Most patients who considered facelifts for decades faced an unspoken trade-off: accept an obviously operated appearance or age without intervention. The telltale signs of surgery taut skin, distorted hairlines, unnatural facial contours followed patients for years and became the defining public perception of cosmetic surgery. Surgeons trained in conventional methods often defended these outcomes as unavoidable. A New York-based facial plastic surgeon decided those results were a failure of technique, not an inevitable consequence of operating on the face.
Dr. Andrew Jacono introduced the extended deep-plane facelift in the early 2000s, publishing his first peer-reviewed study in Aesthetic Surgery Journal in 2011. The study documented outcomes from 153 patients and formalized a departure from decades of accepted surgical practice. Standard facelifts separated skin from the underlying tissue layer and repositioned only the surface, creating tension that produced the characteristic pulled appearance. Dr. Andrew Jacono’s method kept skin, muscle, and fat connected as a unified structure during repositioning, addressing the anatomy rather than the surface.
A New Foundation for Facial Surgery
The extended deep-plane approach works beneath the superficial musculoaponeurotic system, or SMAS the tissue layer connecting facial muscles to skin. Traditional procedures tightened this layer from above, which meant the structural causes of facial aging remained unaddressed. By operating below this layer and releasing key ligaments, Dr. Andrew Jacono repositions midface, jawline, and neck structures vertically rather than pulling skin horizontally. The result is anatomical correction rather than cosmetic tension.
Early clinical data supported the method’s safety profile. Complication figures showed a 3.9% revision rate, approximately 1.9% hematoma rate, and 1.3% temporary facial nerve injury all below industry averages for facelift surgery. Results hold for 12 to 15 years, roughly twice the durability of standard SMAS facelifts. In 2021, Dr. Jacono published a comprehensive medical textbook drawing on insights from more than 2,000 procedures, cementing the technique’s standing as a reference in modern facial plastic surgery and a framework that surgeons worldwide now use in training. Visit this page for more information.
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