What the research shows
Sam Hamra described the deep plane facelift in 1990 to treat the fold between the nose and mouth, which earlier lifts left largely unchanged. His dissection runs under the SMAS, over the cheek muscles and past the fold, releasing every attachment so that skin, cheek fat and the neck muscle move as one thick flap (Hamra 1990). The extended version releases four key ligaments of the face and neck and moves the flap to restore fullness to the cheek and the angle of the jaw, reducing the need to open the neck in front (Jacono 2018).
It is safe in pooled data. A 2026 meta-analysis found a low overall complication rate and no permanent facial nerve injury. Temporary nerve weakness affected about 1 in 80, and hematoma about 1 in 55 (Koroma 2026). Experience matters: one surgeon's complication rate halved between the first and last cases, and skin loss disappeared (Çelik 2026). A multicenter series of a modified extended lift reported low rates of hematoma and revision (Roskies 2024).
The lift moves fallen cheek fat back up. 3D imaging a year or more later showed added volume in the midface, which may spare some patients fat grafting (Jacono 2015). In cadavers, deep plane release pulled the neck muscle much further toward the ear than SMAS plication, and extending the release into the neck pulled it further still, which in theory spares many patients a midline tightening of the neck muscle (Jacono 2011).
Two long-term series point to durable results. In one surgeon's practice, a later tuck-up was needed far less often after deep plane lifts than after SMAS lifts (Kamer 1998). Over 30 years in another practice, patients came back for a second lift after about 11 years on average, and those who had their first lift younger waited longer (Levin 2026).
Where surgeons disagree
- Better than a SMAS lift. In a masked review, SMAS plication scored higher overall, and the deep plane did slightly better only in patients over 70 (Becker 2004). Blinded raters in another study found the deep plane better in the midface and neck (Adamson 2007). A 2026 cohort found no difference in satisfaction or complications at three months (Neel 2026), and a 2025 review found only one direct comparison of results (Vayalapra 2025).
- Complication rates. One review reported a higher overall complication rate after deep plane lifts than SMAS lifts, along with higher satisfaction (Khoury 2025); another found the two equally safe (Vayalapra 2025). A survey of facial plastic surgeons linked deep plane lifts and frequent gland reduction to more temporary nerve injury (Pak 2026), and deep plane neck lifts caused more nerve weakness than traditional neck lifts (Chinta 2025).
- How long it lasts. Against the long-term series above, one critical review saw the fold beside the nose, the jowls and the neck begin to return within 6 to 12 months in every patient and argued for narrower indications (Colombo 2025).
What is new
- In a randomized trial, the extended deep plane lift improved marionette lines, jowls and neck laxity more than the standard deep plane lift, with no permanent nerve injury (Golparvaran 2026).
- The deep plane lift is becoming the preferred technique among facial plastic surgeons in the United States (Pak 2026).
- A randomized trial found a hemostatic net, stitched through the skin, controlled bleeding and fluid as well as drains (Ismail 2025).
- Deep plane lifts with a neck lift are now done under local anesthesia with oral sedation, with complication rates no higher than under general anesthesia (Novis 2026).
What is still unknown
- Whether the deep plane outlasts other lifts in a head-to-head test. Reviewers call for randomized studies, standard outcome measures and long-term follow-up (Koroma 2026).
- Which faces benefit most. One comparison favored it only past 70 (Becker 2004), and one critic would limit it to specific face types (Colombo 2025).
Key papers
- Hamra 1990: the original deep plane facelift.
- Kamer 1998: fewer tuck-ups after deep plane than SMAS lifts.
- Becker 2004: masked comparison that favored SMAS plication under age 70.
- Adamson 2007: blinded comparison that favored the deep plane in the midface and neck.
- Jacono 2015: 3D imaging of the midface volume the lift restores.
- Jacono 2018: the extended deep plane lift and its ligament releases.
- Koroma 2026: pooled safety data with no permanent nerve injury.
- Golparvaran 2026: randomized trial of extended against standard deep plane lifts.
- Levin 2026: patients returned for a second lift after about 11 years.