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Facial Plast Surg 2021 Apr 3;37(2):149-159. Epub 2021 Mar 3.

PLLC-Otolaryngology Division, Rochester, New York.

Facial aging in the midface has been described to encompass both soft tissue descent and volumetric change. Currently, there is no established and widely accepted grading system for midfacial ptosis. We propose a simplified grading system for midfacial ptosis ranging from mild to severe in terms of Grades I through III. Read More

Facial Plast Surg 2020 Aug 31;36(4):416-429. Epub 2020 Aug 31.

Department of Otolaryngology and Facial Plastic Surgery, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil.

South America is a vast territory; its people were made from all parts of the world. The miscegenation made a unique population comprised of Indian, Asian, Caucasian, African, Mestizo, Mulatto, and Zambo. The South American patients tend to have a wider face with a skin-soft tissue envelope (S-STE) that is thicker, heavier, and has less elasticity than the Caucasian patient. Read More

Facial Plast Surg 2020 Aug 31;36(4):376-385. Epub 2020 Aug 31.

Perth Facial Plastic and Cosmetic Surgery, Perth, Western Australia, Australia.

The mini facelift, often referred to as short scar or minimum incision facelift or rhytidectomy, is a facial rejuvenation procedure with limited incisions. It aims to lift and tighten the superficial musculo-aponeurotic system to restore the lower midface and the mandibular contour, thus eliminating undesirable jowls. By performing the deep plane or extended deep plane facelift with short incisions, the midface and upper neck can also be improved without the full face and neck incisions as in the typical rhytidectomy. Read More

Facial Plast Surg 2020 Aug 31;36(4):358-375. Epub 2020 Aug 31.

Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.

In this article, we will provide the reader with the anatomical and embryologic evidence supporting the use of the deep-plane approach in rhytidectomy and insight into the evolution of the technique into the vertical platysma advancement. The original description of the deep-plane technique only described a basic superficial muscular aponeurotic system dissection in the midface with the ability to use tension on the flap without aesthetic consequences. This plane of dissection provides additional advantages not previously described, including access to deeper anatomical structures such as the buccal fat pad, and allows in vivo assessment and treatment of jowling. Read More

Facial Plast Surg Clin North Am 2020 Aug;28(3):331-368

NY Center for Facial Plastic & Laser Surgery/JSpa Medical Spa, 630 Park Avenue, New York, NY 10065, USA. Electronic address:

Traditional superficial musculoaponeurotic system (SMAS) facelifting surgery uses a laminar surgical dissection. This approach does not treat areas of facial volume loss, and requires additional volume supplementation with fat grafting or fillers. The novel volumizing extended deep-plane facelift uses a composite approach to the facelift flap. Read More

Facial Plast Surg Clin North Am 2020 Aug 6;28(3):311-330. Epub 2020 May 6.

Department of Otolaryngology, Rutgers New Jersey Medical School, Newark, NJ, USA; Section of Facial Plastics and Reconstructive Surgery, Department of Otolaryngology, St. Barnabas Medical Center-RWJ Health, Livingston, NJ, USA.

This article provides the facial plastic surgeon with anatomic and embryologic evidence supporting use of the deep-plane technique and understanding the evolution of the technique over decades to the vertical platysma advancement for optimal treatment of facial aging. The original description of the deep-plane rhytidectomy described a basic subsuperficial musculoaponeurotic system dissection in the midface. This plane of dissection provides access to deeper anatomic structures. Read More

Facial Plast Surg Clin North Am 2020 Aug 29;28(3):273-283. Epub 2020 Apr 29.

Holzapfel & Lied Plastic Surgery, Cincinnati, OH, USA. Electronic address:

As a facial plastic surgeon gains experience, further improvements can be gained with more aggressive surgery, but complications begin to occur when more aggressive measures are undertaken. Therefore, the ideal technique is one that maximizes rejuvenation while minimizing adverse effects. The senior author has found that the aggressive techniques in the region of the neck have improved dramatically the overall initial and long-term results for the neck portion of the rhytidectomy. Read More

Aesthet Surg J 2021 01;41(1):1-12

Department of Plastic and Reconstructive Surgery, Loma Linda University, Loma Linda, CA.

Background: Autologous fat grafting is a helpful supplement to facelift surgery that helps to combat age-related volume loss of facial structures. Despite the widespread prevalence of combined facelift and fat-grafting, significant procedural variation exists between providers.

Objectives: The primary purpose of this systematic review was to study the efficacy and complication rates of facelift with lipofilling compared with facelift alone. Read More

J Craniofac Surg 2019 Nov-Dec;30(8):2632-2634

Department of Plastic Surgery, Inha University School of Medicine, Incheon, Korea.

The aim of this study was to compare Hamra's and Mendelson's models of midface lift.The terms "Hamra ST" and "Mendelson BC" were used to search PubMed, yielding 35 and 48 papers, respectively. Of the 83 abstracts, 55 were excluded and 28 full papers discussing midface lift were reviewed. Read More

Aesthet Surg J 2020 03;40(4):351-356

private facial plastic surgery practice in New York, NY.

