Deep Plane Facelift Gone Wrong: Warning Signs, Causes and How a Revision Corrects Them

6 hours ago

8 min read

Searches for a deep plane facelift gone wrong have risen with the popularity of the operation itself. Most of the photographs attached to that phrase online show two different things mixed together: early healing that looks alarming but settles, and technical errors that do not. This article separates them, explains what causes the lasting problems, and describes how a revision corrects them. It is written for patients who have had surgery elsewhere and are not sure whether to wait or to act, and for those still choosing a surgeon who want to know what to look for.

Deep plane facelift before and after
Deep plane facelift before and after
Deep plane facelift before and after

Quick answer

Swelling, firmness, numbness, mild asymmetry and temporary weakness of a smile branch are part of healing and settle over three to six months. Pixie ear, a pulled or windswept look, visible scars in front of the ear, a raised sideburn or hairline, a persistent step at the jaw and lasting nerve weakness are structural problems. They are caused by tension on the skin, poor incision placement or dissection in the wrong layer, and are corrected by a revision facelift that moves the deep tissue and releases the skin.

What the research says about complications

According to PubMed, a 2026 study in the Journal of Plastic, Reconstructive and Aesthetic Surgery followed 240 patients after extended deep plane facelifts by one surgeon. Complications occurred in 12.5 percent. Transient facial nerve dysfunction was the most frequent at 5.8 percent, followed by skin necrosis at 2.5 percent, alopecia at the incision at 1.7 percent, suture reaction and keloid at 0.8 percent each, and hematoma at 0.4 percent. The overall rate fell from 16.7 percent in the first 60 cases to 8.3 percent in the last 60, and skin necrosis fell from 6.7 percent to zero (DOI). Two conclusions follow. Most complications are temporary. And the surgeon's experience with this particular operation is the single largest factor you control.

For the long view, a 20-year review of secondary facelifts from the University of Texas Southwestern found that revision operations carried a complication rate similar to primary ones, about 2 percent, and that the interval between a first and second facelift averaged nine years (DOI). A companion review by the same group stresses that the first task in any revision is to decide whether the patient is showing stigmata of the earlier operation or simply the next decade of ageing (DOI). The two need different operations.

Signs that settle on their own

Swelling and firmness in the cheeks and neck for six to twelve weeks. Firm ridges along the jaw at three weeks are swelling in the deep tissue, not a lump that will stay.
Numbness of the cheek and in front of the ear, which returns over months as small sensory nerves regrow; see our article on numbness after a facelift.
A lopsided smile in the first weeks. The marginal mandibular and buccal branches are stretched or compressed by swelling in a small number of patients; recovery over weeks to months is the rule.
Mild asymmetry. No face is symmetrical before surgery and swelling resolves at different speeds on each side.
Red or raised scars in the first three months. Scars in the crease in front of the ear and behind the tragus fade to a thin pale line by a year when the skin was closed without tension; see where the incisions go and how they heal.

Signs that will not settle

Pixie ear. The lobe is pulled down and forward and looks attached to the cheek. Cause: skin closed under tension at the lobe. It does not improve; see pixie ear after facelift.
The pulled, windswept or operated look. Mouth corners drawn sideways, flat tight cheeks, diagonal lines toward the ear. Cause: the skin was used to carry the lift, or the deep tissue was pulled backward rather than upward along its original path. Explained in how to avoid a pulled facelift look.
Visible scars and a raised sideburn or hairline. Cause: incision placed in front of the tragus rather than behind it, or skin excised upward without a step at the hairline. Men are especially affected because the beard line moves.
Persistent jowl or neck fullness. Cause: the retaining ligaments were not released, the platysma was not treated, or a full submandibular gland was never addressed; see the submandibular gland.
Lasting nerve weakness beyond six months, or contour defects from skin loss or over-aggressive fat removal.
A hollow, tight face. Cause: too much skin and fat removed, no volume restored. A deep plane lift should leave the cheek full, not flat.

Why the deep plane itself is not the problem

The deep plane technique moves the SMAS and the fat above it as a single unit after releasing the ligaments that hold them, which is why it can lift a heavy cheek and jowl without tension on the skin. The problems listed above come from how an operation was performed, not from the plane that was named on the consent form. Many operations marketed as deep plane are in practice skin lifts with a few sutures in the SMAS. Our page on the deep plane facelift describes what the operation involves, and our risks and complications guide covers prevention in detail.

How a revision corrects it

A revision is planned from three sources: your photographs from before the first operation, the operative note if it can be obtained, and an examination of how the skin, deep tissue and scars move now. The sequence then follows the pattern described in the secondary rhytidectomy literature: resect the old scar and the stretched skin, release the SMAS and the pulled vectors, refill lost volume with fat, reshape the deep tissue with the lift, and lay the skin back without tension.

