How Is a Deep Plane Facelift Performed? A Step-by-Step Guide

• August 10, 2026
• Mr Mrinal Supriya

Last updated on September 22, 2026

Medically reviewed by Mr Supriya, FRCS (OTOL-HNS), MRCS Ed, DO-HNS, MS in ENT, MBBS, Facial Cosmetic Surgeon. Last reviewed August 2026.

How Deep Plane Facelift Surgery Repositions the Deeper Facial Tissues

To understand how a deep plane facelift is performed, it helps to look beyond the visible skin. The surgeon works beneath the superficial musculoaponeurotic system (SMAS), a fibromuscular layer that connects the facial muscles with the overlying soft tissue and skin.

Selected retaining ligaments are released so that descended cheek and lower-face tissues can be elevated with less dependence on skin tension. The precise incisions, degree of release and neck treatment are planned around the individual anatomy rather than following an identical sequence for every procedure. For how this differs from other techniques, see our comparison of a deep plane facelift and a traditional facelift.

Deep Plane Facelift Planning Begins Before Surgery

At British Face Clinic, planning for a deep plane facelift begins with an assessment of facial structure, skin quality and soft tissue position. We examine the cheeks, folds, jowls, jawline and neck, then consider how changes in these areas relate to one another.

Medical history, medication, previous procedures, smoking and factors affecting anaesthesia or healing are reviewed before surgery. Photographs and preoperative markings help translate the agreed objectives into a surgical plan, including whether neck or submental treatment is required. The NHS guide to facelift surgery, known clinically as rhytidectomy, sets out what to consider before going ahead and how to check that a surgeon is appropriately registered.

How a Deep Plane Facelift Is Performed Step by Step

Once the surgical plan has been confirmed, the procedure follows a series of connected stages. The extent of each stage varies according to the facial and neck anatomy being treated.

Step 1: Preoperative Marking and Anaesthesia

Before surgery, incision positions and treatment areas are marked with the patient upright so that facial and neck contours can be assessed accurately. The agreed anaesthetic is then administered, and the face, hairline and neck are prepared for the procedure.

Step 2: Placing the Facelift Incisions

Incisions are positioned around natural contours near the ear and hairline, with their extent determined by the planned facial and neck work. Careful placement provides the necessary access while allowing scars to settle within natural creases and less visible areas of the hairline.

Step 3: Entering the Deep Plane

After creating sufficient access near the ear, the surgeon passes beneath the SMAS in the selected treatment areas. Working at this level provides access to the deeper facial tissues while maintaining much of their connection with the overlying skin.

Step 4: Releasing the Facial Retaining Ligaments

Selected retaining ligaments are released to free tissues that have descended but remain tethered to deeper structures. The extent of release depends on which parts of the midface, lower face and jawline require mobilisation.

Step 5: Repositioning the Deeper Facial Tissues

Once adequate mobility has been created, the connected tissue layer is elevated in a direction suited to the anatomy. The tissues are then secured in their revised position to restore cheek support, reduce jowling and improve continuity through the lower face.

Step 6: Addressing the Jawline and Neck Where Required

When a neck lift forms part of the plan, the procedure can address the platysma muscle, submental fat, loose skin or a combination of these structures. The facial and neck components are coordinated so that the contour remains consistent across the jawline.

Step 7: Redraping the Skin Without Excessive Tension

After the deeper tissues have been secured, the skin is redraped over the revised contours. Excess skin can then be removed conservatively, avoiding unnecessary traction that could affect the ear, hairline or facial expression.

Step 8: Closing the Incisions and Applying Dressings

The incisions are closed in layers to support healing and reduce tension along the skin edges. Dressings and any other postoperative support are applied according to the procedure before the patient moves into monitored recovery.

What Happens Immediately After Deep Plane Facelift Surgery?

Early postoperative care focuses on observation, comfort and identifying any concern that requires prompt attention. Swelling, bruising, tightness and temporary numbness are expected to varying degrees, and the face may initially look uneven because the two sides do not always swell identically.

