A Surgeon’s Take

Do you need a deep plane facelift?

The deep plane facelift is a real and valuable operation, but the modified deep plane is the more modern version I perform. The label is being used to sell extent, and extent is not the same as quality.

The best facelift is a complete release of the layers that are actually falling, done with enough restraint that you heal quickly and look like yourself. More dissection doesn’t buy it, and neither does a bigger name or a bigger bill.

Henry D. Sandel IV, MD, FACS

Double board-certified in facial plastic and reconstructive surgery and in otolaryngology, head and neck surgery. Fellowship trained. Practicing in Annapolis since 2008.

Last reviewed 30 August 2026

Seven claims circulating about the deep plane facelift, each one weighed against the published literature and against what Dr. Sandel sees in practice.

The position

Dr. Sandel, in his own words.

What’s trending

For the better part of a decade, “deep plane” has been one of the biggest marketing terms in facial surgery, and in the last few years social media has turned it up, driven by the voices of a handful of surgeons. This is not a new viral moment. It is sustained marketing that has been building for years, amplified recently by social media and by a very public celebrity result. The numbers show it working: one industry forecast reported online interest in the procedure jumping more than 200 percent,²¹ ASPS members performed about 79,000 facelifts in 2024, and facial plastic surgeons report a steady shift toward younger patients.^18,19,20

Here’s what the marketing leaves out.

What “deep plane” means when you hear it on social media

When a surgeon on your feed says deep plane, they are almost always describing the extended deep plane: the dissection carried deep into the midface, the periosteum lifted off the cheekbone, and the release often taken out toward the corner of the mouth. None of this is new. The SMAS layer was named in 1976, surgeons were working beneath it in 1974, the deep plane facelift was published in 1990, and the extended versions have been in the literature for decades.^1,2,3,7 What’s new is the marketing.

The message behind that marketing is that more dissection means a better result. For the vast majority of patients, it doesn’t. Every additional plane you open adds swelling, adds recovery, and adds nerve exposure, and the published comparisons do not show a better or longer-lasting result for the more extensive versions.^{10,11,12,13,14}

The extended deep plane has a place. Heavy midface descent, thick tissue, and some revision cases can justify the added dissection. But as a default operation for every face, it is a choice made for brand, not for anatomy.

Where “more” stops helping

Every additional plane you open adds swelling, adds time, and adds nerve exposure. The published comparisons bear this out. A 2025 meta-analysis pooling nearly 2,900 patients found high satisfaction with both deep plane and SMAS approaches, but a meaningfully higher overall complication rate on the deep plane side, 17.2 percent versus 10.3 percent.¹⁰ A 2025 analysis of over 10,000 patients found comparable safety and no basis to call one approach superior.¹¹ A 2026 systematic review in Plastic and Reconstructive Surgery concluded that medially extended deep plane techniques have not been shown to improve the midface or lengthen results compared with other SMAS-based lifts.¹² Permanent facial nerve injury rates did not differ by technique in the largest safety review to date.⁹

The honest summary: the extended versions of the deep plane facelift have not proven that they deliver more, but they reliably cost more in recovery. There are no large randomized trials here, the studies are mixed, and results depend heavily on the surgeon. But the direction of the evidence is consistent.

What I do instead

As a facial specialist, I perform hundreds of facelifts a year, and the operation I do is the modified deep plane facelift with a corset platysmaplasty. The modified deep plane is the more modern evolution of the extended version. It was developed because the extended dissection required significant downtime and the results were not better for it.

I fully release the SMAS layer across the midface, the jawline and the neck, so the lift is carried by the deep layer and not by tension on the skin. The corset platysmaplasty tightens the neck from the front and sharpens the angle under the chin. What I leave out are the steps that added recovery without adding result: I don’t lift the periosteum off the cheekbone, and I don’t carry the dissection to the corner of the mouth. The lift is significant.

The results are just as good, and the published comparisons bear that out.^{10,11,12,13,14} There are no large randomized trials here and outcomes depend heavily on the surgeon, but the direction of the evidence is consistent. In my practice, sutures come out at day seven and most patients are presentable in public around day ten. The full sequence, step by step, and what recovery looks like day by day are on my facelift page.

On cost

You’ve seen the six-figure headlines.^16,17 Put them next to the national picture: the average surgeon fee for a facelift sits near $11,000 and patient-reported totals average in the low twenty thousands.^20,22 Most fellowship-trained facelift specialists in this country charge in the tens of thousands, not the hundreds. What separates a $30,000 facelift from a $250,000 one is brand, scarcity and geography. It is not a different operation happening inside the face. For contrast, in my practice the surgeon’s fee for a facelift runs from about $8,000 to $13,000 depending on extent, with facility and anesthesia quoted separately.

We are candidacy-first. At your consultation Dr. Sandel will examine your midface, jawline, neck and skin, and tell you what your face needs and what it doesn’t.

Questions

What patients ask about the deep plane.

Sources

What this page is built on.

Every link was checked to resolve and to support the claim it backs. Society statistics (18 to 20) are to be confirmed against the primary reports before this page goes indexable.

Changelog

This page is updated, not replaced.

Reviewed every six months, and whenever the evidence or the conversation changes.

What we do at Sandel-Duggal

I’ll tell you what your face needs, and what it doesn’t.

At your consultation I’ll examine your midface, jawline, neck and skin. I’ll show you what the operation looks like layer by layer and what recovery will realistically be for you.