Introduction
Facial aging cannot be explained by skin laxity alone. The real change happens as the deeper tissues gradually descend, the retaining ligaments loosen, and the structural balance of the face begins to shift. For this reason, my approach to facial rejuvenation is based not simply on tightening the skin, but on restoring age-displaced tissues to a more natural position.
One of the procedures I perform most frequently in my facial aesthetics practice is the extended deep plane facelift. In most patients, this is accompanied by neck rejuvenation as well. This approach aims to create a more balanced, more rested, and more youthful appearance while preserving the natural identity of the face. The goal is not to change the face, but to reveal a younger version of it.
My background in microsurgery, facial nerve surgery, and head and neck reconstruction also allows me to approach the anatomy of this region in a deeper, safer, and more controlled way. I do not see this operation as a simple aesthetic tightening procedure, but as an anatomical repositioning surgery.
What Is an Extended Deep Plane Facelift?
An extended deep plane facelift is an advanced facelift technique designed to mobilize not only the skin, but also the deeper structural support layers of the face as a single unit. In this approach, the skin is elevated only to the extent that it does not increase the risk of complications; the main work is performed in the deeper plane. This allows the structural support tissues of the face to be repositioned in a more natural way.
The term “extended” is important here. In this technique, the dissection extends into the midface, lower face, and nasolabial region. The main retaining ligaments that hold descended tissues in place are released, and the tissues are repositioned as one unit without being pulled from the skin surface.
What distinguishes the extended deep plane facelift from the classical deep plane facelift is, as the name suggests, the wider release of the tissues. This allows for a more effective correction of sagging along the corner of the mouth–jawline region and a stronger lift along the neck contour.
Why Is This Technique Different?
Compared with classic skin-only facelifts or more superficial SMAS techniques, the main difference in the extended deep plane facelift lies in how it addresses the deep anatomy of the face. In more superficial techniques, tension is placed on the skin or the superficial support layer. However, because the deeper retaining ligaments are not fully released, the repositioning that is achieved may remain more limited. As a result, the effect of surgery may be weaker, and jawline laxity in particular may reappear earlier.
In the deep plane approach, the work is performed at a deeper level of the face. The main retaining ligaments are released, and the tissues are moved together rather than being pulled individually. In addition, in more superficial techniques, blind or coarse suture-based traction on the muscles can sometimes create an unnatural “pulled” expression. In the deep plane approach, the nerves and muscles are carefully separated from the descended tissues and protected; the dissection remains at an adequate depth, and only the displaced tissues are addressed. This allows for a more natural repositioning without creating unwanted muscular traction.
For this reason, the result usually looks more natural, and the face does not develop an artificial appearance. This is the main reason I prefer this technique in my own practice: rather than tightening the face superficially in an uncontrolled way and pulling on the muscles, it targets the true structural level affected by aging.
Vector of Lift
In my facelift procedures, the lifting vector is generally between 60 and 70 degrees, meaning it is predominantly vertical in character. A vertical vector places aging tissues back along a more anatomically correct line. For this reason, it usually looks more natural and also produces a more effective improvement across the transition between the midface and lower face.
With facelifts based on a more horizontal pull, the face can sometimes appear “pulled” or artificial. A vertical approach helps reposition descended tissues in a more physiological way. That said, in selected patients, a steeper vector approaching 80–85 degrees may be preferred, while in others a more horizontal vector closer to 45 degrees may be more suitable. In other words, the same vector is not used in every patient; the most appropriate angle is determined according to the pattern of aging, the facial structure, and the direction of tissue descent.
Which Areas Does It Improve?
An extended deep plane facelift provides particularly noticeable improvement in the following areas:
- lower face sagging
- jawline definition
- nasolabial folds
- midface descent
- laxity and irregularity at the face–neck transition
When combined with a temporal lift, it can provide better support to the brow tail and create a fresher appearance around the eyes. However, this operation does not erase every fine line. Dynamic wrinkles may still require botulinum toxin, and fine surface wrinkles or sun damage may benefit from laser treatment or other supportive procedures. The main goal of this operation is not to remove every line on the face, but to create a structurally younger and more balanced appearance.
Who Is a Good Candidate?
This procedure is generally more meaningful in patients who have:
- clear midface descent
- deepening nasolabial folds
- loss of jawline definition
- early or established neck laxity
- a desire for natural but noticeable rejuvenation
In younger patients or in the earlier stages of aging, more limited procedures may be more appropriate. For this reason, the same operation is not suitable for everyone. The right technique should be determined according to the degree of aging, skin quality, anatomical structure, and the patient’s expectations.
