The deep plane facelift is having a moment. Dr. Sam Rizk has performed thousands of them and wants you to ask some questions first.
Marc Jacobs posted the gauze. In July 2021, at age 58, the designer put his own bandaged head and drainage tubes on Instagram, captioning the second post “Three days after. Ready for lewks,” alongside the hashtags “#someswelling #somebruising #andawholelotofsnatchedtightness.” When the wrapping came off he added one more: #deepplanefacelift.
Five years on, the phrase, like the procedure, is gaining more recognition. Actress Jackée Harry, 69, revealed a deep plane facelift in January. Kris Jenner told Vogue last year that her recent facelift “was time for a refresh.” According to the American Academy of Facial Plastic and Reconstructive Surgery’s (AAFPRS) annual member survey, projected facelift procedures among responding members climbed more than 30 percent year over year, increasing from 40,801 in 2024 to 53,223 in 2025.
Dr. Sam Rizk has watched interest in deep plane facelifts skyrocket in recent years. A double board-certified facial plastic surgeon who worked in fine arts before medicine, has performed more than 6,800 facelifts at Manhattan Facial Plastic Surgery on Park Avenue, he attributes the surge to patients rather than to any breakthrough. “The deep plane facelift itself is not new. What has changed is the level of interest in it,” Dr. Rizk told Ethos via email. “Patients are much more educated now, and they are looking for results that look natural rather than pulled or overly tight. They also understand that a facelift is not simply about removing excess skin.”
What is a deep plane facelift?
Everything hinges on which layer the surgeon is actually moving. A skin-only lift works on the surface, pulling the covering taut over structures that have already shifted beneath it. Those structures shift over time as we age: fat compartments migrate, and the superficial musculoaponeurotic system, the sheet of tissue and muscle known as the SMAS, descends along with them. Tightening skin over a collapsed frame produces the drawn quality that made an earlier generation of facelifts recognizable across a room (and not in a good way).
Working in the deep plane means going beneath that sheet and releasing the retaining ligaments that hold aged tissue in place, which lets the whole unit be lifted and reset rather than stretched.
“That allows the deeper tissues, including the fat compartments, to be repositioned rather than simply pulling the skin over them,” Dr. Rizk said. “You are restoring the architecture of the face instead of just tightening the covering.”
The architectural argument is also the longevity argument. Because the correction happens at the level where the descent occurred, the result is held by repositioned tissue rather than by tension on the surface. “If you only tighten skin, you are relying on the skin to hold the result,” Dr. Rizk said.
Why facelift patients are getting younger
Facelifts among 36-to-45-year-olds rose 55 percent in a single year, from 1,691 to 2,620, according to ASPS data. Male facelifts climbed 17 percent, outpacing women. Injectables, the maintenance route that once postponed surgery indefinitely, are losing ground commercially, with AbbVie reporting global Juvéderm revenue down 15.6 percent in 2025 after a double-digit decline the year before.
Dr. Rizk operates on anatomy rather than birthdays, which cuts in both directions. He sets no lower age limit, and he turns away patients who have nothing structural to correct.
“There is no magic age at which someone should have a facelift,” he said. “If someone has minimal laxity and is considering surgery simply because they are afraid of aging, I would not recommend it. The goal is not to operate as early as possible, it’s to operate when the anatomy and the patient’s goals justify it.”
His assessment reads the whole face: skin quality, the volume and distribution of facial fat, where the cheek and jowls sit, the line of the jaw, the neck. Meaningful laxity across the midface, lower face, or neck makes someone a candidate. Early changes often call for something less invasive, and a patient with previous surgery may need an entirely different approach.
“The procedure should be chosen for the face, not because it happens to be the technique everyone is talking about,” Dr. Rizk said.
Why the deep plane facelift is so hard to perform
Branches of the facial nerve run through the territory being released in a deep plane procedure, and knowing where to make an incision is not the same as knowing how tissue behaves once those ligaments are cut.
