Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney
Within the range of facelift options, the extended deep plane facelift is a technical refinement of standard deep plane facelift surgery that takes the dissection further into the neck and addresses an additional retaining ligament group. The defining anatomical concept is straightforward: the SMAS in the face and the platysma muscle in the neck are addressed as a single continuous tissue sheet rather than as separate anatomical zones. For patients whose ageing extends across the lower face, jawline, and neck together, this integrated approach can produce more coherent structural change than addressing the face and neck through separate procedures.
I’m Dr Scott J Turner, a Specialist Plastic Surgeon (FRACS) at our Bondi Junction and Manly clinics in Sydney. This guide covers what the extended deep plane technique is, how it differs from the standard deep plane facelift, the four-ligament release that defines it, who it suits, and how recovery and outcomes compare to other facelift options.
The Anatomy Both Techniques Work With
Understanding extended deep plane technique requires a brief orientation to the anatomical structures involved.
Beneath the skin sits a fibromuscular layer called the SMAS (Superficial Musculoaponeurotic System). The SMAS supports the cheek, jawline, and upper neck, and it transitions seamlessly into the platysma muscle in the neck. Anatomically, the SMAS and platysma are continuous with each other, like two parts of a single tissue sheet that wraps from the face down into the neck. Older facelift techniques tended to treat them as separate structures, addressed through different incisions and different surgical zones. Modern technique increasingly recognises them as a continuous unit.
Beneath the SMAS, fibrous bands called retaining ligaments anchor the deeper soft tissues to the underlying facial skeleton and the cervical fascia. There are four major retaining ligament groups relevant to facelift surgery:
The zygomatic ligaments connect the malar fat pad (the cheek tissue) to the underlying cheekbone. The masseteric ligaments run along the front border of the masseter muscle, the chewing muscle along the jaw. The mandibular ligaments sit along the lower jaw at the front of the chin. The cervical retaining ligaments anchor the platysma muscle at the border of the sternocleidomastoid muscle in the neck.
Standard deep plane facelift releases the first three ligament groups (zygomatic, masseteric, mandibular). Extended deep plane facelift adds release of the fourth, the cervical retaining ligaments. That single anatomical extension is what defines the technique.
How the Extended Deep Plane Differs from Standard Deep Plane
The two techniques share the same fundamental principle: dissect beneath the SMAS into a deeper anatomical plane, release the retaining ligaments, and reposition the entire composite of skin, fat, and SMAS as a single unit. The differences are in scope and continuity.
The three-ligament vs four-ligament distinction. A standard deep plane facelift releases three retaining ligament groups in the face. The dissection focuses on the lower two-thirds of the face: midface, lower face, and jawline. The neck is often addressed separately, either through a small submental incision and platysmaplasty, or through a separate neck lift procedure. An extended deep plane facelift releases the same three facial ligaments plus the cervical retaining ligaments, carrying the dissection from the face down into the neck as one continuous operation.
SMAS and platysma as a single continuous sheet. This is the conceptual shift. Once the cervical retaining ligaments are released, the entire SMAS-platysma sheet can be mobilised as a single tissue unit. The face and neck no longer need to be addressed as separate surgical zones with separate vector considerations. The composite flap that includes facial skin, facial fat, SMAS, and platysma can be repositioned together. The visible result is a more coherent transition between the jawline and neck, rather than the slightly disconnected appearance that can happen when face and neck are corrected through separate dissections with different vectors.
Vector and direction of repositioning. Once the cervical retaining ligaments are released, the surgeon has freedom to reposition the composite flap in whichever direction best matches the patient’s pattern of descent. For most patients, this means a vertical or slightly oblique vector that opposes the gravitational direction of facial ageing. The neck portion of the lift moves alongside the facial portion in the same vector rather than being addressed as an independent axis.
Submandibular gland support. A specific technical refinement of extended deep plane technique is the creation of a “platysmal hammock” that supports the submandibular gland from beneath. In some patients, the submandibular gland descends with age and contributes to fullness or irregular contour at the jawline-neck junction. The extended deep plane technique allows the platysma to be configured into a supportive sling that holds the gland in better position without requiring direct surgical removal of the gland itself. This is a relatively recent technical development in deep plane technique.
