The Truth About Deep Plane Facelifts

Dr. G (00:02):
You are listening to another episode of All the B's with me, Dr. G and my scrub tech Bri.

Dr. Chao (00:08):
I'm Dr. Janet Chao. I'm a facial plastic surgeon here at Restore SD Plastic Surgery, and I work closely with Dr. Kat Gallus. You are listening to All the B's, an unfiltered plastic surgery podcast with our scrub tech Bri. Hi Bri.

Bri (00:21):
Good afternoon. I was going to say good morning, but today Dr. G gets a little break of me, although I don't know why she would want that. So we are going to put Dr. Chao in the hot sea and talk about all things facial plastic surgery. So welcome to Dr. Chao's Corner. Today we're going to talk about deep plane facelifts, but of course we have to gossip a little bit before we do that. So first thing we're going to talk about, I know we've touched on it before, but since we have facial plastic surgeon, Kris Jenner's facelift.

Dr. Chao (00:54):
Yes. So let's talk about why everyone's talking about deep plane facelifts. So Kris Jenner made the headlines, but I think more and more headlines are being made about the deep plane facelift in general, and I think that that has to do with its natural results and longevity. Specifically with Kris, I would love to see some more natural, unfiltered, less makeup photos. I feel like she looks incredible, particularly I'm talking about her Instagram posts incredible but flawless makeup. Definitely some filters going on there. I want to see every angle. I want to see those incisions.

Bri (01:35):
When she came out, the photos that she put out right after the facelift were so heavily filtered and then more and more started coming out a little bit and I'm like, I just want to see, I'm sure all the little things you look at. And when I first look at somebody, I'm like, do they have a facelift? I look at their little tragus, I look at their ears. I try and see if they got scars. So I want to see what your thoughts would be from an unfiltered picture, but of course that's hard to get.

Dr. Chao (02:01):
Totally. I have seen a couple angles, and honestly, it's hard to know what's real and what's not in the era of AI generated images and videos, but I've seen a couple angles where there's maybe some puckering under the chin. Again, don't get me wrong, she looks fantastic, but just show me the raw stuff. I want to see everything.

Bri (02:23):
We need to channel Kylie and her transparency with getting her boobs done. We need Kris to just go on a live and be like, give me the angles. Let me see your facelift. Show me the scars. We need a transparency give us the breakdown Kris.

Dr. Chao (02:38):
I love it. This is the transparency era. Give it all to us. We are waiting, please.

Bri (02:42):
Yeah, we want to know. Also another article, the Why Younger women are opting for Facelifts, and I feel like we really segued from getting preventative Botox to preventative facelifts. 30's the new 50's.

Dr. Chao (03:00):
Totally. So here's my theory on this. I feel like Botox is, it's like getting your nail or your hairs done now, right? Everyone does it. It's so easy, so low risk, readily available, and then it's very easy to get into fillers from there. And I kind of feel like the filler fatigue set in people were getting overfilled or felt like that it was too much. It started to look unnatural. And then people kind of, the pendulum swung the other way and people are dissolving their filler and kind of getting a refresh and maybe noticing after that that things are falling a little bit. They're sagging a little more, and that may have driven some people toward the facelift.

Bri (03:44):
So do you think ozempic or weight loss medications are playing a role into why facelifts are becoming more common?

Dr. Chao (03:51):
Oh yeah, totally. I think that that is definitely a factor too. I mean, ozempic face being the trendy buzzword, certainly when you lose a lot of weight and that facial fat kind of gets deflated, you have more loose skin and a facelift looks great on those patients. So yeah, multifactorial. But I also think that the techniques are just so great now and people are being more transparent about it. It's not just green juice and horseback riding as Martha Stewart said.

Bri (04:21):
It's not just Martha Stewart on the back of a horse drinking chia seeds.

Dr. Chao (04:25):
That's right.

Bri (04:25):
I also feel like when that imaging came out for people were realizing that filler wasn't actually dissolving, it was just migrating throughout their whole face. Now I can't say that's the case, just based off imaging. And I've heard a lot of feedback, at least from patients or people I've talked to. They're like, my filler's not actually leaving. They're like, I'm just adding more and more filler. Do you think, what are your thoughts on that and maybe why people are straying away from getting filler?

