Anyone researching facial surgery will encounter two broad families of facelift. One tightens the skin. The other rebuilds the structure underneath. Dr. Andrew Jacono, a New York facial plastic surgeon, has spent about two decades refining the second.
The Conventional Method
A traditional facelift separates the skin from the SMAS, the superficial musculoaponeurotic system. The surgeon then pulls the skin upward and backward. This firms surface tissue while deeper facial structures remain unchanged. Tension across the skin can make the work obvious, and the effect generally lasts six to eight years before gravity wins again.
The Extended Deep-Plane Method
Dr. Andrew Jacono’s Minimal Access Deep-Plane Extended facelift starts beneath the SMAS. Four ligaments that attach facial tissue to bone are released, allowing descended fat pads in the midface, jawline, and neck to be repositioned vertically. Skin, muscle, and fat move together as a unit.
Several differences follow from that design.
Appearance: Without the surface tension of older methods, results avoid a stretched look. Fashion designer Marc Jacobs told Vogue in 2021 that his outcome looked natural rather than “done.”
Scarring: Incisions run roughly one-third the length of conventional cuts and hide behind the ear and along the hairline.
Longevity: The deep-plane approach can last about twice as long as a standard SMAS facelift. Many patients keep results for more than a decade, some beyond 12 years.
Safety: Jacono’s 2011 study of 153 patients in Aesthetic Surgery Journal reported a 3.9% revision rate, a roughly 1.9% hematoma rate, and 1.3% temporary facial nerve injury. Later studies found deep-plane techniques cause fewer facial nerve injuries than superficial ones because the dissection preserves blood supply and anatomical relationships.
Neither approach freezes time. Skin quality, lifestyle, and aftercare influence any result. Still, the deep-plane method targets the volume loss and downward migration that drive facial aging. Dr. Andrew Jacono now performs around 250 of these procedures a year in Manhattan, and his technique has become a widely adopted approach among other surgeons. See related link for additional information.
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