In addition, some patients with limited bony support in the midface and a naturally more hollow facial structure may require different midface lifting techniques or additional supportive procedures. For this reason, the evaluation should always be based on the overall architecture of the face.
My Approach to Natural Results
For me, a good facelift result is not a face that looks obviously operated on, but one that appears more rested, more balanced, and younger. One of the strongest advantages of the deep plane facelift technique is exactly this: because it repositions the deeper structures without creating superficial skin tension, the natural identity of the face is preserved.
During the first few weeks, the face may look somewhat different, especially around the eyes and lower eyelid transition, due to swelling. This is a natural part of healing. In selected patients, if there is lower eyelid laxity or specific aesthetic goals, additional procedures such as canthopexy or canthoplasty may be planned. However, these are not routine and are evaluated on a case-by-case basis.
One point I particularly want to emphasize is this: cat-eye, fox-eye, an overly slanted look, a shift toward an “Asianized” appearance, or excessively elevated brows are not a natural part of this operation. These are approaches I do not aesthetically prefer and generally avoid. They may only be considered in a very limited and highly selected group of patients.
The aim is not to make someone look like someone else, but to help the face appear younger and more balanced without disturbing its natural expression.
Risk of Nerve Injury
One of the most common questions about the deep plane facelift is the risk of nerve injury. Yes, such a risk exists in theory. However, permanent facial nerve injury is quite rare. In the literature, when performed in experienced hands, the nerve risk of the deep plane facelift does not appear to be significantly higher than that of other modern facelift techniques.
The real risk comes from performing deep plane facelift surgery without sufficient command of deep facial anatomy. For someone experienced in deep plane surgery and facial nerve surgery, this risk is no different from that of a standard facelift.
This section is especially important to me because I have substantial experience in facial nerve surgery and head and neck reconstruction. That background requires knowing the facial nerve anatomy not only at the level of aesthetic surgery, but at a much more advanced and detailed level. Of course, this does not make the operation risk-free, but it does make it possible to understand the risk, anticipate it, and manage it carefully. In revision cases or in patients who have had prior surgery, the risk of temporary weakness may be slightly higher. In most cases, this is temporary and improves with time.
For this reason, the message I give to patients is clear: the risk is not zero, but with the correct anatomical approach and careful technique, it can be kept very low.
Facelift and Neck Rejuvenation Together
In many patients, addressing not only the face but also the neck creates a more balanced result. For this reason, in my practice, the extended deep plane facelift is most often planned together with neck rejuvenation. The neck is a continuation of the face; when one is rejuvenated and the other is left unchanged, the result can feel incomplete.
More advanced neck procedures, such as deep neck reduction or contouring, are not routine in every patient. These are evaluated separately according to the patient’s neck anatomy and are planned only when indicated.
What Can It Be Combined With?
When a full facial rejuvenation plan is made, this procedure can often be combined with:
- upper and lower eyelid surgery
- fat grafting
- lip lift
- temporal brow lift
- CO₂ laser skin resurfacing
- small complementary procedures in selected cases
By contrast, I do not believe combining this surgery with rhinoplasty in the same session is the right approach. It increases the risk of infection, prolongs the procedure, and divides the surgical focus. In the same way, combining facial rejuvenation surgery with body contouring procedures in the same session usually adds unnecessary risk. In most cases, it is better to perform facial rejuvenation as a strong, focused, and controlled operation on its own.
Scars
Incisions are generally placed within the natural transition zones around the ear. They may be planned along the preauricular region, tragus, around the earlobe, behind the ear, and when needed, along the posterior hairline. The exact placement varies according to the patient’s skin laxity, age, and anatomy. In male patients, the beard line is an additional consideration, and in revision cases, previous scars are also taken into account.
In the deep plane approach, the tension is placed on the deeper plane rather than on the skin. For this reason, scars often heal better, and issues such as pixie ear are seen much less frequently. In female patients in particular, I avoid incision designs that may disturb the sideburn line.
My Surgical Approach
What makes this operation different for me is not only the name of the technique, but how it is performed. My background in microsurgery and nerve reconstruction allows me to approach facelift surgery not merely as an aesthetic tightening procedure, but as a repositioning surgery that requires anatomical precision.
Respect for tissue, safe dissection, the correct vector of lift, and preservation of the natural balance of the face are at the center of all my planning. For me, a successful facelift is not a face that looks over-pulled or excessively altered, but one that does not appear obviously operated on and simply looks younger.
Extended Deep Plane Facelift – Frequently Asked Questions
What should I pay attention to before surgery?
