6 Minute Read | Posted April 22, 2026 in Facelift
Before we talk about facelifts, let’s first understand what actually causes the face to age. The youthful firmness and elasticity of your skin and underlying tissues depend largely on two key proteins: collagen and elastin. These molecules act like tiny springs—they allow tissues to stretch and move, then snap back into place.
Your body constantly breaks down and rebuilds collagen. In your 20s, it replaces exactly what is lost, so levels stay stable. But around age 30, the body begins to fall behind in production. From that point forward, collagen content steadily declines. Over time, the supportive structures in your face lose strength and integrity. Skin and deeper tissues begin to loosen, sag, droop, and migrate downward—these are the classic signs of facial aging.
Table of Contents
- The Old-School Approach: “Too Much Skin” Facelifts of the 1980s
- Why Traditional Skin-Only Facelifts Often Fell Short
- The Modern Solution: The Extended Deep Plane Facelift
- Addressing the Neck: Complete Control with the Platysma
- Don’t Forget Volume: Fat Grafting for Complete Rejuvenation
- Why This Matters for You
The Old-School Approach: “Too Much Skin” Facelifts of the 1980s
In my opinion, some procedures are truly “skin issues.” An upper eyelid lift (blepharoplasty) is a great example, and to some extent, a breast lift is as well.
Back in the 1980s, most plastic surgeons viewed an aging face the same way—as a problem of excess skin. The solution was simple: pull the skin as tight as possible, remove the excess, and hope the wrinkles and sagging disappeared. This was called a subcutaneous facelift. Surgeons would separate the skin from the underlying layer (the superficial musculoaponeurotic system, or SMAS), pull it back aggressively, cut away several centimeters of skin, and close the incisions under tension.
While this approach did reduce some wrinkles in the short term, it created several well-known problems.
Why Traditional Skin-Only Facelifts Often Fell Short
- The skin is not a strong “lifting” layer. It simply isn’t designed to withstand long-term tension. When all the lift depends on tight skin, the result can look “windswept” or overly pulled—the classic “facelift face” many patients fear.
- Tension on the skin closure leads to poor scarring. Plastic surgery 101 tells us to avoid tension on the skin when closing incisions. Yet skin-only techniques placed heavy tension exactly where it shouldn’t be—especially behind the ears—resulting in widened or stretched scars.
- It ignored the deeper structures. Facial aging occurs vertically, but skin laxity accumulates more diagonally. Pulling only the skin forced surgeons to compromise on the lift vector, leaving them unable to achieve truly natural, harmonious results.
Imagine your face like a carpeted floor in your home. If the floorboards underneath start to warp and buckle over time, you wouldn’t just stretch and staple the carpet tighter. You’d need to fix the foundation.
The Modern Solution: The Extended Deep Plane Facelift
By the early 1990s, surgeons began developing techniques that addressed the deeper layers of the face. The true deep plane facelift—and specifically the extended deep plane facelift I perform—represents this major evolution in facial rejuvenation surgery.
(Note: Many surgeons today say they perform a “deep plane” lift, but simply going under the SMAS a short distance does not qualify. A genuine extended deep plane facelift involves a complete, thorough release and elevation of the SMAS layer across the face and into the neck.)
In this technique, we elevate the skin off the SMAS, then release and lift the SMAS as a single, robust unit. This layer of connective tissue and muscle is strong and reliable—it can hold tension beautifully. By repositioning and securing the SMAS first, we restore the deeper foundation of the face. The skin then simply redrapes naturally over the new structure with zero tension on the incisions.
The benefits are dramatic:
- Longer-lasting results because the lift is anchored in strong tissue rather than fragile skin
- A far more natural appearance with no windswept or “Joker” look
- Better scarring and faster healing because skin closure is tension-free
- Precise control over the facial fat pads, which are lifted back into their youthful position
Addressing the Neck: Complete Control with the Platysma
The SMAS is continuous with the platysma muscle in the neck—a thin, sheet-like muscle of facial expression (not a true neck mover like the sternocleidomastoid). Over time, the platysma descends and separates in the midline, contributing to the loss of that sharp, youthful angle between the jawline and neck.
With the extended deep plane approach, we gain complete control over this layer. We can tighten, reposition, and sometimes partially remove portions of the platysma to restore a clean, defined jawline and neck contour—one of the most telling signs of youth.
Don’t Forget Volume: Fat Grafting for Complete Rejuvenation
Around the same time, deeper-plane techniques were developing, and our understanding of facial volume loss improved dramatically. Starting in the late 1980s, fat grafting became a reliable tool.
Most patients first lose volume in the temples (often hidden by hair) and then in the cheeks (malar eminence). The face doesn’t just sag; it also becomes hollow and gaunt. That’s why a complete facial rejuvenation today almost always includes strategic fat grafting alongside the extended deep plane lift. We restore the deeper support and the youthful fullness that patients lose over time.
Why This Matters for You
Plastic surgeons often invent new names, trademark techniques, and use terms interchangeably, which can confuse patients. When I talk about a facelift, I always include the neck—because true facial harmony requires it.
I hope this explanation helps you understand exactly what an extended deep plane facelift is and why it has become the gold standard for natural, long-lasting results. The more you know about what your surgeon is actually doing, the more confident you’ll feel going into surgery—and the better your questions and results will be.
If you’re considering a facelift and want to learn whether the extended deep plane approach is right for you, I’d be happy to meet with you for a personalized consultation.
Schedule Your Deep Plane Facelift Consultation in New Orleans, LA
If you are considering a deep plane facelift in New Orleans, LA, or want to better understand your options for facial rejuvenation, schedule your personal consultation with board-certified plastic surgeon Dr. Matthew Bartow. Dr. Bartow has years of training and experience performing advanced aesthetic surgical techniques, including the extended deep plane facelift.
Contact Bartow Plastic Surgery today by calling (504) 895-7200 or by completing our online contact form.