For much of cosmetic surgery’s history, facelift patients accepted a trade-off: visible improvement at the cost of a tell-tale stretched appearance. That bargain defined the field for decades, until Dr. Andrew Jacono introduced an approach that challenged its core assumptions. His extended deep-plane facelift technique, developed in the early 2000s, operates on a fundamentally different principle than the procedures it has since overshadowed.
Anatomy as the Starting Point
Conventional facelifts addressed aging at the surface, tightening skin and the superficial musculoaponeurotic system, known as the SMAS, from above. The result was tension-driven, and tension produces distortion over time. Dr. Jacono instead works beneath the SMAS layer, releasing the ligaments that tether facial tissue and repositioning the midface, jawline, and neck as an intact structural unit. Skin, muscle, and fat move together, preserving their natural relationships.
Dr. Andrew Jacono published his first peer-reviewed study on the technique in Aesthetic Surgery Journal in 2011, documenting outcomes from 153 patients. The data made a compelling case. Complication rates fell well below industry averages, with a 3.9% revision rate, approximately 1.9% hematoma rate, and 1.3% rate of temporary facial nerve involvement. Subsequent research confirmed that dissecting beneath the SMAS actually protects the facial nerve rather than endangering it, because the anatomy is preserved rather than disrupted.
Evidence Over Time
Results from the extended deep-plane method last 12 to 15 years, roughly twice the longevity of standard SMAS facelifts. This durability follows logically from the technique’s mechanics. Restoring displaced fat pads and descended soft tissue to their original positions addresses the cause of facial aging, not just its appearance. Dr. Jacono performs approximately 250 of these procedures each year, a volume that enables refinement and consistency unavailable to surgeons encountering these cases infrequently. His 2021 textbook, The Art and Science of Extended Deep Plane Facelifting, codified the method for surgeons worldwide. Visit this page for more information.
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