The deep plane facelift is considered the most advanced technique in facial rejuvenation surgery — and also the most technically demanding. Rather than pulling on skin or repositioning only the superficial SMAS layer, the deep plane approach releases the true retaining ligaments of the face and repositions the mid-face, jawline, and neck as a single anatomic unit. Done well, the result is the most natural, longest-lasting facelift outcome available in modern plastic surgery. Done poorly, it is one of the riskiest facial surgeries a patient can undergo. The surgeon’s level of expertise is the single greatest variable in the outcome.

Dr. John Anastasatos performs the deep plane facelift at his Athens, Greece practice with a level of international facelift recognition few surgeons in Europe can match. Board certified by the American Board of Plastic Surgery and a Fellow of the American College of Surgeons (FACS), Dr. Anastasatos has been invited to deliver lectures on advanced facelift techniques at the Royal Society of Medicine in London in three consecutive years (2024, 2025, and 2026) — a distinction that places him among the small group of surgeons globally recognized for thought leadership in facial rejuvenation. He delivered Grand Rounds at the University of Alabama at Birmingham on the mechanisms of aging and anti-aging surgical practices, and has presented on facelift innovation at multiple international conferences. Named by The Luxe Insider as one of the Top 10 Plastic Surgeons in the World, recognized as a Castle Connolly and U.S. News & World Report Top Doctor, and featured in Reuters, the Boston Globe, FOX News, Forbes, LA Confidential, Vogue Greece, and Elle Greece — as well as on the plastic surgery series Nip/Tuck — he brings his facelift expertise to patients traveling to his Athens practice from across Europe, the Middle East, and the United States.

Understanding the Deep Plane Facelift

Facelift surgery has evolved significantly over the past four decades. The earliest facelifts tightened only the skin, producing results that often looked pulled and that loosened quickly as the underlying tissues continued to sag. The SMAS facelift added tightening of the superficial musculoaponeurotic system — a layer of connective tissue beneath the skin — producing longer-lasting, more natural results.

The deep plane facelift goes further. Instead of working on the skin and SMAS as separate layers, the surgeon enters the deep plane between the SMAS and the facial muscles, releases the true retaining ligaments that anchor the aging face in its sagging position, and repositions the entire mid-face, jowl, and neck soft-tissue envelope as a unified composite flap. The buccal fat pads — which descend with age and produce hollow cheeks combined with heavy jowls — can be repositioned upward along with the SMAS and skin, restoring the heart-shape of a youthful face rather than simply stretching older tissue tighter. The result is a face that looks younger because the aging pattern has been genuinely reversed, not merely concealed.

“The deep plane facelift is the most elegant operation in facial rejuvenation because it addresses the actual anatomy of aging. When I release the retaining ligaments and reposition the composite tissue, I am restoring the face to where it naturally sat twenty years earlier — not creating tension, not pulling on skin, not producing that operated look patients are right to be afraid of. The result lasts longer because the tissues are back where they belong.” — Dr. John Anastasatos

Why Patients Choose the Deep Plane Facelift

The deep plane facelift is not for everyone — patients in early stages of aging are often better served by less extensive procedures. For patients with meaningful mid-face descent, jowling, and neck laxity, however, it produces results that simpler techniques cannot match. Common motivations include:

• Pronounced Jowling: Loss of jawline definition where the cheek tissue has descended over the mandible, softening the angles that define a youthful profile.
• Deep Nasolabial Folds: The creases from nose to mouth that deepen as the mid-face descends, often unresponsive to fillers alone in more advanced aging.
• Mid-Face Hollowing: Loss of the cheek volume and the downward shift of the buccal fat pad that creates a tired, gaunt appearance.
• Neck and Jawline Laxity: Loose skin and platysmal banding along the neck that extends into the jawline area.
• Desire for Natural, Long-Lasting Results: Preference for a facelift outcome that looks unoperated and holds its shape over many years rather than needing repeated intervention.
• Previous Facelift That Fell Short: Patients who had a more superficial facelift elsewhere and want the deeper, more lasting correction they did not receive the first time.

How the Deep Plane Facelift Differs From Other Facelifts

Understanding what makes the deep plane approach different helps explain why it produces the results it does.

Skin-Only Facelift

The original approach — tightens only the skin. Produces short-lived results that often look pulled. Rarely offered by modern plastic surgeons as a primary technique.

SMAS Facelift

Lifts the superficial musculoaponeurotic system and skin together. Produces more natural, longer-lasting results than skin-only facelifts and remains a widely used modern technique. More appropriate for patients with less advanced aging.

