A Leading Plastic Surgeon Shares Everything to Know About the Deep Plane Facelift

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A Leading Plastic Surgeon Shares Everything to Know About the Deep Plane Facelift featured image


For patients visiting Newport Beach, CA plastic surgeon Sanjay Grover, MD, they get a one-stop-shop for all of their aesthetic needs. “What’s nice is that some patients can get all of their treatments performed at one center, or by one surgeon,” says the Stanford-trained doctor who’s been practicing for 20 years and specializes in the face, nose, breast and body. “Our practice is called Grover Aesthetics, and our surgery center is Grover Surgical Arts, but we have our medspa at Grover Aesthetics, so we offer a number of treatments here—everything from fillers and neuromodulators to lasers, microneedling and other minimally invasive treatments.”

In terms of facial rejuvenation specifically, Dr. Grover says he’s seen an uptick in since COVID—among many other plastic surgery procedures—whether that’s “due to people seeing themselves on Zoom calls, or whether they are on social media doing more selfies. Or perhaps they have more time to recover now because they’re working from home, or they have more money because they aren’t traveling.” Whatever the reason, Dr. Grover welcomes these facial rejuvenation patients with open arms. “After my Stanford training, I did an additional aesthetics surgery and ocuplastic surgery fellowship in Atlanta, so I’m very well-versed in treating patients for facial and oculoplastic aesthetic procedures. We also have a brand-new, fully accredited outpatient surgery center that’s state-of-the-art, so our patients are in good hands.”

One procedure that he’s particularly well-versed in is the deep plane facelift, which he performs regularly. Here, the surgeon tells us everything we need to know about the procedure, and more.

Is a deep plane facelift the most thorough facelift you can get?

“Yes, I’d say that’s accurate because this type of lift addresses where the tissues are actually sagging or drooping. There’s a natural tissue plane, or gliding plane, underneath the SMAS layer, so by going directly to the area that’s becoming relaxed and addressing it, you’re getting a much better lift and can really put things back into a youthful position. The results are very natural, there’s minimal bruising and the scars are hidden very well around the contours of the ear. And because we’re putting the tension on the underlying muscular tissue—the SMAS—as opposed to the skin, the scars heal beautifully.”

Is this procedure reserved for those who are older with more advanced signs of aging?

“Actually no. In many ways it’s ideal for a younger patient—someone in their early 40s—but it’s also useful for patients in their late 70s and early 80s.”

Interesting. Who is the ideal candidate?

“A deep plane facelift can help give improvement in the midface with the nasolabial folds and the smile lines, as well as the jowls and neck bands. It can also improve the contour of the neck and create a more distinct jawline. As we age, we lose volume in our midface and the angle of our jaw due to bony loss, so it can really help to reposition the tissues.”

Because you’re manipulating the SMAS layer, is the recovery longer for this type of facelift?

“It’s actually not because there’s less bruising in general due to less direct undermining of the skin.”

What type of anesthesia is necessary?

“It can be done under twilight or general anesthesia—it really depends on the surgeon. I prefer to do mine under general anesthesia. The length of the surgery depends on the extent of what we’re doing—the face and neck, just the face, the face and eyes, etc.—but typically ranges somewhere between three to six hours.”

If you’re combining a laser treatment with a facelift surgery, what order do you perform those procedures in?

“When we’re combing lasers and facelifts, the nice thing about the deep plane facelift is that there’s less undermining of the skin, so you can perform laser-resurfacing treatments more safely. We can actually do them at the same time. With a fractionated laser, you have to remember we’re only treating about 20 to 25 percent of the skin, but it looks like you’ve had 100 percent of your skin treated—this allows for more rapid healing. Whereas with a full ablative laser, especially the ones we were using in the ‘90s, we’re treating 100 percent of the skin.”

What other nonsurgical treatments do you commonly pair for patients?

“We have a number of offerings for nonsurgical facial rejuvenation, including fractionated CO2 lasers and microneedling with RF (Vivace), which we’re combining for a number of patients. That way the Vivace addresses the deeper dermis and enhances skin tightening, texture and overall collagen synthesis, whereas the fractionated CO2 is a nice refresher on the surface of the skin. We’re seeing patients be more open to having a combination of procedures for a more natural-looking result, than just one procedure.”

Can these be done on the same day too?

“Yes. We do the Vivace first and then follow it up with a light fractionated CO2 laser on the face, neck and chest afterward. For patients who have more sun damage, we’ll either do photofacial treatments and potentially combine those with fractionated CO2 as well, or we’ll do the Elluminate treatment, which is a series of laser treatments that include four different lasers all done at one time, spaced one month apart. Patients will usually do three sessions, and those have minimal downtime.”

Are there any other facial rejuvenation procedures that are popular at your practice?

“I also perform Y-Lift procedures and Ellevate neck suture suspension procedures. The Y-Lift procedure is a closed facelift using fillers alone to reestablish the bony structure, or the pillars of the face, to help elevate the sagging soft tissues. That’s done under local anesthesia here in the office.”

What does the “Y” stand for, and how is this different than a “liquid lift”?

“The ‘Y’ really tries to show the pillars of the face. The two upper arms of the Y, one that extends over each side of the midface; the central part of the face being the base of the Y; and the lower face, the jawline, being the two arms of the Y upside down. it was developed by a maxillofacial surgeon in New York. As we age, not only do we lose volume, but also bony volume. With a Y-Lift procedure, we’re actually injecting filler on the surface of the bone to act and feel like bone, so it helps redrape the underlying soft issues that have started to droop and has a longer-lasting effect. Whereas a ‘liquid facelift’ is injecting the fillers more in the soft tissues, and that’s where you can potentially have a puffy look.”

You also mentioned the Ellevate neck procedure. What can you tell me about that one?

“This is a permanent, nonabsorbable thread under the surface of the skin in the subcutaneous tissues, which I do in the neck to improve some of the bulky soft tissues there. Usually, I combine that with some liposuction of the neck and Renuvion plasma treatments for better skin tightening.”

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