The first useful question in any facelift consultation is not how much, how long, or what is involved. It is whether the patient is actually a candidate for the procedure being discussed, and if so, which technique is the right one. Recovery, longevity, and cost only matter once that question has a clear answer.
Not every patient who books a facelift consultation needs a deep plane lift. Some are better suited to a less extensive procedure. A small number are better off not having surgery at all and pursuing non-surgical options for a few more years. An experienced doctor should be willing to say so when that is what the assessment suggests.
This article sets out the anatomical, health and lifestyle factors that influence whether someone is a good candidate for a deep plane facelift. It is a general guide. The only definitive assessment is the one performed in person, with the patient sitting in front of the doctor, in good lighting, with the face at rest and animated. Individual anatomy varies more than written descriptions can capture.
What a Deep Plane Facelift Addresses
A deep plane facelift works in the anatomical layer beneath the superficial musculoaponeurotic system, or SMAS. It releases the facial retaining ligaments, small fibrous bands that anchor the soft tissues of the face to the underlying bone. Once those ligaments are released, the SMAS, the malar fat pad, and the deeper soft tissues are repositioned together as a single composite unit rather than as separate layers stretched against one another. Dr Rastogi has written a more detailed explanation of the deep plane technique for patients who want the details.
The technique is well-suited to specific patterns of facial ageing. The midface, the area beneath the eyes and across the cheekbones, is the region where the difference is usually most visible. When the malar fat pad slides down with age, the cheek flattens out at the front, and the area sitting between the lower eyelid and the cheek starts to look hollow. A deep-plane approach lifts that fat pad up and out, restoring midface volume to its former position and reducing the sharpness of the upper nasolabial fold.
Further down the face, a deep plane lift sorts out jowling and the loss of a clean jawline. Since it shifts the deeper tissues rather than relying on skin tension, the look is usually softer, and the result tends to hold up better over time. That also has a real effect on how the incision lines settle.
The technique does not address the upper third of the face. The forehead, brow position, upper eyelid hooding, and under-eye bags are concerns that require separate procedures (brow lift, blepharoplasty, fat repositioning). A deep plane facelift can be combined with these procedures in a single anaesthetic where appropriate, but it does not treat them on its own.
The Age, Anatomy and Skin Quality of A Potential Candidate
Anatomy carries more weight than the number on a birth certificate. Most people who go ahead with a deep plane facelift are between 45 and 70, though that range is just a rough guide. Some women and men in their early forties already show noticeable midface descent, deep nasolabial folds, and early jowling, making them good candidates. Others in their late sixties or seventies bring complicating factors that shift the picture. What’s on the driving licence is only one piece of the puzzle.
Skin elasticity is one of the more important factors. Skin that retains good elasticity redrapes well after the underlying tissues are repositioned. Skin with very poor elasticity (for example, after substantial weight loss, prolonged uncontrolled sun exposure, or heavy smoking) may not redrape as cleanly. The principle is sometimes summarised as younger tissues hold stitches better. There is a real anatomical truth to that observation.
Fat distribution is the second factor. Patients with a moderate amount of facial fat tend to achieve the most predictable results, because the malar fat pad is the tissue that the deep plane lift repositions. Patients with very limited facial fat, those who would describe themselves as thin-faced, sometimes benefit from fat grafting performed at the same time as the facelift, to restore a degree of midface volume that the lift alone cannot create. Patients with very heavy facial fat distribution may need different planning, since the goal is to reposition tissue rather than to remove it.
Bone structure provides the framework for the soft tissue to sit on. Strong underlying bone in the cheekbones and along the jawline tends to provide better long-term support for repositioned tissue, contributing to the longevity patients ask about when researching how long a deep plane facelift lasts. Patients with less prominent underlying bone can still be excellent candidates; the surgical plan simply accounts for the bony framework.
What we look for is ligamentous laxity, not skin laxity alone. A face that has actually lost its deeper structural support, through stretching of the retaining ligaments, is the one that responds best to a deep plane lift. Where the skin has gone a bit slack, but the deeper structure is still doing its job, a smaller operation suits the patient better.
Health and Lifestyle Factors
Good candidates for a deep plane facelift are in good general health. That does not mean perfect health. Patients with well-controlled chronic conditions, including hypertension, controlled type 2 diabetes, treated thyroid disease and stable cardiovascular conditions, are commonly able to proceed with surgery once medical clearance is obtained. The relevant question is whether the condition is stable and managed, not whether it exists.
Smoking is a separate category. Patients who smoke, vape or use any form of nicotine are not candidates for a deep plane facelift until nicotine has been ceased for at least four to six weeks before surgery, with continued abstinence afterwards. The reason is not preference; it is wound healing biology. Dr Rastogi has covered preparation requirements in detail, including smoking, alcohol and supplements. The deep plane technique involves more extensive tissue elevation than a SMAS lift, making it even more sensitive to compromised blood supply.
Weight stability matters. Patients should be at a stable weight for at least 3 to 6 months before surgery and maintained afterwards. Significant weight loss following a deep plane lift can alter the position and volume of the repositioned tissues. Significant weight gain has a similar effect in the opposite direction.
