes matter.
Is Modern Facelift Technique Right for You?
Modern facelift technique isn’t a single procedure, it’s a philosophy applied through specific surgical methods. Preservation thinking, limited skin undermining, and selective submandibular gland reduction are three expressions of that philosophy currently shaping how facelift surgery is performed at the highest level.
Current Medical Board and AHPRA requirements for cosmetic surgery in Australia include a referral from a GP or specialist, a minimum of two pre-operative consultations (with at least one in person with the operating surgeon), a cooling-off period of at least seven days after consent before surgery is booked, and psychological screening for suitability. Where screening raises concerns, referral for independent evaluation may be required before surgery proceeds.
If you’d like to discuss whether modern facelift technique is the right fit for your anatomy and goals, I consult from clinics in Bondi Junction and Manly. You can find more detail on the deep plane facelift procedure page or contact the practice to arrange a consultation.
Frequently Asked Questions
1. What is preservation deep plane facelift technique?
Preservation deep plane facelift refers to a surgical approach that performs the structural lifting work at the deep plane (beneath the SMAS layer) while minimising disturbance to surrounding facial anatomy. The surgeon releases specific retaining ligaments and repositions the deep tissue composite without extensive dissection of skin, fat compartments, or other structures. The aim is to reposition tissue that has descended without dramatically altering the face’s underlying architecture. This approach typically produces results that look more like the patient and tend to age more gracefully than traditional facelifts that involved wider dissection.
2. Why is limited skin undermining better than traditional facelift dissection?
Limited skin undermining preserves the small blood vessels that supply the skin during surgery, lowering the risk of skin healing problems. This is particularly important for smokers, former smokers, revision facelift patients, and older patients with thinner skin. Limited undermining also typically allows tension-free closure, which produces finer scars and reduces the “pulled” appearance associated with older techniques. It pairs naturally with deep plane technique because the structural lift happens beneath the skin rather than by moving the skin itself, so wide skin elevation is no longer necessary.
3. What is submandibular gland reduction and who needs it?
Submandibular gland reduction is a deep neck lift technique that involves partial removal of the superficial portion of the salivary gland that sits beneath the jawline. In some patients, this gland is visible as a fullness in the lateral neck and limits the contour outcome that other neck lift techniques can achieve. Submandibular gland reduction is considered for patients who have demonstrable gland prominence, who are also having other deep neck work done, and who understand the additional risks. It is not a routine part of every facelift. The procedure carries specific risks including potential injury to the marginal mandibular nerve, salivary fluid collection, and increased bleeding, so it requires careful patient selection and specialist surgical training.
4. Are modern facelift techniques safer than traditional methods?
Modern facelift techniques reduce certain risks (particularly skin necrosis from over-undermining) but do not eliminate the inherent risks of facelift surgery. Bleeding, infection, scar quality issues, and nerve injury remain possibilities with any approach. Modern techniques tend to produce more predictable recovery and more natural-appearing results, but they require greater surgical training and consistent volume to perform well. Submandibular gland reduction in particular adds specific additional risks (marginal mandibular nerve injury, salivary leak) that are not present in traditional facelift surgery. The safety profile depends on appropriate patient selection and surgeon experience as much as technique itself.
5. How do I know if a surgeon performs modern facelift techniques?
Ask specific questions at consultation rather than relying on marketing language. Useful questions include: Do you use preservation deep plane technique? How much skin undermining do you typically perform? Do you address the submandibular gland when it’s contributing to neck fullness? Can I see before and after photos at 1 to 2 years post-operation? What is your approach in revision cases or for smokers? A surgeon with depth in modern technique can answer these questions specifically with case examples. A surgeon who answers in generalities about “advanced techniques” without specifics may be using marketing terms without the underlying expertise. Specialist Plastic Surgeon (FRACS) credentials and consistent surgical volume in facelift work are baseline qualifications to look for.