Dr. Chao (04:52):
I mean, I think it's really hard to, I mean hyaluronidase works great and you can dissolve it, but it's really hard to get exactly where the filler was and everywhere that it was and everywhere that it may have moved to. I have had a lot of patients recently who've wanted their filler dissolved, and sometimes it takes a few sessions. You might miss an area here or there.

Bri (05:14):
Yeah, we did a chin implant the other day and you had dissolved quite a bit of filler. And even when went there, there was still a little bit, you can see.

Dr. Chao (05:26):
That's kind of what I was referring to, that case. I mean, we dissolved as much as we could in advance and even intraop, I could see little bits of filler here and there, and it's just really difficult to get all of it.

Bri (05:40):
So do you recommend people that have facelifts, do you have any preoperative protocols set forth to where you can't have filler within a certain time of getting a facelift? Or how does that affect getting them?

Dr. Chao (05:52):
Yeah, I mean, if I know a patient's interested, I'm like, stop the other stuff now. Let it all dissolve. Stop. I want to see you in your natural state. Even the Botox, I'm like, just chill out on everything

Bri (06:06):
Botox and all.

Dr. Chao (06:06):
Let it all settle in. Let me see you, your anatomy as it is. And sometimes I'll even dissolve the filler depending on where it was placed, but I think it's best to correct people in their natural anatomic state so then you can really fix everything.

Bri (06:23):
Agreed. How long would you recommend people, just like a general stop things before their facelift?

Dr. Chao (06:31):
That's a good question. For anything like s Sculptra, I say at least a year or two before, I would say do it.

Bri (06:41):
Just start planning for your facelift now.

Dr. Chao (06:43):
Yeah, I would say don't do it at all. If you know what's in your future even longer than two years down the line, even if you're in five years, I'm going to get one. Just hold off and wait for the surgery. It just makes it so much easier as a surgeon to go into a virgin face like untouched and pristine, which is somewhat rare these days, but hold off on the filler. I would say just trying to be as natural as possible up until surgery is honestly the best. Botox and all of that. That's fine. And then the number one thing I'd say is to work on a great skincare regimen, get that skin prepped. The one thing that I,

Bri (07:23):
Amen.

Dr. Chao (07:24):
Don't touch during surgery. Your skin is your skin and we can laser it and do chemical peels and all of that, but getting your skin in a great flawless state before is going to make the facelift look that much better.

Bri (07:40):
It's a commitment. It's not just a surgery.

Dr. Chao (07:43):
Totally. It's a lifestyle.

Bri (07:46):
It really is that your face, the lifestyle. Now, I know we're talking about people in their thirties getting facelifts and so forth. Are these people I know are specifically talking about deep plane facelifts? Is there, I didn't even know at least prior to working here, there was any other kind of facelifts. So can you describe what the difference may be from a patient in their thirties getting a facelift versus a patient getting a deep plane facelift?

Dr. Chao (08:14):
Sure. So let's just talk really quickly about what is a deep plane facelift, right. So a deep plane facelift lifts both the skin as well as the deeper support layer, which is called the SMAS and the platysma, and you lift that together after releasing ligaments in the face. And I believe that gravity causes the redundancy and laxity of soft tissue. And so you basically are trying to reverse gravity by lifting both of the layers as a single piece, giving kind of a smoother, longer lasting and unpulled look.

Bri (08:48):
So speaking of different techniques for doing facelifts, what's the history of the techniques?

Dr. Chao (08:55):
So the early facelifts just tightened the skin, and then they discovered the SMAS and the results started to get better when surgeons started going underneath the SMAS. That was in the seventies that it got discovered. And then in the nineties, surgeons started to release key ligaments in the face, and that was kind of the birth of the deep plane facelift that we use today. So when we talk about deep plane, it's really like a natural glide plane that's just under the SMAS and right above the facial nerves. And when you get into it, well, it can be bloodless, obviously you have to know the anatomy and it demands a lot of experience and expertise to get into it. But yeah, when you do, it's a really smooth recovery and patients look very natural afterwards.