Thin-faced patients are sometimes told they are not candidates for a deep-plane lift. The more accurate statement is that they may be excellent candidates for fat grafting, which restores volume to areas where natural facial fat has thinned over time. The combined approach addresses both descent and volume, which are often what the patient actually notices in the mirror.
Active autoimmune disease, particularly when a patient is on systemic immunosuppression, needs to be carefully evaluated on a case-by-case basis. The same goes for any history of bleeding disorders, a tendency to scar badly (keloid history), or past complications with anaesthesia. None of these rules automatically excludes anyone. They simply change the planning, and in some cases, they change what we recommend.
Realistic expectations and psychological readiness are part of every consultation. A deep plane facelift can restore structure that has been lost over time; it does not stop the face from continuing to age, nor does it change the underlying bone shape or skin colour. Male facelift candidates often raise their own version of these questions; the same anatomical and lifestyle factors apply.
When Deep Plane Is Not the Right Approach
Some patients arrive at a consultation specifically requesting a deep plane facelift after reading about the technique online. A good doctor’s job at that point is honest assessment, not enthusiastic agreement. The deep plane lift is the right operation for the right anatomy. It is not the right operation for every face.
Patients with minimal facial descent, where the concern is mild skin laxity rather than true ligamentous involvement, are typically better suited to a less extensive procedure. A SMAS lift, or short-scar facelift, can address mild to moderate changes with less surgical exposure and a shorter recovery. Dr Rastogi has compared SMAS and deep plane techniques directly for patients who want to weigh up the two side by side.
Patients whose primary concerns sit in the upper third of the face, heavy brows, deep forehead lines, hooded upper eyelids, and prominent under-eye bags, are not best served by a deep plane facelift on its own. A brow lift, upper or lower blepharoplasty, or a combination of those procedures, addresses the upper face directly. A deep plane lift performed for the wrong indication results in a face that has been operated on without addressing the patient’s actual concern.
Patients seeking only volume restoration, where descent is not the issue but flatness or hollowness is, may be better served by fat grafting or other volumising approaches rather than by a structural lift. Volume restoration and structural repositioning are distinct goals, achieved with distinct procedures.
Patients who cannot or will not cease smoking should not undergo a deep plane facelift. The risk of skin necrosis and wound healing complications is high enough that the procedure cannot be performed safely. The cessation requirement is not negotiable.
Previous Surgery and Revision Candidacy
Someone who has already had a facelift can still be a candidate for a deep plane lift. It depends on what was done the first time round and how the face has aged in the years since. The most common situation we see is a patient who had an SMAS or limited-incision lift ten or more years back, has watched the original result soften, and is now weighing up a more comprehensive secondary procedure.
The deep plane approach is anatomically useful in this situation. It works in a layer beneath the SMAS, which may be largely undisturbed by previous superficial surgery. This is one of the reasons the technique has become more common as a revision option. However, every revision is individual and depends on factors that are not visible from the outside.
Scar patterns from the previous surgery are assessed at consultation. If the original incisions were placed in standard positions, revision is generally straightforward to plan. If incisions are placed in unusual locations or the patient has experienced significant scarring, the surgical approach may need to be modified. Tissue quality also matters; tissue that has been operated on once heals the second time differently, and recovery from a revision deep plane facelift may follow a slightly different course.
How much time has passed since the last surgery also matters. A revision performed within the first year or two of the original procedure is a very different operation from one performed ten or fifteen years down the track. Each patient is assessed individually, with anatomy, scar quality, the goals for the secondary procedure and any health changes since the first operation all factored in.
The Consultation: What Dr Rastogi Assesses
A deep plane facelift consultation is a careful, hands-on process. You can’t tell from a photo how stretchy the skin is or how lax the underlying ligaments have become, so part of the consultation involves a gentle hand examination as well as the visual side.
Dr Rastogi examines skin quality and elasticity across the cheek, jawline and neck, the position and projection of the malar fat pad, the depth of the nasolabial folds, the degree of jowling, the position of the hairline and ear, the condition of the neck and submental area, and the symmetry of the face at rest and during animation. Medical history is reviewed in detail, including current medications, supplements, previous surgery and any history of complications with anaesthesia. Photographs are taken from standard angles for surgical planning and as a record.
The surgical plan is then talked through with the patient. That means going over which technique is recommended and why, what the alternatives look like, and the realistic limits of surgery for that particular face. If a deep plane lift isn’t the right call, we say so plainly and explain why. Alternatives, whether that’s a different operation or a non-surgical option, are laid out in straightforward terms. The cooling-off period set by the Medical Board of Australia falls between consent and surgery, giving patients time to think things through before making a final decision.
