Deepest Plane Facelift

The face is built in layers: skin, fat, a fibrous muscular layer called the SMAS, and deeper ligaments that anchor the soft tissues to the bone. With age those ligaments loosen and everything above them descends. The cheek fat slides down, the jawline blurs and folds deepen beside the nose and mouth.

A traditional skin-tightening facelift pulls on the surface. It smooths wrinkles, but it does not move what actually fell, and skin under tension stretches again, which is where the familiar windswept, 'operated' look comes from.

A deepest plane facelift does not stop at the SMAS. The dissection continues to the deepest plane of the face, the retaining ligaments that tether the soft tissues to the bone. Those ligaments are released, and skin, fat and muscle are lifted together as a single unit. Because that deepest layer carries the load, the skin closes without tension. The result is a face that looks lifted from within rather than pulled from the side.

Prof. Tezel introduced endoscopic facial surgery to Türkiye after a clinical fellowship in Baltimore with Dr. Oscar Ramirez, one of the pioneers of endoscopic facial rejuvenation, and has practised it for more than 25 years. His facelift philosophy comes from that work: the face is shaped in three dimensions, lifted upward and slightly outward, and treated as a whole.

In practice, the deepest plane lift of the lower face and neck is frequently combined with an endoscopic lift of the brow and midface, performed through 1.5 cm incisions within the hair using a camera thinner than a pencil. Brows, the outer corners of the eyes and the cheeks rise together, the effect many people notice when they tie their hair back in a tight bun, and are held in position with dissolvable sutures.

Because the connection between the facial muscles and the skin is preserved, expression is not lost. Patients look rested and recognisably themselves, not tighter.

• ·Sagging cheeks and deepening folds between nose and mouth
• ·Jowls and a softened, irregular jawline
• ·Loose skin and visible bands in the neck
• ·A tired or sad expression caused by descending brows and midface

Most patients are between their mid-forties and their seventies. Younger patients with an early descent of the brows or midface may be better served by endoscopic facial contouring alone. Good general health and not smoking are essential for safe healing.

Incisions run inside the hairline at the temples and follow the natural contours in front of and behind the ear. The hair is not shaved. When an endoscopic component is added, its small access points are hidden in the scalp. Because the closure carries no tension, scars heal fine and are designed to be very difficult to find.

A youthful face needs a clear angle between jaw and neck. Depending on your anatomy, the facelift may be combined with tightening of the platysma muscle through a short incision under the chin, removal of deep fat or liposuction, to restore that line. Read more about neck lift.

1. 01Night 1: one night in hospital; dressings checked the next morning.
2. 02Days 5–7: stitches in front of the ear are removed.
3. 03Days 10–14: most bruising has settled; you are usually cleared to fly after your check-up.
4. 04Weeks 2–3: return to work and social life, with light make-up if needed.
5. 05Months 3–6: residual swelling and tightness resolve; the final result matures over 6–12 months.

No operation stops time. But because a deepest plane facelift repositions the deepest layer of the face instead of stretching skin, results are typically long-lasting and the face continues to age gently from its new starting point. Sun protection, a stable weight and not smoking all help.

Possible complications include haematoma, temporary numbness, temporary weakness of facial movement, visible scarring, asymmetry and hair thinning near the incisions. Working in the deepest plane requires detailed anatomical knowledge, and experience is what keeps these risks low. Every risk is discussed with you in detail before you decide.