Complication rates rarely make headlines, but they matter to anyone weighing a facelift. When Dr. Andrew Jacono published his Minimal Access Deep-Plane Extended (MADE) facelift in Aesthetic Surgery Journal in 2011, he documented outcomes in 153 patients. The initial numbers came in below industry averages for facelift surgery. Those early results gave weight to a technique Jacono had been developing since the early 2000s.
The Figures
Initial clinical data showed a revision rate of 3.9%. Hematoma, a collection of blood beneath the skin, occurred in approximately 1.9% of cases. Temporary facial nerve injury appeared in 1.3%.
Later studies supported a broader conclusion: deep-plane techniques carry a lower chance of facial nerve injury than superficial approaches. The explanation lies in how the dissection is performed. Working in the deep plane preserves anatomical relationships and the blood supply to the tissue.
How the Technique Works
A conventional facelift separates skin from the superficial musculoaponeurotic system (SMAS) and pulls the skin tight. Dr. Andrew Jacono’s method goes beneath the SMAS and keeps skin, muscle, and fat together as one unit. He releases four ligaments that attach facial tissue to bone, which frees descended fat pads in the midface, jawline, and neck to be lifted vertically.
Incisions are roughly one-third the length of those used in traditional facelifts. They are placed behind the ear and along the hairline, leaving patients free to wear their hair up. Jacono describes the result as “ponytail-friendly.” Results can also last roughly twice as long as a standard SMAS facelift.
Volume matters too. Dr. Andrew Jacono performs about 250 extended deep-plane facelifts a year at his Manhattan practice, and that repetition refines his judgment about which ligaments to release and which lifting vectors work best. He has also taught the technique in master lectures at more than 100 international conferences and summarized lessons from over 2,000 procedures in a 2021 medical textbook.
For prospective patients, the published data offer a practical point: a deeper operation need not come with more complications. Read this article for more information.
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