Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney
Key Takeaways An extended deep plane facelift carries the deep plane dissection beyond the face and into the neck, releasing a fourth retaining ligament group (the cervical ligaments) so the SMAS of the face and the platysma of the neck move as one continuous sheet. It suits ageing that spans the lower face and neck together, with four to six hours of operating time and a result that may last around 12 to 15 years. Suitability is assessed at consultation in 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 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 with other options.
The Anatomy Behind the Technique
Beneath the skin sits a fibromuscular layer called the SMAS (Superficial Musculoaponeurotic System), which supports the cheek, jawline, and upper neck. The SMAS transitions seamlessly into the platysma muscle in the neck, so anatomically the two are continuous, like two parts of a single tissue sheet wrapping from the face down into the neck. Older techniques tended to treat them as separate structures through different incisions; modern technique increasingly recognises them as one unit.
Beneath the SMAS, fibrous bands called retaining ligaments anchor the deeper soft tissues to the facial skeleton and cervical fascia. Four major groups are relevant to facelift surgery. The zygomatic ligaments connect the malar fat pad to the cheekbone. The masseteric ligaments run along the front border of the jaw muscle. The mandibular ligaments sit along the lower jaw. The cervical retaining ligaments anchor the platysma at the border of the sternocleidomastoid muscle in the neck.
Standard deep plane facelift releases the first three groups. 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
Both techniques share the same principle: dissect beneath the SMAS, release the retaining ligaments, and reposition the composite of skin, fat, and SMAS as a single unit. The differences are in scope and continuity.
Three ligaments versus four. Standard deep plane releases three facial ligament groups and focuses on the lower two-thirds of the face, addressing the neck separately or not at all. Extended deep plane releases the same three plus the cervical retaining ligaments, carrying the dissection from face into neck as one continuous operation.
SMAS and platysma as a single sheet. Once the cervical ligaments are released, the whole SMAS-platysma sheet mobilises as one unit, so the face and neck no longer need separate vectors. The result is a more coherent transition between the jawline and neck than can occur when the two zones are corrected through separate dissections.
Vector of repositioning. With the cervical ligaments released, the composite flap can be repositioned in whichever direction best opposes the patient’s pattern of descent, usually a vertical or slightly oblique vector, with the neck moving alongside the face on the same axis.
Submandibular gland support. A refinement of the technique is a “platysmal hammock” that supports a descended submandibular gland from beneath, holding it in better position without removing the gland itself. This is a relatively recent development in deep plane surgery.
For the standard procedure detail, see the deep plane facelift page, which 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 hospitals in Sydney. Operating time is typically four to six hours, with a hospital stay of one or two nights.
The standard facelift incision is used, from the temporal hairline, around the ear, and into the posterior hairline, along with a small incision under the chin to access the central platysma and deep neck. The extended approach does not require longer incisions than a standard deep plane operation. Through these incisions, the surgeon enters the plane beneath the SMAS, releases the three facial ligament groups, then continues into the neck to release the cervical retaining ligaments at the border of the sternocleidomastoid, which is what lets the SMAS and platysma move together.
Through the chin incision, the central platysma is addressed: platysmaplasty in the midline, creation of the platysmal hammock for gland support, and treatment of subplatysmal fat or the digastric muscles where indicated. Once the four ligament groups are released, the composite of skin, fat, SMAS, and platysma is repositioned, redundant skin is trimmed without tension, and the incisions are closed in layers, often with drains for the first 24 to 48 hours. Fat grafting, eyelid surgery, brow procedures, or a lip lift can be combined where indicated.
What an Extended Deep Plane Facelift Addresses
The technique is designed for ageing that spans both the face and the neck. It addresses jowls and loss of jawline definition where descent is moderate to advanced, loss of the cervicomental angle, platysmal banding, upper and mid-neck skin laxity, submandibular gland prominence where soft-tissue support can help, midface descent, deepening nasolabial folds, and marionette lines, repositioning all of these zones in one coordinated movement.
It does not routinely address the brow, forehead, eyelids, or upper face. Where ageing 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 separately depending on the plan.
Who May Be a Suitable Candidate
The technique may suit patients whose ageing spans the lower face and neck together, where correcting only one zone would leave a mismatch: significant jowling combined with neck laxity or platysmal banding, loss of the cervicomental angle, or submandibular gland prominence. Most candidates are in their 50s to 70s, though the pattern of anatomical change matters more than age. Suitability also depends on good general health, non-smoking status (or willingness to cease all nicotine for at least six weeks before and after surgery), stable weight, and realistic expectations.
