Deep Plane Face Lift

Dr. Basu (00:08):
Welcome back to Behind the Double Doors. I'm Dr. Bob Basu. Today on this podcast, we're gonna answer all of your questions about face and neck lift surgeries and help you understand which might be the right course of action for you. There are many variations for a face and neck lift, and I'm gonna dive deep on a procedure called the deep plane face and neck lift and what all that means. What's the right age for a facelift? Well, there's no right or wrong answer to this. If you're concerned about jowling, loose skin, the appearance of your neck, the appearance of your cheek and midface, you might be a good candidate for a deep plane face, a neck lift. Now there are a lot of different techniques for face and neck lifting and it gets really confusing. Look, I get it. It's there's a skin lift, there's a SMAS lift.

(00:52):
Then you have all these surgeons putting their name on the technique, and the list goes on and on and on. And so I'd like to dispel some of the myths here. So first, there's a skin lift where you're tightening loose skin and that's what everyone thinks a facelift is. But the problem is as we age, you all know that our skin is losing elasticity and tone, and if you tighten just the skin, well, we're not changing the intrinsic quality of your tissue. That skin can relax again, and you get some, you can get some recurrence of laxity. So I worry about skin lifts, although very easy to do. They're often very inexpensive. What about the longevity of that result? Number two, I worry about skin lifts making you look too tight, giving the artificial fake look. Look, we've all seen it right on this Hollywood award shows where people have had way too much tight facelift surgery.

(01:41):
And you see that weird crease line horizontally on the corner of the mouth. That's a telltale sign that they've had way too much surgery. It's been overdone, and the best facelift results are the results that look really refreshed, but you can't tell they've had something done. And that's what the kind of type of result we should be shooting for. The other type of facelift technique is called a SMAS lift. So what's this SMAS? So let's talk about anatomy. So first on the face we have skin. Then underneath the skin we've got fat. Then underneath that fatty layer, we have a layer called the SMAS. Some people call the strength layer, some people call it the platysma. Some people call it the deep plane. Just think of it as a strength layer to our face. And underneath that strength layer or the deep plane are muscles and very important nerves that we need to be very careful of.

(02:31):
So what is a deep plane face and neck lift technique? What that really is, is that we are tightening some skin, but the lifting and power of the facelift does not come from skin tightening. It actually comes from tightening the deeper layer of the face, the strength layer of the face where the pulling and tightening is done deep below and you're not disconnecting the strength layer from the skin. So together as a composite, you're actually tightening the deeper layer, but the skin's going with it. And the power of this technique is that you're not pulling on skin, but you're pulling on the deeper layer, which really restores the balance of your face, giving you a much more refreshed result without that overtight look. In addition, it takes the tension of the skin off your incision lines, so your facelift incisions heal much better and faster.

(03:24):
So my preferred technique is the deep plane technique, and also we do some release of some important ligaments so that we can give you a sharper jawline, eliminate the jowls, and give you an absolutely flat neck, which I think is really important to me for all of my face and neck lift patients. So my preferred technique is a deep plane face and neck lift. And of course every surgeon has their own iteration and tweaking of the techniques, but I really believe the deep plane face neck lift really gives me superior results for my patients. So where do we hide the scars from a deep plane face and neck lift? Well, depends on how much loose skin you have. Typically, I show my patients that the incision starts behind the sideburn, it goes along your ear crease line. Then I take the incision inside your ear canal.

(04:14):
So nobody's looking inside your ear canal that's hidden, right? Unless you've got an otoscope and you're a doctor and you're looking inside your ear <laugh>, nobody's doing that. So basically incision goes behind your sideburn, along the front portion of your ear, inside your ear canal, then it comes out around your ear lobule, and then dips behind your ear and goes behind the ear groove, also known as a sulcus. And then if you have more severe skin, we may need an extension going into your posterior hairline, depending on the amount of excess skin that you have. So the wonderful thing is when patients come back and see me the next day after their surgery, even while the incision is fresh, and I love to do a cosmetic closure on all my incisions. The only areas where they can see the scar one day after surgery is one centimeter segment at the top of their ear, in front of their ear groove and maybe a one centimeter segment in front of their ear lobule.

