What is a deep plane facelift?
A deep plane facelift is an aesthetic surgical procedure for facial rejuvenation.
The procedure achieves midface lift, lower facelift, and neck lift by releasing all of the facial retaining ligaments, elevating and repositioning the fatty midface layer and muscle layer. Once this is done, the excess skin is removed.
Facelift surgery delivers truly transformative results for the aging face. Dr. Bustillo –one of the best facial plastic surgeons in Miami— performs the deep plane facelift rejuvenating the aging face naturally and conservatively. Our patients’ results never look pulled, stretched, or show scarring signs.
Should I have a facelift?
As we get older, we inevitably experience the negative effects of aging. Loss of skin elasticity, firmness, and volume can significantly change the contour of the face. If a mini-facelift doesn’t solve the development of wrinkles, creases, and hanging skin on the neck, a facelift may be the most effective solution.
While a healthy diet and good skincare routine are useful ways to slow the aging process, other factors like genetics, smoking, and sun exposure also contribute to facial aging and may be difficult to avoid.
Using the most advanced Deep Plane Facelift techniques and relying on years of experience, Dr. Bustillo specializes in making patients look younger and healthier – without the telltale signs of plastic surgery.
Facelift Before and After Photos
Each patient is unique and individual results may vary.
The majority of patients that undergo the facelift operation do so in their mid to late forties and on. Occasionally, patients with premature facial aging or weight loss will undergo the surgery at an earlier age.
The ideal patient should have the proper expectations before undergoing surgery. Although with the deep plane facelift technique, results are better than they ever were, there are still limitations. It is important that the patient has a good understanding of what can be achieved. Patients with poor skin quality in the neck must understand that they will have a great improvement but complete correction of the neck may not be possible. Communication between the patient and the surgeon is important so that the limitations of the surgery with regard to the patient’s anatomy can be discussed before the procedure.
Patients that undergo a facelift with Dr. Bustillo feel that they look refreshed and have an increase in confidence. They feel rejuvenated and feel more comfortable in social settings and in pictures.
The Deep Plane Facelift explained
People are often confused about what exactly a facelift corrects and how they are performed. This uncertainty can be compounded by the advent of the different types of lifts.
How does deep plane facelift differs from a traditional facelift?
The fundamental difference between the extended deep plane facelift and traditional facelifts is that traditional facelift fails to release all the ligaments of the muscular layer, while the deep plane facelift severs all of the retaining ligaments, thereby allowing for a complete lift that is not held back by the presence of the retaining ligaments. Because the deep plane facelift works on the deeper muscle layer, patients never look pulled or stretched.
A properly executed facelift procedure should accomplish four main goals:
- Elevate the cheek
- Improve the jowls
- Improve the neck
- Restore lost volume
The deep plane facelift is the only technique that can accomplish a satisfactory midface or cheek elevation. The release of the facial retaining ligaments allows the elevation of the upper fatty cheek layer and the lower deep muscular layer as one. It then repositions the entire complex in a vertical vector. The result is a comprehensive facial rejuvenation that works to improve the cheek, jowls, and neck.
The descent of the midface along with volume loss in the cheek and tear trough can often make the person appear tired and aged. The deep plane facelift is the only facelift technique that improves the midface by elevating the malar fat pad (cheek fat). The elevation of the midface back to its natural position will restore fullness and in so doing will improve the transition between lower eyelid and cheek. Oftentimes fat is transferred to the tear trough to further improve the midface. Midface elevation can restore the youthful look to a face (Figure 1, 2).
The deep plane facelift improves the jowls in a way that other SMAS facelifts cannot. The entire platysma muscle in the lower face is completely elevated and repositioned in a vertical vector. The elevation of the platysma occurs by the severing of all of the retaining ligaments that anchor the platysma muscle down. This provides maximal correction of the jowls. (Figure 3)
The neck is improved by both the lateral pull on the platysma and by the work done on the neck through a small incision in the crease just behind the chin. Through this incision, the fat deep to the platysma (this fat is not accessible through liposuction as it is deep to the muscle), and occasionally some deep muscles are trimmed to further improve the neck contour. The platysma muscles are then tightened and cut inferiorly to help prevent the re-occurrence of the neck muscle bands.
As part of the facial aging process, the face loses volume. This volume loss is treated with fat transfer. The fat is typically harvested from the outer thighs or the abdomen, treated and transferred to the areas as needed.