For the standard deep plane procedure detail, see the Deep Plane Facelift page, which now includes a section on the extended approach.
How the Procedure Is Performed
An extended deep plane facelift is performed under general anaesthesia at accredited private hospital facilities in Sydney. Operating time is typically four to six hours depending on extent and whether additional procedures are included. Hospital stay is typically one or two nights.
Incisions. The standard facelift incision pattern is used: starting at the temporal hairline, following the natural curve in front of the ear, wrapping around the earlobe, and extending behind the ear into the posterior hairline. A small submental incision under the chin is also used to access the central platysma and the deep neck structures. The extended deep plane approach does not require additional or longer incisions than a standard deep plane operation.
SMAS-platysma dissection. Through the facelift incisions, the surgeon enters the deep plane beneath the SMAS and systematically releases the three facial retaining ligament groups. The dissection then continues downward into the neck, where the cervical retaining ligaments at the lateral border of the sternocleidomastoid muscle are identified and released. This release is what allows the SMAS and platysma to move together as a continuous unit.
Submental work. Through the small chin incision, the central platysma is addressed. Depending on individual anatomy, this may include platysmaplasty (suturing the medial edges of the platysma together in the midline), creation of the platysmal hammock for submandibular gland support, addressing subplatysmal fat where indicated, or treating the digastric muscles. The combination addresses both the lateral neck (through the facelift incisions and cervical retaining ligament release) and the central neck (through the submental approach).
Composite flap repositioning. Once the four ligament groups are released and the central neck is addressed, the entire composite of skin, fat, SMAS, and platysma is repositioned in a vertical or oblique vector. The redundant skin is trimmed without tension, and the incisions are closed in layers. Drains are often placed for the first 24 to 48 hours.
Optional combined procedures. Fat grafting is often incorporated to address volume loss in the temples, midface, and undereye regions. Facial fat compartments that have hollowed with age can be augmented as part of the same operation. Eyelid surgery, brow procedures, or lip lift can also be combined where indicated.
What an Extended Deep Plane Facelift Addresses
The technique is designed for ageing changes that span both the face and the neck.
Specifically, the extended deep plane approach addresses jowls and loss of jawline definition where the descent is moderate to advanced; loss of the cervicomental angle (the “neck-to-chin angle” that becomes blurred with ageing); platysmal banding (the vertical cords that become visible in the front of the neck); upper and mid-neck skin laxity; submandibular gland prominence in patients where the gland has descended; midface descent and deepening nasolabial folds; marionette lines from the corner of the mouth to the chin; and integrated repositioning of all of these zones in a single coordinated movement.
What the extended deep plane does not routinely address: brow position, forehead, eyelids, and upper face concerns. For patients whose ageing also extends to the upper face, the extended deep plane is sometimes combined with brow lift, blepharoplasty, or fat grafting at the same operation, or those zones are addressed at a separate procedure depending on the individual surgical plan.
Who May Be a Suitable Candidate
The extended deep plane facelift may suit patients with the following characteristics.
Ageing changes that span the lower face and neck together, where addressing only one zone would leave a noticeable mismatch. Significant jowling combined with significant neck laxity or platysmal banding. Loss of the cervicomental angle (a less defined transition between neck and chin). Submandibular gland prominence where soft-tissue support could provide improvement. Patients in their 50s to 70s typically, although chronological age matters less than the pattern of anatomical change. Good general health with no uncontrolled medical conditions. Non-smoking status, or willingness to cease all nicotine products for at least six weeks before and after surgery. Stable weight maintained for at least six months. Realistic expectations about what surgery can and cannot achieve.
The extended approach may not be the right choice for patients whose changes are concentrated only in the lower face without significant neck involvement (a standard deep plane or lower facelift may be more appropriate); patients with very early ageing where less extensive surgery would be sufficient; patients seeking a shorter recovery; active smokers unwilling to cease; patients with uncontrolled medical conditions; or patients with unrealistic expectations.