In practice this means:

Pixie ear is released, the lobe is reset with a small amount of skin and the scar hidden in the new crease. Often done alone under local anaesthesia in under an hour.
The pulled look needs a true deep plane dissection beneath the earlier skin flap, release of the ligaments that were never released, and repositioning of the cheek upward. The skin is then redraped loosely. Fat grafting restores the fullness that tension flattened.
Visible pretragal scars are excised and the new closure placed behind the tragus; a raised sideburn is brought down with a small hair-bearing flap.
Persistent neck fullness is treated with platysma work, deep fat sculpting and, where indicated, partial reduction of the submandibular gland.

At our clinic in Istanbul revision facelifts are performed under local anaesthesia with sedation, without drains, and with the same eight-day stay in Istanbul and one-year online follow-up as a first operation. Our revision facelift guide explains timing and what to bring to the consultation.

Video: 77-Year-Old Scarless Facelift: Revision After a Classic Facelift. Watch on YouTube

Revision after an earlier facelift

The video below shows a 77-year-old patient who had a classic facelift years earlier with a visible scar, treated with a scarless facelift and neck lift. Age alone did not exclude her; her general health did the deciding.

When to wait and when to act

Wait if the problem is swelling, numbness, firmness, early redness of scars or a smile that is already improving. Re-assess at three and six months.
Act on a structural problem once the tissues have softened, usually from six to twelve months after the first operation. Earlier surgery through immature scar is harder and less predictable.
Seek an independent opinion if the operating surgeon dismisses a problem that has not changed by six months, or if you were never shown photographs of your own face from before surgery.

What to ask a surgeon before a revision

Which of my problems are tension problems, which are volume problems and which are scar problems?
Will you dissect in the deep plane beneath the earlier flap, and how will you protect the facial nerve in scarred tissue?
Where will the new incisions sit and what happens to the old scars?
How many revision facelifts do you perform each year?
What is the plan if the result still needs adjustment at a year?

Frequently Asked Questions

How common are complications after a deep plane facelift?

According to PubMed, a 2026 single-surgeon series of 240 extended deep plane facelifts in JPRAS reported complications in 12.5 percent of patients, the most frequent being transient facial nerve weakness in 5.8 percent, followed by skin necrosis in 2.5 percent and hair loss at the incision in 1.7 percent. The rate fell from 16.7 percent in the surgeon's first 60 cases to 8.3 percent in the last 60, which is why experience with this specific operation matters.

My smile is crooked two weeks after surgery. Is it permanent?

Usually not. Weakness of a facial nerve branch after a deep plane facelift is most often a stretch or swelling injury that recovers over weeks to a few months. Permanent weakness is rare. If there is no improvement at all by three months, an assessment by the operating surgeon or an independent plastic surgeon is reasonable.

What is a pixie ear?

An earlobe that has been pulled downward and forward so that it appears to grow out of the cheek rather than hanging free. It is caused by closing the skin under tension at the lobe. It does not settle with time and is corrected in a small revision under local anaesthesia; see our article on pixie ear after facelift.

What does a pulled or windswept facelift look like?

The corners of the mouth are drawn sideways, the cheek is flat and tight rather than full, there may be diagonal lines running from the mouth toward the ear, and the sideburn or hairline has moved upward. It happens when the skin, rather than the deep tissue, has been used to carry the lift. A revision releases the skin and moves the deep tissue instead.

Can a facelift that went wrong elsewhere be revised in Istanbul?

Yes. Revision facelift is a regular part of our work and many patients come after an operation in another country. We ask for the original operative note where available, photographs from before the first surgery, and at least six months, preferably a year, since the previous operation so that scar tissue has softened.

How long should I wait before judging the result?

Swelling and firmness are normal for three months and small asymmetries often even out by six. Scars keep fading for a year. A result should not be judged final, or revised, before six months unless there is a clear structural problem such as pixie ear or a visible step in the hairline.

About the Author

This article was written and medically reviewed by Prof. Dr. Suleyman Tas, a plastic, reconstructive and aesthetic surgeon in Istanbul with over 20 years of experience. He is the author of Rhinoplasty in Practice (CRC Press, 2020), has more than 40 peer-reviewed scientific publications and five patents, and teaches facelift and rhinoplasty techniques to surgeons at international courses. Read more about Prof. Dr. Suleyman Tas.

Individual results vary. Before and after photos and videos are shared with patient consent. This article is for general information and does not replace a personal medical consultation.

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