Face Lift

A deep plane facelift lifts the face by releasing the retaining ligaments and vertically repositioning the SMAS layer and overlying tissue as a single unit, rather than by pulling on skin. It corrects jowls, a loose jawline, and neck laxity, and typically holds for 10 to 15 years. Sam Naficy, MD, FACS performs deep plane facelifts under general anesthesia in Bellevue, Washington. Most patients return to desk work 10 to 14 days after surgery.

What is a deep plane facelift?

A deep plane facelift is a facial rejuvenation procedure that lifts the deeper structural layer of the face — the SMAS (superficial musculoaponeurotic system) — together with the overlying fat and skin as one composite unit. The surgeon releases the facial retaining ligaments that tether these tissues in a descended position, which allows the cheek, jawline, and neck to be repositioned vertically with very little tension on the skin.

This is the technical distinction that matters. Older facelift techniques tightened skin and pulled it laterally (backward), which produced a swept, tightened look and relapsed as skin stretched. The deep plane technique moves the tissue that actually descended with age, in the direction it descended (vertically or upward more than backward), and lets the skin redrape over the new foundation. Tension is held by the deep layer, not the incision line — which is why deep plane closures tend to heal as fine scars, and why the result reads as the patient's own face rather than a tightened one.

Deep plane facelift vs. SMAS facelift vs. Mini facelift

The three techniques differ in how deep the dissection goes, whether the retaining ligaments are released, and how long the correction holds.

	Deep plane facelift	SMAS facelift	Mini lift / S-lift
Layer addressed	Beneath the SMAS; skin, fat, and SMAS lifted as one unit	SMAS lifted, folded, or partly excised; skin lifted separately	Skin and limited SMAS plication
Retaining ligaments	Released	Not released	Not released
Direction of lift	Vertical (upward)	Primarily lateral	Lateral, limited
Midface / cheek correction	Yes — malar fat pad is repositioned	Limited	Minimal
Typical longevity	10–15 years	5–10 years	2–5 years
Best suited to	Moderate to advanced jowling and neck laxity, typically age 50+	Moderate laxity	Early laxity, typically early to mid-40s
Incisions	Temple, around the ear, behind the ear	Full or short	Short, usually in front of the ear only
Anesthesia	General	General or IV sedation	Often local

Is a deep plane facelift better than a SMAS facelift? For advanced midface and neck descent, the deep plane technique generally produces more durable correction, because it repositions the malar fat pad and releases the ligaments rather than tightening around them. Both are safe operations in experienced hands. There is no single best facelift — there is a best match between technique and anatomy.

A note on terminology. Patients encounter a long list of branded and descriptive names: quick lift, weekend lift, S-lift, vertical lift, laser facelift, thread lift, MACS lift, ponytail lift. Most describe variations on limited-incision, superficial techniques. As a general rule, procedures that are shorter, less invasive, and technically easier to perform deliver a more limited and shorter-lived degree of improvement. Ask any surgeon which anatomic layer they operate in and whether they release the retaining ligaments. Those two answers tell you more than the marketing name.

Who is a good candidate for a deep plane facelift?

You are likely a good candidate if you have:

• Visible jowling along the jawline, with loss of a clean mandibular border
• Laxity or banding in the neck, or a blunted angle between the jaw and neck
• Descent of the cheek and midface, often with deepening nasolabial folds
• Reasonable skin quality and elasticity
• Stable weight and good general health
• Realistic expectations — improvement of your own features, not a different face

Most patients who come to Naficy Plastic Surgery for a deep plane facelift are between their early 50s and late 60s. That said, there is no ideal age. With the popularity of GLP-1 drugs and patients undergoing significant weight loss, we now see more and more patients in their 40s and even late 30s presenting for facelift surgery. Candidacy is determined by anatomy and health, not by the number.

Who is not a good candidate for a facelift?

