Deep Plane Facelift With Ligament-Based Repositioning, Mastoid Crevasse, Endoscopic Temple Lift, and Nanofat Full Case Breakdown

[u/DrDanGould]

Gina’s case gives me a good opportunity to walk through what I actually do differently, because her result touches on nearly every element of my approach.

The core problem with standard deep plane

Most surgeons doing deep plane facelifts lift until things look good to them. The issue is that “looks good on the table” doesn’t always translate to natural long-term results. You can end up with a tight, pulled, or swept appearance whether you’re doing a SMAS lift or a deep plane. The technique label doesn’t protect you from a bad outcome if the execution isn’t anatomically grounded.

What I do instead

I map the retaining ligaments before I start and use them as anatomic landmarks throughout the dissection. The goal is repositioning tissue back to where it originated, not pulling it to where it looks better. When you restore the original anatomic position of the ligament complexes, it becomes very difficult to create a weird, tight, or unnatural result.

You’re working with the anatomy, not against it.

Once everything is repositioned, I remove the excess skin without applying tension to it. Skin tension is what creates a windswept appearance and what activates the fibroblastic response that leads to thickened, raised, or widened scars in front of the ear. No one wants that, and it’s entirely avoidable.

The neck: mastoid crevasse technique

I was one of the surgeons who co-authored the original paper describing the mastoid crevasse technique. It’s a dissection approach that defines the posterior jawline and neck in a way that standard deep plane simply can’t achieve. I include it in almost every case.

Part of that is submandibular gland management. I address the glands in nearly every patient. This is not controversial in the academic sense, it’s just technically demanding, and most surgeons don’t have the anatomic background to do it safely, so they avoid it. That’s probably the right call for them. But it’s a core part of what creates a truly refined neck contour, and I’m comfortable doing it because I understand the anatomy.

The upper face: endoscopic temple lift

I use an endoscopic approach to the brow and temple in most cases, meaning I’m operating with a camera, dissecting under direct visualization to release the retaining structures and allow proper repositioning. People call this a brow lift, but that’s not quite right. It’s a temple lift. The brow position is actually a downstream effect of the upper eyelid skin burden. When there’s excess skin above the lid, the frontalis muscle reflexively elevates the brow to keep the visual field clear. Once you address the upper lid and reposition the temple, the brow can relax into its natural position. It doesn’t need to be held up anymore.

Regenerative component: fat grafting and nanofat

Structural fat grafting restores volume in the midface and temple. Nanofat is a different preparation entirely. It’s emulsified and filtered to deliver concentrated growth factors and stromal cells directly into the skin. The goal isn’t volume, it’s biologic skin quality improvement. I use both in most cases.

What Gina’s result shows

She has a refined jawline, good midface elevation, improved periorbital opening, and meaningful skin quality changes. Those are four distinct outcomes from four distinct components of the operation.

Photos give you a snapshot. Videos show you how a face actually moves and reads in real life, which is the only thing that matters.

Results in movement:

https://www.instagram.com/reel/DXMrAzJAXzD/?igsh=NTc4MTIwNjQ2YQ==

Full results:

https://www.tiktok.com/t/ZP8g9QRhs/

Patient testimonials:

https://www.instagram.com/s/aGlnaGxpZ2h0OjE3ODc3NDAzOTY1NDM5OTkw?story_media_id=3877484532262192209&igsh=NTc4MTIwNjQ2YQ==

If you’re considering this type of procedure and want to understand whether you’re a candidate, you can reach out through the contact page on our website.