A deep plane facelift is a surgical procedure that releases and repositions the ligamentous attachments of the midface, allowing the deeper facial tissues (the SMAS-platysma complex and the malar fat pad) to be lifted as a single unit rather than tightening only the skin. Because the lift occurs beneath the superficial musculo-aponeurotic system, the skin is redraped without tension, the cheek apex is restored, and the result avoids the windswept appearance associated with skin-only techniques. The technique has been refined in published facial plastic surgery literature since the 1990s and is considered by many subspecialty surgeons to be the reference approach for patients with midface descent, deep nasolabial folds, and jowl formation.
The procedure is performed under general anaesthesia, typically takes three to five hours depending on whether adjuncts (blepharoplasty, neck lift, lip lift, or fat grafting) are combined, and is followed by a recovery window that most patients plan around for two to three weeks before returning to social activities. Suitable candidates are usually in their late 40s to 60s with structural ageing rather than surface ageing, are non-smokers (or willing to stop), and have realistic expectations about what repositioning (rather than resurfacing) can achieve. The sections below cover how the technique works, who it suits, what recovery involves, and how to evaluate a deep plane facelift against the other facelift variants a reader will encounter during their research.
What a deep plane facelift actually does
A standard (SMAS) facelift tightens the superficial musculo-aponeurotic system and removes a strip of skin, which lifts the jawline and cheek to a degree but leaves the deeper ligaments (zygomatic, masseteric, mandibular) tethering the midface in its descended position. A deep plane facelift releases those retaining ligaments so the malar fat pad can be elevated vertically over the cheekbone, restoring the triangular contour of youth that recedes with age. By carrying the lift in the deeper tissue plane, the overlying skin is closed under minimal tension, which tends to produce a finer scar and a softer expression line.
Because the dissection runs beneath the SMAS rather than above it, the technique addresses three ageing changes that a skin-only lift cannot correct as cleanly: midface flattening, deepening of the nasolabial fold, and jowling along the mandibular border. The cost is a more demanding operation. Surgeons performing the deep plane approach require detailed knowledge of facial nerve branches (particularly the buccal and zygomatic branches, which travel in or near the dissection plane), and operating time is longer than for a skin-and-SMAS lift. Patients should expect an extended surgical day and a slightly longer early recovery than they would after a shorter-scar or mini-lift.
How the deep plane compares to other facelift techniques
Patients researching facelift surgery in South Africa typically encounter three to four named variants on clinic websites. The table below summarises the structural difference between them, where each one is most useful, and what a reader should weigh when comparing quotes from different practices. Pricing is intentionally excluded; figures vary by region, adjunct procedures, anaesthetist fees, and facility costs, and should be discussed in person.
| Technique | Plane of dissection | Best suited to | Key trade-off |
|---|---|---|---|
| Skin-only facelift | Subcutaneous (just under the skin) | Older patients with significant skin laxity and limited midface descent | Higher risk of a “pulled” look and wider scars; results tend not to last as long |
| SMAS facelift (standard) | Superficial to the SMAS layer | Jawline and lower-face laxity with mild midface descent | Less correction of the midface and nasolabial fold than the deep plane approach |
| Deep plane facelift | Deep to the SMAS, with release of the zygomatic, masseteric, and mandibular ligaments | Midface descent, deep nasolabial folds, jowls, and loss of cheek volume | Longer operating time and a steeper learning curve; recovery is similar to a standard SMAS lift |
| Short-scar / mini-lift | Limited skin and SMAS work, shorter incision | Younger patients with early jowling who want a smaller procedure | Does not address the midface or deep nasolabial fold as comprehensively |
The right choice depends on which part of the face has aged most. A patient whose jawline has softened but whose midface still sits high on the cheekbone may do well with a SMAS lift; a patient whose cheek has flattened and whose nasolabial fold has deepened into the corner of the mouth typically needs the deep plane release to see a meaningful change in those areas. Surgeons performing the deep plane technique should be able to explain, in the consultation, which ligaments they intend to release and what specific change each release is meant to produce.
Who is a good candidate for a deep plane facelift
Good candidates share three features: structural ageing (volume descent, not just fine lines), reasonable skin elasticity so the redraping heals smoothly, and good general health for an elective general-anaesthetic procedure of three to five hours. Smoking impairs flap vascularity and is a contraindication to the deep plane approach in most published series; patients are asked to stop at least four weeks before and after surgery. Blood-thinning medication, uncontrolled hypertension, and active skin infection are also reasons to defer.
