Surgical Facelift

A surgical facelift is an operation in which the SMAS (superficial musculo-aponeurotic system) beneath the skin, along with the "supporting ligaments (retaining ligament)" that fix it to the facial skeleton, are released and re-fixed. Our clinic is based on the Deep Plane (deep dissection) technique proposed by Sam Hamra in Plastic and Reconstructive Surgery in 1990. By moving the SMAS, subcutaneous fat, and skin as an integrated unit in a natural vector, minimal tightness is achieved and natural facial rejuvenation is realized.

Anatomical Basis of Deep Plane Technique

Facial soft tissues descend with aging, with the primary cause being "relaxation of supporting ligaments" (Retaining Ligaments of the Face, 2025). The Deep Plane method directly releases four major supporting ligaments: zygomatic ligament (McGregor's patch), masseteric-cutaneous ligament, platysma-auricular ligament, and mandibular ligament. This allows repositioning of tissues in a superolateral direction as a composite flap that includes the mid-face fat compartments that conventional subcutaneous dissection cannot reach.

Difference from SMAS Facelift

The formerly mainstream "SMAS plication" method only brings the SMAS closer and sutures it without releasing the ligaments, which has been noted to result in higher tension on the skin (PRS 1998 comparative study). In the Deep Plane method, ligament release frees the tissues, thereby reducing direct tension on the skin and making a tight appearance less likely. A review discussing the evolution of rhytidectomy techniques (Evolution of Rhytidectomy, 2016) also states that the trend toward deeper anatomical planes is the result of prioritizing natural repositioning.

Adaptation to Asian Patients

A retrospective study of 61 Asian cases (mean age 52 years, range 38–75 years) reported in Plastic and Reconstructive Surgery in 2025 demonstrated that the Deep Plane method has technical superiority in mobilization of anterior soft tissues in the Asian face and allows direct fixation. The study showed that the deep plane approach with ligament release is effective for the soft tissue characteristics of Asian patients—thick subcutaneous fat and ligament distribution (Deep Plane Face Lift in Asian Patients, PRS 2025).

Safety and Complications

The Deep Plane method involves deep dissection in regions where facial nerve branches (particularly the zygomaticbranch and infrazygomatic branch) run, so the surgeon's anatomical knowledge is critical to safety. A 600-case 22-year follow-up study in Aesthetic Surgery Journal (Ponytail Lift, 2024) reported safety data showing zero postoperative flap necrosis and zero permanent nerve injury. Additionally, an anatomical study from 2024 defining safe entry points for the facial nerve zygomaticbranch by surface landmarks has contributed to improved reproducibility of deep plane dissection. The most frequent complication is hematoma (most common in rhytidectomy overall), and postoperative compression management is essential.

Downtime Guide

The procedure is performed under general anesthesia for approximately 6–7 hours. Swelling and bruising occur for 1–2 weeks postoperatively. Return to public appearance typically takes 2–3 weeks. Incisions are placed within the temple hairline, anterior to the ear, and posterior to the ear, with redness subsiding over 6 months to 1 year. Final results are typically assessed at 6 months to 1 year postoperatively (individual variation applies).