Bri (09:39):
We love that. So are patients in their thirties getting the deep plane or are they doing, you think more of just just a little skin tightening or are they getting that SMAS pulled up?

Dr. Chao (09:51):
So I get young patients who are like, I want a mini facelift, which to me, mini means maybe just skin, and honestly, it's a personal preference, but I'll tell them to wait. I'll say, wait until the aging changes get more significant, and then just do it one and done when it's time, when it's your time, I think it's a little much to be doing these little mini lifts every few years. And surgery is, it's gotten a lot better, but it still incurs risks. You're risking scarring and asymmetry and the facial nerve being nearby. So I feel like the benefit has to be great for you to incur those risks.

Bri (10:38):
Those people that keep getting little small revision facelifts, how does that play into effect when they do want to go get their big, deep plane facelift? I'm really talking with my hands today guys. Does it affect it? Is it better to not do them? Does it create more scar tissue? What are your thoughts?

Dr. Chao (11:00):
Yeah, if it was just like a mini facelift, like skin only, it's usually okay. I think the question I'm always asking is the deep plane untouched? Is that glide plane under the SMAS going to be untouched? Cuz that's kind of the area where all the facial nerves and your muscles live. And so that's the area of risk. I mean, there is some risk of scarring and wound healing when you're doing any additional revision surgery, but the deep plane facelift keeps the blood vessels to the skin so well vascularized because you're going deep and you're leaving all of those little blood vessels to the skin attached. So revision surgery is fine. It's actually better to do a revision if somebody has not had a deep plane before. If somebody's already had a deep plane, it's little bit more of a risk.

Bri (11:55):
Harder to do.

Dr. Chao (11:56):
Yeah.

Bri (11:57):
So what would your ideal candidate be then? Who would get a facelift?

Dr. Chao (12:02):
One of my favorite reasons for doing deep plane facelifts is the type of people who choose it. I feel like facelift patients tend to be kind of energetic, accomplished, youthful at heart, working professionals at the top of their game, busy moms, active community members, people who kind of still feel vibrant and full of life, but they're starting to notice that their appearance doesn't really reflect how they feel on the inside. My patients will say things like, I'm not trying to look different. I still want to look like myself, just what I used to look like. And that's kind of what the deep plane facelift can deliver. It doesn't really create that tight pulled artificial look of the old facelift. It's just restoring the natural contours of your face, so you still look like you just maybe 10 or 15 years ago. I think plastic surgery in general can get a bad reputation when the results look too distorted or overdone, but I really love the deep plane technique because it respects facial identity and kind of enhances you without changing your features too much.

Bri (12:59):
We love that. Is there anyone that you would recommend not to get a facelift?

Dr. Chao (13:06):
I mean, it's a surgery, so if you're not a candidate for general anesthesia or IV sedation, I would say probably not a great idea to get a facelift. Make sure that your heart and lungs are in good condition. Patients who smoke, patients who are actively still losing weight on weight loss medication or through diet and exercise. It's good to be at a good stable weight for a while before, and then obviously before you undergo anesthesia to be off of any of the GLP-1 drugs just because it delays your stomach emptying and you can have risks of anesthesia. I'd say if you want to get a facelift, get active, get any diabetes under control because that affects wound healing, stop smoking, just try to be as healthy as possible. A good candidate is a healthy candidate, and obviously someone who has physical changes that would benefit from a facelift if you actually have heavy jowls or platysmal banding or a lot of extra skin in the face or the neck.

Bri (14:13):
And I think this goes back to I've touched on before is we are a cosmetic office. It's an elective surgery, and there is no point of doing surgery on someone that is not a good candidate. If you are not healthy, if you are taking certain meds, there is no point. It's not an emergency. We'd love to see you. But

Dr. Chao (14:30):
Yeah, and I have had patients before too who maybe came to me initially and weren't a candidate, but then they really significantly changed their lifestyle and they got that hemoglobin A1C down, or they started working out more, or they got off of the GLP-1 and got to a stable healthy weight. So it's still possible to get there.

Bri (14:53):
So with a facelift, is the neck generally involved or where, I know neck lift facelift, how do they intertwine?

