By Dr Scott J Turner, Specialist Plastic Surgeon | Sydney & Brisbane
The extended deep plane facelift represents a sophisticated surgical approach that addresses facial ageing through structural repositioning rather than superficial skin tightening. This advanced technique works beneath the superficial musculoaponeurotic system (SMAS) layer, systematically releasing retaining ligaments to reposition facial tissues as a unified composite unit. For patients presenting with moderate to advanced facial and neck changes, understanding this procedure may assist discussions during consultation with Dr Turner regarding appropriate treatment options.
Table of contents
The Foundations of Deep Plane Surgery
Conventional facelift methods typically operate at the superficial SMAS level, employing plication or excision techniques. Whilst these approaches address surface laxity effectively, they may not comprehensively correct the descent of deeper soft tissue structures. The deep plane methodology, initially described by Sam Hamra in 1990, introduced the concept of working beneath the SMAS to access and reposition deeper facial tissues.
The extended deep plane facelift advances upon these established principles by carrying dissection further into the cervical region whilst incorporating more thorough ligament release. This approach enables the surgeon to address facial changes from the temporal region through to the submental area in an integrated manner.
Anatomical Foundations of the Extended Approach
The face contains multiple retaining ligaments anchoring soft tissues to the underlying bone and deeper structures. Over time, tissues between these ligaments may descend whilst the ligaments themselves remain tethered, contributing to visible facial changes including jowling and deepened nasolabial folds.
The extended deep plane technique involves systematic release of four critical ligament groups. The zygomatic ligaments connect the malar fat pad to the underlying bone, and their release may permit repositioning of cheek tissues. Masseteric ligaments attach along the anterior masseter muscle border, where tissues posterior to these ligaments remain relatively fixed, whilst anterior tissues may descend, contributing to jowl formation. Mandibular ligaments along the lower jaw, when released, may help address anterior jowl formation and marionette lines. Finally, cervical retaining ligaments anchor the platysma muscle to the sternocleidomastoid border, and their release enables more comprehensive neck treatment integrated with facial lifting.
This fourth ligament release distinguishes the extended technique from standard deep plane procedures, which typically release only three ligament groups without extending into the cervical region.
Distinguishing Features from Standard Facelift Methods
Comparison with SMAS Techniques
SMAS plication and imbrication techniques operate on the superficial musculoaponeurotic system by folding or tightening this layer. Whilst effective for certain patients, forces applied to the fixed SMAS may not transmit effectively to the medial face due to resistance from unreleased ligaments.
The extended deep plane technique bypasses the fixed SMAS portion over the parotid gland to access and mobilise the mobile segment overlying the mimetic muscles by releasing the ligamentous anchors; the entire soft tissue envelope may be repositioned rather than merely stretched.
Comparison with Standard Deep Plane
Standard deep plane facelift focuses primarily on the midface and jawline, with dissection typically terminating at or near the mandibular angle. The extended modification carries a dissection 5-10 centimetres below this point along the anterior sternocleidomastoid muscle border.
This extension transforms the procedure from primarily a facial operation into comprehensive face-neck integration. The platysma muscle receives more extensive treatment, and subplatysmal contouring may be performed to address the submental region from within the operative field.
Potential Benefits of the Extended Technique
Comprehensive Cervical Treatment
Standard deep plane surgery provides indirect neck improvement through SMAS repositioning and upward facial tissue lift. However, the platysma muscle’s own descent and banding are not directly addressed. Patients with significant vertical neck bands or substantial cervicomental angle changes may require separate platysmaplasty procedures.
The extended technique incorporates comprehensive neck treatment as an integral procedural component. Midline vertical platysmaplasty directly repositions the platysma muscle, addressing vertical neck bands through underlying muscular support rather than skin tightening alone. Lateral platysma elevation creates structural support for submandibular tissues that may otherwise descend with ageing.
Fourth Ligament Release
Whilst standard deep plane releases three ligament groups (zygomatic, masseteric, and mandibular), the extended technique adds cervical retaining ligament release. This fourth ligament group release creates anatomical freedom necessary for comprehensive neck treatment integrated with facial lifting, potentially resulting in smoother transitions from jawline into neck.
Enhanced Structural Support
A fundamental principle of deep plane surgery involves elevation of a composite flap where skin and deeper supporting structures move as a unified unit, maintaining blood supply between layers. Standard deep plane creates a skin-SMAS composite flap, though the SMAS layer becomes progressively thinner, extending into the lower face and neck. The extended deep plane creates a skin-SMAS-platysma composite flap, incorporating a distinct muscular layer providing more substantial structural support throughout the neck region. This architectural difference may contribute to the technique’s reported longevity.
