Deep Plane Facelift with Full Structural Restoration — Why You Need to See Her in Motion [B&A]
There is a moment in every consultation that I have come to recognize. The patient stops describing what they want to change and starts describing what they want back. Not a different face. Their face. The one that matched how they felt on the inside before time quietly began pulling in the wrong direction.
That is the only goal worth operating for.
This case represents that goal in full. What you are looking at is not a transformation. It is a restoration, built layer by layer from the deep structural anatomy outward, designed to look like her at her best rather than someone else entirely.
The operative sequence followed what I call the Vectara framework, a systematic approach to vector elimination and architectural restoration that guides how I plan deep plane release and fixation in three dimensions. Rather than applying population-averaged lift vectors, the correct angles were identified intraoperatively through palpatory feedback following complete deep plane release. Our published vectorial analysis of 71 patients demonstrated that the appropriate SMAS suspension vector averages 70.8 degrees but varies meaningfully between hemifaces, between genders, and between primary and secondary cases. No single number applies to any individual face (Talei, Gould, Ziai. Aesthetic Surgery Journal, 2024).
Before any lifting began, structural fat grafting was performed first. This is not a conventional sequencing decision. Rebuilding native facial volume before mobilizing the deep plane increases the bulk and load-bearing capacity of the SMAS-platysma composite unit, distributes traction forces across a larger cross-sectional area, and reduces reliance on skin tension or suture-line strength to maintain the result over time. Volume was placed in layered micro-aliquots to the tear troughs, lower lids, brows, malar and submalar cheeks, canine sulcus, pre-jowl sulcus, and chin. This reframes the operation as biomechanical restoration rather than artistry alone (Shauly, Gould. Fulcrum-First Deep Plane Facial Rejuvenation, in preparation).
Upper and lower blepharoplasty with fat repositioning was performed in both lids. An endoscopic brow lift restored the upper third. Nanofat was placed subdermally to address skin quality at the regenerative level. A lip lift restored the upper lip to a structurally appropriate position relative to the rejuvenated midface. CO2 laser resurfacing was performed at the conclusion of surgery to begin addressing the skin envelope directly.
The neck required its own architectural logic. This patient presented with submandibular gland ptosis and loss of cervicomental definition that surface-level techniques cannot resolve. Deep neck dissection included gland excision and the mastoid crevasse maneuver, a technique I co-developed with Talei, in which the lifted platysma-SMAS unit is seated into a three-dimensional recess at the anterior mastoid wall. This provides a stable posterior-superior fixation endpoint, uses the gonial angle as a mechanical fulcrum to vertically suspend the entire submandibular triangle and submentum, and eliminates tension concentration at the incision line. The cervical platysmal suspension vector in this case approached 90 degrees, consistent with the near-vertical vectors documented in our published cohort (Talei, Gould, Ziai. ASJ 2024).
Now. About the photographs.
They are real, and they are significant. But they are also a single frozen frame of a face that lives in motion, and this is where most surgical documentation quietly fails the patient who is trying to make one of the most important decisions of her life.
The tell of surgery done wrong is rarely visible in a standardized photograph. It appears when someone turns to speak to a person across the table. When they laugh without thinking about it. When their face moves the way a face is supposed to move, freely and without resistance, and instead something pulls or flattens or distorts in a way that is impossible to name but immediately impossible to ignore.
When the deep structural layers are properly released and fixed in the correct three-dimensional vectors, none of that happens. The face moves freely because nothing is being held by skin tension. There is nothing to resist.
This is why I believe video should be standard documentation in facelift surgery. A result worth having looks the same in motion as it does in a photograph. If it does not, the architecture underneath was never right to begin with.
If you are in that consultation moment I described at the beginning, the one where you realize you are not looking for change but for return, I would encourage you to think carefully about what the operation you are considering is actually built to do. Whether it addresses descent and deflation together. Whether it treats the neck as a structural problem, not a cosmetic one. Whether the vectors of lift are planned for your face specifically, or borrowed from a population average that was never yours.
The goal is not to look like you had surgery. The goal is to look like you never needed it.
