Dr Marc DuPéré
A deep plane facelift is one of those operations that is both technically demanding and philosophically interesting: it forces you to decide what you think “youth” actually looks like in three dimensions, not just on the surface of the skin. It is NOT a new technique, and I have performed this variation of facelifts for more than 10 years here in Toronto. Yet, the “deep plane” facelift has had a “cultural rebirth” with the recent Kris Jenner’s second facelift, which was highly publicized on many social platforms. So, I thought I would dive into this facelift to explain to my patients where it comes from, how to think about “age,” and why VISAGE Clinic offers the best options of facial rejuvenation in Toronto and Canada. It is a long blog, but I believe it will be appreciated by anyone interested in a facelift.
1. Why the deep plane facelift matters now
Facelifts have existed for over a century, but for most of that time, they were essentially skin operations: pull, cut, and hope the patient didn’t look too “done.” As understanding of facial anatomy evolved, surgery moved deeper—first to the SMAS, and then below it into what we now call the “deep plane.”
The deep plane facelift was originally described in 1990 by Dr Sam Hamra, who formalized a dissection plane beneath the SMAS and included the malar fat pad and midface soft tissues in the lifted unit. Rather than simply tightening a superficial layer, his approach repositioned the deeper structures that actually fall with age.
For a while, the technique was something of a connoisseur’s choice: used by a subset of plastic surgeons, including my mentors and early pioneers Drs Bruce Connell in Los Angeles and Daniel Marchac in Paris, discussed at meetings, but largely invisible to the public.
Then the Kardashian arrived, the culture caught up, and the rebirth of the Deep Plane facelift (and the Brazilian Butt Lift) happened.
In the last couple of years, media coverage and social media speculation—particularly around Kris Jenner’s recent facelift—have pushed “deep plane facelift” searches into the mainstream. She’s openly described the procedure as a “refresh” of a facelift she had 15 years ago and framed it as her version of aging gracefully and staying the “best version” of herself.
Coverage in outlets like The Guardian has used her case as a springboard to explain what a deep plane facelift is and why it’s perceived as more natural and long-lasting than traditional techniques, noting that searches spiked after public speculation about her unusually youthful appearance (which, unfortunately, was initially heavily and misleadingly photoshopped and filtered).
So, we’re at an interesting moment: a sophisticated technique, developed decades ago, is being “rediscovered” by the public in the age of Instagram and high-definition video.
2. Origins: from skin pulls to the deep plane
To understand the deep plane, you have to understand what it was trying to fix.
2.1. Skin-only and early SMAS facelifts
Early facelifts largely elevated skin removed the excess, and re-draping it. That addressed laxity but did nothing for the underlying descent of the SMAS, ligaments, and facial fat pads. Results tended to look tight but flat, with a characteristic “wind-tunnel” “wind-swiped” look when surgeons pushed too hard on the skin, not to mention an exaggerated wide smile and an earlobe glued and elongated on the cheeks… the so-called “pixie ear”.
The next and very important wave was SMAS surgery: elevate the skin, then either fold, tighten, or excise part of the SMAS (plication, imbrication, or SMASectomy). This added durability and reduced skin tension, but the SMAS was still manipulated as a separate layer, often with limited midface elevation.
2.2. Dr. Hamra and the deep plane paradigm
Dr. Hamra’s contribution was to go under the SMAS and release the retaining ligaments that tether the face, especially around the zygoma and along the jawline, and then move the skin–SMAS–malar fat complex as one unit. Then came Drs Tord Skoog, Bryan Mendelson, Bruce Connell, Timothy Marten and Dino Elyassnia.
Key conceptual shifts of the DEEP plane technique:
- Plane of dissection: Instead of stopping superficial to the SMAS (the old skin-only lift), the deep plane dissects beneath it in a relatively avascular plane.
