Deep Plane Facelift in Sydney

Deep Plane Facelift at a Glance

The Deep Plane

The deep plane is a surgical plane lying beneath the SMAS and above the deeper structures of the face, including the parotidomasseteric fascia, the buccal fat pad and the branches of the facial nerve, which run deeper still.

Dissecting in this plane separates the SMAS from the tissue beneath it while the skin remains attached to the SMAS above. The skin and SMAS are lifted together as a single composite unit rather than as two layers moved independently, which means the movement comes from repositioning the deeper tissue rather than from tension applied to the skin.

Selected retaining ligaments are released along the way, since the ligaments would otherwise resist the movement of that composite layer. Release is selective rather than routine. These ligaments lie close to branches of the facial nerve, and the ligaments addressed, the extent of the dissection and the direction of repositioning are planned according to each patient’s anatomy, tissue position and surgical history, and are discussed at consultation. How far that dissection extends is what distinguishes the preservation and extended approaches described below.

Preservation and Extended Deep Plane Techniques

Preservation and extended describe two halves of the same modern approach rather than two competing operations. One concerns how much skin is lifted away from the layer beneath it. The other concerns how far the release beneath the SMAS extends. They are used together because each depends on the other: if the skin is not separated from the SMAS, the movement has to come from the deeper release, and a more complete ligament release is what allows that layer to move.

Preservation: Limiting the Skin Dissection

Deep plane surgery has conventionally begun with a broad subcutaneous flap, lifting the skin off the fat and SMAS across the lateral cheek and neck before the deep plane is entered. A preservation approach keeps that skin dissection to a minimum instead. The skin is lifted off the SMAS only for a short distance in front of and behind the ear, sufficient to gain access. Beyond that the skin, subcutaneous fat and SMAS-platysma layer remain attached to one another.

The rationale is anatomical. Much of the blood supply to the facial skin runs within the subcutaneous layer, and keeping the layers attached disturbs less of it. Retaining that circulation may reduce bruising and swelling in the early recovery period and is relevant to wound healing, particularly in patients with additional healing risk factors such as smoking. Recovery still varies between patients, and direct comparisons between facelift techniques in the published literature remain limited.

Extended: More Complete Ligament Release

Extended describes how far the sub-SMAS dissection continues once the deep plane has been entered. A more extended release continues medially across the zygomatic and masseteric ligaments toward the midface, and inferiorly past the mandibular ligament, so that the SMAS and the platysma are addressed as one continuous sheet into the upper neck.

The purpose of releasing the ligaments more completely is directional as well as structural. Facial descent occurs downward and toward the midline, so the tissue needs to be repositioned upward, along a vertical vector, rather than pulled backward toward the ear. The retaining ligaments resist vertical movement in particular, and a fuller release is what allows the deeper layer to be repositioned in that direction. It also means dissecting over a broader field and closer to branches of the facial nerve, which is why the extent of release is planned according to anatomy rather than applied routinely.

Why the Two Work Together

Limiting the skin dissection and extending the ligament release are complementary parts of the same plan. Because the skin, fat and SMAS-platysma remain attached, they behave as a single composite flap, and a composite flap can only be moved as far as the ligaments beneath it allow. Releasing those ligaments more completely is therefore what makes the preservation approach workable, and keeping the layers attached is what allows the repositioning to come from the deeper layer instead of from tension on the skin.

Comparing the two illustrations shows the difference directly. In the traditional dissection above, the green subcutaneous area is broad and the purple sub-SMAS area comparatively small. In a modern approach, the proportions are reversed: the green band is narrow, and the purple area extends further across the midface and jawline.

Neither element is applied as a default. The extent of skin dissection, which ligaments are released, how far the release continues and the direction of repositioning are planned according to anatomy, tissue position, skin quality, prior surgery and what is being addressed, and are discussed at consultation. Further detail is set out in the preservation deep plane facelift and extended deep plane facelift guides.

Deep Plane Facelift Before and After

The photographs below are of Dr Turner’s patients, published with their consent. Each set shows the same patient before surgery and at a stated interval afterwards. Results vary between patients because anatomy, skin quality, tissue position, healing and surgical planning differ. The images indicate the type of change surgery may produce for a particular anatomy, not a guaranteed or typical outcome.

Further examples, along with guidance on what to look for when reviewing surgical photographs, are in the facelift before and after gallery. Relevant case examples may also be discussed during consultation where appropriate.

Combining a Deep Plane Facelift with Other Procedures

A deep plane facelift repositions the deeper tissues of the midface, jowls and jawline. It does not change eyelid position, brow height, skin texture or the area around the mouth, so where those also contribute to a patient’s concerns, other procedures may be considered.

The neck is the most commonly combined component, and a deep plane facelift can be performed with or without a formal neck lift or deep neck lift. Others that may be considered include:

• Upper blepharoplasty for excess upper-eyelid skin.
• Lower blepharoplasty for under-eye fat and lower-eyelid skin.
• Brow lift for brow descent contributing to upper-face heaviness.
• Facial fat transfer for volume loss in the midface and temples.
• Lip lift for lengthening of the upper lip.