The deep plane facelift has several advantages over other techniques. This facelift approach allows the repositioning of the malar fat pad (cheek) up to its youthful position. In addition, the jawline definition is greatly improved due to the muscle work that is performed in the lower face and neck. The most significant advantage, in my opinion, is the natural appearance that is attained with the deep plane facelift.
Custom Facelift Procedures
Dr. Bustillo customizes the deep plane facelift procedure for each individual. His signature deep plane facelift lifts the cheek fat back to its natural position, elevates and softens the jowls, and tightens the neck muscles (platysma). The platysmaplasty tightens the neck muscles and is essential to creating a well-defined neck.
Dr. Bustillo often combines the facelift operation with additional procedures as needed. For example, because the face loses volume with time, a fat transfer procedure is often performed at the same time. Fat is often used to help replace facial volume that patients may lose with age. Dr. Bustillo often combines fat transfer with his deep plane facelift. Fat is harvested from the outer thighs or the abdominal area. This fat is then processed and transferred to areas that may have lost volume. These areas where fat is most commonly transferred to are the tear troughs under the eyes, cheeks, temples, nasolabial folds, marionette lines, or lips.
Miami facelift patients that may need to have their eyelids rejuvenated can also have a blepharoplasty or eyelid lift done at the same time. When the brows descend, they can be lifted with a brow lift. Patients with weak chins often undergo chin augmentation to strengthen the chin and jawline.
Fine lines and wrinkles are completely natural for mature skin, but they can also be a source of insecurity for many people. Dr. Bustillo often combines skin resurfacing techniques such as medium-depth peels to improve fine wrinkles and skin blemishes. Although we can’t stop the aging process entirely, options are available to restore your youthful features and shave years off your appearance. Often called the “gold standard” of facial rejuvenation, the deep plane facelift is a cosmetic procedure known for its ability to dramatically improve skin laxity and smooth out deep facial wrinkles.
In recent years, the mini facelift has become very popular. Those that market them have given them “brand” names. Certain types of mini face lift are also known as an S-lift or ponytail facelift. The idea sounds promising. Mini is a term that is associated with easy and fast. However, the results are also usually “mini.” If a person demonstrates signs of an aging face and wants a surgical solution, the procedure of choice is a deep plane facelift.
When it comes to costs, a mini face lift is also less expensive than a deep plane facelift, but we often see patients that had mini facelifts and are unhappy with the result. They ultimately end up having a deep plane facelift to improve the poor result they obtained from the mini facelift.
Non-Surgical and “Liquid” Facelifts
A non-surgical facelift, also known as a liquid facelift, is a procedure performed with injections to rejuvenate the face. It usually consists of Botox or Dysport used to improve the wrinkles in the upper third of the face. These include the glabellar lines (also known as the “elevens”), the crow’s feet, and the horizontal forehead creases.
Dermal fillers are then used to elevate the cheeks and smooth the nasolabial and marionette folds. The downside of this treatment option is that it does not treat the sagging neck or heavy jowls.
How the Face Ages
There are four visible transformations that the face goes through as a result of the aging process. These are:
- Facial soft tissue descent
- Facial deflation (loss of volume)
- Radial expansion of the soft tissues
- Loss of skin quality.
Facial soft tissue descent refers to the inferior displacement of the facial soft tissues. Deflation refers to the loss of facial fat. Radial expansion is the loosening of the facial tissue layers.
As the face ages, the layers of the face (skin, fat, and muscle) separate and loosen. A properly planned and executed facelift should address these in order to fully rejuvenate the face and neck.
Facial soft tissue descent
As a consequence of the aging process, the facial skin and underlying tissues descend. This can first be seen in the midface, where the cheek fat begins to descend. This descent of the cheek fat has two effects: In the area between the lower eyelid and cheek, hollowness forms. The other effect is the creation and deepening of the nasolabial fold. The jowls begin to appear as the facial tissues begin to descend forward and downward.
The platysma muscle descends in both the lower face and in the neck as we age. In the lower face, its descent creates the jowl. The jowl is actually the sagging front end of the muscle along with excess fatty tissue. In the neck, the platysma descends with aging, sometimes causing the bands that appear in the front of the neck.
The second visible change is deflation. This describes the hollowness that is sometimes seen in some areas of the aging face. Deflation can be due to either a loss of fat volume or a descent of the facial fat. The most common areas to undergo deflation are the tear troughs, midface/cheeks, temples, and the areas around the chin and mouth.
