Deep-Plane Facelift Helps Ensure Patients Don’t Get ‘Pulled’ In The Wrong Direction


The end goal for facelift patients is typically very straightforward—look younger without looking fake. Still, even with significant advances in surgical techniques, many people shy away from the surgery because they don’t trust that the results will match their expectations.

“Almost every patient is concerned about looking like they had a facelift,” Dr. Andrew Jacono explains. Dr. Jacono is dual board-certified in facial plastic surgery and head and neck surgery and is one of the top New York plastic surgeons. “They see the celebrities on TV who look like the skin on their faces has been pulled. And, quite honestly, it’s not flattering.”

But it doesn’t have to be that way, he explains. Dr. Jacono says the primary reason a facelift looks “pulled” is because the most commonly performed facelift surgery in the United States, the SMAS plication lift, does not adequately lift the facial muscles that droop with aging and gravity. Therefore the tension of the lift is on the skin and the face looks stretched.  

With that in mind, Dr. Jacono has this advice for individuals who want a facelift but don’t want to look fake or pulled: Check out the Minimal Access Deep Plane Extended (M.A.D.E.) facelift technique.

To understand the M.A.D.E. approach, Dr. Jacono first explains a bit about the term "deep plane”. “Deep plane is the term used to describe the anatomic area that exists beneath the surface of your face in between the superficial muscular aponeurotic system (SMAS)—which is muscle and fascia—and the deeper layer of muscles responsible for facial expression,” he says. 

With a M.A.D.E. facelift, the “deep” structures of the face are lifted and reattached with hidden incisions, so the face appears smooth and not tight under the skin. “The deep plane facelift focuses on release and movement of muscle and fat layers instead of skin pull and removal,” Dr. Jacono asserts. By comparison, a traditional facelift tightens the face horizontally or toward the ears. This can make the face appear stretched and the cheeks flattened. Additionally, it can also cause the corners of the mouth and eyes to look pulled. 


“The facelift surgeon you choose should be able to show you countless examples of their work.” Dr. Jacono says.


“By lifting the facial more vertically—like M.A.D.E.—a smoother more-natural appearance is created. The cheeks are restored and the corners of the mouth that sag with age are elevated,” Dr. Jacono says. 

Another significant advantage to deep plane facelifting is the ability to perform the work through a smaller incision. “This approach utilizes an incision that is half the length of a typical facelift and thus is often referred to as an s-lift or short scar facelift,” Dr. Jacono says. “And it is hidden inside the tragus and behind the ear, so it can’t be seen even when hair is pulled back or placed in a ponytail.” As a result, female patients are able to wear their hair back in pony tails, and male patients are free to wear short haircuts or shave their heads because of hair loss.  Because of this, the technique is often referred to as a ponytail facelift.

This is one of the many reasons Dr. Jacono asserts that anyone interested in a facelift should consider their chosen doctor’s work. “Ask specific questions about the doctor’s technique and approach, and be sure to see real proof,” he advises. “The facelift surgeon you choose should be able to show you countless examples of their work.”

Dr. Jacono is certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology/Head and Neck Surgery. He has presented clinical research and conducted live surgery in front of peer audiences at over 100 plastic surgery meetings and symposiums around the world including Paris, Rome, Japan, Spain, Brazil, Colombia, Portugal and Russia.



Andrew A. Jacono, MD

FACIAL plastic surgery
face Surgery
new york, ny