Why Choose Dr Rastogi for Deep Plane Facelift in Sydney
Dr Anoop Rastogi (B. MED, FACCSM, AHPRA registration MED0001145438) has over 30 years of medical and surgical experience in Australia and internationally. He holds a Bachelor of Medicine from the University of Newcastle and is a Surgical Fellow of the Australasian College of Cosmetic Surgery and Medicine (ACCSM). He currently serves as Surgical Dean of the ACCSM and is its immediate past President. As a Surgical Preceptor, he plays a key role in training and mentoring the next generation of cosmetic surgery practitioners through the College’s surgical training programme. His full clinical profile is available on the practice website.
Dr Rastogi has previously been an AHPRA-appointed surgical supervisor and has contributed to the Australian Medical Council’s Project Advisory Group, advising on programs of study in cosmetic surgery. He completed international fellowships in cosmetic surgery in London, Cambridge, Rome and Paris, working alongside surgeons including Dr Anthony Erian, Dr Giorgio Fischer and Dr Jean-Luc Bachelier. His council membership can be independently verified through the ACCSM website.
He founded his Double Bay practice in the 1990s and continues to attract patients from across Australia and internationally. Further information about his clinical background is available on the about page.
To arrange a deep plane facelift consultation with Dr Rastogi at his Double Bay clinic in Sydney, call 02 9362 1426 or complete the contact form on the website.
Deep Plane Facelift Candidate FAQs
What is the best age for a deep plane facelift?
There isn’t a single perfect age for a deep plane facelift. Most patients fall between forty-five and seventy, but the anatomy matters more than the year on the calendar. If someone has moderate midface descent, jowling and deep nasolabial folds, they may be a candidate regardless of their age. Younger tissues do sometimes hold the structural lift a bit longer.
Can I have a deep plane facelift in my forties?
A patient in their forties may be a candidate for a deep plane facelift if they have significant midface descent, deep nasolabial folds, or early jowling that do not respond to non-surgical options. Patients with only mild skin laxity are generally better suited to less extensive techniques such as an SMAS or short-scar facelift.
Who should not have a deep plane facelift?
Patients who continue to smoke, have significant uncontrolled medical conditions, have active autoimmune disease or have primarily upper-face concerns (brow, forehead, eyelids) are generally not candidates for a deep plane facelift. Patients with only mild laxity may be better suited to less extensive procedures. Realistic expectations are essential.
Can a deep plane facelift be performed after a previous facelift?
A deep plane facelift can sometimes be performed as a secondary procedure after a previous SMAS or limited-incision facelift, particularly if deeper tissues were not previously addressed. The deep plane approach often works in an anatomical layer undisturbed by superficial surgery. Suitability depends on tissue quality, scar patterns and time since the previous procedure.
What does a deep plane facelift not treat?
A deep plane facelift treats the midface, lower face, jowls, and jawline. It does not treat forehead lines, brow descent, upper eyelid hooding or under-eye bags. These concerns require separate procedures such as brow lift or blepharoplasty. A deep plane facelift can be combined with these in a single anaesthetic, where appropriate.
How do I know if I need a deep plane or SMAS facelift?
The decision between deep plane and SMAS facelift depends on the depth of facial descent and the involvement of the deeper retaining ligaments. Patients with significant midface descent and deep nasolabial folds often benefit from a deep plane approach. Patients with primarily skin and superficial tissue laxity may be suited to an SMAS technique.
Disclaimer: Any surgical or invasive procedure carries risks. The content on this page is general in nature and does not constitute medical advice. Individual results vary and depend on multiple factors, including anatomy, healing and aftercare. Before proceeding with surgery, you should seek a second opinion from an appropriately qualified medical practitioner. Dr Anoop Rastogi, MED0001145438.
Further Reading
What Is A Deep Plane Facelift? (An anatomical explanation of how the deep plane technique works)
Understanding the Differences: SMAS Facelift vs Deep Plane Facelift (A side-by-side comparison of the two main facelift techniques)
Is Deep Plane Facelift Better Than SMAS Facelift? (An honest look at when each technique is the appropriate choice)
How Long Does A Deep Plane Facelift Last? (What patients can expect in terms of longevity of results)
Deep Plane Facelift Recovery (Recovery considerations specific to patients on the deep plane pathway)
Male Facelift in Sydney (How facelift surgery is adapted for male patients)
Medical References
Healthdirect Australia – Facelift (Government-funded Australian health information service covering facelift surgery)
Better Health Channel (Victoria) – Facelift (Meloplasty) (Australian state government resource on facelift techniques, candidacy and risks)
Medical Board of Australia – Cosmetic Surgery Guidelines (Official source for the cooling-off period and other Australian cosmetic surgery requirements)
Australian Health Practitioner Regulation Agency (Ahpra) – Cosmetic Surgery Information for Patients (Regulatory guidance on choosing a registered medical practitioner for cosmetic procedures)
Cleveland Clinic – Facelift (Patient education resource covering facelift candidacy and surgical techniques)
PubMed – Current Trends in Facelift and Necklift Procedures (J Clin Med, 2025) (Peer-reviewed review of deep plane technique and candidate selection criteria)
PubMed – Deep Plane Facelift: A Case Series and Anatomical Review (Peer-reviewed anatomical review of ligament release and tissue repositioning)
