Facelift planes and vectors — What is raised, which way it is pulled and why
From mini-lift to deep plane, plication versus imbrication, why the biplanar technique was abandoned, the exact angle of each vector and the surgical sequence step by step.
Content intended for healthcare professionals. It does not replace clinical assessment and is not written as patient information.
Key points
- Techniques differ not by name but by two decisions: which layer is mobilised and whether the ligaments are released. Everything else is variation.
- The vertical vector replaced the horizontal one for a specific reason: the horizontal pushes the commissures backwards and produces a marionette mouth.
- The angles are not arbitrary: SMAS at 60 and platysma at 80 degrees to the horizontal through the tragus. The 60-degree vector is found simply by following the direction of zygomaticus major.
- The skin has no vector of its own: it is repositioned passively and closed without tension. The SMAS bears the tension.
- The accumulated evidence: the deep plane gives higher satisfaction but also more complications than SMAS techniques.
The spectrum of techniques
| Technique | What it does | For whom and with what limits |
|---|---|---|
| Mini-lift or short-scar facelift | Preauricular incision with minimal S-shaped retroauricular extension. The SMAS is not raised and the ligaments are not released: only plication or imbrication of the SMAS onto itself. The neck is not accessed | Under 50 without major medial descent. It does not eliminate the nasolabial fold or the prejowl sulcus. All tension falls on skin: higher risk of necrosis, a pulled look and early relapse, of the order of 5 years |
| Lower third and neck lift | S-shaped incision without temporal extension plus a submental incision. Deep plane limited to the lower third and neck | Younger patients with cervical laxity and little midface problem. Limited jowl repositioning |
| Deep plane | A composite flap of skin, subcutaneous tissue, SMAS and platysma is raised, and the retaining ligaments are released before traction | It is what corrects the grooves, because it acts on the mobile SMAS and not only the fixed one. Short- and long-term results |
Plication and imbrication are not synonyms
| Plication | Imbrication | |
|---|---|---|
| What is done | Suture the SMAS onto itself, without opening or dissecting it | Suture the already dissected SMAS flap in the deep plane |
| Resection | No resection needed | The supraparotid preauricular portion must be resected in a crescent |
| Where it is used | Mini-lift | Deep plane facelift |
| Durability | Short term | Short and long term |
Why the biplanar technique was abandoned
For years skin and SMAS were dissected separately and resuspended with independent vectors. The rationale was a reasonable hypothesis: that skin ages horizontally while the SMAS-platysma complex ages vertically, so each layer should be treated in its own direction. Results disproved the hypothesis. The biplanar technique produced a set of recognisable effects — a laterally swept skin deformity, distorted commissures, early cervical relapse and poor volume repositioning — which led to the combined technique: a single flap of skin, subcutaneous tissue, SMAS and platysma is raised and resuspended along one single vector.
The four effects that gave the biplanar facelift away
- Laterally swept skin deformity: the look of skin pulled towards the ear, recognisable from a distance.
- Doll-like or Joker commissures, precisely because the skin was tensioned horizontally.
- Early cervical relapse, from poorer skin adjustment in the neck.
- Failure of volume repositioning: the skin moved but not the block that gives shape.
The vector: horizontal versus vertical
| Horizontal vector | Vertical vector | |
|---|---|---|
| Direction | Towards the earlobe | Upwards, along the so-called angle of maximal rejuvenation |
| What it does to the commissure | It pushes it backwards: marionette mouth | It pushes it upwards |
| What it restores | Little: it tightens without repositioning | The cheek, which is volume, and the jawline, which is definition |
| Relapse | Jowl relapse from insufficient submental tension, sometimes within a year | It maintains submental tension and cervicomental angle definition |
The angles, and how to find them
- Suspension is always performed at 60-70 degrees to the horizontal through the tragus.
- That angle need not be measured: it is obtained by following the direction of zygomaticus major, the anatomical reference for the vector.
- Usual distribution: SMAS at 60 degrees, platysma at 80 and skin passive, which ends up around 50-60 degrees in a combined facelift.
- The first suspension suture goes at the gonial angle, joining SMAS-platysma to the mastoid fascia or, failing that, to the supraparotid SMAS.