- Unitary movement: The skin isn’t pulled separately (as done in the later SMAS technique); the overlying skin and deeper tissues move together in a more anatomic, “en bloc” fashion (i.e. more of the deep dissection, lesser of the skin undermining)
- Volume preservation: The malar fat pad is repositioned rather than deflated or excised; very important! Later, Hamra’s “composite facelift” extended the dissection to include the orbicularis oculi for more continuous eyelid–cheek rejuvenation.
Over time, surgeons have evolved variations: high SMAS (Dr Bruce Connell), extended deep plane, and preservation facelifts, all trying to refine vectors, reduce complications and the overdone look, and target specific anatomic problems (midface ptosis, heavy necks, loose neck bands, chin and temple hollowing, etc.) with such techniques as temple and chin implants, microfat grafting, direct neck bands correction (platysmaplasty), etc.
3. What a deep plane facelift really does (ie. anatomy and technique in plain language)
From a patient’s point of view, “deep plane” often just sounds like “stronger facelift.” But anatomically, it’s quite specific.
3.1. The layers that matter
If you move from the outside in, you pass through:
- Skin and subcutaneous fat
- SMAS – the superficial musculoaponeurotic system, continuous with platysma in the neck and includes the mimetic facial muscles (muscles of animation)
- Deep plane – relatively loose and avascular areolar plane (with a few retaining ligaments that are released during the facelift procedure) between SMAS and the deeper structures
- Deeper structures – parotid fascia, facial nerve branches, masseter, then bones.
In a deep plane facelift, the dissection is carried out under the SMAS, in that “third” layer. The surgeon releases key retaining ligaments (zygomatic, masseteric, mandibular cutaneous) that are literally anchoring the tissues in their aged, descended position. Once those are released, the midface and lower face can be mobilized and repositioned more freely with various vectors, horizontal-oblique, vertical and often both.
3.2. Practical elements of technique
Here is what, in a simplified way, my typical deep plane approach involves:
- Incisions placed around the ear and possibly into the temporal and posterior hairline, similar to an advanced SMAS facelift.
- Sub-mental neck dissection (very important, see my next blog): plastymal band repair and deep fat removal in heavy necks
- Sub-SMAS dissection beginning in the lower face and neck and extending into the midface, staying in a relatively safe, avascular plane beneath the SMAS.
- Release of retaining ligaments around the cheek (zygoma) and along the mandible to allow the malar fat pad, jowl tissue, and platysma to move as a unit.
- Vertical or superolateral elevation of this composite flap to restore cheek fullness, soften nasolabial folds, sharpen the jawline, and improve upper neck contour.
- Skin redraping without tension – key part of the technique!, since the “heavy lifting” is done by the deeper tissues; excess skin is trimmed, but it’s essentially just packaging.
Because the lift acts on the true “framework” of the face, it can correct heavy jowls and deep nasolabial folds more effectively than some SMAS techniques that operate more superficially.
4. Deep plane vs. SMAS facelift: what actually changes?
There is a tendency in marketing to present the deep plane facelift as universally “better” than SMAS, which isn’t really accurate. The trade-offs are more nuanced.
4.1. Depth and vectors
- SMAS facelift with plication or imbrication (commonly done by ENT surgeons in Canada):
- Dissection is usually above the SMAS.
- The SMAS is tightened or folded, but the release of ligaments is more limited.
- Vectors can be tailored, but midface lift is sometimes constrained.
- Deep plane facelift:
- Dissection is beneath the SMAS, with systematic ligament release.
- The malar fat pad and cheek tissues move more as a block, often giving a more robust midface lift and better contour at the nasolabial fold and jowl.
4.2. Aesthetic outcomes and longevity
Deep plane results look more natural and last longer because the deeper support is corrected and the skin isn’t over-tightened.
The fairest conclusion is that the deep plane is a powerful tool, particularly for significant midface descent and heavy jowls.
4.3. Recovery and risk profile
Because the dissection is deeper and the midface is more mobilized:
- Recovery
- Deep plane: typically, more swelling and bruising, especially in the cheek area, and slightly longer social downtime (often 2+ weeks for patients who want to be “event-ready”). The recovery will also be affected when fat grafting is done at the same time.
