A deep plane facelift works beneath the superficial musculo-aponeurotic system (SMAS), releasing the retaining ligaments that support the midface and jawline and repositioning deeper tissue as a unit rather than pulling only on the skin. It is most often performed under general anaesthetic and takes about three to five hours. A facelift alone may be day-case or require one overnight stay, while added procedures can change both anaesthetic and hospital requirements.
The technique may be considered for people with midface descent, jowling and reduced cheek or jawline definition who retain enough skin elasticity for tension-free closure. A surgeon also reviews medical history, blood pressure, smoking, medications, previous facial surgery and recovery responsibilities. High ultraviolet exposure common in South Africa may add surface photoageing that requires a separate skin-treatment plan.
Recovery is staged rather than defined by one date. Bruising and swelling are most obvious during the first week, public presentation is usually possible at two to three weeks, and residual swelling may take three to six months to settle. candidacy, risks and outcomes vary between patients, so an in-person assessment remains essential before selecting a surgical plan.
What “deep plane” actually means
Facial tissue is arranged in layers: skin, subcutaneous fat, the SMAS, and deeper muscles, fat and ligaments. Many superficial techniques tighten or redrape the SMAS. A deep plane facelift enters below it and releases the zygomatic, masseteric and cervical retaining ligaments, allowing the midface and jawline to move as a deeper composite. This anatomical approach is described in the deep-plane literature indexed as PMID 20967162.
Releasing these ligaments can reposition the malar fat pad over the cheekbone and move deeper tissue in a superior or superolateral direction. The skin is then redraped with limited tension. The exact dissection varies with facial anatomy and the surgical plan.
What the technique may address
- Midface descent and reduced cheek support
- Deepened nasolabial folds
- Jowling and loss of jawline definition
- Imbalance between facial volume and contour
Longevity depends on age, skin quality, smoking, weight change and technique, and no outcome is permanent.
– Results typically last 10-15 years with proper care.
Who is a good candidate?
A likely candidate has midface descent, jowls or reduced cheek and jawline definition, together with enough skin elasticity for tension-free closure. The surgeon also reviews general health, diabetes, blood pressure, smoking, previous facial surgery, medications and expected recovery. Candidacy is individual, and an online checklist cannot replace an in-person examination.
Many patients in their late 40s to mid 60s seek this degree of structural correction, but age is not a strict cut-off. Significant descent under age 40 may require a different plan, while patients over 70 need careful anaesthetic and haematoma risk assessment. Active smoking, uncontrolled hypertension, inability to follow recovery instructions or unrealistic goals may make elective surgery unsuitable.
How the procedure is performed
The operation is planned according to the areas requiring correction rather than applied as a fixed package. The main stages are described below.
1. Consultation, marking and preparation
The patient is assessed upright and seated, and photographs are taken for planning. The surgeon maps the intended vectors, scar placement and areas of undermining. Medical optimisation, fasting, medication and smoking instructions are confirmed before the procedure.
2. Anaesthesia and incision
Most deep plane facelifts use general anaesthetic because the dissection is extensive and combined surgery may be planned. The anaesthetic team tailors the method to the patient’s health and procedure mix.
Local or general anesthesia is administered for comfort.
Incisions commonly extend from the temple hairline, around the natural curve of the ear and into the hairline behind the ear. Their length depends on the lifting vector and whether a neck lift is included.
3. Sub-SMAS dissection and ligament release
The surgeon enters the deep plane near the ear and separates the SMAS and deeper tissue from the underlying muscles. The appropriate zygomatic, masseteric and cervical retaining ligaments are released to permit controlled movement of the cheek and jawline. This step distinguishes the operation from a skin-only tightening procedure.
4. Tissue repositioning and fixation
The deep composite is elevated along the vectors marked during the consultation. The midface is usually moved superiorly or superolaterally, while lower-face and neck tissues may require a more lateral vector. Deeper tissue is secured with sutures to stable anatomical structures, such as the deep temporal fascia or suitable preauricular tissue.
5. Closure and initial recovery
The skin is redraped without significant tension and closed in layers. A small drain may be placed and is commonly removed within 24 to 48 hours if used. A head bandage and, in some cases, a compression garment are applied before discharge planning begins.