“You have to know the anatomy in three dimensions and understand how the tissues move when you release them, so there is very little room for error,” Dr. Rizk said. “If the surgeon doesn’t understand the plane, the anatomy or how much to release, you can compromise the result or, more seriously, injure a facial nerve. Like any surgical procedure, facelift surgery carries risks, which is why the surgeon behind the technique matters as much as the technique itself.”
The published evidence supports that caution more than it supports the marketing. A survey of 150 facial plastic surgeons published in the Journal of Craniofacial Surgery in May found that 90 percent now perform deep plane facelifts, that transient nerve injuries occurred in 1 percent to 5 percent of cases, and that higher rates of nerve injury were significantly associated with the deep plane technique. Longevity of results, the same survey found, was not. A meta-analysis of 21 studies published in Aesthetic Plastic Surgery put deep plane patient satisfaction at 94.4 percent against 87.8 percent for SMAS, with complication rates of 17.2 percent against 10.3 percent, and concluded that both techniques “provide robust and long-term outcomes with high patient satisfaction.”
That returns the question to the surgeon. “While the deep plane facelift represents a meaningful evolution in technique, results ultimately depend on the surgeon’s experience, judgment, and artistic sensibility,” details Dr. Rizk “It’s not just the method — it’s the artistic eye, the strategy, the experience, the know-how and how it’s applied that matters.”
What can go wrong in a deep plane facelift
Roughly half of Dr. Rizk’s facelift practice is now correcting surgical work done elsewhere, much of it on patients who were told they had a deep plane procedure. He does not read that as an indictment of the technique. The failures he sees are failures of matching and execution: tissue that was never adequately released, leaving the surgeon to rely on tension instead of true repositioning; movement in the wrong direction for that particular face; a lift that addressed the midface and left the neck alone.
“A successful facelift is not about how tight you can make the skin. It’s about how well you can restore the underlying anatomy,” Dr. Rizk said.
“The neck is also connected to the lower face anatomically, so you cannot always treat one without considering the other,” Dr. Rizk said. “Patients sometimes come in asking about their jawline and are surprised by how much the neck changes as part of the overall correction.”
Dr. Rizk has replaced traditional drains with tissue sealants where appropriate, an approach he has published on in Archives of Facial Plastic Surgery. Working within a defined plane also avoids the wide skin undermining that drives swelling.
“The goal is not simply to lift the face. It is to understand how the tissues are repositioned, how they are secured, and how they behave over years of facial movement,” Dr. Rizk said. “This modification represents an evolution of the deep plane facelift, designed to improve the durability of the lift while also allowing for a more efficient recovery.”
Correction is its own discipline, conducted through scar tissue and anatomy that has already been rearranged once, and it demands a different order of planning than a first operation. It has also given Dr. Rizk a specific view of what the phrase on the consent form is worth.
“Two surgeons can both call something a deep plane facelift and have very different approaches, levels of anatomical understanding and results,” he said. “The technique matters, but the surgeon’s judgment and execution matter just as much.”
What to ask a deep plane facelift surgeon
Dr. Rizk’s consultation script is short. He says to ask how often the surgeon performs the procedure, whether they take on revisions, and what they mean when they say deep plane. Ask to see patients whose anatomy resembles yours rather than a portfolio of best cases. Then, he says, ask the question almost nobody asks: “Don’t be afraid to ask about complications. Every surgery has risks. A surgeon should be able to explain those risks clearly and tell you how they manage them,” Dr.Rizk said.
Most important, is a speedy recovery — proof that the procedure worked. “I tell people that being presentable socially in roughly two weeks is realistic for many patients, but healing continues well beyond that,” he said. “Most of my patients are back to work in a week, and camera ready in two.”
As the understanding of fat compartments, ligament anatomy, and skin quality deepens, the work is getting more specific rather than more extensive. “The next evolution isn’t necessarily making the facelift more aggressive, it’s making it more precise,” Dr. Rizk said. “The goal is always the same: make the patient look refreshed and restored, not operated on.”
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