- SMAS: generally, somewhat less swelling and a faster return to work, in the 7–10 day range for many patients, yet may not last as long as the deep plane and will not release the deep tethering ligaments.
- Risk
- Deep plane is anatomically close to facial nerve branches, so the surgeon must be extremely comfortable identifying safe planes (as are many plastic surgeons) and managing the risk of neuropraxia or injury.
- That said, some experts argue that working under the SMAS actually keeps you “below” some key branches and may be protective when done correctly.
- Both SMAS and deep plane share the risks of hematoma, infection, wound issues, contour irregularities, and dissatisfaction with aesthetic outcome.
In short: the deep plane facelift usually offers more power and potentially more durability at the cost of increased technical demands and often a slightly heavier recovery.
5. The “rebirth” through Kris Jenner and modern aesthetics
Kris Jenner’s public discussion of her new facelift—framing it as her personal version of “aging gracefully”—has done something important: it shifted conversation from “Did she or didn’t she?” to “What did she do, and why does it look like that?”
A few notable cultural shifts tied to this:
- Normalization of a second or “refresh” facelift. She openly acknowledged this was a repeat operation 15 years after her first, which mirrors the timeframe surgeons often quote for high-quality deep or SMAS-based lifts.
- Visibility of high-end, subtle work. Photos of her at high-profile events—compared to older images, sometimes in the same dress—have been used to illustrate how modern facelifts can “reverse age” without obvious distortion, when bone structure, volume, and skin are all handled thoughtfully (yet readers should be cognizant that many of her first post-op pictures and videos were misleadingly photoshopped/filtered and therefore deceiving).
- Elevated expectations. Patients now turn up to consultations asking specifically for deep plane facelifts because they’ve read that it looks more natural and lasts longer. Articles note that demand has spread to men and to somewhat younger patients who want to age more gradually.
This “rebirth” is less about the technique being newly invented and more about the public finally noticing what a deeper, more anatomic operation can achieve when done by a plastic surgeon.
6. Why surgeon training and specialization matter so much
Deep plane facelift is not an entry-level operation. It demands:
- Comfort dissecting close to facial nerve branches
- A 3D understanding of midface and neck anatomy
- The ability to manage major complications, not just aesthetic tweaks
That’s where formal plastic surgery training (and not ENT training) becomes so critical.
6.1. Training depth and case exposure
Board-certified (USA) and Royal College-certified (Canada) plastic surgeons typically:
- Complete 5–7+ years of surgical training with rigorous anatomy, microsurgery, trauma, and reconstructive work.
- Many will add a fellowship training post-graduation: for example I myself traveled to Paris, Los Angeles, New York City and Brazil for my extended training in facial surgery).
- Accumulate extensive experience in facial soft-tissue handling, flap design, and nerve management—skills directly relevant to sub-SMAS dissection.
Contrast that with the misleading wide world of “cosmetic surgeons,” which can include practitioners from many specialties with highly variable formal training in facial anatomy, facelift surgery, or complication management. Some are excellent; others may have limited exposure to advanced facelifts.
Professional societies and patient-education sources emphasize choosing board-certified and Royal College-certified surgeons in plastic surgery for complex facelifts, precisely because of this training depth and scope.
6.2. Judgement, not just technique
A deep plane facelift in untrained hands is dangerous not just because of nerves and vessels, but because the surgeon might:
- Choose the wrong patients (poor skin quality, unrealistic expectations)
- Over- or under-correct
- Fail to coordinate with adjunctive volume (chin implant, microfat grafting, etc.) and skin treatments
- Be unprepared for hematoma, nerve palsy, or revision
So the real message for patients—and frankly for marketing—is: the surgeon you choose is more important than the brand name of the technique.
When you combine a technically advanced method like deep plane with sound aesthetic judgment, anatomical mastery and honest patient communication, you get the kind of natural, long-lasting results that have made the technique famous.