MACS Facelift

The minimal access cranial suspension lift — a short-scar variation that uses suture suspension to lift the SMAS. Appropriate for patients with mild-to-moderate changes who want a shorter incision and faster recovery.

Deep Plane Facelift

Repositions the composite tissue below the SMAS, releasing the true retaining ligaments and elevating the buccal fat pads, jowls, mid-face, and neck as a unified layer. The most comprehensive facelift technique, producing the most natural and durable results for patients with significant aging changes.

What to Expect From a Deep Plane Facelift

The deep plane facelift is performed under general anesthesia or deep sedation and typically takes four to six hours. Most patients stay overnight for observation before returning home or to an accompanying caregiver. Incisions are placed along the hairline, around the ears, and into the hairline behind the ears — designed to be concealed within natural hair and skin-fold patterns. Bruising and swelling are most pronounced during the first two weeks and resolve progressively over four to six weeks. Most patients feel socially presentable at approximately three weeks and fully recovered by six to eight weeks. Final refinement continues as tissues settle over three to six months. Scars mature and fade significantly over the following twelve to eighteen months. For patients traveling from abroad, extended-stay recovery can be coordinated at properties near the Athens office.

Frequently Asked Questions About Deep Plane Facelift Surgery

Am I a candidate for a deep plane facelift?

The best candidates have meaningful jowling, mid-face descent, and neck laxity — typically patients in their late forties through their sixties and seventies. Patients in the earliest stages of aging are often better served by less extensive procedures. Dr. Anastasatos evaluates skin quality, bone structure, soft tissue descent, and goals during consultation to determine the right approach for each patient.

How long do the results last?

Deep plane facelift results typically last longer than any other facelift technique — often ten to fifteen years or more — because the underlying anatomy is genuinely repositioned rather than simply tightened. Natural aging continues, but the face continues to look younger than it would have without surgery even many years later.

Will the scars be visible?

Incisions are placed along and within the hairline, in natural folds around the ears, and into the hairline behind the ears. When healed, they are generally difficult to detect even at close range. Dr. Anastasatos uses refined closure techniques to optimize scar appearance, and scars fade significantly over twelve to eighteen months.

How is a deep plane facelift different from a SMAS facelift?

The SMAS facelift lifts the SMAS layer and skin as separate components. The deep plane facelift works beneath the SMAS, releasing the actual retaining ligaments of the face and repositioning the mid-face, jowls, and neck as a composite unit. The deep plane approach produces more natural results and lasts longer, but is more technically demanding and is only appropriate for surgeons with specific advanced training.

Can a deep plane facelift be combined with other procedures?

Yes. It is often performed alongside eyelid surgery (blepharoplasty), brow lift, fat transfer for volume restoration, or lip lift to address the full aging pattern in one coordinated surgery. Combining procedures requires careful planning but allows for a single anesthesia and recovery.

Will I look like myself or like someone else?

A well-performed deep plane facelift should make you look like a younger version of yourself — not like a different person, and not like you have had surgery. Dr. Anastasatos’s approach is to restore natural anatomy to its earlier position, which produces results that read as “rested” or “well-aged” rather than “done.”

Why Choose Dr. Anastasatos for Your Deep Plane Facelift

• Royal Society of Medicine Invited Lecturer: Presented on advanced facelift techniques at the Royal Society of Medicine in London in three consecutive years (2024, 2025, 2026) — a distinction few plastic surgeons in the world share.
• Board-Certified and FACS: Certification by the American Board of Plastic Surgery and Fellowship in the American College of Surgeons reflect rigorous, verified training.
• Academic Authority on Aging: Grand Rounds presentations at the University of Alabama at Birmingham on aging mechanisms and anti-aging surgical practices.
• Featured on Nip/Tuck: Appeared on the plastic surgery series widely recognized for featuring respected plastic surgeons and real surgical innovation.
• Top 10 International Recognition: Named by The Luxe Insider as one of the Top 10 Plastic Surgeons in the World and recognized as a Castle Connolly and U.S. News Top Doctor.
• Dual-Continent Practice: Offices in Beverly Hills and Athens welcome patients traveling from across Europe, the Middle East, and the United States with coordinated planning and recovery support.

Schedule Your Deep Plane Facelift Consultation in Athens, Greece

If you are considering a facelift and want the most advanced technique available, performed by a surgeon who teaches his peers at the Royal Society of Medicine, Dr. John Anastasatos welcomes you to the Athens, Greece office at Palas Kefalari, Kolokotroni 23, Kifisia. A thorough consultation will cover your anatomy, the facelift approach best suited to your aging pattern, incision and recovery details, and realistic outcomes. Contact the practice to arrange your appointment with Dr. Anastasatos.