Surgeons use the word plane for the boundary between two layers of tissue. The deep plane in a deep plane facelift lies beneath the SMAS, the sheet of fibrous tissue and muscle that supports the cheeks and jaw, and the name describes where the surgeon works rather than any special device or trademark.
A Houston practice, Leo Lapuerta, MD, Plastic Surgery, publishes a step-by-step account of the operation. Stripped to its steps, that account describes a lift that moves deeper tissue as a unit so the skin does not have to carry the correction.
Dr. Leo Lapuerta, a triple board-certified plastic surgeon and Chairman of Plastic Surgery at St. Joseph Hospital, frames his specialty around that kind of rearrangement. “I love plastic surgery because it is an opportunity to take what appears to some as a negative or a deficit and reconfigure and reimagine that undesirable quality into something desirable that brings vitality and joy to a patient.”
As a face ages, support beneath the skin weakens and tissue descends. The practice lists the results: jowls and a blurred jawline, deep nasolabial folds, heavier cheeks from midface descent, and volume that shifts as fat pads drop. A lift that tightens skin alone leaves those deeper structures where they fell.
The practice describes the deep plane technique as reaching below the SMAS, so the lift comes from support instead of surface tension. A traditional facelift, by its account, often focuses more on skin and the SMAS layer.
The practice calls the procedure complex and says it requires careful judgment and detailed knowledge of facial anatomy. Its outline runs as follows.
An extended deep plane facelift widens the release for more advanced descent. The practice notes that not every patient requires that level of dissection.
The practice describes good candidates as people with visible jowls or lower-face heaviness, descended cheeks and moderate to significant signs of aging, whose skin quality and facial structure support surgery. Age alone does not decide it. Some younger patients with meaningful tissue descent may qualify.
The practice also lists poor fits: aging mild enough for a mini lift or SMAS facelift, concerns centered on texture, pigment or sun damage, volume loss that may call for fat transfer instead, and patients who smoke or vape and cannot stop before surgery. Anyone hoping for zero downtime is also steered elsewhere.
The practice publishes a timeline for the deep plane lift:
Patients sleep with the head elevated, use cold compresses as directed, protect incisions from the sun and wait for clearance before resuming moderate exercise. The practice describes the sensation as more tightness and soreness than sharp pain for most patients. Like any surgery, the operation carries risks that belong in the consultation.
The practice states that the deep plane facelift is not better by default than a SMAS lift. It becomes the right choice when laxity and descent are advanced enough that a lighter lift may undercorrect. Making that call is a judgment, and Dr. Lapuerta holds that a surgeon’s experience with a procedure, in cases and years, together with board certification, is the best determinant of an outcome patients judge as good.
He has more than 30 years of experience and more than 30,000 surgical and non-surgical procedures, and he operates in a QuadA accredited facility he owns, with physician anesthesiologists. Preparation starts well before surgery day. The practice asks patients to stop nicotine as directed, arrange for a friend or family member to drive them home and stay with them, and set up a recovery space where the head can stay elevated.
This article is for general information only and is not medical advice. Results vary from patient to patient. Consult a board-certified plastic surgeon or your physician about your own situation. Written in partnership with Joseph Lambert, a publicist working with Leo Lapuerta, MD Plastic Surgery.
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