Deep Plane Lift in East Paris
Aesthetic Surgery Pr Meningaud
Facelifts today
Facelifts have become conservative, i.e. tissue-friendly, removing less skin or fat. In extreme cases, no skin is removed at all; reconstituting lost volumes is sufficient.
At last, neck plastic surgery has become permanently effective, with predictable results. It took a lot of trial and error to achieve this result. We can now restore a graceful neck, guaranteeing a 90 to 110° angle between the neck and the face without removing any skin.
The mid-facial area is now taken into account. Maxillofacial surgery has also made it possible to accentuate the rejuvenation of certain areas through actions on the bones of the face, either through bone cuts known as osteotomies, or through small associated prostheses, to enhance the cheekbones or erase nasolabial folds that are resistant to injection techniques.
Deep Plane Lifting in East Paris
Maxillofacial Surgeon Paris Est Créteil
How does a facelift work?
A facelift is a three-dimensional work of art. Aging is accompanied by a loss of volume, particularly in the cheekbones, creating what is poetically known as the “valley of tears”. With age, deep wrinkles appear in the nasolabial folds. A little lower down, fat accumulates in the lower cheeks. Finally, under the chin, fat accumulates over the years. For each patient, therefore, a specific strategy must be defined, aimed at reconstituting certain volumes and erasing others. The surgeon has several weapons in his therapeutic arsenal.
Centrofacial lifting
The centrofacial facelift is a particularly effective way of removing fat. This involves lifting the entire area between the eyelids and the upper lip, with strong attachments to the lower orbital rim. Surgery can also treat fat directly by removal or addition. With a good knowledge of anatomy, the submental region or areas once considered delicate, such as the jowls, can be suctioned. In this region, the facial nerve is in close proximity, but a good knowledge of the planes and correct orientation of the suction cannula make the procedure safe.
Botox injections
At an early stage, botulinum toxin injections can be used for correction. A more effective and definitive correction can be achieved by sectioning or lengthening certain muscle fibers. Three main areas are concerned: the anterior edge of the neck’s skin muscle, the glabella where frown lines are located (between the eyebrows), and the area below the corner of the lips where bitterness folds appear. Several techniques are available, some of them minimally invasive by endoscopy. Appropriate instrumentation has been developed. Other muscles, on the other hand, tend to relax. Dissection of the muscular plane, known as SMAS (Système Musculo Aponévrotique Superficiel – Superficial Musculoaponeurotic System), reduces the extent of skin dissection, and is therefore both more effective and less traumatic.
Professor Jean-Paul Meningaud
Deep Plane lift in East Paris
A short history of facelifts
When I was a student, facelifts consisted solely of lifting and pulling the skin. The scars were considerable. Patients had long and difficult after-effects. Their faces looked drawn. It was difficult to hide the fact that they’d had a facelift. Under the pressure of aesthetic medicine, facelifts have become less and less invasive and, above all, more effective. The real effect of a facelift was barely three years. It had to be shown that much more could be achieved in terms of rejuvenation with short follow-up periods compatible with an active professional life.
Facelifts have become more democratic, and are therefore mainly aimed at working people. Patients must be able to recover within a fortnight at most. The modern facelift aims to minimise scars, and in all cases to make them unnoticeable. It takes into account the ageing of the skin itself. The aim is not simply to tighten withered skin, but to restore its youthfulness. The work is three-dimensional. We no longer want these drawn, flat faces with no relief. We have to work with volumes, erasing some and recreating others. A great deal of work is now done on the muscles themselves, and not just on the skin. It is no longer the skin that bears the strain of the facelift, but the muscular plane. In addition, a better understanding of facial ageing has made it possible to consider tightening certain muscle fibers, while relaxing others, sometimes within the same muscle, such as the skin muscle of the neck.
Facelifts today
Facelifts have become conservative, i.e. tissue-friendly, removing less skin or fat. In extreme cases, no skin is removed at all; reconstituting lost volumes is sufficient. At last, neck plastic surgery has become permanently effective, with predictable results. It took a lot of trial and error to achieve this result. We can now restore a graceful neck by guaranteeing a 90 to 110° angle between the neck and the face, without removing any skin. More on this later. The mid-facial area is now taken into account. Maxillofacial surgery has also made it possible to accentuate the rejuvenation of certain areas through actions on the bones of the face, either through bone cuts known as osteotomies, or through small associated prostheses, to enhance the cheekbones or erase nasolabial folds that are resistant to injection techniques.
Several advances have made this possible. Previously, scars were simply hidden in the hair and in a crease in front of the ear. But as the facelift was essentially based on skin traction, the scars ended up enlarging and becoming visible, prohibiting certain hairstyles. They often gave the appearance of earlobes pulled downwards, thus modifying the anatomy of the ear and marking the facelift for good. Today, facelifts are no longer considered to be based on skin tension. Once certain muscles have been re-tensioned (and others relaxed), the skin should be applied without tension.