A facelift is not the right procedure if:

• Your primary concern is skin texture, fine lines, or pigment. A facelift repositions tissue. It does not change skin quality. Laser resurfacing, chemical peels, or a medical skincare program address those concerns.
• Your primary concern is volume loss rather than sagging. Hollow temples and flattened cheeks are treated with fat grafting, which may be performed with or without a lift.
• You have uncontrolled hypertension, poorly controlled diabetes, or a bleeding disorder. These substantially raise the risk of hematoma and wound-healing problems.
• You use nicotine in any form. Nicotine constricts the small vessels supplying the elevated skin flap and markedly increases the risk of skin necrosis. Complete cessation is required for at least three weeks before and three weeks after surgery.
• Your weight is actively changing. Significant loss or gain after surgery will alter the result. Patients on GLP-1 medications should reach a stable weight before scheduling.
• You are seeking a specific celebrity's face, or surgery to resolve a relationship or career situation. These expectations do not survive contact with a real outcome.

Being turned down for one procedure does not mean nothing can be done. Often it means a different procedure is the right one.

How is a deep plane facelift performed?

The procedure takes approximately 2.5 to 3 hours for a face and neck lift, longer when combined with other procedures, and is performed under general anesthesia.

1. Incisions. Placed in the temple hairline, along the natural crease in front of the ear, around the earlobe, and behind the ear into the hairline. Placement is adjusted to each patient's hairline and ear anatomy.
2. Skin elevation. A short segment of skin is elevated to expose the SMAS layer.
3. Entry into the deep plane. The dissection passes beneath the SMAS, into the plane between the SMAS and the underlying facial muscles. This is the step that separates the deep plane technique from all superficial techniques.
4. Ligament release. The zygomatic and masseteric cutaneous retaining ligaments are divided, freeing the composite flap so it can be repositioned without tension.
5. Repositioning. The composite flap — skin, fat, and SMAS together — is elevated vertically and secured in its new position with semi-permanent sutures.
6. Neck work. Through a small incision under the chin, the platysma muscle bands are addressed and, where indicated, excess fat is contoured. This is what restores the angle between the jaw and neck.
7. Skin redraping and closure. Excess skin is trimmed conservatively and the incisions are closed in layers with fine sutures. Because the deep layer holds the tension, the skin closure is tension-free. Drains are typically placed and removed the following day.

Is a neck lift included? In most cases, yes. The jawline and neck are a single aesthetic unit, and correcting one without the other produces an unbalanced result. Nearly all deep plane facelifts performed here include neck work.

Where are the incisions, and how visible are the scars?

Facelift incisions are placed within the natural creases and shadows in front of, within, and behind the ear, and within the hairline at the temple. Once healed, they typically fade to a thin line that is difficult to see in ordinary conversation, and is generally concealable with hair or makeup during healing.

Timeline for scar appearance:

• Weeks 1–3: Incisions are pink and visible. Most patients cover them with hair or makeup.
• Weeks 4–12: Color fades progressively; texture continues to soften.
• Months 6–12: Scars reach final maturity.

Scar quality depends on closure tension, technique, genetics, and post-operative care. Tension-free closure — a direct consequence of holding the lift in the deep layer — is the surgical factor most within a surgeon's control. Patients who smoke, or who have a personal history of hypertrophic or keloid scarring, should expect a different scar course and should discuss it at consultation.

The photographs below show healed incisions of face and neck lifts performed by Dr. Naficy. During the first few weeks, incisions are more visible and may require coverage with hair or concealer.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Healed incisions of face lifts performed by Sam Naficy, MD. * Individual results may vary.

What is deep plane facelift recovery like, week by week?

Most patients return to desk work 10 to 14 days after surgery. Physically demanding work generally requires 3 to 4 weeks. Final settled results take 6 to 12 months.

Time after surgery	What to expect
Days 1–3	Swelling and bruising increase and peak around day 3. Discomfort is usually mild to moderate and is often controlled with acetaminophen; a prescription is provided. Drains are removed the day after surgery. A soft dressing is worn for 1–2 days. Rest with the head elevated.
Days 4–7	Swelling begins to subside; roughly half resolves by the end of week one. Sutures are typically removed around days 5-7. Short walks are encouraged.
Weeks 2–3	Bruising fades and can usually be camouflaged with makeup. Approximately 75–80% of swelling has resolved by the end of week three. Most patients return to desk work and light social activity in this window.
Weeks 4–6	Contours become clearly visible. Light to moderate exercise may resume, typically around week 3 or 4 with clearance.
Weeks 6–8	Full strenuous activity is generally cleared. Residual firmness and areas of numbness along the cheeks and in front of the ears are normal and continue to resolve.
Months 3–12	Fine swelling continues to settle and scars mature.