At British Face Clinic, dressings and incision sites are reviewed according to the postoperative plan. Each patient receives instructions concerning wound care, head position, activity, medication and warning signs, while changes in swelling and facial contour continue well beyond this immediate period.

As a general guide, the most noticeable swelling and bruising often begin to settle within 1–2 weeks, with many patients feeling comfortable returning to desk-based work within 2–3 weeks and resuming wider social activities within 3–4 weeks, once bruising has faded and confidence in the result has grown. The final contour continues to refine over several months as deeper swelling resolves. Recovery varies with the extent of surgery, whether the neck is treated at the same time, and individual healing. The British Association of Plastic, Reconstructive and Aesthetic Surgeons publishes an independent patient guide to face and brow lift surgery covering the usual recovery period and the recognised risks.

Careful Deep Plane Facelift Planning Supports Balanced Results

The amount and direction of tissue movement depend on facial shape, cheek position, skeletal support and the distribution of laxity. Tissue thickness, skin quality, previous procedures and neck anatomy also influence how the procedure is carried out.

Moving the tissues too far can be as inappropriate as providing insufficient correction. Planning each stage around the individual anatomy allows the procedure to improve facial support while preserving expression, recognisable features and continuity between the face and neck.

Discuss a Deep Plane Facelift With a Surgeon

If you would like to understand how a deep plane facelift is performed and how the steps may vary for your anatomy, schedule a free initial phone consultation to discuss your concerns. A detailed facial assessment can establish which areas require treatment and whether a deep plane facelift, neck treatment or another approach may be appropriate. If you are weighing a more focused operation, our guide to the differences between a deep plane facelift and a mini facelift covers when each is considered.

Frequently Asked Questions About Deep Plane Facelift Surgery

How long does a deep plane facelift procedure usually take?

Deep plane facelift surgery generally takes several hours, although the exact duration depends on its extent. Neck treatment, fat grafting, eyelid surgery or other additional procedures can increase the overall theatre time.

Is a deep plane facelift performed under general anaesthetic?

At British Face Clinic, deep plane facelift surgery is performed under either general anaesthesia or twilight sedation. A dedicated anaesthetist remains present throughout, with the most appropriate option agreed in advance following medical assessment and review of the surgical plan.

Where are deep plane facelift incisions normally placed?

Incisions are generally positioned around the ear and within natural boundaries near the hairline. Their precise extent varies according to the facial areas being treated and whether the procedure includes a neck lift.

What happens to the SMAS during a deep plane facelift?

The surgeon works beneath the SMAS and mobilises it together with the associated skin and soft tissue. This connected layer is repositioned and secured after selected retaining ligaments have been released.

Which facial ligaments are released during deep plane facelift surgery?

The required ligament release depends on the surgeon’s technique and the facial areas being treated. Retaining structures through the cheek and lower face can be released to provide sufficient mobility without extending the dissection unnecessarily.

Is the platysma muscle treated during every deep plane facelift?

Platysma treatment depends on the neck anatomy and whether neck rejuvenation forms part of the surgical plan. Some patients require direct platysma work, while others need a different or more limited neck approach.

Can fat removal or fat transfer be performed during the same procedure?

Targeted fat removal or facial fat grafting may be incorporated when volume distribution contributes to the concern. These procedures serve different purposes and are selected only when they support the overall facial plan.

Are drains or compression garments used after a deep plane facelift?

The use of drains, dressings and compression varies with the surgical technique and the extent of facial and neck treatment. Patients should follow the specific postoperative instructions provided for their procedure rather than relying on a general facelift protocol.

How does the surgeon protect the facial nerves during the procedure?

Protection depends on detailed knowledge of facial nerve anatomy, controlled dissection and identification of the appropriate tissue plane. Nerve injury remains a recognised surgical risk and should be discussed during the consent process.

Will facial movement feel or look different after deep plane facelift surgery?

Swelling, tightness and temporary weakness or altered sensation can affect movement during early healing. As recovery progresses, the aim is to preserve natural expression by repositioning tissue without intentionally restricting normal facial function.