It may not be the right choice where changes are concentrated only in the lower face without significant neck involvement, where ageing is very early, or for patients seeking a shorter recovery. The extended approach is more demanding than standard deep plane in 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 is broadly similar to a standard deep plane facelift, with slightly larger operating time and tissue territory. Hospital stay is one or two nights. Most patients return to desk-based work around two to three weeks, though bruising may still be visible in the upper neck and jawline. Social activities typically resume from three to four weeks, light exercise from four weeks, and more demanding activity from six weeks. Deeper swelling continues to settle over three to six months, with the final settled appearance at approximately twelve months. Bruising may be more prominent in the neck than after a standard deep plane operation because the dissection extends further.
Published clinical experience suggests structural improvements may last approximately twelve to fifteen years, depending on technique specifics, individual factors, and lifestyle. Stable weight, sun protection, non-smoking status, and general health all influence how long the result remains visible. Individual outcomes vary considerably. For more on recovery generally, see our recovery after facelift guide.
Risk Considerations
All facelift surgery carries risk. Being more extensive than standard deep plane, the extended approach has a slightly higher cumulative profile in operating time and tissue territory, though published complication rates are broadly similar. Risks common to both include swelling, bruising, temporary numbness, haematoma, infection (uncommon with current protocols), unfavourable scarring, prolonged altered sensation, asymmetry, and the rare risks of any major surgery.
Both techniques involve dissection near the facial nerve branches. Published series report temporary facial nerve weakness in around 1 percent of cases for both standard and extended deep plane, with permanent injury very rare; the extended approach adds a small consideration around the marginal mandibular and cervical branches near the platysma. Where the platysmal hammock is created, the submandibular gland is repositioned rather than removed, an important distinction from older techniques that excised gland tissue. Published facelift revision rates range from approximately 5 to 15 percent, and extended deep plane sits within this range. For a fuller overview, see our risks and complications after facelift surgery guide.
How It Compares With Other Facelift Options
Versus 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. For significant neck involvement alongside facial concerns, it provides integrated correction; where the concern is facial without significant neck laxity, standard deep plane is usually more appropriate.
Versus vertical restore facelift. Both use deep plane dissection. The vertical restore facelift extends the operation upward into the brow, temple, eyelids, and lip with fat grafting as standard, while the extended deep plane extends it downward into the neck. See our deep plane vs vertical restore comparison for detail.
Versus deep neck lift alone. Patients with neck concerns but limited facial ageing may be better suited to a standalone deep neck lift. Where both face and neck need addressing together, the extended deep plane integrates both.
Versus SMAS facelift. Standard SMAS facelift techniques work at the SMAS layer without the same ligament release. For mild to moderate lower-face ageing they may suffice with shorter recovery; for moderate to advanced ageing extending into the neck, the extended deep plane provides broader structural change. See our deep plane vs SMAS comparison for detail.
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 in the neck are addressed as a single continuous tissue sheet rather than as separate 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 releases the same three plus the cervical retaining ligaments, which anchor the platysma in the neck. This fourth release allows the SMAS and platysma 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 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 groups are the zygomatic ligaments, which connect the malar fat pad to the cheekbone; the masseteric ligaments, along the front border of the jaw muscle; the mandibular ligaments, along the lower jaw; and the cervical retaining ligaments, which anchor the platysma 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, though bruising may still be visible in the neck and jawline. Social activities typically resume from three to four weeks, light exercise from four weeks, and more demanding activity from six weeks. The 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 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 that spans 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 help. Most are in their 50s to 70s, though the pattern of anatomical change matters more than age. Candidates also need good general health, non-smoking status (or willingness to cease for at least six weeks before and after surgery), and realistic expectations. Because the extended approach is more extensive than standard deep plane, the trade-off between additional benefit and additional surgical scope is part of the consultation discussion.
Consult with Dr Scott J Turner
Dr Turner consults for facelift surgery in Sydney at Bondi Junction and Manly. Surgery is performed at Bondi Junction Private Hospital and Delmar Private Hospital, Dee Why. Contact the practice to arrange a consultation.
About Your Surgeon
Dr Scott J Turner is an AHPRA-registered Specialist Plastic Surgeon (FRACS) consulting in Sydney (Manly and Bondi Junction), Brisbane and Canberra. His practice focuses on facial aesthetic surgery, rhinoplasty and cosmetic breast surgery, performed at accredited private hospitals in Sydney. Dr Turner emphasises individual patient assessment, surgical planning and clear information on risks, recovery and costs, holds Fellowship of the Royal Australasian College of Surgeons.
