By Dr Scott J Turner, Specialist Plastic Surgeon (FRACS) | Bondi Junction, Sydney
If you’ve spent any time researching facelifts recently, you’ll have come across the term “preservation deep plane facelift.” It’s everywhere right now — on Instagram, in surgical conference programs, across patient forums. And honestly? The way it’s discussed online can make it sound like an entirely new operation. It isn’t.
But there are real differences worth understanding. That’s what this article is about. Not a rehash of deep plane facelift basics — I’ve written about that separately — but a proper comparison between the traditional and preservation variations of the technique, where this concept actually came from, and what it means (and doesn’t mean) for patients considering surgery.
Explore topics on this page
The Backstory Most Websites Skip
The deep plane facelift has been the gold standard for structural facial surgery since Dr Sam Hamra described it in 1990. Surgeons have spent thirty-plus years refining it — tweaking vectors, adding fat grafting, extending the dissection further into the neck. It works. The results speak for themselves.
So where did the preservation idea come from?
Truthfully, it started with something experienced surgeons had noticed for a while. When you separate skin from the SMAS across a large part of the face — which is standard in a traditional deep plane — you get great access and visibility. No question. But you’re also cutting through small blood vessels, lymphatic channels, and those fine fibrous strands that connect skin to the deeper tissue. And some surgeons started wondering: do we actually need to separate all of that to get a good result?
Turns out, probably not in every case.
In 2024, a group of surgeons — Gordon, Gualdi, Nayak, Talei and Roskies — published a formal study on what they called “limited delamination.” Basically, do the same deep plane dissection underneath the SMAS, release all the same ligaments, but reduce how much skin you peel away from the SMAS beforehand. Keep more of the face as one connected unit. They reported good complication rates and felt patients healed more comfortably.
But here’s the thing people don’t mention enough — the anatomical groundwork was laid years earlier. Mendelson’s writing on facial spaces and composite flap handling. Work on the “deep plane transition zone” showing that keeping skin and SMAS connected in the lateral cheek actually helps the lift translate to the midface. The preservation concept didn’t drop from the sky. It formalised ideas that thoughtful surgeons were already moving towards.
So What’s the Actual Technical Difference?
Strip away the marketing and it comes down to one thing: how much skin gets separated from the SMAS before the surgeon enters the deep plane.
Both approaches do the same work underneath. Sub-SMAS dissection. Release of zygomatic, masseteric and cervical retaining ligaments. Vertical repositioning of descended tissue. That part — the part that actually produces the correction — is identical.
The difference is what happens on top.
With a traditional deep plane, the surgeon lifts skin off the SMAS across a broad area. Think of a flap extending from the ear incision to roughly a line between the outer eye corner and jaw angle. It’s a proven method. Gives you excellent access to the deeper structures. The downside? You’re creating a large space between skin and muscle, cutting through the small vessels and fibrous connections along the way.
With the preservation approach, the surgeon gets into the deep plane much sooner — closer to the ear — and leaves the skin stuck to the SMAS across most of the face. The whole thing (skin, fat, SMAS) moves as a single block. You only separate a narrow strip near the incision itself.
I sometimes explain it to patients this way. Imagine the difference between lifting a tablecloth off a table entirely (traditional) versus lifting the tablecloth with the table still attached and moving the whole thing together (preservation). The table goes to the same place either way. You’re just handling the cloth differently.
Does It Actually Matter in the Real World?
This is what you want to know. Here’s where I’ll be direct about what we’re seeing and what we’re not.
Less skin separation means less disruption to the blood supply and lymphatics. Several surgeons — myself included — have observed that patients seem to bruise and swell less in those first couple of weeks. A retrospective study published in 2025 in Plastic and Reconstructive Surgery – Global Open looked at 134 patients across both techniques and found shorter drainage durations and fewer complications in the preservation group. That’s encouraging, though it’s one study.
There’s a fluid management angle too. Separating skin from SMAS creates dead space — a gap where blood or serum can pool. Keeping those layers connected shrinks that gap. It’s partly why some surgeons doing preservation work have dropped surgical drains from their protocol.
And there’s a biomechanics argument that I find genuinely interesting. When you keep skin attached to the SMAS, pulling the SMAS upward drags the skin with it directly. You get a more direct transfer of the lift to the surface. Some surgeons report smoother cheek contours as a result. When the layers are separated, you’re relying on skin redraping independently after the deeper work is done — a slightly less predictable process.
Recovery? Patients probably get back to social settings a few days earlier. Maybe. The gap narrows quickly though. By week six or eight, most people from either approach look and feel similar.
What Doesn’t Change — And This Matters
I want to be straightforward about the limits of the preservation modification, because the online conversation sometimes overstates things.
The structural correction is the same. Both techniques enter the same tissue plane, release the same ligaments, and reposition the same structures. Preservation doesn’t go deeper, lift more, or address areas the traditional approach can’t reach. It changes superficial handling. Full stop.
We don’t have evidence it lasts longer. Since both methods achieve their results through the same deep mechanism, there’s no biological reason to expect different longevity. Deep plane facelifts generally hold up for 10 to 15 years. Nobody has tracked preservation outcomes specifically over that timeframe yet, so claims either way are premature.
Nerve safety? Same. The facial nerve sits in the deeper planes that both techniques navigate. Your surgeon’s anatomical knowledge and experience matters far more than which version of skin handling they use.
And not everyone’s anatomy suits it. Patients with a lot of skin excess, badly sun-damaged skin, prior facelift surgery that needs scar work, or a neck requiring full-access deep neck lift — these people may still need wider skin undermining. The preservation concept works well when skin quality and elasticity cooperate. It’s not a universal solution.
Being Honest About the Evidence
I’d rather be upfront with you here than tell you what sounds good.
The preservation deep plane facelift makes anatomical sense. The early clinical data is positive. Respected surgeons around the world are adopting it. The Gordon et al. 2024 study was an important first step in formal documentation.
But we’re short on the kind of evidence that would settle the debate properly. No large randomised trials comparing the two approaches head-to-head with long follow-up. No standardised outcome measures across studies. We’re working with surgeon case series and retrospective reviews — useful, but not definitive.
Some surgeons pitch preservation as the next revolution in facial surgery. Others (and I tend to lean this direction) see it as a smart refinement of principles experienced surgeons were already applying — just without a formal name. The answer’s probably somewhere in between. What I can tell you is that it’s not a gimmick, and it’s not magic either.
How This Fits Into My Practice
At FacePlus Aesthetics in Bondi Junction, I don’t start with a technique and fit the patient to it. I start with the patient. Skin thickness, elasticity, how far the midface has dropped, what’s happening in the neck, what they actually want to look like afterwards — all of that determines the plan.
The philosophy behind preservation — don’t disrupt tissue you don’t need to, protect blood supply, reduce dead space — aligns with how I’ve approached facelift surgery throughout my career. Whether the operation is a deep plane facelift, the Vertical Restore Facelift, or something combined with neck lift and blepharoplasty, I’m always trying to get the necessary correction done with the minimum disruption that allows it.
Here’s the part I keep coming back to. Whether a surgeon enters the deep plane two centimetres further from the ear or two centimetres closer isn’t what determines your outcome. What determines your outcome is whether your surgeon understands the anatomy they’re working in, whether they’ve chosen the right technique for your specific face, and whether they execute it precisely. That’s it.
If you’re trying to figure out which approach makes sense for you, a consultation is genuinely the best place to start. I’ll look at your face, talk through your goals, and explain what I’d recommend — and why — without the jargon.
