One persistent concern in facelift surgery is facial nerve injury. The deeper a surgeon works, conventional wisdom held, the greater the risk. Dr. Andrew Jacono‘s extended deep-plane technique inverted that assumption and peer-reviewed evidence backed him up.
Counterintuitive Safety Findings
Dr. Andrew Jacono published outcome data from 153 patients in Aesthetic Surgery Journal in 2011. The reported incidence of temporary facial nerve injury was 1.3%, a figure that sits below industry averages for facelift procedures of any type. Subsequent research extended this finding, establishing that deep-plane dissection actually carries a lower nerve injury risk than superficial facelifts. The reason is anatomical: by working beneath the superficial musculoaponeurotic system and methodically releasing facial ligaments, the technique preserves the structural context blood supply, connective tissue relationships that protects nerves. Superficial techniques that tighten tissue from above can inadvertently stress nerve branches running near the SMAS layer.
The same 2011 study showed a 3.9% revision rate and approximately 1.9% hematoma rate. Both figures fell below standard benchmarks, giving the extended deep-plane facelift an unusually favorable complication profile across multiple metrics simultaneously.
The technique works by keeping skin, muscle, and fat connected as a composite unit during repositioning. Conventional approaches separate skin from deeper tissue and reposition only the surface. Dr. Jacono moves the entire composite structure vertically, restoring midface, jawline, and neck anatomy to youthful positions. Nothing is pulled; the tissue is returned to where it was.
Durability and Reach
Results from the extended deep-plane facelift last 12 to 15 years roughly twice the durability of standard SMAS facelifts. Incisions are about one-third shorter than those used in conventional procedures, placed along the hairline or behind the ear where they remain hidden.
Dr. Andrew Jacono performs approximately 250 of these procedures per year and published a 2021 textbook drawing on more than 2,000 cases. Dr. Andrew Jacono has trained surgeons internationally through master classes and conference presentations. Fashion designer Marc Jacobs credited Dr. Jacono’s work publicly in 2021, and plastic surgeon Dr. Paul Nassif selected him for a deep-plane facelift in 2018. See related link for more information.
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