Procedures commonly combined with a facelift
- Blepharoplasty for eyelid contour and bags
- Fat grafting to the midface, temples or perioral area
- A brow lift when forehead and brow position also require correction
- Laser or chemical peel treatment for surface photoageing
- A neck lift, which may be integrated into the deeper dissection
Combination surgery increases operating and anaesthetic time. The number of procedures should therefore be based on the tissues requiring correction and the patient’s safety rather than on a pre-set package.
Recovery: a staged timeline
Recovery milestones reflect general patterns described in ASPS and APRASSA patient guidance. The patient’s operative plan and surgeon’s instructions take priority.
| Stage | Timeframe | Typical experience |
|---|---|---|
| First 48 hours | Days 0-2 | Bandage and possible drain; swelling and bruising often peak; head elevation, a soft diet and oral analgesia may be required. |
| Early healing | Days 3-7 | Bruising may move down the neck; sutures or staples are commonly removed around day 5-7. |
| Public appearance | Weeks 2-3 | Most bruising has settled, although residual swelling may remain noticeable to the patient. |
| Light activity | Weeks 2-4 | Walking is usually early; light gym work may resume from week 3-4 after clearance. |
| Strenuous activity | Weeks 4-6 | Heavy lifting, bending and strenuous exercise are generally resumed only after surgical review. |
| Final settling | 3-6 months | Residual swelling resolves gradually, while scars continue maturing for 12 months and longer. |
Swelling and bruising may last 1-2 weeks.
Most patients return to normal activities within 2-3 weeks.
Final results become evident over 3-6 months as tissues settle.
For the early milestone, “normal activities” usually means routine daily tasks and light work rather than heavy exercise. Strenuous exercise, heavy lifting and forceful bending commonly wait until four to six weeks and require surgical clearance. Swelling can fluctuate during the day and may persist longer in patients who heal slowly.
Risks and complications
A facelift carries material risks even in a healthy patient. A systematic review of facelift complications, PMID 28983660, and ASPS safety guidance provide the following context. Individual risk also depends on smoking, medical history, operative technique and aftercare.
- Haematoma: A collection of blood is the complication most likely to require return to theatre. Published series report roughly 1-3% overall, with rates around 2-4% reported in some male cohorts.
- Nerve injury: Temporary weakness affecting the marginal mandibular, buccal or other facial-nerve branches is reported in approximately 0.5-2% of cases. Permanent injury is rare, with published rates below 0.1%.
- Skin necrosis: Poor blood supply can cause skin injury, often behind the ear. Published series report rates around 1-3%, with greater risk and delayed healing among active smokers.
- Scarring: Wide or hypertrophic scarring is reported in about 1-2% of cases. Incision placement, skin quality, tension and wound complications affect the result.
- Infection: Infection is uncommon, at less than 1% with appropriate wound care and prophylaxis.
- Anaesthesia and blood-clot risk: General anaesthetic carries standard risks. Deep-vein thrombosis and pulmonary embolism are uncommon after facelift surgery but require assessment and preventive care.
Asymmetry, contour irregularity, residual laxity, numbness or an unsatisfactory scar may require revision or additional treatment. Smoking cessation at least four weeks before and after surgery materially reduces wound and vascular complications, and many surgeons decline to operate while a patient is actively smoking.
Urgent assessment is warranted for shortness of breath, chest pain, one-sided calf swelling, rapidly expanding neck swelling, severe new facial asymmetry, new weakness, fever or increasing wound discharge.
Cost drivers in South Africa
Deep plane facelift is usually classified as elective cosmetic surgery, so medical aid does not cover it in most cases. A reconstructive indication, such as post-trauma, post-cancer treatment or congenital asymmetry, may attract partial cover after review by the surgeon and medical aid.
A reliable cost requires an in-person examination and written quote. Published online ranges may omit essential components:
- Plastic surgeon and anaesthetist fees
- Hospital and theatre charges
- Consumables, implants and compression garments
- Follow-up visits and possible revision provisions
Blepharoplasty, fat grafting, a brow lift or other combination procedures increase operating and anaesthetic time. APRASSA and ISAPS caution against choosing a surgeon primarily on price, and a low quote should be assessed alongside qualifications, facility standards, aftercare and complication cover.
How to choose a surgeon
Confirm that the surgeon is registered as a specialist plastic surgeon through the HPCSA online register. A description such as “cosmetic doctor” or “cosmetic surgeon” does not necessarily indicate specialist plastic-surgery registration. Active APRASSA membership is another useful indicator of training and professional accountability.