The technique is more demanding than standard deep plane surgery in terms of operating time and dissection extent, so the trade-off between additional benefit and additional surgical scope is part of every consultation discussion.
Recovery and Longevity
Recovery from an extended deep plane facelift is broadly similar to recovery from a standard deep plane facelift, with the operating time and tissue territory both being slightly larger. Hospital stay is typically one or two nights. Most patients return to desk-based work around two to three weeks post-surgery, although bruising may still be visible in the upper neck and along the jawline. Social activities typically resume from three to four weeks. Light exercise from four weeks, more demanding activity from six weeks. Subtle deeper swelling continues to settle over three to six months, with final settled appearance visible at approximately twelve months.
Bruising may be more prominent in the neck region than for a standard deep plane operation because the dissection extends further. Most patients find this manageable with the same post-operative protocols.
For longevity, published clinical experience suggests structural improvements from extended deep plane facelift may last approximately twelve to fifteen years depending on the technique specifics, individual patient factors, and lifestyle. Maintaining a stable weight, sun protection, non-smoking status, and good general health all influence how long the result remains visible. Individual outcomes vary considerably.
For more on facelift recovery generally, see our recovery after facelift blog.
Risk Considerations
All facelift surgery carries risk. The extended deep plane facelift, being a more extensive operation than standard deep plane, has a slightly higher cumulative risk profile in terms of operating time and tissue territory, though the specific complication rates are broadly similar in published series.
Common to both standard and extended deep plane: swelling, bruising, temporary numbness, sensation of tightness, haematoma risk (collection of blood beneath the skin that may require drainage), infection (uncommon with current protocols), unfavourable scarring, prolonged altered sensation, asymmetry, hair loss around incisions, and rare risks of any major surgery including deep vein thrombosis.
Facial nerve considerations. Both techniques involve dissection near the facial nerve branches. Published series report temporary facial nerve weakness in approximately 1 percent of cases for both standard and extended deep plane, with permanent injury very rare. The extended approach also carries a small additional consideration around the marginal mandibular branch of the facial nerve and the cervical branches that travel near the platysma in the upper neck. Experienced deep plane technique navigates around these branches with care.
Submandibular gland considerations. When the platysmal hammock is created to support the submandibular gland, the gland is not surgically removed, only repositioned. This is an important distinction from older techniques that removed gland tissue and carried higher risk of nerve injury and salivary complications.
Revision rates. Published revision rates for facelift surgery vary from approximately 5 to 15 percent depending on technique and definition of revision used. Extended deep plane sits within this range.
For a fuller overview of facelift risks, see our risks and complications after facelift surgery guide.
How It Compares with Other Facelift Options
Understanding where extended deep plane sits in the spectrum of facelift options helps frame the choice.
Extended deep plane vs standard deep plane. Extended deep plane is the broader operation, releasing four ligament groups instead of three and addressing face and neck as a continuous unit. Standard deep plane focuses on the lower two-thirds of the face and addresses the neck through a separate component (or not at all, depending on the individual case). For patients with significant neck involvement alongside their facial concerns, extended deep plane provides integrated correction. For patients whose primary concerns are facial without significant neck laxity, standard deep plane is typically more appropriate.
Extended deep plane vs Vertical Restore facelift. Both are comprehensive operations using deep plane dissection. The Vertical Restore Facelift extends the operation upward into the upper face (brow, temple, eyelids, lip) and includes fat grafting as standard. The extended deep plane extends the operation downward into the neck. For patients whose ageing is predominantly lower face and neck, extended deep plane may be sufficient. For patients whose ageing extends into the upper face as well, Vertical Restore addresses more zones. See our Vertical Restore vs Deep Plane comparison for a detailed comparison.
Extended deep plane vs deep neck lift alone. Some patients have neck concerns that warrant deep neck lift surgery (which addresses subplatysmal fat, submandibular glands directly, and digastric muscles) but limited facial concerns. For those patients, a deep neck lift as a standalone operation, with limited or no facelift component, may be more appropriate. For patients with both facial and neck concerns where the two zones are best addressed together, extended deep plane integrates both. See our Deep Neck Lift page for the standalone procedure.