The vector adapts to the gland
The repositioning vector should vary with submandibular gland ptosis, which determines whether the jawline can be left clean. There are two legitimate, opposing positions on what to do with the gland, and both are worth knowing: some authors advise against resection because it can create unaesthetic submandibular concavities, and others perform partial resection in virtually all patients. The practical consequence is that the decision is made beforehand, by palpation at examination, and it conditions the design: without glandular ptosis, the platysmal incision is more anterior with about 2 cm of subplatysmal dissection and the point of maximal tension at the mandibular ligament; with ptosis, the incision is at the posterior platysmal insertion, with up to 4 cm of dissection to the facial vessels and two points of maximal tension, at the mandibular ligament and the cervical angle.
The mastoid crevasse: why the platysma is fixed to bone
Platysmal resuspension has two requirements: that it be vertical — hence the 80 degrees — and that it be fixed, that is, anchored to a point that does not give. The described technique consists of separating the parotid tail from the mastoid process — partially reducing it if needed, always preserving the capsule — in order to suspend the platysmal flap directly to the mastoid periosteum. This achieves four things: it creates a fulcrum at the mandibular angle that increases platysmal tension, it ensures the platysma sits vertical and deeper, it compresses the parotid tail against the mastoid, and it provides a strong fixation point instead of a soft-tissue suture that gives way over time.
Marking, with the patient seated
- Volume areasMark where fat will be replaced: malar compartment, tear trough, prejowl, nasolabial and temporal
- Dissection limitsAnterior borders of sternocleidomastoid and the midline cervical line at the thyroid cartilage
- The two linesThe ligament line, from lateral canthus to mandibular angle, and Pitanguy’s line, from earlobe to 1.5 cm above the brow tail
- IncisionsSubmental incision and cervical midline, plus the S-shaped facial incision
Incisions change with sex
| Segment | In women | In men |
|---|---|---|
| Preauricular | Endoaural, with a geometric shape at the intertragal notch | Preauricular through the beard hair, so as not to drag beard into the canal |
| Cranial extension | Following the helix and hairline | The same, but with a more geometric temporal extension to preserve the sideburn shape |
| Caudal extension | Around the lobule and retroauricular, following the concha and not the sulcus | The same |
| Retroauricular | Through the triangular fossa to the occipital hairline, in an M shape | The same |
| Submental | 2 cm, better placed 2 mm caudal to the submental crease | The same |
Two incision details that change the scar
Do not bevel the blade near the hairline. The reason is that after the facelift different skins will be joined, and they need edge-to-edge, tension-free contact to heal well; bevelling does the opposite. And a warning about design: the transverse occipital incision, within the hair, limits how much cervical skin can be resected, so it is not recommended. Instead, the M-shaped retroauricular extension along the occipital hairline allows the excess to be removed without compromising the neck result.
Subcutaneous undermining
- InfiltrateTumescent, insisting on the infraorbital region and that of the zygomatic ligament: it pushes the muscles against bone and opens the plane
- Where to startThe preauricular area first and then the cervical one. Blade held facing upward to stay supra-SMAS
- How farThe supra-SMAS dissection must connect the neck with the submental space and run along the whole mandibular border, releasing the mandibular ligament, and reach the ligament line on the face
- Why so wideBecause the deep plane flap is composite: the wider the skin undermining, the more tension can be applied to the flap without loading it onto the skin
Leave fat on the skin flap
This is one of those details absent from diagrams that decides the result. When raising the skin flap, a layer of fat must be left attached to the skin rather than dissecting flush with the dermis. If it is not, two things happen: the skin looks darkened, because the underlying platysma shows through, and contour irregularities appear months later. The same principle protects against necrosis: a flap with thickness keeps its subdermal plexus. It is also why the tragal flap must be left redundant and its SMAS removed while leaving the hypodermic tissue intact, which is what it lives on.
SMAS undermining and ligament release
- Where to openSMAS incision slightly posterior to the marked ligament line, pulling the SMAS-skin complex superiorly to open it
- Order of the ligamentsOpen first at the orbicular and the masseteric, leaving the muscle deep in both, and the zygomatic last. After the first two, the prezygomatic space can be opened with the finger
- How to dissectScissors held vertically, resting on the finger of the retracting hand and pressing towards the deep plane
- How farTo zygomaticus major and the facial artery. That is the anterior limit
The plane is not exactly the one in the books
The classic description places the deep plane just above the deep fascia. In practice — and recent anatomical work has qualified this — the so-called deep plane is really subplatysmal and deep subcutaneous, and may include part of the most superficial leaf of the deep fascia. The extent of the flap depends on the surgeon and not on anatomy. Hence an operative rule that prevents most pareses: the plane should not be immediately suprafascial but slightly more superficial, one in which the nerve branches are never seen. If they come into view, you are too deep.