In addition, a significant part of the scar may be hidden inside the ear in the external auditory canal. A new suturing technique called trichophytic suturing makes scalp scars invisible, allowing hair to grow back through them[1]. We owe this advance to a South Korean hair surgeon I had the opportunity to visit in 2015 at his institute in Seoul, Dr. Dae Young Kim. Finally, a recent innovation from Brazil reduces the risk of haematomas to almost zero, while dispensing with drains and considerably reducing the after-effects[2].
Ageing skin
Facelifts have become conservative, i.e. tissue-friendly, by removing less skin or fat. In extreme cases, no skin is removed at all, and the reconstitution of lost volumes is sufficient. At last, neck plastic surgery has become permanently effective, with predictable results. It took a lot of trial and error to achieve this result. We can now restore a graceful neck by guaranteeing a 90 to 110° angle between the neck and the face, without removing any skin. More on this later. The mid-facial area is now taken into account. Maxillofacial surgery has also made it possible to accentuate the rejuvenation of certain areas through actions on the bones of the face, either through bone cuts known as osteotomies, or through small associated prostheses, to enhance the cheekbones or erase nasolabial folds that are resistant to injection techniques.
Several advances have made this possible. Previously, scars were simply hidden in the hair and in a crease in front of the ear. But as the facelift was essentially based on skin traction, the scars ended up enlarging and becoming visible, prohibiting certain hairstyles. They often gave the appearance of earlobes pulled downwards, thus modifying the anatomy of the ear and marking the facelift for good. Today, facelifts are no longer considered to be based on skin tension. Once certain muscles have been re-tensioned (and others relaxed), the skin should be applied without tension.
In addition, a significant part of the scar may be hidden inside the ear in the external auditory canal. A new suturing technique called trichophytic suturing makes scalp scars invisible, allowing hair to grow back through them[1]. We owe this advance to a South Korean hair surgeon I had the opportunity to visit in 2015 at his institute in Seoul, Dr. Dae Young Kim. Finally, a recent innovation from Brazil reduces the risk of haematomas to almost zero, while dispensing with drains and considerably reducing the after-effects[2].
Deep plane facelift: the salivary glands
Another recent advance in facial rejuvenation is the treatment of the salivary glands. It involves the ageing of the salivary glands. We have four main glands: the two parotid glands and the two submandibular glands. With age, they tend to hypertrophy and ptosis.
This, of course, varies from one person to another, but is always encouraged by iterative weight gain/weight loss. Hypertrophy of the parotid glands tends to result in a “pear-shaped” face. Previously, treatment was complex, requiring surgery that risked damaging the facial nerve.
A much simpler, and highly effective, alternative is to plicate the fascia covering the gland. In the case of submandibular glands, it is essential to diagnose hypertrophy and ptosis prior to facelift surgery.
Otherwise, once the neck has been trimmed and the muscles re-tensioned, the glands may paradoxically appear much more prominent. If they are enlarged, they should be partially removed. This is now a well-codified and safe technique. If they are simply ptosis, they can be secured upwards.
Les résultats des liftings
Illustrative drawings by the author aimed exclusively at understanding the targets of rejuvenation surgery (non-contractual, these are drawings only).
Publications
[1] Kim CK, Kim DY, Kim JY. Asymmetric dermal-subdermal suture in trichophytic closure for wide hair transplantation donor wound. Dermatol Surg. 2013;39(7):1124-1127.
[2] Auersvald A, Auersvald LA. Hemostatic net in rhytidoplasty: an efficient and safe method for preventing hematoma in 405 consecutive patients. Aesthetic Plast Surg. 2014;38(1):1-9.
[3] Le Dr Vladimir Mitz est le premier à avoir décrit le SMAS (système musculo aponévrotique superficiel) qui a révolutionné la prise en charge des liftings. The Superficial Musculo Aponeurotic System (Smas) In The Parotid And Cheek Area. Mitz, Vladimir, Peyronie, Martine Plastic and Reconstructive Surgery: July 1976 – Volume 58:80-88.
[4] Coleman SR. Long-term survival of fat transplants: controlled demonstrations. Aesthetic Plast Surg. 1995;19(5):421-425.
[5] Coleman SR. Structural fat grafting. Aesthet Surg J. 1998;18(5):386-388.
[6] Barbara Hersant, Jonathan Bouhassira, Mounia SidAhmed-Mezi, Luciano Vidal, Mayoura Keophiphath, Barbara Chheangsun, Jeremy Niddam, Romain Bosc, Aurelie Le Nezet, Jean-Paul Meningaud, Anne Marie Rodriguez. Should platelet-rich plasma be activated in fat grafts? An animal study. J Plast Reconstr Aesthet Surg. 2018;71(5):681-690.
Questions often asked by patients about the deep plane lift
Aesthetic Surgery in Paris Est Créteil
What is a deep plane facelift?
A deep plane facelift is a facelift technique that targets the deeper layers of the skin and muscles, offering more natural and longer-lasting results than traditional techniques.
How does it differ from a traditional facelift?
Unlike a traditional facelift, which primarily tightens the skin, the deep plane facelift also adjusts the underlying muscle structures, reducing tension on the skin and improving aesthetic results.