Gonial Area Definition
The extended technique targets explicitly the gonial area (the region overlying the mandibular angle) through rotational repositioning of the composite flap. Clinical literature has demonstrated measurable jawline changes, with one prospective study showing an average of 3.5cc of volume gain in the gonial area and 2.7 centimetre lengthening of the visual mandibular line.
Unified Surgical Approach
Rather than requiring separate procedures to address facial and neck concerns, the extended deep plane provides a unified surgical approach. This integration may offer more harmonious outcomes and eliminate multiple operations in patients with concurrent facial and neck changes.
Vertical Vector Repositioning
Unlike techniques relying on horizontal or oblique lifting vectors, the extended deep plane emphasises a near-vertical vector of approximately 60 degrees. This approach aims to counter the natural vertical descent of facial tissues rather than pulling them sideways.
The vertical emphasis may help avoid the “swept” or “windblown” appearance sometimes associated with horizontal-vector techniques. Because deeper structures carry the tension, skin can be redraped without excessive pull, potentially allowing for more natural-appearing outcomes.
Technical Complexity and Surgeon Selection
The extended deep plane facelift represents one of the most technically demanding procedures in facial plastic surgery. The complexity of this technique means surgeon selection constitutes a critical factor in achieving safe outcomes.
Technical Demands
All challenges of standard deep plane dissection apply to the extended technique, with additional demands created by cervical dissection. The surgeon must navigate anatomical structures, including the marginal mandibular nerve near the submental region and cervical nerve branches along the sternocleidomastoid border. Precise electrocautery management and constant monitoring for facial nerve activity are essential throughout extended dissection.
The procedure requires detailed knowledge of facial anatomy, including the layered architecture of facial tissues, the location and course of facial nerve branches, and positioning of retaining ligaments. Understanding the biomechanics of tissue repositioning and vector forces is equally important.
Experience with Advanced Techniques
The learning curve for extended deep plane surgery is significantly steeper than for standard facelift techniques. Surgeons typically develop proficiency through incremental skill progression, beginning with limited dissection and advancing with mentorship and ongoing training.
Experience specifically with deep plane techniques—not merely facelift surgery generally—is an important consideration. A surgeon performing SMAS plication or skin-only facelifts may not possess the same familiarity with sub-SMAS dissection planes and ligament release that the extended technique requires.
Selecting a Qualified Surgeon
When considering an extended deep plane facelift, patients should seek a Specialist Plastic Surgeon with demonstrated experience in deep plane techniques. Essential factors include FRACS (Fellow of the Royal Australasian College of Surgeons) qualification, specific experience with deep plane and extended deep plane procedures, willingness to discuss surgical approach and outcomes, and before-and-after photographs of patients with similar concerns.
Dr Scott J Turner is a Specialist Plastic Surgeon who performs extended deep plane facelift surgery. His training and experience in advanced facial surgery techniques allow him to offer this procedure to appropriate candidates at his clinics in Sydney and Brisbane. For patients who may not require the extended technique, Dr Turner also offers other facelift options tailored to individual needs.
Longevity of Outcomes
The extended deep plane facelift may achieve longer-lasting outcomes compared to other techniques due to its structural approach. Clinical literature suggests results typically persist for 10-15 years, though individual outcomes vary considerably.
This durability reflects the procedure’s reliance on repositioning deeper tissues rather than skin tension alone. Ligaments released during surgery may re-adhere to bone in their new position, providing biological fixation rather than relying solely on suture strength.
Most visible swelling resolves within 4-6 weeks, though subtle swelling may persist for several months. The deep tissue repositioning involved in this technique means internal healing continues longer than surface appearance might suggest. For detailed information about what to expect during the healing process, patients can review comprehensive facelift recovery information.
Facial ageing continues after any procedure. Whilst the extended deep plane technique may provide long-lasting outcomes, some patients choose revision procedures after many years. Individual factors, including genetics, sun exposure, lifestyle, and skin qualit,y influence how outcomes evolve over time.
Arrange a Consultation
If you are considering facial surgery, Dr Scott J Turner offers comprehensive assessments at his clinics in Sydney and Brisbane. As a Specialist Plastic Surgeon with experience in facial aesthetic surgery, Dr Turner can evaluate your individual concerns and discuss the most appropriate surgical approach. Learn more about what to expect during your facelift consultation.
For patients travelling from regional areas or interstate, information is available for out-of-town patients.
To arrange your consultation, please contact us.
