The deep-plane facelift you often see on social media. But does this really suit us Asians?
On social media and in overseas beauty information, the chances of seeing the term "deep-planefacelift" are increasing. Hollywood celebrities are also said to undergo this technique, butcan a technique developed for Westerners be applied as is to the Asian face?
In fact, there is research data that reported 600 cases. It verifies how it should be adapted to the characteristics of the Asian face, and the actual anatomical differences and endoscopic approach.
For those who have questions like "I'm interested in afacelift, but does it suit me as a Japanese person?" and "What if the scars are conspicuous?", there is research data we want you to know.
What is the deep-plane method? The difference from conventional techniques
There are several facelift techniques, and they are broadly divided as follows.
- Skin-only elevation: a method of pulling only the skin. Reversion is fast and it tends to be unnatural
- The SMAS method: a method of operating on the SMAS layer (superficial fascia) beneath the skin. The current standard technique
- The deep-plane method: a method of dissecting to an even deeper layer than the SMAS, severing the ligaments, and moving the tissue three-dimensionally
The feature of the deep-plane method lies in the point oflifting the skin and the deep tissue as one. Because excessive tension is not applied to the skin, the scar is hard to notice, and a natural result can be expected. However, there are individual differences in the effect.
The 3 facial characteristics peculiar to Asians — the effect these have on surgery
In the report byWong et al.[1], the anatomical considerations when applying the deep-plane method to Asians are described in detail. This study emphasizes the necessity of further accumulation of cases and long-term verification going forward.
1. The thickness and texture of the skin
Asian facial skin tends to havethick skin and a lot of subcutaneous fatcompared with Westerners. While thick skin tends to maintain blood flow, on the other hand the way the lifting force is transmitted differs, so a more careful dissection technique becomes necessary.
2. The difference in bone structure
The Asian facial bone structure tends to havelittle protrusion of the cheekbones and a flat midface. Techniques for Westerners use the height of the cheekbones to produce the lifting effect, but in Asians there are cases where this premise does not hold.
3. The pattern of aging change
Whereas Westerners have wrinkle-centered signs of aging, in Asianssagging and the descent of volumetend to be conspicuous. Not just simply lifting, but an approach that adjusts the position of the lost volume becomes important.
Safety and points to note, seen in the 600-case report
The 2024 report byKao et al.[2]summarizes the long-term outcomes of600 casesof endoscopic deep-plane facelift over 22 years by a single operator. This technique is also sometimes called by the nickname "ponytail lift."
The occurrence of the main complications reported in this retrospective study[2]is as follows.
- Flap necrosis (necrosis of skin tissue): 0/600 cases (0%)
- Permanent facial nerve injury: 0/600 cases (0%)
- Transient facial nerve palsy: occurred in a small number of cases, but all reportedly recovered
This report shows a result of a low incidence of serious complications, but it should be noted that this is a result at a single facility by a specific skilled operator. In general, facelifts can have complications such as hematoma, infection, skin necrosis, nerve disorders (facial nerve palsy or sensory dullness), scarring, and hair loss. Because these risks vary depending on the operator, the facility, and the patient's health condition, one cannot conclude from this data that "this technique is safe."
A heart-shaped face — a result matched to the Asian ideal
In the study byKao et al.[2], an endoscopic technique specialized for Asians is explained in detail.
Whereas the Western facelift aims at a sharp jawline and the emphasis of high cheekbones, in the Asian aesthetic sensea "heart-shaped (inverted-triangle)" facetends to be preferred.
In the deep-plane method for Asians, the following devices are employed.
- Repositioning the volume of the midface upward and creating fullness at a high position on the cheek
- Lifting the sagging of the lower face and shaping the jawline
- Avoiding excessive lifting and leaving a natural roundness
- Combining fat injection as needed to replenish volume
To the worry that "won't it become unnatural from pulling too much," in a procedure that takes into account Asian anatomy and aesthetic sense, risk reduction is sought by avoiding excessive lifting. However, this does not completely eliminate risk, and postoperative swelling, asymmetry, scarring, changes in sensation, and a difference from the expected effect may still arise.