Dr. Chao (15:04):
So that's a good question. For me, I always, almost always do the neck with the face, and I do that. I kind of treat them all as one unit. So the SMAS is connected to the platysma, which is the muscle in the face and neck, and I treat them as a unit. So I feel like a good neck lift means a good facelift. You kind of pull everything up together just like gravity pulls it all down together. So just trying to reverse those changes. So yeah, I think in general, but I mean, everybody's got their individual concerns. Some people are more worried about their neck, others are more worried about their midface, so we'll always tailor it to be what each patient wants.

Bri (15:52):
And I've seen her do, I think it's pretty cool when we do some facelifts, she really, when she makes her incisions, she'll be like, oh, well, this patient's more worried about this, so we're going to start incision here and we're going to pull up and then focus on that. It's very lots of intricate details that I would've had no idea, and I'm like, oh, wow. That's cool.

Dr. Chao (16:11):
Thanks, Bri.

Bri (16:11):
Yeah, phenomenal. Speaking of incisions, where are the incisions for a facelift neck lift?

Dr. Chao (16:17):
So they're always around the ears, so in front of the ear and behind the ear. In most women, I go behind the tragus, which is that little cartilage in the front of the ear, and sometimes they go into the hairline in the temple area. So right in front of that tuft there. If you wear your hair really short or for males, it'll go behind that temporal hair tuft and then a little bit into the back of the hairline, near the neck as well, and then occasionally a little incision under the chin.

Bri (16:53):
Do you have any suggestions for somebody who really wants a facelift, what it was like? I'm so worried about the incisions. What would you tell them?

Dr. Chao (17:01):
I would tell them that the incisions look like little slivers after several months. I mean, as long as you don't have a history of keloid or hypertrophic scars in your past, most people you can't even tell the incision is there after months. Now, of course, in the beginning you can see them, they're a little bit pink, they're a little bit bumpy, and it takes about six months to a year for any incision to kind of fade to its final state. But by that time, I mean, most people, you can't even tell that it's there.

Bri (17:37):
And then how do you avoid that very overdone wind swept really tight look?

Dr. Chao (17:46):
Yeah, so I would say that that look comes from just pulling on the skin itself for one. And the second thing is pulling horizontally instead of vertically. So I avoid it by putting the tension on the deeper layer and not on the skin, the SMAS and platysma, and just letting the skin drape naturally, and then also going in a more vertical vector rather than going horizontally.

Bri (18:13):
Yeah, that makes sense.

Dr. Chao (18:15):
Yeah, Bri, as she

Bri (18:17):
Here, I sit here in all the podcasts and I'm like, huh, interesting.

Dr. Chao (18:22):
I know. Doing this makes me do it too. I'm like, oh, wow. What?

Bri (18:25):
I know. Sometimes I do it. I'm like, oh, that's not for me.

Dr. Chao (18:29):
And then I'm like, okay, your time will come. I know it'll come, and I know who will do it when it does come, but

Bri (18:36):
I know I've been asking her to do so many things. One day she's going to say yes. So if somebody wanted to take a look at your before and afters for facelifts. Where could they look? Website, Instagram?

Dr. Chao (18:49):
So you can follow me on instagram @drjanetchao.md. I'm always trying to share new cases there, especially on stories I'll admit I'm much better posting to stories than I am to the main grid, but I'm working on that. I share a lot of before and afters during the consult because people, I always have full patient consent, and some people don't want them online. They just want them. They're okay with sharing them in office, but not online. So the best place to see them is during a consultation. And then obviously, go to restoresdplasticsurgery.com and follow us at Restore SD plastic surgery for more. If you're listening today and have questions, need info about scheduling, financing, reviews, or photos, check the show notes for links. Scrubbing in.

Bri (19:38):
And scrubbing out.

Dr. G (19:40):
If you're listening today and have questions, need info about scheduling, financing, reviews, or photos, check out the show notes for links. Restore SD Plastic Surgery is located in La Jolla, California. To learn more about us, go to restoresdplasticsurgery.com or follow us on Instagram @restoreSDplasticsurgery. If you enjoyed this episode, please share it and subscribe to All the B's on YouTube, apple Podcasts, Spotify, or wherever you like to listen to podcasts.