Recovery varies with the extent of surgery, whether other procedures were combined, and individual healing. Patients who combine a facelift with laser resurfacing or eyelid surgery should plan additional time.

How long does a deep plane facelift last?

A deep plane facelift typically holds for 10 to 15 years, compared with roughly 5 to 10 years for a SMAS facelift and 2 to 5 years for limited-incision mini lifts.

An important clarification: a facelift does not stop aging. It resets the position of tissue that has descended. Aging continues from that new baseline, which means you will continue to look better for your age than you would have without surgery. Longevity depends on skin quality, sun exposure, smoking history, weight stability, and genetics. Face and neck lifts can be safely repeated if the need arises later.

What is the best age for a facelift?

There is no ideal age. Most patients seeking a deep plane face and neck lift here are in their early 50s to late 60s, but candidacy is determined by the degree of tissue descent, skin quality, and general health — not by chronological age.

If you are in your 40s: You may have early jowling with good skin elasticity. Some patients in this group are appropriately treated with a more limited procedure; others are better served by waiting, or by non-surgical treatment in the interim. Having a facelift earlier does not commit you to repeating it on a schedule.

If you are in your 70s or beyond: Age alone is not a contraindication. Health status is what matters. Excellent improvement is regularly achieved in this age group.

The example below shows a patient in her 50s who wanted to be proactive about the aging process. She was mostly bothered by her eyes, but wanted to address early changes in her jawline and neck at the same time.

A patient in her 50's after a deep plane face & neck lift, brow lift, eyelid surgery, and fat grafting by Seattle facial plastic surgeon Sam Naficy, MD.  * Individual results may vary.

The example below shows a patient in her 70s, and demonstrates that meaningful improvement is achievable at any age.

A patient in her 70's after a deep plane face & neck lift, brow lift, eyelid surgery, and fat grafting by Seattle facial plastic surgeon Sam Naficy, MD.  * Individual results may vary.

What procedures are commonly combined with a facelift?

A facelift addresses the lower face and neck. It does not treat the eyes, brow, or volume loss. Combining procedures in a single anesthetic is common, and produces a more balanced result than treating the lower face in isolation.

Fat grafting is the procedure most often combined with a facelift. Aging involves volume loss as well as descent — the upper cheeks and temples hollow, and that hollowing accentuates sagging. Repositioning tissue without restoring volume can produce a lifted but still gaunt appearance. Fat is harvested from the patient, processed, and injected into the temples, cheeks, and other deficient areas during the same procedure.

GLP-1 medications and facial volume loss. With the widespread use of semaglutide and tirzepatide, a growing share of facelift patients present with significant facial fat loss alongside skin laxity. These patients need volume restored, not just tissue repositioned. Fat grafting combined with a deep plane lift addresses both. Weight should be stable before surgery is scheduled.

Eyelid surgery (blepharoplasty) addresses upper lid hooding and lower lid bags. Because the eyes are where people look first, an untreated aging eyelid alongside a rejuvenated jawline is a common source of disappointment.

Brow lift raises a descended brow and opens the upper third of the face.

Chin implant. A facelift is quite commonly combined with a chin implant to improve projection and sharpen the angle between the jaw and neck, which magnifies the effect of the neck lift. Patients with a weak chin often get a disproportionate benefit from adding it.

Laser resurfacing treats skin texture, fine lines, and pigment — the things a lift cannot change.

Deep Plane Face & neck lift, lower blepharoplasty, and fat grafting by Seattle facial plastic surgeon Sam Naficy, MD.  * Individual results may vary.

Deep Plane Face & neck lift, brow lift, upper and lower blepharoplasty, and fat grafting by Seattle facial plastic surgeon Sam Naficy, MD.  * Individual results may vary.

Deep Plane Face & neck lift, chin implant, and fat grafting by Seattle facial plastic surgeon Sam Naficy, MD.  * Individual results may vary.

Deep Plane Face & neck lift and fat grafting to temples and cheeks by Seattle facial plastic surgeon Sam Naficy, MD.  * Individual results may vary.