Combining procedures means one anaesthetic and one recovery rather than two, but also a longer operation and more swelling. Whether procedures are combined or staged is a clinical decision based on anatomy, general health and what is being addressed, rather than a package.

Who May Be Suitable for a Deep Plane Facelift?

A deep plane approach is generally considered when the changes are structural rather than skin-deep: the cheek sitting lower than it once did, jowls forming along the jawline, and a softening of the line between the jaw and the neck. Where the main concern is skin texture or surface change, a different approach is usually more appropriate.

Assessment at consultation covers:

• Which layers are contributing to the changes, and whether the neck is involved.
• General health and suitability for a longer general anaesthetic.
• Skin quality and how the tissue is likely to settle.
• Smoking status. Smoking reduces blood supply to the facial skin and increases the risk of delayed healing and wound problems. Cessation is expected before surgery.
• Previous facial surgery or non-surgical treatments.

Assessment of psychological factors forms part of every cosmetic surgery consultation. In line with Medical Board requirements, Dr Turner personally screens each patient for underlying psychological conditions, including body dysmorphic disorder. Where screening indicates significant underlying issues, the patient is referred for evaluation by a psychologist, psychiatrist or general practitioner who works independently of the practice, and that evaluation informs whether surgery is appropriate. Expectations are discussed in the same consultation, including what surgery can and cannot change, what recovery involves, and the possibility that further or revision surgery may be needed.

Surgery is not appropriate in every case. Where the findings do not suit a deep plane approach, Dr Turner will say so and discuss the alternatives, which may include a different facelift technique, a non-surgical option, or no treatment.

A face-to-face consultation following GP referral is required before suitability can be confirmed.

Deep Plane Facelift Recovery

A deep plane facelift involves a meaningful period of downtime, and planning for that is part of deciding whether to proceed. Recovery varies between patients, and swelling, bruising, tightness and temporary altered sensation are expected rather than unusual.

A hospital stay of around one night is usual. Swelling and bruising build over the first few days and begin to settle through the second week, with many patients returning to desk-based work between weeks two and three. Visible bruising usually resolves by weeks four to six. Much of the swelling has settled by around three months, while tissue settling and scar maturation continue over six to twelve months. Recovery takes longer when the facelift is combined with brow lift, blepharoplasty or neck lift components, because the surgical area is broader.

Recovery is not finished when the visible bruising has gone. Follow-up appointments continue through this period to monitor healing, and post-operative care and scar management influence how the result settles. Patients should plan for that continued involvement rather than expecting a single point at which recovery is complete.

A week-by-week account of what to expect is set out in the recovery after facelift surgery guide.

Deep Plane Facelift Cost in Sydney

Risks and Complications

All surgery carries risk. Risks relevant to deep plane facelift surgery, discussed in detail at consultation, may include:

• Bleeding and haematoma. A collection of blood beneath the skin, most common in the first 24 hours, which may require return to theatre.
• Facial nerve injury. Temporary or, less commonly, permanent weakness of the muscles of facial expression. The retaining ligaments released during deep plane surgery lie close to branches of the facial nerve.
• Infection. Uncommon in clean facial surgery but possible.
• Scarring. Scars are permanent. Most fade over months, but raised, thickened or keloid scarring is possible and is more likely in patients with a history of it.
• Delayed wound healing. Increased in patients who smoke or have poorly controlled medical conditions.
• Altered sensation or numbness. Around the ears, cheeks and scalp, usually improving over months.
• Asymmetry. Minor asymmetry may persist, as no two sides of any face are identical.
• Hairline or skin changes. Including temporary hair loss near incisions.
• Anaesthetic risks. Associated with general anaesthesia.
• Need for further surgery. To address healing or to revise an outcome.
• Dissatisfaction with the outcome. Where the result does not meet expectations, or where the change is less than hoped for. Revision surgery is not always possible or appropriate.

Risk is reduced by smoking cessation, optimisation of general health, careful surgical technique, an accredited private hospital setting and structured follow-up.

Further detail is set out in the risks and complications after facelift surgery guide, and general information for all procedures is on the risks and complications page.

Deep Plane Facelift Consultations in Sydney

Consultations with Dr Scott J Turner are available at two Sydney clinics.

The Bondi Junction clinic is at 39 Grosvenor Street, Bondi Junction NSW 2022, a short walk from Bondi Junction station and Westfield. The Manly clinic is at Suite 504, Level 5, 39 East Esplanade, Manly NSW 2095, close to Manly Wharf. Deep plane facelift surgery is performed at Bondi Junction Private Hospital and Delmar Private Hospital, Dee Why.

A GP referral is required before booking a consultation, in line with Medical Board and AHPRA requirements for cosmetic surgery in Australia. Dr Turner conducts a minimum of two consultations before proceeding with surgery, both personally.

To request a consultation, contact the practice on 1300 437758 or [email protected], or visit the contact us page.