Facelift (deep plane)
Facelift surgery aims to address changes that come with the ageing process, focusing on both facial volume and skin laxity. The keys to a satisfactory outcome remain safety and a natural appearance: a fresher face, without the tell-tale signs of surgery. It is also used as a supporting measure to improve the appearance after a facial nerve palsy or in the context of acne scarring.
In our practice we favour the deep plane facelift technique, as it brings more consistent improvement in the jowl area and marionette lines than other facelift techniques. We have combined our own work in 3D evaluation of facial shape with anatomical study, so that the plan can be tailored to different facial characteristics and patient preferences.
A facelift is often only one part of the discussion. The neck, the brow and the eyelids start with individual genetic characteristics; they change over time on their own terms, and they are not corrected by the same manoeuvre. Where it is appropriate, surgery can also be combined with skin treatments so that both shape and surface are considered.
Before and after
Mr Ion's patients, shown with consent. Individual results vary.
On this page
What we are trying to change
The skin of the face and neck changes for two common reasons. Volume in the face is often lost. Elasticity in the skin declines as well — more markedly with sun damage and smoking, but also as a natural course. The ligamentous structures themselves are stable. The laxity develops between them.
In youth the face has a smoother shape, because there is more elasticity throughout the structural support. Later, the points that have stronger support keep their position, and the soft tissue between them tends to glide down. The contour becomes more uneven. Mobility of the face and neck increases. A facelift is, in that sense, predominantly a stabiliser. Once the tissues are settled in a new position, the shape remains more stable, and closer to the face you see when you lie down and look in a mirror — when gravity is not exploiting that difference in mobility.
The deep plane facelift relies on an aggregate displacement of the cheek SMAS and the skin. They move together. That is why the effect is stronger along the jaw and the labio-mandibular (marionette) lines, and why the nasolabial lines often improve as well, though more discreetly. The same movement produces a more vertical vector, which is particularly helpful when there is more sun damage and the skin has lost elasticity. The skin is not asked to hold the result by tension; it follows the SMAS.
Because the skin travels with the SMAS, that displacement pushes tissue up towards the temple. The excess there can be treated in two ways:
by extending the scar along the edge of the hairline in the temple region
by combining the facelift with a brow lift
The second option also absorbs the skin in the temple and reshapes the position of the eyebrows and their relationship with the upper eyelids.
There are things a facelift does not do well on its own. It does not lift a heavy brow, reduce upper eyelid skin, or refine the texture of the skin. Those belong to a brow lift, blepharoplasty, or a skin treatment — or, sometimes, to leaving well alone.
Planning with 3D evaluation
We use 3D analysis of shape and surface as a way of seeing the face more clearly before anything is proposed. It helps us understand the starting contour, the direction in which change is realistic, and how a movement in the jowl or jawline would sit with the neck, the chin and the eyelids. It is a planning tool. It does not promise a particular picture, and it does not replace the conversation about what you like and dislike in your own features.
That conversation matters. Preferences vary more than textbooks allow for, and a technically tidy result that ignores them is not a success. Consultation is the point at which anatomy, health and those preferences have to meet.
The face and the neck
The neck is often part of the same picture. When the skin under the chin is still elastic and the issue is mainly volume, an anterior neck lift can be enough. When the deeper structures of the neck — fat below the platysma, the digastric muscles, the lower part of the submandibular glands — are what blunt the contour, a deep contouring neck lift may be the more honest operation. Those deeper features are frequently hereditary. They are not always a matter of age or weight.
If the face is lifted and the neck is left behind, the junction between the two can look awkward. In the other direction, tightening the neck while the jowls remain heavy can produce its own mismatch. We would rather decide that in the room, with the benefit of the 3D study, than treat the face and neck as separate catalogue items.
When there is more significant laxity affecting the brow position as well as the face and the neck, the combination of a deep plane facelift, a deep contouring neck lift and a brow lift provides a unified reshaping. That is less likely to leave artefacts in the contours than treating each region as an isolated problem.
Brow, eyelids and skin
A lower face that has been rebalanced can make a heavy brow or tired eyelid more noticeable, simply because the eye is drawn there next. Upper blepharoplasty is usually judged together with the position and shape of the brow. Lower blepharoplasty is judged together with the cheek. None of this has to be done at the same time as a facelift. Combining operations can spare you a second recovery; it also lengthens the surgery and the area that has to heal. We discuss that trade as part of the plan, not as an add-on at the end.
Shape and texture are different problems. Surgery changes contour. Fine surface change, sun damage and the quality of the skin often need a separate treatment if they are part of what bothers you. For a more complete rejuvenation we sometimes combine facelift surgery with skin treatments so that both are addressed.
Short scar facelift
The short scar facelift is still a deep plane facelift. It is the proportionate choice when the laxity along the jawline is more limited and displacement of the SMAS does not generate a significant amount of skin excess. There is still a short scar behind the ear, but it is not as extensive as the scar used when a neck lift is carried out together with facelift surgery. It is often combined with a temporal lift or a brow lift.
Consultation
Naturally there will be questions, and you will want to meet the surgeon who would operate. Trust in that relationship is not a small part of the decision. Surgery is unique to each person; a detailed discussion and assessment are what allow advice to be personal rather than general.
We look at your medical history, medicines, previous facial procedures and history of smoking. We look at the face in motion as well as at rest. 3D imaging is used where it helps.
Two points need particular weight when a facelift is being considered. Blood thinners increase the risk of bleeding and have to be managed specifically around the operation. Raised blood pressure also increases the risk of bleeding, and needs the same special attention. Neither is a footnote to the medical history; both influence whether surgery can be planned safely, and how it is planned.