(05:09):
Everything else is hidden. So we really try to hide the incisions and natural body crease lines, so those scars fade away really quickly. The surgery typically takes me between three to four hours depending on how much work I need to do on, on the neck. And it could take more hours if we're treating the eyes, the midface, the brow lift. But a deep plane face and neck lift by itself typically takes me about three to four hours of operative time. This can be safely and comfortably performed as outpatient surgery. I like all my patients to come back the next day so I can check on them and make sure they're doing well. And we transition them to a more comfortable chin strap to keep compression of their neck and jawline and they see their results right away. One of my favorite experiences in the office after seeing post-operative patients is having a facelift patient come back the day and we take their bulky dressing off and we hold a mirror and they, for the first time see their new neck and jawline and they touch their neck and jawline and all the loose skin band, excess fat is gone and they've got that sharp jawline and a flat neck and it, it is really transformative.

(06:14):
It's a special experience for me to go through with my patients after surgery. It's that reveal. One of the things that I tell my patients is with the deep plane face and neck left, I love to be very, and I don't wanna use that word aggressive but comprehensive in the neck. I want my patients to have that absolutely flat, sharp neck. I also want my patients to have a very, very sharp jawline. No jowls. It's gotta look crisp and solid. I want a feminine jawline for my female patients. I want a sharp masculine jawline for my men, male patients. But the one area I tell my patients is that I try not to be too aggressive around the corner of the mouth. A telltale sign that you've had a facelift surgery if it's done too aggressively, is if you end up getting that weird crease line.

(06:59):
You know the horizontal line at the corner of your mouth when you smile, it doesn't look natural. And I try to avoid that. So how do we treat the corner of the mouth? Well, I tell patients that when we're really talking about facial rejuvenation, we have to step back. We have to talk about some surgical things. We have to talk about some nonsurgical things like Botox and fillers cuz they are outstanding adjuncts to improve surgical outcomes. But thirdly, we also have to talk about skin care because we have to treat the quality, texture, and color of your skin. Cause if your skin's looking shiny and healthy, then your surgical results are gonna look so much better and you'll look so much more refreshed naturally. So surgical, non-surgical and skincare go hand in hand. It's not one or the other. And so to get the most refreshed, non-operative results where you're looking really good, but no one can tell why necessarily, you've got to consider all three.

(07:55):
So what doesn't a face and neck lift treat? Well, a face and neck lift treats really everything from your cheeks all the way down to your almost the collarbone area, just above the collarbone area. So a face and neck lift will not treat your cheeks necessarily. That will require some work on your midface. It won't treat the eyes meaning your upper eyelids, lower eyelids, and it will not treat your brow position. Now it's very common for us to treat the brows and the eyes with the, with the face and neck lift. And that's a comprehensive treatment plan. But some patients choose to start with one area first and come back and fight another day. There's nothing wrong with that. But for patients that one and done, they want one surgeon, when they're covering, it's quite common. The typical procedures that I do together are temporal brow lift, upper eyelid lift, maybe a lower eyelid lift deep plane face and neck lift with some midface of treatment either with a little fat grafting or some surgical maneuvers and also a surgical lip lift.

(08:51):
I think that would be a comprehensive treatment plan for a one and done approach. So what's the recovery from a face and neck lift? Here's the good news. It's not as bad as you think. It's actually a lot easier than you think. I tell patients, typically you should be fine to work from home two days right after your surgery. If you have zoom conference call and you, if you get a little bit of bruising, you can use some concealer or maybe for a few days your camera's not working <laugh>. So, but you should be able to work from home just fine. Look, if you're in front of a camera, you have a lot of social engagements, you have a lot of in-person meetings or presentations, I tell my patients, lie low for about seven to 14 days, two weeks in case you swell, in case you bruise.

(09:33):
I like to prepare my patients for the worst case scenario, which is to have some bruising, but most of the time the bruising is quite minimal. But I gotta prepare them for the worst case scenario. I recommend no heavy lifting or strenuous activity for about three to four weeks. I don't wanna get your heart rate or blood pressure elevated while you're healing from facial surgery, cuz that can increase the risk for bruising or bleeding later on. One of the risks of face and neck lift surgery is a blood collection hematoma. So it's very important that we keep you chill, we want your blood pressure well controlled, right? So you heal faster, your swelling goes away faster. So it's really important, just like with any surgery that you prepare for the recovery, the worst thing that you can do is you have the surgery and then you don't plan for the recovery.

