And what about a Mini-Lift?
Why has the Deep Plane Facelift become so popular?
Is it the same as a Vertical Facelift?
If you’re considering a Facelift, you’ve probably come across different techniques and terms that may seem confusing.
The truth is, there’s a lot of noise (and a lot of marketing).
I’m Alejandro Mazarro, a maxillofacial surgeon specialized in Facelift.
As a facelift specialist with over 9 years of experience, I’ve tried them all—believe me.
And today, I’m absolutely clear on the best method for achieving natural rejuvenation: the Deep Plane Facelift.
But let me not jump ahead.
Let me explain the differences between the various techniques so you can see why it’s impossible to achieve the same results with other methods.
Let’s get started!
The evolution of facelift techniques: from Evolución de las técnicas de lifting facial: de lo básico a lo revolucionario
The origins of Facelift Surgery
The first publications about facelift surgery date back to the early 20th century. At that time, aging was thought to be primarily about skin sagging, so surgery was limited to pulling the skin tight and removing excess tissue.
The role of the SMAS
It wasn’t until the 1970s that the SMAS (or superficial musculoaponeurotic system of the face) was discovered, a fibromuscular layer firmly adhered to the skin.
Whilst it may appear that skin sagging occurs with time, what actually happens is a block sliding of skin and SMAS together.
Thanks to this discovery, facelift surgery evolved from a simple “skin tightening” to “SMAS tightening”, something deeper and, at the same time, more effective.
The Retaining Ligaments of the Face
However, our understanding of facial anatomy has continued to evolve, and with it, facelift techniques.
The next step was to discover why the SMAS descends over time and why with traditional facelifts, nasolabial folds and jowls cannot be corrected as much as we’d like.
It wasn’t until the late 1980s that the existence of retaining ligaments was discovered in the famous article “The retaining ligaments of the cheek” published in Plastic and Reconstructive Surgery. This revealed the existence of pillar-like structures that support the soft tissues of the face and which, over time, stretch and facilitate the action of gravity.
Despite this discovery, the vast majority of surgeons continued applying what we call “SMAS lifting” (SMAS Lift), performing techniques such as SMASectomy or SMAS plication.
Let me explain what these involve.
SMAS Facelift: the traditional technique
The SMAS lift works by separating the skin from the underlying SMAS layer (severing their natural connection) and then tightening the SMAS with sutures—either by folding it over itself or removing a section and stitching it back together. This creates tension mainly at the back of the face whilst leaving the deeper structures vulnerable to gravitational pull.
Because it fails to address the weakened retaining ligaments (which sit beneath the SMAS), the deeper facial tissues continue their downward descent at the front of the face. The result is distinctly unnatural: over-tightening at the back with persistent sagging at the front.
The mini-lift: the minimally invasive (and minimally effective) option
The Mini-Facelift emerged as a marketing tool. After all, who wouldn’t be attracted to rejuvenation through mini-surgery?
There are primarily two mini-lifting techniques: the MACS Lift and the S-Lift. Both are characterized by a very short incision that barely allows for SMAS tightening.
Obviously, this doesn’t correct the descent of retaining ligaments, resulting in outcomes that are not only subtle but also short-lived.
Remember: MINIlift = MINIresults!
The Deep Plane Facelift
The Deep Plane Facelift isn’t just another evolution; it’s a paradigm shift.
Unlike “SMAS lifts” (which work on the surface of the SMAS), the Deep Plane technique works directly beneath it, which is where sagging really occurs.
Only this way can we access the retaining ligaments and reposition them to their original location, allowing us to restore youthful anatomy.
Whilst the results are infinitely superior to those of traditional facelifts, it’s also true that this is a technically more sophisticated surgery, requiring a high degree of specialisation to achieve extraordinary results.
So is Deep Plane Lifting more effective because it addresses the retaining ligaments?
Exactly.
To achieve effective results, a detailed understanding of facial anatomy is essential.
Anatomically, the face is far more complex than we imagine, but we can think of the retaining ligaments as pillars supporting the face. When these pillars stretch, gravity takes effect, and unwanted sagging appears.
This is why no exercise can effectively combat sagging: it’s caused by ligament elongation, not by loss of facial muscle strength.
When we talk about the Deep Plane, does this mean the surgery is more aggressive?
Quite the opposite.
Although counterintuitive, Deep Plane technique is actually less aggressive than traditional facelift surgery, especially with the Preservation Facelift modifications.
In a traditional facelift, all facial skin is lifted to place sutures in the musculature. However, anatomically, the skin, subcutaneous tissue, and SMAS are three interconnected layers, so surgically separating them generates an intense inflammatory response because tissues that should remain connected are being separated.
In contrast, with Deep Plane lifting, we work in a deep plane, beneath the SMAS. This deep plane is what we call a natural gliding plane, containing no blood vessels or adhesions between planes except for the retaining ligaments.
This makes it anatomically much more respectful of natural tissue planes, resulting in less inflammation and less pain during recovery.
Don’t believe it?
Click the link below and see how recovery works in my hands.
Are some facelift techniques more dangerous than others?
This is a very common concern.
In fact, historically surgeons always worked in a superficial plane (above the SMAS) because it was believed that the facial nerve, responsible for facial movement, ran just beneath the SMAS.
It wasn’t until 1990 that Hamra described the Deep Plane Lift in his article «The Deep Plane Rhytidectomy», and although the technique gained some popularity, it fell out of use because knowledge of facial anatomy wasn’t yet sufficiently developed.
Over time, thanks to the work of great anatomists and pioneering surgeons, we’ve learned to navigate beneath the SMAS with precision, safely protecting the facial nerve.
In fact, with current advances and in expert hands, Deep Plane lifting far surpasses traditional techniques in:
- Results: much more natural and long-lasting (check here the gallery)
- Recovery: much faster and more comfortable (specially with the Preservation Facelift)
- Safety: lower risk of facial nerve injury, lower bleeding risk, lower risk of skin necrosis, lower risk of hypertrophic scars/keloids.
Lifting de Preservación:
ultimate naturalness with faster recovery
Taking Deep Plane Surgery to the Next Level
Though recently published, this advanced technique has been part of our surgical approach for the past two years.
I’m privileged to collaborate with an elite group of facial rejuvenation specialists who share a common goal: continuously improving patient outcomes through innovation and shared expertise.
The result? The “Preservation Facelift” – a sophisticated enhancement to the Deep Plane technique that not only improves upon the already exceptional results of the Deep Plane technique but also offers a shorter recovery period.
Described in the publication“Limited Delamination Modifications to the Extended Deep Plane Rhytidectomy” (Facial Plastic Surgery & Aesthetic Medicine),the Preservation Facelift is an evolution of the Deep Plane technique that minimizes tissue separation. By keeping the anatomical layers together during surgery, it reduces swelling, accelerates recovery, and delivers more stable and natural results.
Deep Plane Facelift Before and After Results | Dr. Mazarro
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