Background: The vector of superficial musculoaponeurotic system (SMAS) redraping in rhytidectomy is often described in relation to the zygomaticus major muscle (ZMM), so that suspension prevents distortion of the mimetic musculature and a "facelifted appearance." There are no data describing the true orientation of this muscle in the midface.

Objectives: The aim of this study was to define the vector of the ZMM relative to the Frankfort horizontal plane. Read More

Clin Plast Surg 2018 Oct;45(4):527-554

New York Center for Facial Plastic and Laser Surgery, 630 Park Avenue, New York, NY 10065, USA.

This article describes our extended, deep plane facelift technique. This procedure releases 4 key retaining ligaments in the face and neck, the zygomatic cutaneous, masseteric cutaneous, mandibular cutaneous, and cervical retaining ligaments. Once released, the composite deep plane flap is repositioned to volumize the midface and gonial angle. Read More

Facial Plast Surg Clin North Am 2016 Aug 10;24(3):357-66. Epub 2016 Jun 10.

Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, SJH01, Portland, OR 97239, USA. Electronic address:

The primary purpose of the facelift is to restore the shape, volume, and contours of the youthful face. Facelift surgery has evolved over the years into multiple techniques to accomplish the same results. This article discusses the common controversies in facelift surgery and evaluates the best available evidence to guide surgical decision-making. Read More

Aesthet Surg J 2016 06 29;36(6):NP208-12. Epub 2016 Mar 29.

Dr Mani is a plastic surgeon in private practice in Beverly Hills, CA, USA.

Aesthet Surg J 2016 May 1;36(5):546-9. Epub 2016 Mar 1.

From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Aesthet Surg J 2016 May 1;36(5):533-45. Epub 2016 Mar 1.

Dr Mani is a plastic surgeon in private practice in Beverly Hills, CA.

Background: Recent anatomic studies suggest the superficial musculoaponeurotic system (SMAS) layer attenuates in the midface. This led the author to switch from a bilamellar high SMAS dissection to a "total composite flap" technique, preserving skin and SMAS/platysma as one layer in a critical "deep-plane transition zone" (DTZ) lateral to the zygomaticus major muscle. This allows traction on the SMAS to translate to the malar fat pad via a "cantilever bridge" effect, which is lost when skin is undermined in the DTZ. Read More

JAMA Facial Plast Surg 2016 May;18(3):183-7

New York Center for Facial Plastic and Laser Surgery, New York.

Importance: The evaluation of the effects of midline platysmaplasty concomitant with rhytidectomy.

Objective: To determine whether midline platysmaplasty limits the degree of lift during deep-plane face-lift.

Design, Setting, And Participants: Deep-plane rhytidectomy was performed on 10 cadaveric hemifaces. Read More

Aesthet Surg J 2015 Jul 10;35(5):491-503. Epub 2015 Jun 10.

Dr Jacono is the Section Head of Facial Plastic and Reconstructive Surgery at North Shore University Hospital, Manhasset, New York; and Assistant Clinical Professor in the Division of Facial Plastic and Reconstructive Surgery, New York Eye and Ear Infirmary, New York and the Albert Einstein College of Medicine, New York. Dr Malone is a Resident at New York Presbyterian Hospital, Department of Otolaryngology-Head and Neck Surgery, Columbia and Cornell Universities, New York. Dr Talei is a Fellow at a private facial plastic surgery practice in New York.

Background: Facial aging is a complicated process that includes volume loss and soft tissue descent. This study provides quantitative 3-dimensional (3D) data on the long-term effect of vertical vector deep-plane rhytidectomy on restoring volume to the midface.

Objective: To determine if primary vertical vector deep-plane rhytidectomy resulted in long-term volume change in the midface. Read More

Clin Plast Surg 2015 Jan;42(1):129-42

Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Miami Valley Hospital, Kettering Medical Center, Good Samaritan North, Dayton Children's Hospital, Dayton, USA; Southwest Ohio ENT Specialists, 1222 S Patterson Boulevard, Dayton, Ohio. Electronic address:

The deep-plane midface lift offers many advantages in midface rejuvenation. Anatomic analysis of aging and embryologic evidence both support surgical facial “degloving” in the sub-SMAS plane and resuspension of the platysma/SMAS unit. This approach offers more complete repositioning of facial soft tissue compared with nonsurgical techniques, delivering accurate, direct treatment of deeper anatomic aspects of facial aging. Read More

Facial Plast Surg Clin North Am 2014 May;22(2):269-84

Section of Otolaryngology, Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA. Electronic address:

This article provides the facial plastic surgeon with anatomic and embryologic evidence to support the use of the deep-plane rhytidectomy for optimal treatment of the aging neck. An anatomic basis is established that demonstrates this technique's ability to maximize neck rejuvenation through its direct relationship to midface soft-tissue mobilization. A detailed description of the procedure, aimed at providing safe and consistent results, is presented with insights into anatomic landmarks, technical nuances, and alternative approaches to facial variations. Read More

Aesthet Surg J 2012 Aug;32(6):692-9

Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois, USA.

