Surgical techniques rarely earn the label of gold standard unless they demonstrate clear advantages across multiple metrics over an extended period. The extended deep-plane facelift now holds that distinction in facial rejuvenation, with documented outcomes that outpace conventional approaches on longevity, complication rates, and natural appearance. Much of the groundwork behind that standing comes from the career of Dr. Andrew Jacono, a New York facial plastic surgeon who introduced and formalized the method.

The technique differs from standard facelifts at a foundational level. Conventional procedures work by separating skin from underlying tissue and pulling only the surface layer tighter, which produces tension-based results that look artificial and do not address the structural cause of facial aging. Dr. Andrew Jacono instead works beneath the SMAS, the tissue layer that connects facial muscles to skin, releasing the ligaments anchoring tissue in a lower position and repositioning the entire composite structure vertically.

Shorter Scars, Longer Results

One practical advantage of the extended deep-plane approach is the incision length. Dr. Jacono’s technique requires incisions approximately one-third as long as those used in traditional facelifts, positioned behind the ear or along the hairline. Patients can wear their hair up without any visible evidence of surgery, an outcome Dr. Jacono describes as ponytail-friendly. Recovery therefore comes with less visible evidence, and long-term results last between 12 and 15 years, roughly twice the timeline of standard methods.

Peer Review and Professional Trust

Dr. Jacono published his first peer-reviewed study on the technique in Aesthetic Surgery Journal in 2011, reporting outcomes from 153 patients. The revision rate of 3.9%, hematoma rate of approximately 1.9%, and temporary facial nerve injury rate of 1.3% all fell below industry averages. His subsequent textbook, The Art and Science of Extended Deep Plane Facelifting, compiled findings from over 2,000 procedures and serves as a reference for surgeons training in the method. Dr. Andrew Jacono has delivered lectures at international plastic surgery conferences and conducted master classes, extending the technique’s reach well beyond his own practice of approximately 250 annual procedures. Read this article for additional information.

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