Extended Deep Plane Face Lift and Adjunctive Procedures for Rejuvenation of the Upper, Middle, and Lower Face

by Andrew A. Jacono, MD, FACS
In this video, Andrew A. Jacono, MD,FACS, a master facial plastic surgeon specializing in aging face surgery, performs the extended deep plane face lift he has developed, with adjunctive procedures to rejuvenate the upper, middle, and lower thirds of the face. The artistry of facial rejuvenation surgery lies in choosing the right combination of procedures. This comprehensive facial rejuvenation procedure includes an endoscopic lateral temporal lift, tissue-preserving upper blepharoplasty, extended submuscular lower blepharoplasty with orbitomalar ligament release and orbital fat transposition, and modified lip lift. Guiding principles in his technique are repositioning of deep facial and eyelid fat to volumize the aging face and soft tissue sparing. The combination of these procedures—elevation of the temple, lateral brow, and cheeks; blending of the lid-cheek junction; and shortening of the upper lip—redefines the vertical and horizontal axis of the face, converting an aging rectangle to the heart-shape face of youth. Viewers are certain to benefit from Dr. Jacono’s demonstration of meticulous technique informed by his wealth of anatomic knowledge.

This case contains a thorough review of the patient’s preoperative appearance and surgical goals. Step-by-step procedure is demonstrated from local anesthesia infiltration to closure. Throughout the extended deep plane face-lift procedure, Dr. Jacono explains the approach to the deep plane; release of the zygomatic, masseteric, and mandibular cutaneous ligaments; elevation of the malar fat pad off of the zygomaticus musculature; and vertical vectoring the deep plane flap to volumize the midface. During the midface dissection, approach to the buccal space is illustrated for buccal fat pad inspection and reduction if required. The neck-lift portion of the surgery highlights Dr. Jacono’s technique of extending the deep plane dissection into the neck, elevating an extensive platysma muscle flap inferiorly off of the sternocleidomastoid muscle and medially. With a platysma myotomy, this flap is converted into a platysma sling, supporting the submandibular gland and creating a defined jawline contour. To further rejuvenate the midline neck, his technique for opening the neck is described, including subplatysmal medial flap elevation, interplatysmal and subplatysmal fat removal, digastric treatment, and hyoid fascia suspension of the midline platysma during corset platysmaplasty.

This comprehensive facial and neck rejuvenation procedure includes:
Extended deep plane face lift
An endoscopic lateral temporal lift
Tissue-preserving upper blepharoplasty
Extended submuscular lower blepharoplasty with orbitomalar ligament release and orbital fat transposition
Modified lip lift
Neck lift, highlighting Dr. Jacono’s technique of extending the deep plane dissection into the neck