- Visible descent of the malar fat pad with flattening of the cheek apex
- Deep nasolabial folds and marionette lines that do not correct with filler alone
- Jowling along the mandibular border with loss of jawline definition
- Good general health, non-smoker (or willing to stop), realistic expectations about what repositioning can achieve
A useful question to bring to a consultation is which part of the face the surgeon expects the operation to change most. If the answer is the jawline only, a SMAS lift may suffice; if the answer is the cheek and nasolabial fold as well, the deep plane release is what produces that change. Patients in their 40s with early changes tend to be better served by a smaller procedure; patients in their late 50s and 60s with structural descent typically benefit more from the deeper release.
How the operation is performed
The incision is placed in the preauricular crease, curves around the earlobe, and continues into the postauricular sulcus and occipital hairline as needed. Through this incision the surgeon enters the subcutaneous plane, identifies the SMAS, and then proceeds deep to it, releasing the zygomatic, masseteric, and mandibular ligaments in sequence. The malar fat pad and the platysma are then advanced superiorly as a composite flap and secured with sutures. Excess skin is redraped without tension and trimmed. Drains may be placed and are typically removed the next morning. A light compression dressing is worn for 24 to 48 hours.
Adjuncts are commonly combined in the same anaesthetic: upper and lower blepharoplasty for periorbital ageing, a submental lipectomy or neck lift for the cervicomental angle, fat grafting to the temporal hollow or tear trough, and a lip lift for upper-lip elongation. Combining procedures lengthens the anaesthetic but consolidates the recovery into a single window. Patients should clarify with their surgeon how many procedures are planned and how that affects operating time, facility fee, and anaesthetic risk.
Risks and complications
All facelift surgery carries the standard risks of a general-anaesthetic procedure (DVT/PE, bleeding, infection, reaction to anaesthetic agents) and the specific risks of a deep dissection in the face. The latter are uncommon in experienced hands but worth understanding before consenting:
- Facial nerve injury: the buccal and zygomatic branches travel near the deep plane dissection; temporary weakness is reported in published series and usually resolves over weeks to months. Permanent injury is rare.
- Haematoma: the most common surgical complication requiring return to theatre; risk is higher in patients on antiplatelet or anticoagulant medication and in hypertensive patients.
- Skin-flap compromise: smoking, diabetes, and prior radiation elevate the risk of delayed healing or skin loss at the incision edge.
- Asymmetry: minor pre-existing facial asymmetry may become more visible after a symmetrical lift; surgeons typically point this out before surgery.
- Numbness: the great auricular nerve and smaller sensory branches are at risk; sensation usually returns over weeks to months but can take up to a year.
- Hypertrophic scarring or scar revision: uncommon along the preauricular incision but possible behind the ear or in the occipital scalp.
Surgeons should be registered with the Health Professions Council of South Africa (HPCSA) and should discuss complication rates from their own audited series rather than relying on literature averages. The figure most often cited in published deep plane series is a facial nerve weakness rate in the low single digits, with permanent injury well under one per cent.
Recovery timeline and postoperative care
Recovery from a deep plane facelift proceeds in phases rather than days. The milestones patients most often ask about are the visible ones: when bruising settles, when they can return to work, when the result is photograph-ready. The window below reflects what published series and clinical experience report for an isolated deep plane facelift; combining blepharoplasty or fat grafting lengthens the early bruising phase.
- Mild swelling and bruising for 1–2 weeks
- Gradual return to normal activities after 2–3 weeks
- Final results visible after 3–6 months as tissues settle
Postoperative care centres on head elevation, cold compresses for the first 48 hours, avoidance of bending or heavy lifting for two weeks, and suture or staple removal at roughly day seven. Patients are seen at one week, six weeks, three months, and six months so the surgeon can monitor swelling resolution and scar maturation. Sun protection on the incision line is essential for twelve months to prevent hyperpigmentation of the maturing scar.
The practice provides written postoperative instructions at the preoperative visit, and patients are given a direct contact number for the surgical team outside of scheduled visits. Concerns such as expanding swelling, sudden asymmetry, fever, or bleeding through the dressing are flagged in those instructions as reasons to call the practice immediately rather than wait for the next scheduled appointment.
How long the results last
Longevity depends on age at surgery, skin quality, smoking history, sun exposure, weight stability, and genetic factors. Patients often ask for a single number, but the honest answer is a range: most published series report that the structural lift achieved by the deep plane technique remains visible ten to fifteen years after surgery, with the remainder of facial ageing continuing at the patient’s individual rate. Patients who have a deep plane facelift in their mid-50s typically look like a younger version of themselves at 70; patients who have it in their late 60s will see the result carry them comfortably into their 70s. A second touch-up procedure is sometimes considered after a decade, but is not assumed.
