By Dr Scott J Turner, Specialist Plastic Surgeon (FRACS) | Bondi Junction, Sydney
“What’s the difference between a deep plane facelift and an extended deep plane facelift?” I get asked this in my Bondi Junction consulting room constantly. And honestly, I understand the confusion. If you’ve been researching facelift surgery in Sydney, you’ve probably noticed the terminology has gotten out of hand. Some of that’s genuine complexity. Some of it? Marketing.
So here’s what I want to do — walk you through what the extended deep plane facelift actually is. The anatomy, the technique, and where it sits among other approaches. That’s part of my job as your facelift surgeon. Not selling you a brand name. Explaining what’s real.
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What Makes a Deep Plane Facelift “Extended”?
You need a bit of background first. The deep plane facelift — the standard version — goes back to Sam Hamra in 1990. Before that, most facelifts separated the skin from everything underneath and pulled it tight. Hamra’s idea was different. Go beneath the SMAS (that’s the muscular layer sitting under your skin and fat), release the retaining ligaments that anchor your facial tissues to bone, and move the whole thing — skin, fat, muscle — as one unit.
It was a big shift. Still is.
A standard deep plane release targets three ligament groups: zygomatic ligaments over the cheekbone, masseteric ligaments along the jaw, and mandibular ligaments at the lower border. That gives you solid correction through the midface, cheeks, and jawline.
The extended version goes further. It adds a fourth release — the cervical retaining ligaments running along the side of the neck. These anchor the platysma muscle to the sternocleidomastoid border. Once you free them, the lateral neck can be treated in continuity with the face. Not as a bolt-on. As one operation.
How much further does the dissection go? About five to ten centimetres below the mandibular angle. That turns what’s primarily a facial operation into a comprehensive structural facelift — face and neck corrected through the same access. In practical terms, when I combine a facelift with a neck lift, that’s when the extended deep plane approach is used.
Why Does That Fourth Ligament Matter?
Here’s what people don’t always appreciate: your face and neck aren’t separate things. They share the same tissue layers, and those layers descend together. When patients come from Bondi Junction, Double Bay, and the Eastern Suburbs with concerns about both face and neck — which is most patients over fifty, frankly — fixing one and leaving the other creates an obvious mismatch at the jawline.
Now, the cervical retaining ligaments. They run along the anterior border of the sternocleidomastoid muscle, tethering the platysma to deeper cervical fascia. Think of them as anchors. As long as those anchors hold, there’s a ceiling on what you can achieve in the lateral neck. Tighten skin aggressively, do SMAS work — the platysma stays stuck where it’s descended to. Whatever improvement you get in the face looks odd next to a neck that hasn’t been properly addressed.
Release those ligaments and everything changes. The platysma mobilises as part of the composite flap — a smooth, continuous transition from jawline into the cervical region. Cheek through to neck as a single unit, which is how the anatomy actually works. That continuity is what lets you redefine the cervicomental angle without asking the skin to do the heavy lifting.
There’s another piece to this. The platysma adds real muscular bulk to the composite flap — particularly along the jawline. Anatomical studies have shown increased support at the gonial angle after repositioning. A three-ligament release can’t replicate that.
How the Procedure Is Performed
General anaesthesia. Accredited hospital. Three to five hours, longer if we’re combining procedures. I keep patients overnight. Your specific plan gets worked out during your facelift consultation, because anatomy varies enormously.
Marking and preparation — Before I cut anything, I map the deep plane entry point, areas needing correction, and the critical landmarks — especially the frontal branch of the facial nerve. Local anaesthetic goes into the dissection zones for bleeding control and to ease discomfort afterwards.
Incision placement — Incisions start at the temple hairline, curve around the ear in a pretragal or retrotragal pattern (depends on your anatomy), then extend behind the ear into the posterior hairline. Scars end up hidden in natural creases or hair. If the front of the neck needs direct work — midline banding, say, or liposuction — I’ll add a small incision under the chin.
Skin flap elevation — I raise the skin only as far as the deep plane entry point. Not further. Keeping this dissection minimal protects the subdermal blood supply — a better blood supply means more reliable healing.