Background: Rejuvenation of the midface with a natural-looking, safe, and long-lasting result is a challenge in aesthetic surgery. The ideal approach should be easy to perform, with minimal risk and significant benefit. The combination of transconjunctival exposure and preservation of the periosteum may result in lower morbidity than traditional midface rejuvenation. Read More

Aesthet Surg J 2011 Nov;31(8):874-90

North Shore University Hospital, Manhasset, New York, USA.

Background: Modern facelift techniques have benefited from a "repopularization" of shorter incisions, limited skin elevation, and more limited dissection of the superficial musculoaponeurotic system (SMAS) and platysma in order to shorten postoperative recovery times and reduce surgical risks for patients.

Objectives: The authors describe their minimal access deep plane extended (MADE) vertical vector facelift, which is a hybrid technique combining the optimal features of the deep plane facelift and the short scar, minimal access cranial suspension (MACS) lift.

Methods: The authors retrospectively reviewed the case records of 181 patients who underwent facelift procedures performed by the senior author (AAJ) during a two year period between March 2008 and March 2010. Read More

Facial Plast Surg 2011 Feb 18;27(1):124-32. Epub 2011 Jan 18.

Department of Otolaryngology-Head and Neck Surgery, Facial Plastic and Reconstructive Surgery, University of California-Davis, Sacramento, California, USA.

Many face-lift variations have been described including short skin flap, long skin flap, superficial musculoaponeurotic system flap, deep plane, composite flap, and subperiosteal face-lifts. Each technique offers its set of advantages and disadvantages. Theoretical benefits include a more optimal treatment of the midface, nasolabial fold, and periorbital area. Read More

Facial Plast Surg 2011 Feb 18;27(1):67-76. Epub 2011 Jan 18.

Rousso Facial Plastic Surgery Clinic, Birmingham, Alabama 35223, USA.

A patient presenting to a facial plastic surgeon with lower eyelid aging often has accompanying midface descent. Many surgical options exist to address these deformities. Blepharoplasty techniques include both the transcutaneous skin-muscle flap as well as the transconjunctival approach. Read More

Arch Facial Plast Surg 2010 Sep-Oct;12(5):339-41

Section of Facial Plastic and Reconstructive Surgery, North Shore University Hospital, Manhasset, New York, USA.

Objective: To identify whether the deep-plane face-lift or the extended transtemporal subperiosteal midface-lift is more effective in correcting midfacial ptosis.

Methods: Five cadaveric dissections were performed with a unilateral transtemporal subperiosteal midface-lift followed by a deep-plane face-lift on the same hemihead. Three suspension sutures were evaluated-transtemporal midface-lift, zygomaticofacial and melolabial sutures, and a deep-plane face-lift suture-to determine the degree of elevation on the nasolabial fold. Read More

Facial Plast Surg Clin North Am 2009 Nov;17(4):557-73, vi

Section of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan, 1500 East Medical Center Drive, 1904 Taubman Center, Ann Arbor, MI 48109-5312, USA.

The extreme interest in developing new surgical approaches to rhytidectomy and to refining those techniques over the last two decades has resulted in considerable improvement in surgical results. This has taken the form of a more natural and youthful restoration of the face by together lifting forehead, midface, and lower face. This approach produces a more harmonious balance of the upper and lower portions of the face than was possible before the introduction of mid-facelifting techniques. Read More

Ann Plast Surg 2009 Feb;62(2):149-53

Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

The cervicofacial flap has been the reconstruction of choice for midface soft tissue defects for over 30 years. Deep plane dissection has been advocated to decrease complication rates and improve results. However, the subcutaneous approach is still widely used. Read More

Arch Facial Plast Surg 2008 Jan-Feb;10(1):9-19

The Larrabee Center for Facial Plastic Surgery, Seattle, Washington, USA.

Objective: To delineate the anatomic architecture of the melolabial fold with surrounding structures and to elucidate potential implications for face-lift techniques.

Methods: A total of 100 facial halves (from 50 cadaveric heads) were studied, including gross and microscopic dissection and histologic findings. Laboratory findings were correlated with intraoperative findings in more than 150 deep-plane face-lift dissections (300 facial halves) performed during the study period. Read More

Arch Facial Plast Surg 2007 Jan-Feb;9(1):9-11

Department of Otolaryngology -- Head and Neck Surgery, University of Toronto, Toronto, Ontario.

Objective: To determine if there is any observable difference in the midface of patients who have undergone a deep-plane face-lift vs a standard superficial musculoaponeurotic system (SMAS) plication face-lift.

Design: Preoperative and postoperative photographs of 25 patients undergoing each type of face-lift were rated by 3 independent and blinded observers. A 7-point scale was used to grade improvement in 5 areas on the face and neck: malar eminence, melolabial fold, jowls, cervicomental angle, and anterior neck banding. Read More