The surgical rejuvenation of the face must take into account these shifts in volume and attempt to correct them. The first step is the recognition, followed by a surgical plan aimed at repositioning the facial deep tissues to replenish the volume. This can be accomplished by both, repositioning the fat during the deep plane facelift and/or by performing an autologous fat transfer.
The third visible change is radial expansion. This can be best described as the outward inflation seen in some areas of the lower face. This is most commonly seen in the lower face in the areas of the jowls and the lower border of the jawbone. It is a consequence of the weakening of facial retaining ligaments.
As they weaken, the tissues loosen and separate from the deeper tissues. Correction of this involves tightening of the platysma muscle when a facelift is performed.
Loss of skin quality
The fourth visible change that occurs in the face and neck is the loss of skin quality. As skin ages, it loses tone and elasticity. While this occurs in both the face and neck, it is most severe in the neck. This is because neck skin is very thin, in contrast to facial skin with is thicker and has more collagen and elastin. As the skin quality decreases, so does the amount of improvement in the neck after surgery.
How the Neck Ages
Over time, the neck skin can lose elasticity and become lax. This leads to a redundancy of the skin over the neck. While the facelift procedure tightens the underlying neck muscles and removes the excess skin, it does not address the inherent loss of skin quality that the person’s skin may have. The patient with poor neck skin quality may have a less than ideal result in the neck as a consequence. These patients may benefit from certain skin tightening non-invasive procedures after the surgery. It is a well-known fact that facelifts may not satisfy all patients in the neck area. The reason is usually poor skin quality, which facelift surgery cannot address.
Facelift Consultation in Miami
The consultation begins with a discussion about specific concerns that the patient has regarding facial aging. It is important to discuss whether facial aging has occurred slowly over time or recently in the last several years. Any recent weight loss or plans for weight loss are discussed so that the surgery can be planned at the appropriate time. Weight loss should occur before the facelift.
Dr. Bustillo will perform a thorough physical examination. The midface is evaluated for the descent. Dr. Bustillo usually performs a fat transfer procedure at the same time to help with volume loss in the midface. The lower face and jowls are then palpated and mobility of the facial skin and tissues is assessed. The neck is then examined. The amount of fat and muscle descent is determined and the amount of skin laxity is assessed. The eyes and eyebrows are evaluated to see if the patient is a candidate for any other adjunctive procedure, such as a blepharoplasty or a brow lift.
Dr. Bustillo will then have a discussion about the result that he believes can be achieved with a deep plane facelift. The patient should understand exactly what the facelift procedure will achieve for them so that an informed decision can be made. The procedure is explained in detail and all questions are answered.
Face lift cost in Miami
According to CareCredit — a healthcare financial platform that helps to pay for treatments and procedures not covered by insurance — the national average cost of a Facelift procedure is $8,000. But the cost of a facelift varies from patient to patient, from doctor to doctor, and from city to city.
Miami is not an exception. Jessica, our patient care coordinator will meet with you personally after the consultation to explain the cost and financial options.
Preparing for Facelift Surgery
Dr. Bustillo requires that all patients undergoing a facelift procedure obtain pre-operative labs and medical clearance from their primary care physician. Patients should stop taking all aspirin, anti-inflammatory products (naproxen, ibuprofen), and vitamins such as A, Ginkgo Biloba, and St. John’s wort ten days before surgery. These medications or supplements may affect blood clotting and should be stopped ten days before surgery.
Patients should also stop any alcohol five days before the facelift surgery to decrease swelling and bruising. Dr. Bustillo recommends that patients start high dose vitamin C (2000mg/day) one week before surgery and two weeks after the facelift surgery, to help with the healing and to reduce bruising.
Anesthesia for Facelift Surgery
Dr. Bustillo performs deep plane facelift surgery on an outpatient basis in his Miami-based AAAASF certified surgical facility. Patients are allowed to return home or to a hotel the same day after facial rejuvenation surgery. Dr. Bustillo believes that patients recover best in a tranquil environment. If necessary, an overnight nurse will be provided. All surgeries are staffed by board-certified anesthesiologists (MD), which are part of the Baptist Hospital Anesthesiology Department.
The facelift procedure can be performed under either general anesthesia or IV sedation anesthesia, depending on the patient. Certain patients may require general anesthesia for safety reasons. The anesthesiologist will decide which type of anesthesia will be the safest for the patient. The facelift surgery takes about three to four hours to perform.
Risks of Facelift Surgery
The facelift operation, like all surgery, does have risks aside from those of anesthesia. The highest risk patients are smokers.
