Extended Deep Plane Facelift: What "Extended" Means and When It Is Needed

6 hours ago

5 min read

Quick answer: An extended deep plane facelift is a deep plane facelift in which the release goes further towards the centre of the face and down into the neck. By freeing the zygomatic, masseteric and cervical retaining ligaments, the surgeon can lift the cheek fat, the jowl and the neck as one connected unit. It is used for patients with significant midface descent, deep nasolabial folds and neck laxity. It is often combined with a neck lift, a temporal (brow) lift and fat grafting.

Key takeaways

"Extended" describes how far the deep plane release goes, not a different brand of surgery.
It targets the midface, nasolabial area, jowls and neck in one operation.
The lift is fixed in the deep layer, so the skin is not stretched on its own.
It is usually combined with neck muscle (platysma) tightening.
Swelling can last a little longer than after a limited lift, but social recovery is often 2 to 3 weeks.

Standard deep plane vs extended deep plane

In a standard deep plane facelift the surgeon enters under the SMAS layer and releases the ligaments that hold the lower cheek and jowl. In an extended deep plane facelift the release continues higher over the cheekbone, towards the nasolabial area, and lower into the neck. The extra release allows the cheek fat pad to move back up onto the cheekbone, where it sat when the patient was younger.

What can an extended deep plane facelift improve?

Flattened cheeks and, partly, the hollow under the eyes, often together with fat grafting.
Deep folds from the nose to the corners of the mouth.
Jowls and a blurred jawline.
Loose neck skin and neck bands, together with a neck lift.
A tired, heavy look in the lower half of the face.

Video: Facelift with neck lift, temporal and brow lift, fat grafting and laser: before and 7 days after. Watch on YouTube

The video above, viewed more than 14 million times, shows a combined facial rejuvenation by Prof. Dr. Suleyman Tas: a facelift with neck lift, temporal (temple) lift and forehead (brow) lift, nano fat grafting and laser skin tightening, seen before surgery and 7 days later.

Facelift before and after
Facelift before and after
Facelift before and after

How the operation is done

Incisions: hidden in the temple hairline, along the natural curves in front of the ear and behind the ear.
Deep plane entry: the surgeon passes under the SMAS at a defined point on the cheek.
Extended release: the zygomatic, masseteric and cervical ligaments are released so the tissues move freely.
Repositioning: the cheek, jowl and neck are lifted in one direction, usually upward and slightly backward, and fixed in the deep layer.
Neck: the platysma muscle is tightened and, when needed, the central neck is treated through a small incision under the chin.
Skin: the skin is redraped with little tension and only the true excess is removed.

"The extended release is about freedom of movement. When the tissue is truly free, it goes back where it belongs without being forced, and the face looks like the same person on a better day." — Prof. Dr. Suleyman Tas

Who is a candidate?

Candidates are usually in their 50s to 70s, with moderate to marked sagging of the midface, jowls and neck, in good general health and without uncontrolled blood pressure or active smoking. Younger patients with early jowling often need a more limited lift. Patients over 70 can also be candidates after a medical check; see facelift after 70.

Video: Scarless deep plane facelift before and after: excess skin removed, 3 weeks later. Watch on YouTube

The second video shows a patient 3 weeks after a deep plane facelift with neck lift, temporal lift, brow lift, nano fat grafting and laser tightening.

Recovery after an extended deep plane facelift

Days 1 to 3: swelling, tightness and a dressing; rest with the head elevated.
Days 5 to 7: stitches checked; most bruising fades.
Weeks 2 to 3: return to social life for most patients; some residual swelling along the jaw and cheeks.
Months 3 to 6: the final shape becomes clear.

Read facelift swelling and bruising: what is normal for more details.

Risks

The risks are those of any facelift: haematoma, infection, numbness, scar problems, asymmetry and, rarely, temporary weakness of a facial nerve branch. A wider release needs precise knowledge of the facial nerve anatomy, which is why the surgeon's training matters more than the name of the technique. See deep plane facelift risks and complications.

Extended deep plane vs mini facelift

A mini facelift lifts the lower face through shorter incisions and suits early jowling. It cannot move a descended midface or tighten a loose neck to the same degree. Compare the options in full facelift vs mini facelift vs deep plane.

What the consultation checks

Midface position: how far the cheek fat has descended from the cheekbone.
Jowl and jawline: whether the jowl has passed below the jawline.
Neck: loose skin, fat under the chin, bands of the platysma muscle and the position of the glands.
Skin quality: thickness, elasticity and sun damage, which decide whether laser or fat grafting is added.
Previous treatments: fillers, threads or earlier facelifts, which change the dissection.
General health: blood pressure, medicines, smoking and bleeding history.

Combinations that are often added

Temporal (brow) lift: lifts the outer brow and the corner of the eye; often gives a softer fox eye effect.
Upper and lower eyelid surgery: treats heavy lids and under-eye bags.
Fat and nano fat grafting: restores volume in the cheeks, temples and lips and improves thin skin.
Laser skin treatment: improves fine lines that a lift does not remove.

Frequently Asked Questions

Is an extended deep plane facelift a different operation from a deep plane facelift?

It is the same principle with a wider release of the retaining ligaments, so that the midface and neck can be lifted together with the jowls.

Does an extended deep plane facelift fix the nasolabial folds?

It softens them by lifting the cheek fat that hangs over the fold. A very deep crease may still need fat grafting or skin treatment.

How long does the operation take?

Usually about 4 to 6 hours, depending on whether the neck, brows or eyelids are treated at the same time.

How long is the recovery?

Most patients return to social life after about 2 to 3 weeks; the final result appears over 3 to 6 months.

Is it suitable for men?

Yes. The technique is the same, but incisions are adapted to the beard and 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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