Ideally, smoking should be stopped at least 4 weeks before surgery. Vitamins, herbal supplements, and non-essential support products that may increase the risk of bleeding should be discontinued in advance. Blood thinners, hormone treatments, and any regularly used medications must be reported beforehand. Some may need to be continued even on the day of surgery, while others may need to be stopped for a certain period beforehand. For this reason, each one is evaluated individually. If there is an upper respiratory infection or a similar condition, surgery may need to be postponed for safety reasons.
Is general anesthesia safe? Do you work with the same anesthesia team?
Yes, I use general anesthesia. I prefer to perform facelift surgery in full-service hospitals with an intensive care unit. Although these procedures almost never require intensive care, I still believe a fully equipped hospital environment is the safer and more appropriate setting. I also prefer to work with the same anesthesia team, as this improves surgical safety, consistency, and predictability.
What measures are taken during surgery to improve safety?
Standard safety measures are used during surgery, including anti-thrombotic stockings, maintaining body temperature, keeping blood pressure stable, and early mobilization. Additional medical precautions may also be taken when necessary. In terms of systemic risk, facial surgery is generally safer than most body contouring procedures; however, each patient must still be evaluated individually according to their own medical history.
How many nights will I stay in the hospital?
Most of my patients stay in the hospital for two nights after facelift and neck rejuvenation surgery. This is usually sufficient. During those two days, my private nurse stays with the patient and provides close support. For patients who wish to stay longer or require additional assistance, further arrangements can also be made.
What is the recovery process like? When can I return to work?
The first week can be more socially difficult because of swelling and bruising. By the second week, going outside usually feels much easier for most patients. Return to work is generally around 2–3 weeks. For a more visible social event, meeting, or special occasion, waiting 6–8 weeks is the safer option.
How long will I need to wear the mask?
I usually recommend wearing the mask day and night for the first two weeks, and then in a reduced manner during the third week. The mask helps the tissues heal more steadily and supports control of early swelling and fluid accumulation.
When can I shower?
In most patients, a full shower is possible from the second day onward. Cleanliness is an important part of healing. During the first days in particular, using lukewarm to cool water over the face may help make swelling easier to manage.
Do you use a hemostatic net and drains?
Yes, in most cases I use both a hemostatic net and drains. The hemostatic net is one of the most important advances in facelift surgery and can significantly reduce the risk of hematoma. It refers to the special sutures that remain visible on the outside of the skin for the first 2–3 days and may not look aesthetically pleasing. However, this is completely temporary. Drains also help control early swelling and fluid accumulation. They are usually removed on the second or third day.
How does the postoperative follow-up process work?
The first two nights are spent under close observation in the hospital. During this time, my private nurse personally takes care of the patient and remains continuously at their side. Afterward, the healing process is monitored with regular follow-up visits. The drains and hemostatic net are usually removed early, and additional check-ups continue in the following days. If needed, extra nursing support after discharge or closer follow-up can also be arranged.
Do you recommend hyperbaric oxygen therapy?
It is not mandatory for every patient. However, it may be beneficial in selected patients, especially those who smoke, have had fat grafting, want to recover more quickly, or have a higher risk of wound healing problems. These kinds of additional supportive treatments are not routine for everyone; they are considered on a case-by-case basis.
What is included in the price?
The standard package includes the surgeon’s fee, hospital, anesthesia and surgical costs, a two-night hospital stay, basic transfers (between airport, hotel, hospital, and clinic) for international patients, VIP nursing support during the hospital stay, standard postoperative follow-up, postoperative medications, and the compression mask. Hotel costs may vary depending on the package, so you can speak with my assistant for more detailed information. Additional hospital nights, hyperbaric oxygen therapy, and private nursing support after discharge may be priced separately.
What happens if a revision is needed?
The need for revision is uncommon, and each case is evaluated individually. In patients who have already achieved clear rejuvenation compared with their preoperative state, revision requests based more on aesthetic preference are usually handled with hospital-based cost assessment. However, if there is a clear problem, some revisions may be addressed within the package free of charge, depending on a joint decision made by the patient and me.
How many years does the effect of facelift surgery last?
This procedure does not stop the aging process. However, in most patients, an effect equivalent to roughly 10 years of rejuvenation can be expected. This duration may vary depending on the patient’s age, skin and tissue quality, lifestyle, smoking habits, and facial structure. In some patients, the effect may last a shorter time, while in others it may last longer. In patients over the age of 60, contour improvement can often remain visible for a longer period. On the other hand, because tissue quality tends to decrease with age, the tightening effect itself may fade sooner. For this reason, the duration is not the same in every patient; however, an effect of approximately 10 years is a reasonable general expectation.
Does deep neck reduction / contouring need to be done in every patient?
No. This is not a routine part of every case. For more detailed information, please see the relevant section under Deep Neck Reduction / Contouring.