If a facelift is not the better course — because the anatomy does not support it, because the brow or the neck is the real issue, or because the safer option is to wait — that should be said directly.
No operation is planned from a website enquiry. Surgery requires assessment and discussion in person, often more than once. The written information after the consultation allows you to consider it in detail. Fees depend on the combination of procedures and the setting in which they are carried out; they are confirmed in writing for the plan that has actually been agreed.
Recovery
Post-operative care is crucial for a safe and more comfortable recovery. In our practice we provide manual lymphatic drainage to help the early swelling settle. The first days are the most restricted: tightness, bruising and a sense that the face is not yet your own are expected. Help at home is wise. How soon you feel able to be seen at work depends on the extent of surgery, whether the neck or eyelids were included, and on how you bruise.
The face continues to settle for months. Early photographs are not the result. Some firmness in the scars and some unevenness of swelling are part of that course and usually soften. Exercise, hair colouring and travel are timed individually rather than by a single calendar that suits everyone.
Risks
A facelift is still an operation, and it carries the risks of one. Bleeding or a haematoma, infection, delayed healing, visible or thickened scars, asymmetry, a change in the hairline or the shape of the ear, prolonged swelling or numbness, weakness of a facial nerve branch (usually temporary; lasting weakness is uncommon but possible), and, rarely, an area of skin loss can all occur. The appearance may not match what was hoped for. Further surgery is sometimes needed. Anaesthetic complications, though uncommon in healthy patients, are part of the same discussion.
The risk of bleeding is higher if you take blood-thinning medicines or if the blood pressure is raised. Those two factors need honest discussion and specific management before a date is set. Smoking, vaping and some other medicines increase the chance of a wound problem and belong in the same conversation. Ageing does not stop after surgery. How long a result remains pleasing depends on the starting anatomy, the skin, changes in weight and time.
Questions we are often asked
What is a deep plane facelift?
It is a facelift that repositions the cheek SMAS and the skin as one unit, rather than depending on skin tightness. In our practice we use it when the jowl area and marionette lines have changed because both volume and laxity have shifted. The operation acts mainly as a stabiliser, so that the shape of the face is less at the mercy of that extra mobility.
How is it different from a short scar facelift?
The short scar operation is still a deep plane facelift. It is chosen when the laxity along the jawline is more limited and the movement of the SMAS does not create much spare skin. The scar behind the ear stays shorter than when a neck lift is included. One is not automatically better; they answer different starting points.
Will I look as if I have had surgery?
The aim is a revitalised appearance without obvious signs of an operation. That depends on the plan, the healing and on not asking a small procedure to do a large piece of work. Nobody can promise that a particular face will look “unoperated” to every observer.
Do I always need a neck lift as well?
No. If the neck contour is already clean and the trouble sits in the jowls, the face can be treated on its own. If the neck is full, banded, or poorly defined under the chin, leaving it untouched can sit badly next to a lifted jawline. When the deeper structures are the problem, a deep contouring neck lift may be the more honest companion procedure. That is an examination finding, not a package.
Will a facelift help my eyes or my brow?
Not in a reliable way on its own. Because the skin moves with the SMAS, spare tissue is often pushed towards the temple; that can be taken along the temple hairline or absorbed by adding a brow lift, which also resets the brow relative to the upper lids. The eyelids still need their own assessment. Sometimes they are included; sometimes they are left for another time; sometimes they are the better first step.
How long does it last?
There is no honest number that fits everyone. Because the deeper layer is moved with the skin, the change is meant to hold its logic as the face continues to age. Weight, sun and smoking all influence what happens next.
What is the first fortnight like?
Swollen, tight, and not yet socially easy. Bruising varies. We use manual lymphatic drainage in the practice during this period. Some people feel presentable sooner than others, particularly if the surgery was confined to the face rather than the face and neck together.
Is there a right age?
The face decides, not the birthday. Early, localised heaviness along the jawline can be served by a short scar deep plane lift. A more established change in the jowls and neck may need the deeper operation, sometimes with a deep contouring neck lift, and sometimes with a brow lift as well.
Do you operate on men?
Yes, when the anatomy supports it. Beard skin, hairline and the way the male neck holds volume change the planning. For some men the neck is the larger part of the conversation.
What does it cost?
It depends on what is actually done — face alone or face with neck, brow or eyelids — and on the anaesthetic and facility. A figure offered before that plan exists is rarely a useful one. We confirm fees in writing after consultation.
Do medicines and blood pressure matter?
Yes. Blood thinners raise the risk of bleeding and have to be managed around the operation. Raised blood pressure does the same. Both need to be known and planned for; they are not incidental details on a form.
Lucian Ion FRCS(Plast)
Consultations are with Mr Lucian Ion, consultant plastic and cosmetic surgeon, at Aesthetic Plastic Surgery, Aveling House, 1B Upper Wimpole Street, London W1G 6AB. His GMC number is 4276768 and can be checked on the GMC register. The practice is focused on facial surgery — face and neck rejuvenation among it — and on planning that includes the patient’s own sense of the face, not only the measurements.
About Mr IonGetting in touch
If you would like to discuss facelift surgery, the proper next step is a consultation. Come with the usual list of medicines and previous procedures, and with a clear sense of which part of the face is the problem you want examined.
Aesthetic Plastic Surgery, Aveling House, 1B Upper Wimpole Street, London W1G 6AB. Telephone 020 7486 7757.
London W1G 6AB
When you email, it helps to include a telephone number and the procedure you are interested in.