Repositioning: SMAS first, skin after
- Facial SMASSuspension with 3/0 absorbable monofilament to the fixed parotid SMAS, at 60 degrees, with a mattress suture in the mobile SMAS to distribute tension. Five sutures, from the gonion to the temporal SMAS
- PlatysmaSuspension with 2/0 absorbable to the mastoid periosteum, at 80 degrees, also with a mattress suture. Two fixation points
- SkinSuperoposterior repositioning at around 60 degrees, without departing much from the SMAS vector, then passive removal of the excess: the skin must not be left under tension
- Suture orderPositioning suture at the helical base → resect anterior excess → running suture in the temporal extension → suture at the angle between concha and fossa → resect posterior excess → running cervical suture → suture at the lobule → resect the rest
- If a dog ear remainsLengthen the corresponding extension — temporal or cervical — instead of forcing the closure
Closure details that prevent problems
- In the highest-tension areas, simple absorbable sutures that fall out by themselves at 3-4 weeks: they hold while needed and leave no removal marks.
- Transfixing sutures in the temporal and submandibular areas at the gonion: they eliminate dead space, reduce haematoma and seroma risk, and are removed at 3 days.
- The rule of 3 for the postoperative period: hygiene from day three, normal activity at three weeks, photographs at three months.
- The first-day dressing without compression; compression is added from the first postoperative day, after drain removal.
Where the technique is moving
- Preservation: limiting skin dissection further and maximising the composite flap, rather than undermining a lot of skin to then tension it.
- Orbicularis revectoring: including orbicularis oculi within the mobile SMAS, extending the SMAS incision over the lateral orbicularis as a continuation of the flap.
- That manoeuvre releases the orbicularis retaining ligament, dissects in the suborbicularis plane to the premaxillary and prezygomatic spaces, unherniates the SOOF and resuspends orbicularis superolaterally.
- Orbicularis paresis after these manoeuvres is practically impossible: it receives innervation from three different branches — temporal, zygomatic and buccal — so redundancy protects it.
What comparative evidence says
A recent systematic review with meta-analysis compared deep plane against SMAS techniques across 21 studies and nearly 2,900 patients, and the result is not one-sided: the deep plane achieved higher patient satisfaction — around 94 % versus 88 % — but also more overall complications, around 17 % versus 10 %. It is an uncomfortable, honest figure and deserves careful reading: it does not say one technique is better, it says more risk is paid for more result. The reasonable conclusion is that the choice is not doctrinal but a matter of indication: in a younger patient with moderate laxity, a lower-risk SMAS technique may suffice; in one with established grooves and medial descent, only the deep plane corrects the problem, and its complication curve must be accepted.
References
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- 3.Hamra ST. Composite rhytidectomy. Plast Reconstr Surg. 1992;90(1):1-13.
- 4.Jacono AA, Parikh SS. The minimal access deep plane extended vertical facelift. Aesthet Surg J. 2011;31(8):874-890.
- 5.Jacono AA, Bryant LM, Alemi AS. Optimal facelift vector and its relation to zygomaticus major orientation. Aesthet Surg J. 2020;40(4):351-356.
- 6.Jacono AA, Malone MH, Talei B. Three-dimensional analysis of long-term midface volume change after vertical vector deep-plane rhytidectomy. Aesthet Surg J. 2015;35(5):491-503.
- 7.Talei B. The detailed anatomy of the deep plane of the face and neck with current nomenclature. Facial Plast Surg. 2024;40(6):680-686.
- 8.Minelli L, Yang HM, van der Lei B, Mendelson B. Anatomy of the facial glideplanes, deep plane spaces, and ligaments: implications for surgical and non-surgical facial rejuvenation. Plast Reconstr Surg. 2023;154(1):95-110.
- 9.Khoury S, Almubarak Z, Khan H, Boldt G. The deep plane versus SMAS facelift: a systematic review and meta-analysis. Aesthetic Plast Surg. 2025;49(21):5895-5903.
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Related specialty: Facial Lifting & Rejuvenation