Deep Plane Facelift
A facelift (rhytidectomy) is intended to address the effects of aging in the lower face, neck, and jowls. As we age, time and gravity cause a loss of facial muscle tone and skin elasticity. The cheeks begin to sag, creating jowls and distorting the jawline. Loose skin appears in the neck, often called a double chin or "turkey neck." Deep creases between the nose and mouth deepen, and the corners of the mouth turn downward.
Facelift surgery can "set back the clock" by rejuvenating the face — improving the most visible signs of aging by repositioning the deeper tissues, removing excess fat and skin, tightening the underlying muscles, and redraping the skin of the face and neck, restoring more youthful facial contours.
Why Dr. Aharonov Favors the Deep Plane Technique
Dr. Aharonov favors the deep plane facelift — the most advanced form of the SMAS lift. Unlike procedures that only tighten skin, or older SMAS techniques that fold and stitch the SMAS layer from above, the deep plane facelift works beneath the SMAS layer, in the plane directly above the facial muscles.
Once in this deeper plane, the surgeon releases the retaining ligaments — the fibrous attachments (zygomatic, masseteric, and mandibular ligaments) that tether the aging tissues to the deep facial structures and hold jowls in place. With these ligaments released, the skin, fat, and SMAS are repositioned together as one composite unit and anchored with sutures to fixed deep structures such as the deep temporal fascia and the mastoid region. The tissues are lifted vertically, against the direction of gravity, recreating the heart-shaped contours of a younger face.
Because the lift tension is carried entirely by the deep layer, no tension is placed on the skin itself. This is what makes the difference:
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The redraped skin sits naturally in its new position — the tightly pulled, "windswept" look that can accompany a facelift done improperly is avoided.
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With no tension on the incision lines, scars heal as fine lines and remain practically imperceptible, hidden within the hairline behind the temples and in the natural contours around the ear.
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The midface and cheeks — which older techniques barely move — are genuinely lifted, because the ligaments holding them down have been released.
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Jowls are corrected at their source: releasing the mandibular ligament frees the jowl so it can be repositioned upward, rather than pulled sideways.
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Dr. Aharonov uses advanced hemostatic techniques, including hemostatic net sutures that gently seal the skin to the deeper tissues. These greatly minimize bruising and swelling, reduce the risk of hematoma (a collection of blood under the skin — the most common significant facelift complication), and often eliminate the need for prolonged drainage tubes. The overall effect is a more natural, refreshed appearance than simply tightening the skin.
TYPES OF FACELIFTS
Deep Plane
Works beneath the SMAS, releasing the retaining ligaments so skin, fat, and SMAS are repositioned as one unit. Best for moderate to advanced aging, midface descent, heavier jowls, and revision cases.
Midface and cheeks: significant lift.
Neck: strong correction, integral to the operation.
Results last about 10–15 years.
Recovery: about 2–3 weeks before socially presentable.
SMAS Plication
Works above the SMAS — the SMAS is folded or stitched without going underneath.
Best for moderate lower-face aging and jawline laxity.
Midface and cheeks: modest lift.
Neck: moderate correction.
Results last about 7–12 years.
Recovery: about 1–2 weeks.
Mini Lift/
Short-Scar Lift
Limited dissection — SMAS plication or skin tightening through shorter incisions.
Best for patients in their late 30s to early 50s with mild jowling, good skin elasticity, and a firm neck.
Midface and cheeks: minimal lift.
Neck: limited correction.
Results last about 3–7 years.
Recovery: about 1 week.
Thread Lift
Barbed sutures placed under the skin — no dissection, no skin removal.
Best for mild laxity in patients who want to avoid surgery.
Midface and cheeks: subtle to no lift.
Neck: mild correction.
Results last about 1–3 years.
Recovery: days.
What a Facelift Addresses
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Jowls along the jawline
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Loss of jawline definition
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Sagging in the midface and cheeks
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Deep folds between the nose and mouth (nasolabial folds) and below the mouth corners (marionette lines)
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Loose neck skin ("turkey neck") and vertical neck bands
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Excess fat beneath the chin
A Note From Dr. Gal
If you're thinking about a facelift or necklift, you're probably not trying to look like someone else. Most of my patients tell me the same thing: "I just want to look like me — the way I looked ten years ago." And their biggest fear isn't the surgery itself. It's looking like they've had surgery.
I understand that fear, and it's why I favor the customizing each surgery to the unique person in front of me. Instead of pulling the skin tight — which is what creates that stretched, windswept look — I prefer to reposition the deeper tissues that have actually descended, and the skin simply follows. The lift is carried underneath, where it's strong, and the face settles back where it used to be. You should look rested and refreshed. You should still look like you.
