Deep Plane Face Lift

Dr. Gregory S. Keller is a board-certified facial plastic surgeon who performs Deep Plane facelift, facelifts and other cosmetic procedures at Keller Plastic Surgery, for residents of Santa Barbara, Los Angeles, Beverly Hills, and surrounding communities in California.

Though often quoted as performed first in 1990 (the term “deep plane” was coined then), the actual procedure was invented in the early 1970’s by a plastic surgeon in Sweden, Torg Skoog. Dr. Keller has performed approximately 3000 “deep plane” procedures since 1978. Over the years he has developed a unique form of this procedure that artistically sculpts the face, cheek, and neck to give a youthful, natural look.

As a Clinical Professor at UCLA, Co-Director of the UCLA facial plastic surgery fellowship, and co-founder of the Division of Facial Plastic Surgery at UCLA, Dr. Keller has taught these techniques to residents and fellows. He has presented papers, published textbook chapters, and taught surgical technique all over the world.

His approach has several advantages and produces a “natural look” that hides the fact that a facelift was performed. Through the use of advanced technology and medications, Dr. Keller has reduced the recovery period of a “deep plane” facelift to the same or less than a minilift.

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Q:What is the goal of a facelift?

A: Facelifts at Keller Facial Surgery in Santa Barbara, Los Angeles, Beverly Hills, and the surrounding areas are designed to naturally rejuvenate your facial appearance. We consistently produce a younger appearance without people becoming aware that you have had a surgical procedure. The “Masterlift ™” is a surgical procedure performed by Dr. Keller, a UCLA Clinical Professor, that rejuvenates facial appearance by tightening the muscles and skin of the face as a single unit (deep plane facelift) to improve your natural facial contour and produce a smoother, more toned appearance. Every facelift is customized for each patient, and may be combined with other procedures (such as an endoscopic brow lift, Dr. Keller’s original invention, or cheek lift) to achieve overall balance. Achieving a rested, rejuvenated look that enhances youth and beauty in a subtle, natural way is the goal of the “Masterlift’. While we use minimally invasive and non-invasive procedures in our world renowned Medi-Spa, we use the Masterlift to achieve a balanced appearance, when partial treatments are not enough

Q:How do I know if I am a candidate?

A: The best way is to call our office and arrange for a consultation. We perform many procedures on patients from all over the world, and we can gain insight from looking at pictures that you send to us. We can then perform a preliminary evaluation. Each patient is different and Dr. Keller’s experience can be applied to render a tentative treatment plan. Of course, ultimate decisions require an in-person consultation

Q:What can I expect?

A: Most procedures are performed on an outpatient basis. You will need someone to drive you home and provide basic home care for 1-2 days while you rest. Most patients can walk into our office the next day. In fact, walking as a gentle movement exercise is usually allowed the next day. Upon completion of the surgery, the head will be bandaged, and bandages are usually removed on the first day after the procedure. Swelling and bruising is variable. Most patients can return to work with make-up (or, for males growing a scruff beard on a temporary basis) in 10 days to two weeks. Generally, with a scarf and dark glasses, patients will be out in a couple days. Work in an office or home setting without public exposure can usually begin in 2-3 days. More strenuous activities should usually be avoided for at least 3 weeks.

Deep Plane Facelift

Q:How does the deep plane facelift compare to other facelifts?

A: With the deep plane facelift, the surgeon can address the actual problem areas. The loose, fallen structures and ligaments that cause the face to descend with gravity can be repositioned in a natural manner as a single unit. The surgeon can stabilize and lift the descent of the face more permanently than is possible with a skin-only facelift, a “suture up” procedure, or a standard SMAS facelift.

Skin only facelifts can look pulled and contrived, offering only a surface solution. They do not address and reposition the structures of the face that fall with aging.

Standard SMAS or SMAS resection procedures, often referred to as the “muscle pulling lift”, go below the skin and lift the muscular structures. While more effective than skin only or “suture up (made famous by “lifestyle lifts”) procedures, they don’t address some of the deeper structures that fall and age, so these techniques can only achieve a limited result. Some skin pulling is necessary, testing the skin’s blood supply and durability and often causing more obvious incisions after the skin stretch back. Most importantly, because the skin is lifted up and the muscle tightened in a separate layer, a “joker” line or facelifted appearance can result.