Deep plane entry and ligament release — Here’s where things get interesting. The dissection drops beneath the SMAS into well-defined anatomical spaces. I work through them systematically — zygomatic cutaneous ligaments over the cheekbone, masseteric ligaments along the anterior masseter, and mandibular ligaments at the lower jaw. For the extended version, I carry on another five to ten centimetres below the mandibular angle to release the cervical retaining ligaments along the sternocleidomastoid. Throughout all of this, the facial nerve is right there. Zygomatic and buccal branches run through the operative field. Staying in correct anatomical planes keeps them safe — but that awareness has to be constant.
Composite flap repositioning — Once all four ligament groups are freed, the composite flap (skin, SMAS, fat pads, platysma — all connected) lifts as one piece. I set it at roughly 60 degrees. Vertical, not lateral. That distinction matters enormously. Pulling toward the ears gives you that tight, windswept look. Lifting vertically puts tissue back where it started — cheekbone volume restored, jawline redefined — without the telltale pulled appearance.
Neck integration — This is what makes the extended approach a true deep plane neck lift, not just a face procedure with neck work bolted on. The mobilised platysma gets repositioned along the lateral neck, building support under the jaw and sharpening the cervicomental angle. Midline banding? A formal platysmaplasty through the submental incision. Subplatysmal fat can be dealt with from the same field when it’s contributing to fullness.
Skin redraping and closure — All the repositioning tension sits in the deeper structures, so the skin just falls into place. No pulling. This tension-free closure reduces scarring risk and avoids that tight, “done” look you see when the skin itself is doing the work.
How Does It Compare to Other Techniques?
I offer several deep plane facelift approaches at my Bondi Junction practice. No single technique works for everyone.
SMAS Facelift — Works on the SMAS through plication or excision. No sub-SMAS dissection. Ligaments stay intact. Good for mild to moderate changes.
Short Scar Facelift — This is actually a traditional deep plane facelift — full three-ligament release — performed through abbreviated incisions. It’s what I use when the face needs deep plane correction but the neck doesn’t require significant work.
Extended Deep Plane Facelift — When a facelift is combined with a neck lift, that’s when the fourth ligament release comes in. The dissection extends into the cervical retaining ligaments, treating the face and neck as one operation.
Vertical Restore Facelift — My comprehensive approach. Deep plane dissection with vertical repositioning, often combined with facial fat grafting and neck lift components.
The right answer? Whichever one matches your anatomy. I’d rather do a well-executed SMAS plication on someone with mild laxity than push them into something bigger.
Complementary Procedures
Most patients having an extended deep plane facelift will combine it with at least one other procedure — upper or lower blepharoplasty, a brow lift, facial fat grafting, or chin implant surgery. One anaesthetic, one recovery. It makes practical sense.
Recovery After an Extended Deep Plane Facelift
You’ll stay overnight. Drains come out within 48 hours. Compression garments for the first week. Swelling peaks around day two or three, bruising can track into the neck and chest — looks worse than it is, resolves on its own.
Here’s something that surprises people: despite the more extensive dissection, recovery from deep plane work is often no worse than superficial facelift procedures. The sub-SMAS plane doesn’t bleed much, and because the skin stays attached to deeper tissues, blood supply and lymphatic drainage are preserved. Had a deep neck lift component as well? Possibly a bit more neck swelling early on, but the overall timeline stays similar.
Week three is when most people feel comfortable going out. The gym waits for six weeks. And here’s the thing — what you see at three weeks is not your final result. Deep tissues settle for months. Be patient. The facelift recovery page walks you through it week by week.
Risks You Should Understand
I’m not going to minimise this. Extended deep plane surgery means working near facial nerve branches for a prolonged dissection. Temporary weakness of facial muscles happens in a small percentage of patients — it almost always resolves within weeks to months, but “almost always” isn’t “always.” Permanent nerve injury is rare with experienced surgeons. It’s also real. You need to weigh that seriously.
Other complications: haematoma, infection, healing problems, asymmetry. We go through all of this — the full list, no glossing over — at your consultation. It’s not optional.
Frequently Asked Questions
Book a Consultation in Bondi Junction
If you’re researching extended deep plane facelift surgery in Sydney and want a clear, anatomy-based assessment, I’m happy to see you at my Bondi Junction practice for a thorough evaluation.
Contact us to arrange your consultation with Dr Scott J Turner, Specialist Plastic Surgeon (FRACS).