Here is my promise, and it is the same for every patient: I will only recommend surgery if I believe your result will look completely natural. Sometimes that means a less extensive procedure than the one you came in asking about. Sometimes it means telling you honestly that you don't need surgery at all. You will never feel pressured into anything in my office — that's not how I practice.
And every stitch of your closure is placed by my own hand. That is how I have always done it.
Necklift and Deep Neck Sculpting
A necklift is sometimes performed along with a facelift, but can sometimes be performed by itself. While the neck tends to age along with the face, sometimes there can be a discrepancy with the neck being genetically suboptimal compared to the face.
Deep neck sculpting can be performed as a solo procedure. Through a small incision under the chin in the skin's natural crease, the separated edges of the platysma muscle — which spread apart over time, forming visible vertical bands or "cords" — are rejoined and tightened in the midline.
Excess fat beneath the muscles is removed, along with excess glandular tissue or saggy protruding muscle. The hyoid bone can be gently released upwards allowing the neck to have a needer angle.
As a separate procedure, incisions can be placed just behind the ears. The lateral platysma can be released and suspended toward the mastoid, sharpening the jawline and restoring a youthful angle between the chin and neck.
Excess skin is removed and the remaining skin redraped without tension.
In combination with a facelift, a neck lift restores the jawline and creates a more youthful, defined appearance.
If the cheeks are not sagging, a neck lift can be performed on its own. Submental (beneath-the-chin) liposuction can remove excess fat with excellent results, and platysmal bands can be tightened through only the small chin incision.
If loose skin is present as well, however, a combined facelift and neck lift is usually the best solution.
Recovery: What to Expect
Every patient's recovery is individual, but the general course after a deep plane facelift and neck lift follows a predictable pattern:
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Days 1–3. Swelling and bruising build, usually peaking around day 3. The head dressing is removed the day after surgery; any drains are typically removed at the same visit. Most patients describe tightness and pressure rather than sharp pain. Keep the head elevated, apply cold compresses while awake, and walk gently.
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Days 4–7. Swelling begins to subside. Bruising may look worse before it improves and migrates downward with gravity. Washing the hair daily and keeping the incisions clean is encouraged.
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Days 7–10. Sutures are removed in stages. Bruising fades from purple to yellow and then resolves.
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Weeks 2–3. Most patients return to desk work around 10–14 days and feel socially presentable — comfortable in public with light makeup — by 2–3 weeks.
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Weeks 4–6. Roughly 90% of swelling has resolved by week 6. Exercise and strength training are typically cleared around 6 weeks; avoid heavy lifting and strenuous activity before then.
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Months 2–3. The result looks stable; jawline and neck definition emerge as residual swelling clears.
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Months 3–6. Final contours settle. Numbness or tingling around the incisions and earlobes gradually resolves over weeks to months.
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Months 6–12. Scars mature from pink toward normal skin tone and continue to fade. The result is best judged at 6 months at the earliest.
Helpful measures during recovery: keep the head elevated, stay hydrated, eat a protein-rich diet, avoid smoking and nicotine for at least 4 weeks, avoid blood-thinning medications and supplements as directed, and attend all follow-up visits.
Risks and Complications
All surgery carries risk, and a frank discussion of complications is part of every consultation. The documented risks of facelift and neck lift surgery include:
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Hematoma — a collection of blood under the skin. This is the most common significant complication; it can cause pain and swelling and may require a return to the operating room to evacuate. Risk is higher with uncontrolled blood pressure. Meticulous hemostasis, blood pressure control, and techniques such as the hemostatic net are used to minimize this risk.
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Nerve injury — temporary weakness or numbness from stretching of nerve branches is uncommon and usually resolves over weeks to months. The great auricular nerve (sensation around the earlobe) is the most commonly affected nerve and typically recovers. Permanent injury to a facial nerve branch causing lasting weakness is rare (on the order of 1–2% in the published literature). Deep plane dissection works closer to the facial nerve branches, which is one reason the procedure demands an experienced surgeon.
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Skin loss — rare; delayed healing or small areas of skin loss are more likely in smokers, patients with poorly controlled diabetes, or when blood supply is compromised.
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Scarring — incisions are placed to hide within the hairline and the ear's natural contours and usually heal as fine lines. Unfavorable or thickened scarring can occur and may require treatment.