What are the main benefits of a deep plane facelift?
Benefits include more natural results, better definition of facial contours, longer lasting results, and less visible tension on the skin.
Who is a good candidate for a deep plane lift?
Good candidates are generally those with moderate to severe sagging of the skin of the face and neck, who are looking for a significant and lasting improvement.
What is the recovery time after a deep plane lift?
Recovery can take from two to four weeks, during which time patients may experience swelling and bruising, but normal activities can often be resumed after two weeks.
Is the deep plane lift painful?
Patients may experience some discomfort, especially in the first few days after surgery, but the pain is generally manageable with medication prescribed by the surgeon.
What risks are associated with this procedure?
As with any surgery, there are risks such as infection, reactions to the anaesthetic, bleeding, abnormal scarring and changes in skin sensation.
How long do the results of a deep-plane lift last?
Results can last from ten to fifteen years, depending on individual factors such as the patient’s age, skin type and lifestyle.
Can the deep plane lift be combined with other procedures?
Yes, it is often combined with other procedures such as blepharoplasty (eyelid surgery) or a temporal lift to maximise aesthetic results.
How do I choose a qualified surgeon for a deep plane facelift?
It is crucial to choose a plastic surgeon with specific experience in deep-plane lift techniques.
What is the difference between a deep plane lift and a mini-lift?
A deep plane facelift is more comprehensive and targets deeper layers of the face for more pronounced rejuvenation, while a mini-lift targets specific areas with less invasiveness and faster recovery.
Can the results of a deep plane lift be seen immediately?
No, the final results are generally only visible after swelling and bruising have subsided, which can take several weeks.
Does the deep plane lift leave visible scars?
All surgery leaves scars, but deep plane lift scars are usually well hidden in the natural contours of the face and behind the ears, making them less visible.
How should patients prepare for a deep plane lift?
Patients should avoid smoking, certain medications and alcohol before surgery. Good nutrition and adequate hydration are also important to promote healing.
What type of anaesthetic is used during a deep-plane lift?
The procedure is generally performed under general anaesthetic, although in some cases local anaesthetic with sedation may be used.
Can a deep plane lift correct facial asymmetries?
Although it can improve the overall balance of the face, the deep plane lift is not specifically designed to correct major asymmetries.
Is there any specific care to follow after a deep plane lift?
Yes, post-operative care may include using cold compresses to reduce swelling, taking anti-inflammatory and antibiotic medication, and following the surgeon’s specific instructions for wound care.
When can patients return to work after a deep plane lift?
Most patients can return to work approximately two to four weeks after surgery, depending on the nature of their job and individual healing rates.
Does the deep plane lift affect facial expressions?
When performed correctly, a deep plane facelift should preserve or even enhance natural facial expressions, avoiding the ‘pulled’ look that some less advanced techniques can produce.
What is the average cost of a deep-plane lift?
The cost can vary considerably depending on the geographical region, the surgeon’s experience and the complexity of the procedure, but it is generally higher than that of less invasive facelifts due to its complexity and superior results.
How long does the deep-plane lift operation last?
The operation generally lasts between three and six hours, depending on the extent of the areas treated and the specific techniques used by the surgeon.
Is the deep plane facelift recommended for men and women?
Yes, this technique is suitable for both men and women who are looking to achieve deep and lasting facial rejuvenation.
Can a deep plane lift be repeated several years after the first one?
Yes, a second deep plane lift can be performed several years after the first if the patient wishes to refresh the results, taking into account the natural progression of ageing.
What precautions should be taken after a deep plane lift to maintain the results?
It is recommended to maintain rigorous sun protection, eat a healthy diet, stay hydrated, avoid smoking, and follow a suitable skin care regime to prolong the results.
Is a deep-plane lift covered by insurance or considered a cosmetic procedure?
If the purpose is therapeutic (facial asymmetry, after-effects of paralysis, etc.), partial coverage may be available.
What are the signs of a complication after a deep plane lift?
Signs include excessive bleeding, infections, severe reactions to stitches, abnormal scarring, and prolonged changes in skin sensation.
How do the results of a deep plane facelift compare with those obtained with fillers or Botox?
The results of a deep plane facelift are more complete and long-lasting because the procedure repositions the deep tissues and improves the overall structure of the face, unlike fillers and Botox, which are temporary and target specific problems such as wrinkles.
What kind of follow-up is required after a deep plane lift?
Regular follow-up with the surgeon is necessary to assess healing and post-operative adaptation. Follow-up visits are generally scheduled after one week, one month and then annually.
Can the deep plane lift be performed on an outpatient basis?
Yes, if it is not combined with other procedures and the case is simple, this procedure can be performed on an outpatient basis, which means that the patient can go home the same day as the operation, depending on his or her general state of health and the surgeon’s recommendations.
How do you manage expectations of results after a deep-plane lift?
It is important that patients have open and realistic discussions with their surgeon about expected results, understanding that surgery is intended to improve appearance and not to completely change the face.
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