A deep-plane face and neck lift is a surgical procedure designed to lift and tighten a sagging neck, cheeks and jowls that happens with age. The technique separates two layers of the face, the SMAS (superficial musculo-aponeurotic system) from the deeper layer called the parato-masseteric fascia. The space between these two layers is the deep-plane. If you think of the anatomy of the face like pages of a book. Between pages 3 and 4 is the deep-plane. The importance of the deep-plane is that by separating these two layers, the surgeon has direct access to facial retaining ligaments (aka osseocutanous ligaments). The facial retaining ligaments tether the face down during facial rejuvenation surgery. During a deep-plane facelift the ligaments are divided and the face, especially the mid-face, becomes mobile and easily and effortlessly lifts back to its natural position before everything descended. Further, by dividing the facial retaining ligaments, there is no tension on any of the deep layers or, importantly, on the skin layer of the face. The entire block of deep and superficial tissue is simply elevated, lifted up and back and set gently back into place. Dividing the ligaments allows for a temporary mobility of the face, to position everything where it naturally belongs. As it heals into it’s new position, the connective tissue attachments will reform and hold everything up. The results are very long-lasting, beautiful and entirely natural looking in the end.
When was the Deep-Plane Facelift First Developed?
A New York surgeon by the name of Dr. Sam Hamra first described the deep-plane facelift in the 1990’s. While the results were shown to be excellent, natural and very long-lasting, there were a few noted down-sides to this approach. First, the amount of bruising and swelling was significant. This technique required many weeks of downtime to allow the bruising and swelling to resolve. Secondly, during a deep-plane facelift, the facial nerve is covered by a very thin connective tissue layer called the parato-masseteric fascia. While the nerve is technically protected beneath this layer, it is a very thin fascial layer that can be easily penetrated. As such, the risk of damage or injury to the facial nerve rises especially in the hands of inexperienced surgeon. As such, in the early 2000’s, many people migrated away from the deep-plane approach in favor of shorter incision, more limited dissection techniques that were more simple to perform. This is especially true for those with limited surgical experience and knowledge of the facial nerve. So, in the early 2000’s, the pendulum seemed to swing away from deep-plane facelift techniques and more towards limited facial rejuvenation procedures such as purse-string facelift (MACS lift, Ponytail Lift, Weekend Lift, Lifestyle Lift, etc…).
What is a Preservation Deep-plane Facelift?
In the past several years, with the voice of surgeons like Dr. Andrew Jacono, Dr. Mike Nayak, and others, the deep-plane technique has made a bit of a reemergence. The reason for this reemergence is for several reasons. First, many surgeons were noting that the less invasive procedures, especially the purse-string style facelifts, were just simply not effective procedures long-term. Yes, there may be some benefits in the short-term with quicker recoveries and less risk to the facial nerve. But, these approaches also have less of an impact and they simply weren’t very durable. So, why have a purse-string facelift (or other type of facelift) if it just isn’t going to change the trajectory of aging by much. This is especially true for facelift procedures that don’t divide the facial retaining ligaments. Second, the problem of prolonged bruising and swelling often seen with the original Sam Hamra technique was improved. This was accomplished by limiting the delamination performed during dissection. This was demonstrated early on in the deep-plane revolution by Dr. Bitner at Bitner Facial Plastic Surgery.
So, let’s go back to analogy of likening the face to pages of a book. The 1990’s deep-plane technique involved separating several layers of the face. This included separating the skin and subcutaneous layer from the deeper SMAS layer (between pages 2 and 3) and then separating the deep-plane layer (between pages 3 and 4). The thought was that this more extensive opening and isolating the pages of the book (called facial delamination) would allow for a smoother and tighter final result. But, delamination of these more superficial layers is what causes most of the bruising and swelling, especially that which lasts for many weeks. Plus, most of the nerves are found in the superficial layers. So, superficial delamination is the source of most of the pain following surgery.
So, what is a “preservation deep-plane facelift”? Simply stated, this is a deep-plane facelift technique that involves very limited subcutaneous delamination. In other words, we only really open between pages 3 and 4 and leave almost all of the layer between pages 2 and 3 unopened. The only place where we open the superficial layer is just in front of the ears to allow us to access the deep-plane. So, there is a section that is less than 1 cm wide where the superficial plane is opened. What does this mean for you? The amount of bruising and swelling actually goes down even when compared to “fast recovery” techniques like purse-string methods. The pain after the procedure is minimal. While we have narcotic pain medication available to you, most patients are able to recover with Tylenol and Ibuprofen only. And yet, you have all of the benefits of the deep-plane approach, longevity, durability, and extremely natural look.
What is the Rapid-Recovery Mini-Lift?
In short, a Rapid-Recovery Mini-Lift is a Deep-Plane Facelift technique that involves more limited superficial delamination. So, it is a preservation technique. The results are 100% natural yet, beautiful and durable. The Rapid-Recovery Mini-Lift is designed to lift and tighten every thing from the eyes down to the collar bones, elegantly and naturally. The upper portion of the face is not addressed with the Mini-Lift. If a browlift or upper blepharoplasty is desired, then a full lift is an option. During a consultation with Dr. Bitner, we can look and together decide the right approach for you. The Rapid-Recovery Mini-Lift, exclusively designed and developed by Dr. Bitner at Bitner Facial Plastic Surgery, is all of the rapid in recovery, but anything but “mini” in results. This procedure has all of the benefits of older “mini” techniques with shorter incisions and less bruising and swelling for a faster recovery, with all of the benefits of a deep-plane facelift. Is this procedure right for you? Schedule a consultation today. Meet with Dr. Bitner and his friendly staff. They will help you understand the options available to you.
Why is avoiding Tension During a Facelift So Important?
Having a tension-free closure is very important for many reasons. #1 If there is tension, whatever is pulling against the lift (usually facial retaining ligaments) will eventually win. So, the face will descend and return to where it was prior to surgery. This can happen as quickly as a few months or up to a year. But, the tension created during the closure will not hold things up long-term. #2 Tension in either the deep tissues or in the skin will create widened, thickened and unsightly scars. Standard teaching for all surgery is that if there is tension on the closure, the scar will not end up looking thin and fine. #3 Tension on the skin itself can create a disaster. Blood flow to the skin will diminish with tension in the skin. If the tension on the skin is greater than the perfusing pressure of blood flow, then the skin will lose its blood supply and die. This can cause full-thickness skin loss all the way around the ears. This devastating complication is a very rare but horrible situation with few if any options to obtain a satisfactory final outcome.