Deep Plane Face & neck lift and fat grafting to cheeks by Seattle facial plastic surgeon Sam Naficy, MD.  * Individual results may vary.

What type of anesthesia is used?

Deep plane facelifts are performed under general anesthesia, administered by a dedicated anesthesia provider. Long-acting local anesthetic is also infiltrated into the surgical field so that patients are comfortable on waking.

Surgery is performed in our on-site surgery center, which is Medicare-certified and Washington State–accredited. Our anesthesia team has more than 50 years of combined experience, and all providers also hold appointments at the University of Washington or other regional medical centers.

Modern anesthetic agents clear quickly. Most patients are able to go home approximately one hour after the procedure concludes, accompanied by a responsible adult.

Anesthesia guidelines [21kb PDF]

What are the risks of a facelift?

Facelift surgery is generally safe when performed by a qualified surgeon in an accredited facility, but it is real surgery with real risks. Every patient should understand them before consenting.

More common, and usually temporary:

• Swelling and bruising — universal, resolving over weeks
• Numbness of the cheeks, ears, and neck — common, typically resolving over weeks to months
• Firmness or nodularity under the skin as tissues heal
• Temporary tightness around the ears and jawline

Less common:

• Hematoma — a collection of blood beneath the skin, the most common complication requiring intervention. Risk is higher in men and in patients with elevated blood pressure. It usually presents within the first 24 hours and may require a return to the operating room for drainage.
• Infection — uncommon in facial surgery given its rich blood supply; treated with antibiotics.
• Poor scarring — hypertrophic or widened scars, more likely in smokers and in patients with a personal history of abnormal scarring.
• Asymmetry — some degree of facial asymmetry exists in everyone before surgery and persists after it.
• Hair loss near incisions — usually temporary.
• Skin necrosis — loss of skin at the flap edge, strongly associated with smoking.

Rare: injury to a branch of the facial nerve (most often temporary weakness resolving over weeks to months; permanent injury is rare), anesthesia complications, deep vein thrombosis, and the need for revision surgery.

Risk is reduced by operating in an accredited facility with dedicated anesthesia, careful patient selection, blood pressure control, complete nicotine cessation, and disclosing all medications and supplements — including over-the-counter blood thinners such as aspirin, fish oil, and vitamin E.

I have had fillers. Does that affect my facelift?

Almost every patient coming for a facelift today has had injectables first, and this question comes up at nearly every consultation. The honest answer is that it depends entirely on which product, and the difference between categories is substantial.

Tell us what you have had and roughly when. If you do not remember the product names, that is common — bring whatever records you have, or we can usually work it out from examination.

Product type	Examples	Effect on facelift surgery
Hyaluronic acid fillers	Juvéderm, Voluma, Restylane	No effect on the dissection. The consideration is assessment rather than surgery — see below. If fat grafting is being considered at the same time, then fillers may mask the true need for volume.
Poly-L-lactic acid	Sculptra	No difficulty encountered, including in patients treated at other practices. Ideally allow about three months, though facelifts have been performed sooner without issue.
Calcium hydroxylapatite	Radiesse	Can complicate dissection. Behaves more like the permanent products than like Sculptra in this respect. Hyperdilute Radiersse seems to have less issues
Permanent fillers	Bellafill, PMMA products, silicone	Dissection is harder. Surgery remains possible, but the planes are less clean and the operation takes longer. It doesn't make surgery impossible, but harder to do, depending on amount and location of Bellafill.

Hyaluronic acid fillers — and why we sometimes dissolve them first

HA fillers do not interfere with facelift dissection. The reason they still matter is assessment.

A face carrying several syringes of filler is not showing you its true underlying anatomy. Planning a facelift around a temporarily augmented face risks operating on a shape that will change as the product degrades over the following months.

So in some cases we will dissolve HA filler with hyaluronidase before surgical planning — not because it is dangerous to leave, but so that the surgical plan is built on what is actually there. This is more likely where a significant volume has been placed, or where the amount is unclear.  This is especially true if fat grafting is being considered at the same time as a deep plane facelift.

Sculptra

Dr. Naficy has not encountered dissection difficulty attributable to Sculptra, including in patients who had it placed elsewhere.