Patients who smoke should refrain from smoking for approximately two weeks before and two weeks after the surgery. The nicotine patch is not a substitute for smoking cessation as far aesthetic surgery is concerned. Nicotine causes the small blood vessels to become narrower, which decreases the blood flow to the skin.
The potential complication in a smoker is the death of the facial skin, resulting in a poor outcome with facial scarring and possible infection. Facelift surgery will not be performed on an active smoker.
A hematoma is a collection of blood that can accumulate under the skin. Although rare, it can occur after a facelift. The risk of hematoma is about 1%. The treatment usually entails draining it in the office.
Most patients that have a hematoma after surgery recover well without any complications. Infections after facelift surgery are also rare. Patients are given Bactroban ointment to place in the nose three times a day for two weeks before surgery. This helps to decrease the bacterial load that a patient may be carrying. IV antibiotics are given prior to and oral antibiotics are given after the surgery to help prevent infections.
- The patient is discharged home or to a hotel the same day after the facelift surgery. The first night should be spent relaxing. The patient should keep activity to a minimum. A liquid diet should be maintained for the first eighteen hours after anesthesia. The patient should keep the head elevated using two pillows to help reduce swelling of the face and neck. The patient should place small zip lock bags with frozen peas on the face every fifteen minutes for the first two days.
- The face will be wrapped with a bandage used to keep the skin flat. Pain should be minimal. Tylenol is usually enough to control any minor discomfort. Additional pain medication will be provided, in the event that it is needed. Any significant pain should be reported to Dr. Bustillo immediately, as this may signal bleeding under the skin. If a blepharoplasty was performed, some mild bruising may be visible around the eyes.
- The patient is then seen the morning after the lift surgery. The bandage will be removed on the first day after surgery. The drains will be removed if the drainage is minimal. Occasionally, they may be left one more day if necessary. It is normal for some bruising to appear in the neck. A small bandage is then worn for one more day. On the fifth postoperative day, the small stitches in front of the ear and under the chin are removed. Patients can usually shower and wash their hair after this second visit.
- Most patients return to work and daily activities about two weeks after surgery. Seventy percent of the swelling resolves in the first three weeks after the facelift. It is recommended that physical activity, such as running or lifting be resumed three weeks after the surgery. The remainder of the swelling can take up to three months to completely resolve. This remaining swelling is imperceptible.
- The final results of the facelift surgery may not be completely evident until several months after the procedure. The results of a facelift operation usually turn back the clock approximately ten years and the results last about ten years. Dr. Bustillo will take before and after pictures and will give them to you once you are completely healed from the facelift operation. Most patients who undergo facial rejuvenation surgery are extremely happy with the results.
Most patients that undergo a facelift procedure with Dr. Bustillo do not have much pain. Everyone is different, and there are some patients that will have some mild pain. Dr. Bustillo will prescribe pain medication to help with any discomfort you may have.
It depends on your definition of permanent! Yes, the results will stay with you forever. However, the aging process will not stop after a facelift. That being said, you will always look younger after your facelift than if you had never had one before. It is difficult to say how long the facelift will last, since everyone ages differently.
Dr. Bustillo takes about three to four hours to perform the deep plane facelift procedure.
Most patients that undergo a facelift can return to work in fourteen days. Dr. Bustillo will remove the stitches underneath the chin and in front of the ears five days after the facelift and then ones behind the ears ten days after the facelift.
Patients can begin to use makeup about a week after surgery. The makeup can be applied to the cheeks, jowls, and neck. It should be a light, liquid-based base concealer. Sephora has several that work very well. Patients should not apply the concealer to the incisions, as these need to heal in a clean and moist environment.
Dr. Bustillo performs the facelift procedure in an AAAASF-certified facility. Dr. Bustillo only works with board-certified anesthesiologists from Baptist Hospital of Miami.
Why Choose plastic surgeon Dr. Bustillo?
- Castle Connolly Top Doctor for more than 10 years
- American Board of Facial Plastic and Reconstructive Surgery
- American Board of Otolaryngology-Head and Neck Surgery
- Facial Plastic & Reconstructive Surgery Fellowship at The New York University
- Otolaryngology – Head & Neck Surgery Residency at The University of Miami, Jackson Memorial Hospital
- General Surgery Internship at The University of Miami, Jackson Memorial Hospital
If you’re seeking a facelift in Miami, contact us today to schedule a consultation with Dr. Andres Bustillo.