Extended deep plane vs SMAS facelift. Standard SMAS facelift techniques (plication, SMASectomy, high SMAS) work at the level of the SMAS layer and do not release the retaining ligaments to the same extent. For mild to moderate ageing concentrated in the lower face, SMAS techniques may produce appropriate correction with shorter recovery. For moderate to advanced ageing extending into the neck, the extended deep plane provides broader-scope structural change. See our Deep Plane vs SMAS comparison for a detailed comparison.
For an overview of all facelift options Dr Turner performs, including ponytail, mini, lower facelift, and revision techniques, see our main facelift page.
Frequently Asked Questions
What is an extended deep plane facelift? An extended deep plane facelift is a refinement of standard deep plane technique that releases an additional retaining ligament group (the cervical retaining ligaments) and carries the dissection from the face down into the neck as one continuous operation. The defining concept is that the SMAS in the face and the platysma muscle in the neck are addressed as a single continuous tissue sheet rather than as separate anatomical zones. This integrated approach can produce more coherent structural change for patients whose ageing extends across both the face and the neck.
How is an extended deep plane facelift different from a standard deep plane facelift? Standard deep plane facelift releases three retaining ligament groups in the face: the zygomatic, masseteric, and mandibular ligaments. Extended deep plane facelift releases the same three ligaments plus the cervical retaining ligaments, which anchor the platysma muscle in the neck. This fourth ligament release allows the SMAS in the face and the platysma in the neck to be repositioned together as a single continuous sheet rather than as separate units. For patients with significant neck involvement alongside their facial concerns, this integrated approach typically produces more coherent results than addressing face and neck through separate dissections.
What are the four retaining ligaments released in an extended deep plane facelift? The four retaining ligament groups are: the zygomatic ligaments, which connect the malar fat pad to the cheekbone; the masseteric ligaments, which run along the front border of the jaw muscle; the mandibular ligaments, which sit along the lower jaw; and the cervical retaining ligaments, which anchor the platysma muscle at the border of the sternocleidomastoid muscle in the neck. Standard deep plane releases the first three; extended deep plane adds the fourth.
How long is recovery after an extended deep plane facelift? Hospital stay is typically one or two nights. Most patients return to desk-based work around two to three weeks post-surgery, although bruising may still be visible in the neck and along the jawline. Social activities typically resume from three to four weeks. Light exercise from four weeks, more demanding activity from six weeks. Final settled appearance is visible at approximately twelve months. Recovery is broadly similar to a standard deep plane facelift, although bruising may be more prominent in the neck region because the dissection extends further. Individual recovery varies considerably.
Who is a suitable candidate for an extended deep plane facelift? Suitable candidates typically have ageing changes that span the lower face and neck together, including significant jowling combined with neck laxity or platysmal banding, loss of the cervicomental angle, or submandibular gland prominence where soft-tissue support could provide improvement. Most candidates are in their 50s to 70s, although chronological age matters less than the pattern of anatomical change. Patients also need to be in good general health, non-smokers (or willing to cease for at least six weeks before and after surgery), and have realistic expectations. The extended deep plane is more extensive than standard deep plane technique, so the trade-off between additional benefit and additional surgical scope is part of the consultation discussion.
Book a Consultation
If you’re researching facelift options that address both the face and neck together, book a consultation with me at our Bondi Junction or Manly clinic in Sydney.
Please obtain a GP referral before your appointment. The consultation includes a detailed facial and neck anatomy assessment, discussion of all facelift technique options (not only the extended deep plane), realistic information about recovery and outcomes, and the mandatory two-consultation cooling-off process required under Australian cosmetic surgery law.
Contact our clinic on 1300 437 758 or email [email protected].
General information only, not medical advice. All surgery carries risk. Outcomes vary considerably between patients based on anatomy, skin quality, health factors, and individual response to surgery. Any decision about facelift surgery requires individual clinical assessment by a qualified health practitioner.