The deep plane lift, does not resort to half measures and allows the surgeon to release and reposition the supporting tissues and ligaments of the face below the SMAS layer. The SMAS, muscle, skin, and fat are then repositioned as a unit without causing joker lines. Re-suspension of the deeper structures lifts the whole face as a unit, without stressing the skin and incisional scars by increasing the skin tension.

Q:Is the deep plane facelift a more complex surgery compared to other facelifts?

A: Yes and No.

Yes, because to procedure requires a surgeon with a superior ability to handle the deeper tissue layers. What is filtering out with all types of surgery is that the surgeon who specializes in specific surgeries is usually better than a more “general” surgeon. Because I specialize and am board certified in “facial plastic surgery” (I don’t do breasts or body plastic surgery), I am “honed in” on the nuances of the deep plane procedure.

Yes, because the surgeon performing deep plane facelifts requires superior skill and expertise. If you do your homework in researching surgeons on the West Coast and around the world, you will find only a handful of surgeons performing the procedure. It is more challenging than other types of facelifts.

No, because, from a patient’s point of view, it really should not be considered a more serious surgery. Recovery is normal for facelift procedures, because most surgical work is done on deeper tissue layers of the face rather than near the surface. As such, the skin does not get separated from the underlying lympatics and blood supply, so healing and incisions are generally favorable.

Q:Is it more risky and have more complications?

A: The deep plane facelift procedure has no more risks than other facelifts, when performed by a skilled surgeon.

Q: Is it more painful than other facelifts?

A: No. Pain is, generally, about a 2-3 out of a 10 point pain scale; often less than other facelifts.

Q: Is recovery longer than other facelifts?

A: No, Dr. Keller is using Tranexamic Acid. Healing with this is rapid and bleeding and bruising are avoided.

Q:Who is a good candidate for a deep plane facelift?

A: Practically anyone who is a candidate for a facelift can benefit from a deep plane lift. The deep plane lift, however, can benefit both younger and older patients who may not be candidates for other types of facelifts.

The deeper layers of the face that other lifts do not address sag earlier than skin and muscle. Fat pads, sagging ligaments and the like appear early in the sequence of facial aging, often in the mid to late 40’s. Deep plane lifts performed in the mid to late 40’s and early 50’s can last for long periods of time, and set aging back ten to fifteen years with a natural look. (see our facelift pictures of younger patients).

Older people, including many who have already had a facelift Los Angeles, can also benefit. Many of these want to look younger, less tired or mad, and have an upbeat appearance without having the pulled, plastic look of a facelift. By repositioning the deeper structures, skin, and muscle as a unit, these people can appear younger but not dramatically different. (see our facelift pictures of more mature patients). The deep plane facelift lasts a long time, and usually will be sufficient to avoid another subsequent facelift for patients who are older.

Q:Is the “Masterlift” a good revision facelift Los Angeles?

A: Yes, the “Masterlift” reverses the signs of aging that are often missed in other facelifts. The deep plane facelift, the mid-face lift, and the neck lift components of the “Masterlift” often address aging concerns that other types of facelift omit.

Q:Why is a “Masterlift” deep plane facelift different than other deep plane facelifts?

A: Several things make a difference. Our pioneering mid-face work, lifts the midface fat pads and structures in a more vertical manner than deep plane lifts. We have several journal articles and textbook chapters on this. Our evolved neck lift is more complex and long-lasting than most used with the deep plane lift. Finally, the way that we perform a deep plane lift, allows a more vertical lift direction than most deep plane lifts, improving the jaw and neckline, as well as the mid-face. I recently published our deep plane technique as the senior author with two of my fellows. (Deep Plane Facelift: An Evaluation of the High-SMAS vs. Standard Incision Points. Facial Plastic Surgery. 2018: 646-650).

Six Ways That Improve the Deep Plane Facelift:
1). Tranexamic acid to reduce the bruising and swelling and markedly reduce recovery time. Most patients have no bruising and only a small degree of swelling with a deep plane facelift, using tranexamic acid given at the time of surgery. This usually produces a shortened recovery, similar to or even less than a mini-lift. Most people are presentable within a week to 10 days.