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Asymmetry, prolonged swelling, and contour irregularities — usually improve with time; small revisions are occasionally needed.
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Hair loss along incisions — usually temporary.
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Need for revision — as healing completes over months, a touch-up procedure is occasionally recommended.
Choosing a board-certified facial plastic surgeon who performs facelifts routinely is the single most important factor in minimizing these risks.
How Long Do Results Last?
A deep plane facelift typically lasts 10 to 15 years — longer than SMAS-plication lifts (about 7–12 years) or mini lifts (about 3–7 years). Patients do not "suddenly look old again" when the effect fades; the clock is set back, and aging continues from a younger starting point. Longevity depends on skin quality, age at surgery, sun exposure, smoking, weight stability, and genetics — sunscreen, stable weight, and good skincare help results last.
It is equally important to understand what a facelift does not do:
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It does not stop the natural aging process.
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It does not change your fundamental appearance or identity — the goal is a younger version of you.
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It does not improve skin texture, pigmentation, or fine wrinkles on its own — those require resurfacing or injectables.
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It does not address the eyes or forehead — eyelid surgery or a brow lift is needed for those areas.
Procedures Commonly Combined with a Facelift
Because the face ages as a whole, patients frequently combine a facelift with complementary procedures — one surgery, one anesthesia, one recovery, and a harmonious result:
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Eyelid surgery (blepharoplasty) — addresses hooded upper lids and under-eye bags the facelift does not reach.
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Brow lift — elevates a descended brow and smooths the forehead for upper-face balance.
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Facial fat grafting — restores age-related volume loss in the cheeks, temples, and around the mouth; lifting repositions tissue, but only grafting replaces lost volume.
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Lip lift — restores youthful tooth show when the upper lip has lengthened with age.
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Chin implant — strengthens chin projection for overall facial balance.
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Laser resurfacing — improves skin texture, tone, and fine wrinkles that lifting alone cannot fix.
Whether to combine or stage procedures depends on the surgical plan, anesthesia time, and safety — Dr. Aharonov will advise what is appropriate for you.
Frequently Asked Questions
Will I look natural? Will I still look like me?
This is the most common concern, and the reason Dr. Aharonov favors the deep plane technique. Because the lift is carried by the deep tissues and the skin is redraped without tension, the result is a refreshed, rested version of you — never pulled or windswept. The most frequent compliment facelift patients report is some version of "you look great" from people who cannot tell anything was done.
How long does a facelift last?
A deep plane facelift typically lasts 10 to 15 years. Aging continues from a younger starting point — you will always look younger than if you had not had the surgery.
What is the best age for a facelift?
There is no ideal age — candidacy is determined by anatomy, not the calendar. Most patients are in their 40s to 60s, but healthy patients in their 70s and beyond can be excellent candidates, while some younger patients with early jowling benefit sooner.
Do I need a mini facelift or a full facelift?
A mini lift suits mild, early aging with a firm neck. If you have significant jowling, neck laxity, or midface descent, a mini lift cannot deliver the correction — and its recovery is often comparable to a full facelift. Dr. Aharonov will tell you honestly which operation your anatomy requires.
Will I have visible scars?
Incisions are hidden within the temporal hairline, in front of and behind the ear along its natural contours, and into the occipital hairline, with a small incision under the chin when the neck is addressed. Because the skin is closed without tension, scars typically heal as fine lines and become practically imperceptible. Preoperative scar anxiety is nearly universal — and postoperative patients consistently report that the scars were a non-issue.
How painful is facelift surgery?
Most patients describe tightness, pressure, and soreness rather than sharp pain, and pain is typically well controlled with prescribed medication for the first several days. Many are surprised that the discomfort is less than they feared.
When can I go out in public / return to work?
Most patients return to desk work in 10–14 days and feel comfortable socializing by 2–3 weeks, with light makeup if desired. Strenuous exercise waits until about 6 weeks.
Do I need a neck lift too?
In most cases, yes — the face and neck age together, and addressing one without the other can look incomplete. If your cheeks and jawline are still firm and only the neck bothers you, a standalone neck lift may be the right operation.
Will I still need fillers or Botox after a facelift?
Possibly, for different reasons than before. A facelift repositions sagging tissue; it does not replace lost volume or relax dynamic wrinkles. Many patients use small maintenance treatments to extend and refine their surgical result.
How do I choose the right facelift surgeon?
The most important decision is not the technique — it is the surgeon. Choose a board-certified facial plastic surgeon who performs facelifts routinely, whose before-and-after results show the natural outcome you want, and who discusses risks as frankly as benefits.