Most people notice aging in the mirror as loose skin. Underneath, the process is more structural. Faces lose volume over time, and the tissues that once sat high on the cheekbones gradually slide downward. Dr. Andrew Jacono built his surgical approach around that anatomical reality.

Where Traditional Facelifts Fall Short

A conventional facelift treats the visible symptom. The surgeon separates skin from the superficial musculoaponeurotic system, or SMAS, then pulls the skin up and back. Surface tissue gets tighter, yet the deeper structures that actually descended stay put. Results usually fade within six to eight years, and the tension can leave a stretched quality that gives the surgery away.

Lifting From the Foundation

The Minimal Access Deep-Plane Extended facelift, which Dr. Andrew Jacono introduced in the early 2000s, goes beneath the SMAS. Four facial ligaments anchor soft tissue to bone, and he releases them. With those tethers loosened, descended fat pads in the midface, jawline, and neck can be moved back up vertically.

Skin, muscle, and fat are repositioned together as one connected unit instead of being peeled apart. Because the surgeon restores support at the deepest level, the face gains a foundation that tightening the surface cannot provide.

Durability follows from that foundation. The extended deep-plane facelift can last roughly twice as long as a standard SMAS lift. Many patients keep their results for over ten years, and some for more than 12. Skin quality, lifestyle, technique, and ongoing care all play a part.

Safety data have been encouraging as well. Jacono’s first published series of 153 patients, which appeared in Aesthetic Surgery Journal in 2011, recorded a 1.3% rate of temporary facial nerve injury and a hematoma rate near 1.9%. Later work showed deep-plane dissection causes fewer nerve injuries than superficial methods because it preserves blood supply and anatomical relationships.

Dr. Andrew Jacono kept refining the method. A 2019 update added modifications for the jawline and lower-face volume, tracked through measurements such as the “mandibular defining line,” which charts jawline contour. The underlying principle stayed the same: correct aging where it begins. Read this article for more information.

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