Conventional facelift techniques shared a common premise for most of the 20th century lift the skin and secure it at a higher position. The problem was structural. Skin is not what descends significantly during the aging process. Fat pads, retaining ligaments, and underlying muscle layers shift position over decades, and surface manipulation alone cannot correct those changes at their source. The gap between what conventional surgery addressed and what facial aging actually involves led to outcomes that looked operated on rather than naturally refreshed. Patients accepted this as the cost of intervention.
Dr. Andrew Jacono identified this fundamental gap and built a technique around eliminating it. The extended deep-plane facelift operates beneath the superficial musculoaponeurotic system, accessing the tissue plane where the face’s supportive ligaments anchor fat compartments to bone. By releasing these ligaments and repositioning the entire composite unit of skin, fat, and muscle together, Dr. Jacono restores the vertical positioning that the face held in youth rather than creating artificial tension through surface-level skin tightening.
Working Beneath the Surface
The SMAS layer had long been recognized as a critical structural element in facial aging. Standard procedures addressed it from above, tightening but not repositioning. Dr. Andrew Jacono’s departure was to work beneath it, freeing the anchoring ligaments that held descended tissue in its aged position. This allowed true vertical repositioning of the entire anatomical unit rather than superficial redistribution of slack skin.
Published outcomes support the approach’s superiority across multiple measures. His 2011 Aesthetic Surgery Journal study documented a 3.9% revision rate, approximately 1.9% hematoma incidence, and 1.3% temporary facial nerve issues among 153 patients. Later research confirmed that deeper dissection preserves anatomical relationships and reduces nerve injury risk compared to superficial techniques. Patients consistently report looking like refreshed versions of themselves. Dr. Jacono performs approximately 250 of these procedures each year, and results from his practice last between 12 and 15 years a durability that clearly separates his technique from alternatives. See related link for additional information.
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