7. Benefits of the deep plane facelift – and its limits
For the right patient, in experienced hands, the deep plane facelift offers several compelling advantages:
- Midface restoration, not just lower-face tightening
By mobilizing the malar fat pad and midface tissues, deep plane techniques can restore cheek projection and soften nasolabial folds in ways that some superficial SMAS techniques struggle to match. - More natural skin drape
Because the deeper tissues are doing the lifting, the skin isn’t pulled tight like a bedsheet; it is simply redraped. This tends to avoid the classic swept-back, over-tightened look that patients fear. - Longer-lasting structural change
Re-suspending ligaments and deeper support structures often means results age more gracefully, with improvement persisting 10–15 years in many series, though individual mileage varies. - Better jawline–neck continuity
When the platysma and lower face are handled as part of a continuous deep plane or extended deep plane dissection, along with addressing comprehensively the neck and its deeper structures, the jawline–neck angle can look cleaner and more youthful than with more limited lifts.
But it also has limits:
- It does not fix skin quality (sun damage, pigmentation, creep) – that still needs lasers, peels, skincare.
- It does not replace volume if bone and deep fat are significantly depleted—fat grafting or fillers or temple/chin implants may still be needed.
- It can be too much surgery for patients with only mild laxity who might do well with less invasive procedures.
- It is more complex and expensive, and not every patient needs the “full power” it provides.
8. Ideal age for a deep plane facelift: more anatomy than numbers
Patients (and journalists) love a number. “What is the best age for a deep plane facelift?” is a perennial question.
The honest answer: there is no magic number—only a convergence of anatomy, lifestyle, and psychology.
There is no hard “right” age; it depends on genetics, sun exposure, weight changes, degree of laxity, quality of the skin, bone structures and facial volumes, and overall health.
Many facelift (including deep plane) patients fall between mid-40s and mid-70s, with a clustering in the 50s and 60s.
Deep plane facelift candidates are often described as being 40+ with moderate to severe facial sagging, but still having decent skin elasticity.
8.2. Younger vs older patients: pros and cons
Doing it earlier (40s–early 50s):
- Pros:
- Better skin elasticity → smoother redraping
- More subtle, “quiet” changes – friends notice you look good, not “operated”
- Potentially easier, more predictable healing
- Cons:
- May need another major operation later in life (as Kris Jenner openly accepted).
Doing it later (late 50s–70s):
- Pros:
- More dramatic before-and-after, especially in jowls and neck
- One “big” surgical intervention may be enough for the rest of life
- Cons:
- Skin may be less elastic, potentially making some maneuvers more challenging
- Health comorbidities are more common and must be evaluated carefully
The “ideal” deep plane facelift age is therefore the point at which:
- Structural descent (jowls, neck, midface) bothers the patient enough
- Skin still has reasonable elasticity
- The patient is medically fit
- And psychologically ready to embrace a major, visible intervention.
9. Pulling it together: deep plane as a philosophy, not a buzzword
The deep plane facelift is more than a trending hashtag or a celebrity secret. It represents a philosophy of facial rejuvenation:
- address structure, not just skin
- move tissues in harmony, not in isolation
- respect volume and vector
- and define “aging gracefully” in collaboration with each patient.
Kris Jenner’s high-profile “refresh” simply brought that philosophy into public view and attached it to a familiar face. Her story dramatizes what the technique can achieve: not a different person, but a version of the same person who looks more like their younger self than their birth certificate might suggest.
For surgeons, the takeaway is humbler: deep plane is a powerful tool, but its success lives or dies on training, anatomy, judgment, and communication. For patients, the most important decisions are who operates, not just what technique is used, and when to do it based on one’s own anatomy, life, and sense of self.
Used thoughtfully, the deep plane facelift is less about chasing youth and more about recalibrating the face to match how the patient feels inside—quietly, structurally, and with a long horizon.
I look forward to meeting you at VISAGE Clinic and to finding the best way for a “refreshed YOU”.
Book a consultation with Dr. DuPéré.
By Dr Marc DuPéré