In the report byWong et al.[1], it is also stated that for Asian patients, by operating with a more restrained vector (the direction and force of lifting) compared with Westerners, a natural result and high satisfaction were obtained. This suggests that a "not overdoing it" approach may, in the end, lead to a good result.
The merits and limits of an approach using an endoscope
In some deep-plane methods, an endoscope (a camera) is used together. This makes it possible tooperate while viewing the deep structures magnified on a monitor through a limited incision.
Using an endoscope, the following merits and limits are reported.
[Points reported as merits]
- Because the surgical field can be viewed magnified, it may become easier to identify nerves and blood vessels
- It may be possible to limit the incision to an inconspicuous site such as within the hairline
- Through an accurate approach to the deep tissue, excessive tension on the skin is said to be avoidable
[Limits and points to note]
- It is not indicated for all cases
- The operator's advanced technique and proficiency are indispensable, and the learning curve is long
- The surgery time may be prolonged
- Even using an endoscope, the risk of complications such as hematoma, infection, and nerve injury does not become zero
In the report byKao et al.[2], it is suggested that using an endoscope may have contributed to an improvement in safety, but this also greatly depends on the operator's abundant experience. Rather than judging the superiority of a technique by the presence or absence of endoscope use alone, it is important to comprehensively consider the physician's technique and experience and whether it is a method suited to your own condition.
Downtime and the postoperative course
In considering a deep-plane facelift, the downtime (recovery period) is also a point you want to know.
1 to 2 weeks after surgery
is the period when swelling and bruising are most conspicuous. Realistically, you should refrain from making plans to meet people. The pain is considered to be within a range controllable with analgesics.
2 to 4 weeks after surgery
The swelling gradually subsides, and in many cases it becomes a level that can be hidden with makeup. Many people can resume light activities such as desk work.
1 to 3 months after surgery
The remaining swelling and numbness settle. The final result is appropriately evaluated 3 to 6 months later. With a minimally invasive approach using an endoscope, the downtime tends to be shorter compared with the conventional incision method.
Because there are individual differences in the postoperative course, it is important to return to daily life at a reasonable pace while following the attending physician's instructions.
Conclusion: the importance of understanding the technique and choosing the physician
The deep-plane facelift is an advanced technique that processes the ligaments and repositions the tissue from the deep layer. Especially in the case of Asians, an approach that takes into account bone structure and skin characteristics different from Westerners is required.
The research report introduced in this article[2]suggests a good safety profile under specific conditions, but this cannot be generalized. All facelift surgeries are accompanied by the following potential risks.
- Common complications:hematoma, infection, skin necrosis, scarring, hair loss
- Nerve-related:facial nerve palsy (transient or permanent), dullness of the sensory nerves
- Aesthetic problems:asymmetry, unnatural pulling, a difference from expectations
The final result is greatly governed not only by the technique itself but also by the surgeon's anatomical knowledge, technique, and aesthetic sense. Accurately diagnosing your own wishes and anatomical characteristics, receiving sufficient explanation about both the merits and limits, and choosing a trustworthy physician are most important.
If there is anything that concerns you, please feel free to consult us first. At Zetith Beauty Clinic, we provide consultation based on medical grounds.
Author of this article
Hiromitsu Nakamura Physician
Zetith Beauty Clinic Ginza, Osaka, Fukuoka
He has a track record of research presentations at domestic and international academic conferences, and is also engaged in technical guidance and education for Zetith Beauty Clinic as a whole. He specializes in precise rhinoplasty based on anatomical grounds, pursuing natural results tailored to each person's bone structure and tissue.
References
- Wong C, Hsieh M, Mendelson B. Deep Plane Face Lift in Asian Patients. Plastic & Reconstructive Surgery. 2025 (DOI)
- Kao C, Duscher D. The Ponytail Lift: 22 Years of Experience in 600 Cases of Endoscopic Deep Plane Facial Rejuvenation. Aesthetic Surgery Journal. 2024 (DOI)
- Kao C, Duscher D. Advanced Endoscopic Techniques in Asian Facial Rejuvenation. Clinics in Plastic Surgery. 2023 (DOI)
If you find yourself thinking, "What about my case?"
Book a free consultation
There is no pushy sales. Please feel free to get in touch.