(10:15):
Cuz remember what you do after surgery is equally important as what I do in surgery. So we gotta work together as a team so we get you healed and we get you to a really happy place with your outcomes. So a common question that I get is timing. When do I consider a surgical face and neck lift? And how long will a surgical facelift last? They're actually very similar answers. It all depends on what you've been doing, right? So first, can you do some things to hold off on a facelift? Absolutely. And it has to do with what are you doing on a monthly basis to take care of your skin? What are you doing to protect against UV radiation? What are you doing for your nutrition and hydration? What are you doing to help build collagen? So I'll give you an example. I had a patient who was in her mid forties who came to me, busy professional.

(11:09):
She's an executive, got a lot on her plate. She's got kids and she's been really thinking about a deep plane face, a neck lift. But we talked about recovery, we talked about her schedule. She simply didn't have time for surgery. Fortunately, she was a very good candidate for minimally invasive face tite, also known as neck tite, which on my other podcast episode we dove deep on it, which is basically a minimally invasive procedure that takes me an hour where I use radiofrequency to liquefy and remove fat, but also to tighten skin. I also utilized non-invasive Morpheus8, which is external radio frequency, a non-surgical procedure, further build collagen. And she's gotten a wonderful result. She's super happy and I think we've been able to push back her deep plane facelift for five to 10 years. And she may be able to push it back even longer than five years, maybe to 10 years because she's doing monthly HydraFacials.

(12:00):
She's doing our Zo prescription strength skincare regimen. So she's taking care of her, she's investing in her skin, and I may not be seeing her for a facelift for 10 years. And that's okay because she's happy and she's doing the right thing. The same thing goes for when patients ask me, how long will my face and neck lift result last? Well, it depends on several variables. Number one, it has to do with the technique that's being used. If you're having a skin lift, I, I can tell you skin relaxes, right? If you're doing a deep plane facelift, I think you think the results will last longer. But typically I answer the question, it could be anywhere from five to 15 years. But it depends on many variables. It depends on one, your genetics. Some people have good tone and elasticity and their facelift results are gonna last longer than others.

(12:44):
It also depends on what you're doing to take care of your skin. Are you doing monthly HydraFacials? Are you doing collagen stimulation treatments? Are you doing Morpheus8 radiofrequency treatments to build collagen to maintain the tightness. And so if you're doing the things you're supposed to do, then I think the longevity of any face and neck lift results gets longer. It lasts longer. Think of it this way, if you buy a car and you maintain it, you do the oil change, you rotate the tires, you wash it, you're doing what you're supposed to do, that car's gonna last you a very long, long, long time. But if you buy a car and you don't wash it, you don't change the oil or filter, you don't change the tires, you don't take care of it. How long do you think that car's gonna last? Right? So what you do for maintenance therapy is super important for your face, and that also includes nutrition and hydration as well too.

(13:33):
So a lot of different variables. Sometimes I get a question, well, I just want my neck lift. And that is an option. I mean, there are isolated neck lifts where you're only treating below the jaw line, basically area underneath your chin, and that's called the isolated neck lift where the incision is placed underneath the chin, about a small two centimeter incision and sometimes an incision behind your ear. And that's definitely a viable option. But I tell my patients, well, if you're gonna undergo anesthesia to do the neck lift, it only adds about 45 minutes for me to do your jawline and also up to your cheeks. So I typically do a face of neck lift together. It's really, really rare that I'm just gonna do a isolated neck lift because if you're already there, why not get the best results? Because my philosophy is, if you're coming to me for surgery, I'm gonna give you the recommendations to give you the absolute best result that I can achieve for you. If you're listening today, we want to ask you for a special favor. If you love this podcast, if you learn something from it, if it's helped you, follow the show, tell your friends and write a review on the show on Apple Podcast to get special updates and be notified by email when a new episode is available., click the link in the show notes to sign up for our email list. Follow us on Instagram at Basu Plastic Surgery.

Speaker 2 (14:53):
Basu Aesthetics and Plastic Surgery is located in Northwest Houston in the Towne Lake area of Cypress. If you'd like to be a guest or ask a question for Dr. Basu to answer on the podcast, go to basu plastic surgery.com/podcast on Instagram. Follow Dr. Basu and the team at Basu Plastic Surgery. That's B A S U Plastic Surgery. Behind the Double Doors is a production of the Axis, the axis.io.