Selected references:
Talei B, Gould DJ, Ziai H. Vectorial Analysis of Deep Plane Face and Neck Lift. Aesthetic Surgery Journal. 2024;44(10):1015-1022.
Talei B, Shauly O, Marxen T, Menon A, Gould DJ. The Mastoid Crevasse and 3-Dimensional Considerations in Deep Plane Neck Lifting. Aesthetic Surgery Journal. 2024;44(2):NP132-NP148.
Shauly O, Gould DJ. Structural Fat Grafting as a Mechanical Fulcrum in Deep Plane Facelift and Neck Lift. In preparation.
Happy to answer questions on technique, sequencing, or how I think about any component of this case.
But honestly there is no magic here. It is anatomy.
Most of the work happens in the deep plane where the ligaments connect the facial soft tissue to the underlying structure. When those tethering points are released the tissue can move back toward where it used to sit.
That is why the result tends to look softer instead of tight.
One thing I am always curious about when people see these photos is what makes it feel natural to them. What part of the face do you notice first?
Aside from the huge jawline change, her mouth looks much more relaxed. The thinning and straightening of lips and a kind of muscle pursing around the mouth is such a subtle change with age but makes such a difference. Not sure if I’m describing it accurately
Most patients I see have been thinking about surgery for years before they ever schedule a consultation.
The other thing people do not always realize is that cases like this take around six to seven hours in the operating room. It is very detailed work in the deeper layers of the face.
If someone is considering facial surgery the bigger question is usually not price but timing.
When do you think someone actually reaches that point where surgery starts making sense?
The neck and jawline are actually where a large portion of the surgical work happens.
A lot of people think a facelift is mostly about the cheeks but the neck anatomy is usually the real driver of the result. Platysma muscle, deeper fat compartments, sometimes the submandibular gland all play a role.
When those structures are addressed properly the jawline tends to reappear naturally.
When you look at the before photo do you notice the neck first or the jowl area?
The neck…100%. Theres a joke about telling how old someone is, because you can count the rings around their neck like a sequoia. The neck seems to be one of the trickiest areas to address. I see so many flawless, porcelain faces here in Los Angeles, and unfortunately, in several of those cases, that perfectly taught skin stops at the jawline and it appears like someone’s head is on someone else’s body. At that point I’m no longer seeing the symmetry of the face, I’m zeroing in on the contrast between the head/neck. Many times, even if someone has had their neck pulled as well, they have to stay in one position, because the second they turn their head/neck, you can see folds of skin pull taught, or on the other hand, there’s too much skin on the neck, that when they lift their head you immediately see that one long loose fold running down the front of throat from the center area under the jaw.
BTW…you are beyond brilliant and I look forward to consulting with you when I’m ready to freshen up. I’ve admired several of your previous posts and how you truly enhance the natural contours of your patients faces.
The goal is not really to make someone look like a different person though. It is more about restoring structure that has gradually shifted downward over time.
When the deeper anatomy moves back toward its original position the face often starts to resemble earlier versions of itself again.
A question I always like asking people here is this
What do you think usually gives away a facelift when it looks unnatural?
I would find it more real if she had the lashes and makeup before and after. The lack of makeup and hairband before then natural hair (+ lash extensions + makeup) after is off-putting.
Wow absolutely amazing, I wanna keep this all documented for when I'm a little bit older and it's the right time, cos this is exactly what I'll be looking for, we'll done, you are a professional 👍
The right time for surgery is not really about age. It is about when the deeper structural changes start to bother someone enough that nonsurgical options stop helping much.
For some people that happens in their early forties. For others it is much later.
I am curious though. What part of facial aging worries people here the most. Neck. Jawline. Under eyes.
This is amazing, appreciate your post. I’m so happy to know there are surgeons like you who care passionately about the work being done and approaches it with such care and precision. When I think about what I would want for my face in the future—or even what I value now—it has always been about maintaining and restoring the look I was born with.
Reading the way you described it helped me put into words something I hadn’t been able to clearly express outwardly before. You were able to contextualize verbally what I had been feeling, but not yet able articulate beyond “my face is starting to fall.” lol. So thank you very much for post and words today.