The concern raised by some surgeons is that a collagen-stimulating product could create denser tissue planes. In practice the variable is where the product was placed rather than the product itself — material in the appropriate plane does not interfere with the dissection.

Ideally allow about three months between the last session and surgery, so the collagen response has settled and the operation is planned on a stable result. Facelifts have been performed on patients treated more recently without difficulty, so this is a planning preference rather than a requirement. Further detail on the Sculptra page.

Radiesse and permanent fillers — the honest caveat

This is where a genuine trade-off exists, and it is rarely mentioned at the time these products are injected.

Radiesse (calcium hydroxylapatite) and permanent fillers such as Bellafill, other PMMA products, and injected silicone can make a subsequent facelift dissection more difficult. The tissue planes are less distinct, separation is less clean, and the operation takes longer.

What this does not mean: it does not make you inoperable. Patients who have had these products have facelifts, and they get good results. The surgeon simply needs to know in advance, and the dissection takes more care and more time.

What it does mean: if you are currently deciding between a temporary and a permanent filler, and you think surgery is a possibility within the next decade, this belongs in the decision. A five-year filler is a bigger commitment than the fee suggests. We say the same thing on the Bellafill page, where we also recommend most patients establish what they like with a reversible product first.

Silicone injections are a separate category and a more serious problem — they are not reversible, migrate over time, and can produce chronic inflammatory changes. Disclose them if you have had them, wherever they were done.

What we need from you at consultation

• Which products, as specifically as you can recall
• Roughly when, and how many sessions
• Which areas were treated
• Anything done outside the United States, where product regulation varies and permanent fillers are more common

None of this is asked to catch anyone out. It changes how the operation is planned, and a surprise in the operating room is worse for you than an awkward conversation beforehand.

How much does a deep plane facelift cost?

At Naficy Plastic Surgery, a deep plane face and neck lift ranges from $40,000 to $75,000. The range reflects the extent of surgery and which procedures are combined in the same anesthetic.

Total cost depends on:

• Whether the neck is addressed (in most cases it is)
• Whether fat grafting, eyelid surgery, brow lift, or resurfacing are combined
• Length of the operation and corresponding anesthesia time
• Facility fees

Quoted fees are itemized in writing at consultation, covering surgeon, anesthesia, facility, and follow-up care. Financing is available through PatientFi.

A note on comparison shopping: quotes for a facelift are frequently not comparable, because a short-incision skin lift under local anesthesia and a deep plane face and neck lift under general anesthesia are different operations with different results and different durability. Ask what anatomic layer will be addressed and what is included in the quoted price.

Fees & payment policies · Financing

Why choose a facial plastic surgeon for a facelift?

Most plastic surgeons operate across the full body, and in practice spend much of their time on breast surgery, liposuction, and abdominoplasty. A facial plastic surgeon's practice is limited to the face and neck.

Dr. Naficy's practice has been devoted exclusively to facial plastic surgery for 25 years, and he performs more than 100 face lifts each year. He is certified by the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS). He graduated first in his class from the University of Washington School of Medicine, and completed both his residency and his fellowship at the University of Michigan. He has been recognized as a top doctor by Seattle Magazine. Patients travel from across the United States and internationally for facial surgery here.

It is also worth verifying who is performing your surgery. Facelifts are advertised by physicians from a range of backgrounds, including some who are not surgically trained. Ask about board certification, where the surgeon operates, how many facelifts they perform annually, and ask to see before-and-after photographs of patients whose starting anatomy resembles yours.

How does the face age?

Facial aging is not simply sagging skin. Four processes occur simultaneously:

Descent. The retaining ligaments that suspend facial soft tissue weaken, and gravity draws the cheek, jowl, and neck tissue downward. This is what produces jowls and a blurred jawline.

Volume loss. Fat compartments in the upper cheeks and temples deflate, and facial bone — particularly around the orbit and jaw — resorbs. The result is hollowing, which makes descent look worse than it is.

Skin change. Collagen and elastin decline, so skin thins and loses recoil. Sun exposure accelerates this substantially.

Muscle change. The platysma muscle in the neck separates and its edges become visible as vertical cords.