Ask where the operation will take place, who administers the anaesthetic, how emergencies are managed and who will review complications. The facility should be an accredited hospital with appropriate anaesthetic and surgical support. Review consented before-and-after photographs of patients with similar facial structure, lighting and age, and consider obtaining a second opinion before committing to elective surgery.
Common mistakes and misconceptions
- “Deep plane” is not a brand: It describes an anatomical dissection. Any surgeon claiming a proprietary version should be able to explain the plane, ligament release and tissue movement in anatomical terms.
- It does not replace skin treatment: Surgical repositioning does not remove fine lines, pigmentation or surface texture changes. Laser, peels and medical-grade skincare may still be appropriate.
- It does not stop ageing: Normal ageing, gravity, weight change and skin quality continue to affect the face. Maintenance may be medical, procedural or surgical.
- Thread lifts and HIFU are not equivalent: These produce more modest and shorter-duration changes. A thread lift may suit early, mild descent and often lasts around 12-18 months.
- More combined procedures are not always safer: Adding several operations increases operative time, anaesthetic exposure and recovery burden. A staged plan may be more appropriate.
- Choosing on price alone is risky: Revision is more complex and often more expensive than primary surgery. Safety, scope and surgeon credentials should guide the decision.
Deep plane facelift in South Africa: practical logistics
Patients travelling to Fourways from another province should discuss the complete follow-up schedule before booking flights. A common schedule includes review around day 5-7, another review at two to three weeks and final photography around three months. As a practical baseline, plan to remain in Gauteng for at least seven days after surgery before flying, then confirm the timing with both the surgeon and airline.
A virtual or photo-based first consultation may help establish preliminary candidacy and reduce unnecessary travel. It does not replace the in-person examination needed to assess facial anatomy, skin quality, health and consent. The surgeon can also coordinate follow-up with an appropriate local practitioner when necessary.
Frequently asked questions
How long does the surgery take?
The surgery usually takes 3-5 hours, depending on the individual case.
How long does a deep plane facelift last?
While aging continues naturally, deep plane facelifts provide long-lasting improvements for 10-15 years.
Longevity varies, and this range should not be interpreted as a guarantee.
Does medical aid cover a deep plane facelift in South Africa?
For a cosmetic indication, medical aid usually does not cover the procedure. A reconstructive indication, such as post-trauma, post-cancer or congenital asymmetry, may attract partial cover after case-by-case review with the surgeon and medical aid.
When can I return to work and exercise after a deep plane facelift?
Most patients are presentable in public and comfortable with light work at two to three weeks. Light gym work can resume at three to four weeks. Strenuous exercise and heavy lifting are generally cleared at four to six weeks, while swelling continues to settle over three to six months.
Is a deep plane facelift riskier than a standard facelift?
Risk depends on patient selection, smoking, surgical technique, haematoma control and aftercare. The technique involves deeper dissection, but published complication rates are not automatically higher. A systematic review reports haematoma in roughly 1-3% overall and temporary facial-nerve weakness in about 0.5-2%, while permanent nerve injury is rare.
What is the difference between a deep plane facelift and a thread lift?
A deep plane facelift releases retaining ligaments and repositions deeper facial tissue surgically. A thread lift places temporary sutures under the skin and usually creates a more modest change lasting 12-18 months. A thread lift may suit early, mild descent but is not equivalent to a structural facelift.
Consultation and planning in Fourways
Dr Deon Weyers is a HPCSA-registered specialist plastic surgeon and APRASSA member who performs deep plane facelifts at Life Fourways Hospital in Gauteng. Patients from across South Africa may use a virtual first consultation to discuss preliminary candidacy and travel plans, followed by the required in-person assessment.
To arrange a consultation, call 011 875 1694 or visit Suite B22, Life Fourways Hospital, Fourways. Online Consultation & Photo Review
Also Read:
- DEEP PLANE FACELIFT
- Facelift Surgery | What Does Deep Plane Facelift Procedures Involve In South Africa?
- Deep Plane Facelift Recovery in South Africa: Timeline and What to Expect
Medical disclaimer: This page is general information about a deep plane facelift and what the procedure involves. It is not medical advice for any individual. Candidacy, recovery, risks and outcomes vary from person to person and can only be properly assessed in person by a HPCSA-registered specialist plastic surgeon.