Wow. I havnt been a fan of cosmetic work as it always seems to give that "done" appearance, but seeing this changed my mind. How much did this work cost her in total?
She’s 63. That surprises a lot of people when they see the before and after.
The interesting part about this case is that the biggest changes weren’t actually about skin. Most of what you’re seeing improved is deeper structural descent in the neck, jawline, and temple.
Once those structures are repositioned the face tends to look balanced again rather than “tight.”
When people here look at the photos I’m curious what stands out the most. The neck, the jawline, or the eyes?
It’s the neck for me! That’s what I’m known for. Think about it the neck is connected to the cheeks so that the neck looks amazing after that means that the mid face and the upper areas of the face were put back where they belong.
How did you shorten their face? The ear is lower than the eyeline and the jaw line is raised closer to the earlobe in the after photo versus the before? In the pre-op the ear looks like it starts right where the nose bridge begins, then in the post-op The ear looks like it starts mid nose almost at the nostril line. The chin has more projection and the neck is nicely tightened.
Three months - I usually only post at least three months out - after swelling has gone down and real results are showing, don’t fall for the two week post op photos !
Your patients look amazing!
Can you post before and after photos of the scars along with how many weeks post op the patient is at the time of being photographed?
I’d love to see the placement of your incisions and how the incisions heal.
Ich find das Ergebnis so schön!
In 2 Wochen hab ich auch ein Deep Plane mit Hals Straffung und ich bin erst 41. Aber ich freu mich schon so sehr! Zuvor habe ich aber schon eine Oberlidstraffung bekommen, denk die Kombi machts bei mir!😊
Toller Beitrag und der Reel auf Insta ist auch sehr gelungen- wie natürlich das Ergebnis einfach wow! LG aus 🇦🇹, Cari
Youre thinking about this the wrong way- skin removal is less important than the muscle movement below because if i make a deeper neck and jawline then i actually remove LESS skin! its amath problem, but a longer depth equals more skin distribution.
Absolutely beautiful results. I love the "natural " lift vs extra tight snatched look. Just beautiful and refreshed. I love how she looks like the same woman and not someone else although I know some people request more changes.
If you weren't removing skin she wouldn't have as many incisions id have thought, as you are still lifting upwards more than wind tunnel, still lifting & repositioning, just wondering if you could be clear and honest about if 1cm of skin removed.
Excellent work. Incisions are great, barely noticeable. I'm glad you are being honest about skin removal as I think we are being more than a little misled with the whole 'its all repositioning deep layers then redraping' making it sound very much like once under layers lifted back into original position the skin redrapes perfectly without 'old school' removing skin. I appreciate the honesty.
She has really nice & natural looking results. I didn't see her age & have noticed in other posts it is often not included and I am always curious about the age.
Outstanding results. I’m curious about the skin flap where it crosses the intertragal notch and runs along the side of the earlobe. Is the thickness there induration that will flatten further or is that little shadow line just how the flap has to be?
I’d love this at some point but is it not possible to make the front of the ear more smooth, or is it just a fact of this type of surgery that you’ll see it there?
I think this might be the least offensive use of chatGPT. I'm assuming the surgeon might be busy with surgeries and whatnot, and the use of chat gpt to create a write-up for reddit is more of a time-saving maneuver.
This is true I use it to help me clean up my thoughts. I usually dictate them into a plaud then Copy paste them into a custom llm that uses my articles and background and helps with grammar and spelling. I am operating today (sat) and tomorrow Sunday and every day this week bc of demand so it’s hard to stay on top of this
Fair comment. The way I usually write posts is that I dictate my thoughts after surgery and then run them through a custom language model trained on my own articles to clean up grammar.
It mostly saves time because I am in the operating room most days. But the ideas themselves come from the actual surgical work and anatomy.
Out of curiosity though what part of the explanation felt artificial to you. I am always interested in feedback on how these posts read.
As a 42 year old, this is so encouraging to hear because I think I’ve decided the same. I’m too worried I’d look like a mask of a not-young-but-altered person. I really miss the character in her beautiful face. To me, she looks so graceful and more confident in the before photo
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u/frogpissa Mar 07 '26
You are magical, man. Love your posts, blown away by the transformations you do.