A facelift addresses the first process directly, and the fourth in the neck. Fat grafting addresses the second. Resurfacing and skincare address the third. Understanding which processes dominate in a given face is what determines the right plan — and it is why a single technique applied to every patient produces inconsistent results.

Deep plane facelift before and after photos

You may wish to browse the gallery of representative before and after face and neck lift photographs. All procedures were performed by Dr. Sam Naficy, and some patients had more than one surgical procedure performed. The text accompanying each photograph describes the details of the procedures performed.

* Individual results may vary.

Frequently asked questions

I have had fillers. Can I still have a facelift?

Yes. Hyaluronic acid fillers such as Juvéderm and Restylane have no effect on the dissection, and Sculptra has not caused difficulty in our experience. Radiesse and permanent fillers such as Bellafill can make the dissection harder and slower, but they do not make surgery impossible. Tell us what you have had and when.

Do I need my fillers dissolved before a facelift?

Sometimes, and for planning rather than safety. A face carrying several syringes of filler is not showing its true underlying anatomy, so we occasionally dissolve hyaluronic acid filler with hyaluronidase before planning surgery, particularly where a significant or unclear volume has been placed.

Does Sculptra make a facelift harder?

Not in our experience, including in patients treated at other practices. The concern turns on where the product was placed rather than the product itself. Ideally allow about three months before surgery so the collagen response has settled, though facelifts have been performed sooner without difficulty.

Will Bellafill or permanent filler stop me having a facelift?

No, but the dissection is harder, the planes are less clean, and the operation takes longer. It is worth weighing before choosing a permanent filler if surgery is a possibility within the next decade.

Is a deep plane facelift painful?
Most patients describe tightness and pressure rather than sharp pain. Discomfort peaks in the first two to three days and is frequently managed with acetaminophen; a prescription pain medication is provided for the early period.

Will a facelift make me look pulled or done?
The pulled appearance associated with older facelifts comes from tightening skin laterally. The deep plane technique repositions the deeper tissue vertically and closes the skin without tension, which is why results generally read as natural.

Does a facelift help nasolabial folds?
Partially. Repositioning the malar fat pad softens the folds, but it does not eliminate them. Combining fat grafting or filler addresses the remainder.

Does a facelift treat the eyes or forehead?
No. A facelift treats the lower face and neck. Eyelid surgery and brow lift address the upper face and are commonly performed at the same time.

Can a facelift be redone?
Yes. Face and neck lifts can be safely repeated when aging progresses, typically after 10 or more years.

How soon can I fly after a facelift?
Patients traveling from out of the area are typically asked to remain locally for 7 to 8 days for drain and suture removal and the first follow-up visit before flying home. See Out of Town Patients.

When can I exercise again?
Walking is encouraged within days. Light to moderate exercise typically resumes around week 4, and full strenuous activity around weeks 6 to 8, with surgical clearance.

How long before I can wear makeup?
Makeup over the incisions is generally permitted once sutures are removed and the skin has sealed, usually around 10 to 14 days.

Do facelift results look worse before they look better?
Swelling peaks at day 3 and dominates the first two weeks, so early appearance is not representative. Most patients first see their result clearly around weeks 4 to 6, and it continues to refine for a year.

Is a facelift covered by insurance?
No. Facelift surgery performed for cosmetic reasons is not covered by insurance.

I am interested. What do I do next?

If you are considering this procedure, we encourage you to complete the Surgical Consultation Intake Form. Dr. Naficy will evaluate your anatomy, tell you whether you are a suitable candidate, and inform you of the potential risks of the procedure. There is great variety in the features of the aging face and neck, so each procedure must be custom tailored for the best possible result. You will also have a chance to view before and after photo albums of patients who have undergone procedures similar to what you are considering.

Post-operative care instructions [17kb PDF]

Naficy Plastic Surgery & Rejuvenation Center — 1110 112th Ave. NE, Suite 150, Bellevue, WA 98004 · (425) 450-0880. Serving Bellevue, Seattle, Kirkland, Redmond, Medina, Mercer Island, and the greater Puget Sound region.

This page is for general education and does not constitute medical advice. Individual results vary. Written and medically reviewed by Sam Naficy, MD, FACS. Last reviewed August 2026.