Choosing a surgeon for a deep plane facelift
The deep plane technique is technically demanding and the published learning curve is long. Surgeons offering it should be able to discuss their training in the technique (often with a fellowship or cadaver-lab experience specific to facial plastic surgery), their audited complication rates, and the specific ligaments they release during the operation. Photos of their own patients at three months and twelve months postoperatively are more informative than marketing imagery. Membership of the South African Society of Plastic Surgeons and registration with the Health Professions Council of South Africa are baseline requirements.
Patients should leave the consultation with a clear written plan: which procedure is recommended, what adjuncts are suggested and why, what the recovery will look like, what the total fee includes, and what the surgeon’s own revision policy is. If any of these is vague, that is reasonable grounds for a second opinion. Phone enquiries can be directed to 011 875 1694.
Cost considerations
Facelift fees in South Africa vary significantly between provinces and between practices in the same city, and are influenced by the surgeon’s training, the facility, and whether adjunct procedures are added. A deep plane facelift is generally at the upper end of the facelift fee range because of the operative time and the surgical skill required; patients should request an itemised quote covering the surgeon’s fee, the anaesthetist’s fee, the facility fee, implants or grafts if used, garments, and follow-up visits. Insurance does not cover elective cosmetic facelift surgery; some policies contribute to the anaesthetic or facility component when a documented functional indication is present, which the practice can advise on during the consultation.
Frequently asked questions
How is a deep plane facelift different from a standard facelift?
A standard (SMAS) facelift tightens the superficial musculo-aponeurotic system and removes excess skin. A deep plane facelift goes beneath the SMAS, releases the zygomatic, masseteric, and mandibular ligaments, and repositions the malar fat pad and platysma as a single unit. The deeper release allows correction of midface descent and the deep nasolabial fold that a SMAS lift cannot reach as effectively.
Where are the scars placed, and how visible are they?
The incision runs in the preauricular crease, around the earlobe, and into the postauricular sulcus, sometimes extending into the occipital hairline. Because the skin is redraped rather than pulled, the scar sits in a natural contour and matures to a fine line. Sun protection for twelve months is the single most important step the patient can take to keep the scar inconspicuous.
How long do the results last?
Results typically last 10–15 years, depending on age, lifestyle, and skin quality.
What adjunct procedures can be combined with a deep plane facelift?
Upper and lower blepharoplasty, neck lift, submental lipectomy, fat grafting to the temples, cheeks, or tear troughs, and a lip lift are all commonly combined. Combining procedures consolidates the recovery into a single window but lengthens the anaesthetic; the surgeon should explain the trade-off and the total operative time at the consultation.
When can I return to exercise and social activities?
Walking is encouraged from day one. Light lower-body exercise resumes at two weeks. Heavy lifting, running, and high-intensity training wait until four weeks. Social events are usually comfortable by three weeks, when residual bruising can be concealed with makeup; the result continues to refine over the following three to six months.
What happens if I gain or lose weight after surgery?
The structural lift is stable through typical weight fluctuations of five to seven kilograms. Larger weight changes affect facial fat distribution and can blunt or exaggerate the result. Patients planning significant weight loss are usually advised to reach their target weight before surgery so the operative plan reflects the final facial volume.
Summary
A deep plane facelift is a structural operation that releases the retaining ligaments of the midface and repositions the deeper facial tissues as a unit. It is most useful for patients with midface descent, deep nasolabial folds, and jowl formation who want a longer-lasting result than a skin-only or SMAS lift can offer. Recovery takes two to three weeks of social downtime, with final refinement over three to six months. Choosing a surgeon registered with the Health Professions Council of South Africa, trained in the technique, and willing to share audited outcomes is the single most important decision in the process. The practice offers an online consultation and photo review for patients who want to begin the conversation before travelling to the rooms.
Also Read:
- DEEP PLANE FACELIFT
- What Are the Advantages of a Deep Plane Facelift?
- What is the Best Type of Facelift to Get? | Benefits of Deep Plane Facelifts
Medical disclaimer: This article is provided for general information by Dr Deon Weyers (MBChB, Pretoria) and is not a substitute for an in-person surgical consultation. Individual suitability for a deep plane facelift, the choice of adjunct procedures, and the recovery plan depend on examination findings, medical history, and the patient’s own goals. Readers are encouraged to book a consultation before making a decision about surgery.
