Deep Dive into Deep Plane Facelifts (Ep. 57)

All right. What's the deal with the deep plane facelift? What does it do? What does it not do? And tell me a little bit about the surgery. That's what we're going to do today on this episode of the Trillium Show, where we help you make the changes that you want to see in your mind, your body, and your life.

I'm Dr. Jason Hall. Thanks for listening. So deep plane facelifts are having a moment these days on the internet. If you're on Instagram, you're looking for plastic surgery. or on social media anywhere looking for plastic surgery, you're going to come across somebody who is pushing a deep plane facelift.

But what is it? What does it do? And how is it different from other facelifts? A little history of the facelift. The facelift is seen by most patients is a skin operation. You Pull the skin tight and get rid of the extra because that's what you see. You see extra skin at the jowls. You see extra skin under your chin and your neck.

And the facelift procedure couldn't be further from a skin removal operation. In all actuality, there is a whole lot less skin removed than you think there is. Is there skin that takes, is taken out? Sure. But, The majority of facelift surgery is muscle surgery. As most anti gravity surgeries, brow lifts, facelifts, things like that, anti gravity, anti aging surgeries are, they're muscle surgeries.

We're tightening, repositioning muscles, reshaping what's underneath the skin, and the skin acts kind of as a passive cover. There is no tension on the skin. That's how we have scars that are very difficult to see. That's how we avoid these, bad facelift results. And Kenny Rogers seems to be the poster child for that one.

This kind of windblown like look that is really unnatural. Those are the result of tension, deep plane facelifting. is different from traditional facelift, from the traditional, your traditional SMAS lift. And the SMAS is the layer under the skin where the muscles live, but is different from the traditional SMAS lift in that a SMAS facelift typically rotates and puts tension on that muscular layer.

It puts all the tension on the muscles, so there isn't tension on the skin. The deep plane facelift, which has been around for a while and was popularized by Dr. Jacono up in New York City, and further popularized, by some of his colleagues, such as Ben Talei out in Los Angeles, Mark Mani also out in LA, or my buddy Mike Nyack up in St.Louis. what a deep plane does is goes, the dissection of the muscles, it goes much further into the face. It's a much more technically demanding dissection, but then it frees up all of those muscles and allows those to be repositioned back where they need to go and held there really with very minimal tension, if any tension at all.

So it is more of a tension free. facelift, which gives a, in my opinion, more natural result. Likewise, in the neck, there's a lot of sculpting of things that are under the platysma muscle. So this kind of curtain of muscle under, between your jawline and your collarbone, so that that gets reshaped and we're not just pulling that muscle to try and flatten things out.

That procedure from a From a time perspective, it takes about the same amount of time as a traditional high SMAS facelift. The theoretical risks of the procedure are increased nerve injury, specifically the nerves that let you move your face, so really important things, live just below the layer that we're working.

In some patients who are really thin, you can actually see through that layer and see the nerves underneath. one of my surgical mentors, who was doing this kind of thing in my training and early in my career had a saying, closest to danger, furthest from harm. And I think that with, with deep plane facelifting, that is certainly the truth.

You're close to the nerves, which means you can see them and you can avoid injury. Okay. Now, are there temporary kind of nerve weaknesses after the surgery? Yes, there are. And it's typically what we call the marginal mandibular branch of the facial nerve, which lets you Lower your lower lip. And that can be weak anywhere from a day to a couple of months in some patients and is thought to be just from spreading, kind of lifting things apart because we kind of gently spread those layers apart because they're not attached where we're working.

And so, can that happen? Sure it can. Is it permanent? Knock wood. The incidence of permanent nerve injury, um, in my practice is twofold. It's very, very low, like zero, um, and even in, you know, patient, people like Dr. Giccono who have done thousands of deep plane facelifts, the incidence of nerve injuries about 1 percent

so not very high percentages. Deep plane facelift surgery, you know, depending on who you talk to, where you go, can take anywhere between three and five hours. Whether that is done under general anesthesia, whether that is done under what we call Teva or IV sedation and local anesthesia, or whether it is done with oral sedation in somebody's office and local anesthesia really is a surgeon specific issue.

I do my surgeries under general anesthetics because I feel like it is easier for me, easier for the patient. Your back doesn't start hurting after a couple of hours of laying the same position, you don't start squirming around. Some surgeons get great results and have a, have patients have a great experience doing them under local anesthesia in their office.

It very much is kind of dependent on your surgeon and their setup. So, but it's a good question to ask. Recovery from a deep plane facelift is similar to recovery for any other facial cosmetic procedure. It's a big surgery. Swelling is really more of an issue than pain. Facelifts look scary during recovery, but you look a lot scarier than you feel.

It really is not a terribly painful procedure. I have, tell all of my patients, , expect two weeks of social downtime. So you're not going to want to go to a, you're not going to want to go to church. You're not going to want to go out to a restaurant out to eat for about two weeks because you will be noticeably swollen.

There may be some bruising. Um, and you want to just kind of plan that time. Work is the same way. Just don't, don't go to work for two weeks. After that, you're able to go out, you can wear makeup. Um, if you're a guy, I wouldn't recommend it, but you can go out and not look like you've just had surgery.

You look better, you don't have your final result yet, but you, you don't look scary. You don't look, you don't have the just operated look. For big events, and I kind of qualify big events as being any event where you are going to have pictures from that event on your mantle. For a long period of time, so weddings, class reunions, things like that.

You really want about three months between your surgery and your event. Not because you don't look good well before then. Most patients look great at about six weeks after surgery. But if we have a problem, if we have some nerve weakness, like we were talking about, if we get a little hematoma that we have to drain out in the office, or in the operating room, Then we have some time to do that.

If we get a little fluid collection, if there's some prolonged swelling from gland reductions, we have some time to fix all of that and still let you make your event without wringing your hands the night before, hoping that things are going to be better the next day when you have your wedding or your class reunion.

So two recovery periods, kind of the, your, your restaurant recovery at two weeks and then your red carpet recovery at three months. What adjunctive procedures can we do with that? Well, lots of them. , lip lifts, eyelid surgery, brow surgery, laser, we can do and do perform the full gamut of facial aesthetic surgery.

At the same time, we can do a deep plane face and neck So, That is kind of deep plane facelifting in a nutshell, and I would encourage you to go back and listen to my facial aging podcast, we'll link to that in the show notes. That gives you just a general overview of how we age, and it really helps, I find, if you listen to that and understand at least a little bit of that, it can help make.

The procedures that are recommended make a lot more sense. So thanks for listening today. I hope you enjoyed this. If you have any questions, you can shoot me a DM on Instagram at Dr. Jason Hall, or you can send me an email media@drjasonhall.com. Thanks for listening. We'll talk to you soon.