Surgery evolves when someone asks why a standard approach produces the same recurring failures and then builds something different. Dr. Andrew Jacono asked that question about facelifts early in his career and spent years developing an answer that addressed aging at the structural level rather than the surface. The extended deep-plane facelift he introduced is now trained to surgeons worldwide and documented across hundreds of published pages of clinical outcomes.
Gravity Works on Structures, Not Just Skin
The conventional explanation for facial aging focuses on skin: it loses elasticity, develops wrinkles, and sags. That framing leads logically to skin-tightening solutions. But Dr. Andrew Jacono recognized that skin alone is not what falls. Fat pads descend. Facial retaining ligaments stretch under the weight of tissue they were never designed to support indefinitely. The SMAS layer connecting muscles to overlying skin shifts downward, pulling midface volume with it. Skin-tightening procedures address the symptom, not the cause.
The extended deep-plane facelift works below the SMAS, releasing the ligaments that anchor tissue in its descended position. Once freed, the composite of skin, muscle, and fat moves as a unit, repositioned vertically to restore the face’s original geometry. This vertical lift contrasts with the horizontal pull of traditional techniques, which compresses features laterally and often produces the stretched, windswept appearance patients dread most.
Results Documented in Volume and Time
Dr. Jacono’s 2011 Aesthetic Surgery Journal study established baseline outcome data from 153 patients, with complication rates below field benchmarks. His published results document longevity of 12 to 15 years roughly double what SMAS facelifts achieve. He performs approximately 250 extended deep-plane procedures annually and compiled findings from over 2,000 cases into the 2021 textbook The Art and Science of Extended Deep Plane Facelifting. Incisions for the procedure run about one-third the standard facelift length, hidden behind the ear or along the hairline. Dr. Andrew Jacono’s approach has become a reference point for what facelift surgery can accomplish when built on anatomical logic rather than surface tension. See related link for additional information.
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