The Detailed Anatomy of the Deep Plane of the Face and Neck with Current Nomenclature

Abstract

The fundamental goal of modern face and neck lifting is to enhance and restore a more youthful facial appearance by addressing soft tissue descent. There are variations in described facelift technique including superficial musculoaponeurotic system (SMAS) flaps, composite flaps, deep plane, skin flaps, and subperiosteal facelifts, among others. The term “deep plane rhytidectomy” was originally described by Hamra. This term has since been linked with facelift surgery with recent advances including incision placement, treatments of SMAS–platysma complex, and mastoid crevasse among others. In the lead authors' experience, using deep plane techniques have demonstrated superior facial surgical rejuvenation results with less dependence on ancillary measures such as fat grafting or implantation for midface volumization. In order to successfully perform any face or neck lift, it is key to understand the relationship of the skin, the fat compartments, and the ligamentous attachments. This chapter details the anatomy of the deep plane of the face and neck and explains some nuances as it relates to surgical lifting. We also describe recent anatomical revelations of the mandibular ligament and its management in deep plane face lifting. In this chapter, given this opportunity to share personal experiences and preferences, the authors hope to describe relevant anatomy for the deep plane and provide some clarity on the merits of deep plane face and neck lift technique.

Keywords

deep plane - face lift - neck lift - rhytidectomy - SMAS

Publication History

Accepted Manuscript online:
14 February 2024

Article published online:
15 March 2024

• References

• 1 Mitz V, Peyronie M. The superficial musculo-aponeurotic system (SMAS) in the parotid and cheek area. Plast Reconstr Surg 1976; 58 (01) 80-88
• 2 Talei B, Shauly O, Marxen T, Menon A, Gould DJ. The mastoid crevasse and 3-dimensional considerations in deep plane neck lifting. Aesthet Surg J 2024; 44 (02) NP132-NP148
• 3 Jacono AA, Talei B. Vertical neck lifting. Facial Plast Surg Clin North Am 2014; 22 (02) 285-316
• 4 Jacono AA, Parikh SS. The minimal access deep plane extended vertical facelift. Aesthet Surg J 2011; 31 (08) 874-890
• 5 Tellioğlu AT, Tekdemir I, Erdemli EA, Tüccar E, Ulusoy G. Temporoparietal fascia: an anatomic and histologic reinvestigation with new potential clinical applications. Plast Reconstr Surg 2000; 105 (01) 40-45
• 6 Hamra ST. The deep-plane rhytidectomy. Plast Reconstr Surg 1990; 86 (01) 53-61 , discussion 62–63
• 7 Jacono AA, Ransom ER. Patient-specific rhytidectomy: finding the angle of maximal rejuvenation. Aesthet Surg J 2012; 32 (07) 804-813
• 8 Alsarraf R, Johnson Jr CM. The face lift: technical considerations. Facial Plast Surg 2000; 16 (03) 231-238
• 9 Minelli L, van der Lei B, Mendelson BC. The superficial musculo-aponeurotic system (SMAS): does it really exist as an anatomic entity?. Plast Reconstr Surg 2024; 153 (05) 1023-1034
• 10 Alghoul M, Codner MA. Retaining ligaments of the face: review of anatomy and clinical applications. Aesthet Surg J 2013; 33 (06) 769-782
• 11 Furnas DW. The retaining ligaments of the cheek. Plast Reconstr Surg 1989; 83 (01) 11-16
• 12 Bosse J, Papillon J. Surgical anatomy of the SMAS at the malar region. In: Transactions of the IX International Congress of Plastic and Reconstructive Surgery. New York, NY: McGraw-Hill; 1987: 348-349
• 13 Ozdemir R, Kilinç H, Unlü RE, Uysal AC, Sensöz O, Baran CN. Anatomicohistologic study of the retaining ligaments of the face and use in face lift: retaining ligament correction and SMAS plication. Plast Reconstr Surg 2002; 110 (04) 1134-1147 , discussion 1148–1149
• 14 Minelli L, Yang HM, van der Lei B, Mendelson B. The surgical anatomy of the jowl and the mandibular ligament reassessed. Aesthetic Plast Surg 2023; 47 (01) 170-180
• 15 Mendelson BC, Freeman ME, Wu W, Huggins RJ. Surgical anatomy of the lower face: the premasseter space, the jowl, and the labiomandibular fold. Aesthetic Plast Surg 2008; 32 (02) 185-195
• 16 Surek CC, Moorefield A. Deep plane anatomy for the facelift surgeon: a comprehensive three-dimensional journey. Facial Plast Surg Clin North Am 2022; 30 (02) 205-214
• 17 Sykes JM, Riedler KL, Cotofana S, Palhazi P. Superficial and deep facial anatomy and its implications for rhytidectomy. Facial Plast Surg Clin North Am 2020; 28 (03) 243-251
• 18 Talei B, Ziai H. PHAT lips and PHAT face: platelet hybridized adipose therapy for superficial musculoaponeurotic system and dermal rejuvenation. Facial Plast Surg 2023; (e-pub ahead of print).
• 19 Ash C, Dubec M, Donne K, Bashford T. Effect of wavelength and beam width on penetration in light-tissue interaction using computational methods. Lasers Med Sci 2017; 32 (08) 1909-1918