2). Dr. Keller’s unique deep plane facelift approach allows a directional facial repositioning that can be artistically customized for each patient. Most deep plane facelift surgeons reposition the face in only one direction. By freeing the “2ixed SMAS” with a unique “high SMAS” approach, Dr. Keller creates a deep plane surface that allows for either a vertical, diagonal, or horizontal lift of the face. It also gives a better “lift” in the jowl area near the chin, as he has illustrated in peer reviewed articles. Lifting the skin and muscular/fascia in one layer from a more posterior point, he releases all of the facial ligaments rather than a select few, creating a sturdy 2ixation area.

3). Performing a “subperiosteal” mid-face (cheek) lift with most “deep plane” lifts relieves the “tired look” and artistically restores the natural, youthful position of the cheek and nasolabial folds and lifts additional layers of fat that are not lifted with the deep plane lift (SOOF- -under eye- -and subperiosteal fat pads). As a result of this cheek elevation, an “artistic 2low” is produced between the face, the eyes, the cheek, the jowl, and the neck, and the folds between the nose and the mouth are usually reduced in depth.

Dr. Keller’s (cheek) procedures, published in peer reviewed literature and textbook chapters, can restore a natural, youthful beauty and avoid, a “face-lifted” look.

The following patient has had a deep plane facelift, and more youthful, natural appearance is restored by lifting the cheek (subperiosteal mid-face lift).

4). FaceTite, a bipolar radiofrequency “energy” device works above and below the skin to tighten the skin simultaneously with the neck lift. FaceTite has a computer-controlled ability to avoid overheating the skin. It is especially useful in skin that is overly loose or has excessive wrinkles. It can help, to a degree, with both horizontal neck lines and “leather like” sun-damaged neck skin.

5). Unique neck lifting techniques tighten and lift the neck in a natural manner. An “extended neck lift”, used by Dr. Keller for over 35 years separates and incises the muscles and fascia in the neck, so that the platysma muscle can be pulled more ef2iciently backward for tightening. In addition, a form of internal suturing of the neck to tighten it upward and emphasize the neckline along its entire border (Ellevate and Trampoline Platysmaplasty). This “web neck” procedure can be done without an incision under the chin. For heavy necks, or more extreme cases, a “corset platysmaplasty” and more extensive work might be necessary, but over 95% of patients can achieve neck tightening and platysma muscle tightening without a deforming “under the chin” incision.

Trampoline Platysmaplasty creates a “web” of suture that can be tightened like “lacing up your shoelaces” and avoids a scar under the chin. No facelift is performed for this patient.

6). SAFETY. A Masterlift deep plane facelift facelift is safer than most deep plane facelifts. The “deep plane” layer is a natural layer that was not well understood until Dr. Keller and Dr. Chiara Amaretto Amadeo de2ined it in their landmark papers in 2010-13. It is a layer that lifts the face under the skin and SMAS (super2icial muscle and fascia layer) and over the covering (deep fascia) of the muscles of expression that move the face. This approach preserves a greater blood supply to the face and improves the skin healing. It also improves the safety of the deep plane facelift by preserving the layer that covers the nerves. Most deep plane lifts remove this layer. Dr. Keller has used his procedure for over 35 years (calling it a “supra2ibromuscular” layer), but it was only recently that Dr. Amadeo and Dr. Keller de2ined the anatomy.

Q:Why does the deep plane facelift cost more than other facelift Los Angeles?

A: As mentioned above, the deep plane technique requires the skill and expertise that only a few facial plastic surgeons possess. It provides a natural long lasting lift that exclusively addresses the structural signs of aging.

There are non-invasive procedures that can continue to tighten the skin and “Maintain” your facelift, such as Ultherapy, FaceTite, Microneedling with RF! You may also use our DefenAge products to keep your skin in good shape. These products and procedures are the most advanced products available and, with our Rejuvalase Medi-Spa allow us to take total care of your facial rejuvenation and maintenance. We call this approach “Integrative Rejuvenation” which combines the best and most advanced surgeries, non-invasive treatments, cosmeceuticals, and minimally invasive procedures and injections to make you look your best.

Residents of Santa Barbara, Los Angeles, Beverly Hills, and the surrounding communities in California who want to rejuvenate their appearance through a facelift Los Angeles or other cosmetic procedure should contact Keller Plastic Surgery for a complimentary consultation.