Surgeons had accepted for decades that facelifts required a compromise: dramatic results came with obvious scarring and an artificial appearance, while subtle interventions failed to deliver meaningful rejuvenation. The field operated within these constraints until a New York facial plastic surgeon questioned whether the fundamental approach itself needed revision.
Dr. Andrew Jacono introduced the extended deep-plane facelift in the early 2000s after recognizing that traditional techniques addressed symptoms rather than causes. Conventional facelifts separated skin from underlying tissue, pulled it taut, then trimmed excess. The method produced that stretched look patients dreaded. Dr. Jacono’s innovation abandoned this surface-level manipulation entirely.
Anatomical Understanding Drives Technical Innovation
The breakthrough came from studying facial anatomy at a structural level. Traditional facelifts operated on the superficial musculoaponeurotic system (SMAS), the tissue layer connecting facial muscles to skin, by tightening it from above. Dr. Andrew Jacono works beneath this layer, in the deep plane where skin, muscle, and fat remain connected as a single unit.
His technique releases key facial ligaments that anchor tissue in place. With these attachments freed, he repositions the midface, jawline, and neck structures vertically, restoring them to their youthful positions rather than pulling them backward. The approach addresses the root cause of facial aging: tissue descent and volume deflation occur in three dimensions, not just on the surface.
Dr. Jacono first published his findings in Aesthetic Surgery Journal in 2011, documenting outcomes from 153 patients. The data revealed significant advantages over traditional methods: only a 3.9% revision rate, approximately 1.9% hematoma rate, and 1.3% temporary facial nerve injury. These complication rates fell substantially below industry averages.
Results lasted 10 years or more in the initial patient series. Subsequent research confirmed the durability of 12 to 15 years, roughly double the longevity of standard SMAS facelifts. The deeper tissue support maintains position longer because it reconstructs architecture rather than merely tightening skin. Key factors that affect longevity include technique, lifestyle, skin quality and care.
Refinement Through Volume and Clinical Experience
Dr. Andrew Jacono continued refining the technique through his exceptionally high surgical volume. He performs approximately 250 deep-plane facelifts annually. This case load enables continuous technical improvement and produces expertise that comes only through repetition at scale.
A 2019 publication introduced further advances for jawline rejuvenation and volume enhancement in the lower face. The refinements addressed specific aging patterns that earlier iterations hadn’t fully resolved. Each modification emerged from observing long-term outcomes and identifying opportunities for improvement.
Impact Beyond Individual Practice
The extended deep-plane facelift’s influence extends throughout facial plastic surgery. The New York Times coverage in 2022 noted Dr. Jacono as a pioneer who teaches the technique to surgeons globally. Many leading specialists have incorporated extended deep-plane principles (vertical lift vectors and ligament releases) into their own practices.
High-profile patients validated the approach’s capabilities. Fashion designer Marc Jacobs publicly revealed in 2021 that Dr. Jacono performed his facelift, praising results that avoided the “can’t fix things” territory of overdone surgery. Fellow plastic surgeon Dr. Paul Nassif chose Dr. Jacono for his own procedure in 2018, demonstrating trust within the surgical community.
Dr. Jacono published a comprehensive medical textbook in 2021, The Art and Science of Extended Deep Plane Facelifting, synthesizing insights from over 2,000 procedures. The publication serves as technical documentation for surgeons adopting the method and represents the culmination of two decades of refinement.
Why Innovation Matters
The extended deep-plane facelift’s development reveals how surgical innovation happens: through questioning accepted limitations, understanding anatomy at a deeper level, documenting outcomes rigorously, and refining techniques based on accumulated experience. Dr. Andrew Jacono didn’t simply modify existing approaches but reconceptualized the procedure’s fundamental mechanics.
His method acknowledges that faces age structurally, not superficially. Addressing changes at their anatomical source produces results that appear natural because they restore rather than distort. Patients look like refreshed versions of themselves. That shift represents the extended deep-plane facelift’s lasting contribution to facial plastic surgery.