Bleeding under the skin, a hematoma, that requires a return to the operating room. This is the most common serious complication of any facelift; the hemostatic net reduces it but does not eliminate it. Temporary weakness of a branch of the facial nerve. Uncommon, usually resolves over weeks to months. Permanent injury is rare, and the nerve check at the end of the case exists because rare is not zero. Numbness of the cheek and ear for months. Expected. Visible scarring or a shifted hairline. Placement matters, and healing varies. Asymmetry. Faces are not symmetric before surgery and will not be after. Skin healing problems, much more likely in nicotine users, which is why the nicotine rule is a rule. The need for a revision. Some percentage of facelifts need a touch-up, mine included. When I judge that a revision is indicated within the first year, my surgeon fee is waived; facility and anesthesia costs apply. That policy is in writing before surgery. And the one nobody puts on a list: a facelift does not stop aging. It resets the clock; it does not stop it.

How long does it last

Longer than a skin-only lift, because the tissue that is repositioned is the tissue that dropped, and it is held by released-and-reset ligaments rather than by tension on the skin. Most patients are still clearly ahead of where they would otherwise have been a decade later. But “ahead” is the honest word. You keep aging from the new starting point, and the rate depends on your skin, your sun, your weight, and your genetics more than on me.

Revision of a facelift done elsewhere

A meaningful part of my practice is secondary facelifts: people who had a facelift somewhere else and are unhappy with the result, or who had a good result fifteen years ago and want it addressed again. These are harder operations. The scar tissue changes the anatomy, the earlier incisions constrain where the new ones can go, and the nerve is at more risk. They are also the cases I find most worthwhile, and a good number of the patients who travel to Phoenix for surgery are coming for exactly this. If this is you, bring your operative report from the first surgery if you can get it.

Deep Plane Facelift In Phoenix & Scottsdale, Arizona

Deep Plane Facelift

Introduction

The Deep Plane Facelift, Explained by the Person Who Does Them

By Randall O. Craft, MD. Medically reviewed Sept 2026

Start with the thing you are actually worried about, because it is the right thing to worry about. You have seen facelifts that look like facelifts. Pulled at the corners of the mouth, a wind-tunnel flatness across the cheek, a jawline that reads as tight rather than young. Those results are not bad luck. They are what happens when an operation tightens skin and calls it a day.

The tissue that dropped is not the skin. It is the layer underneath, and that is where the operation has to happen. That sentence is the whole argument for a deep plane facelift, and the rest of this page is the detail.

What is actually sagging

Three things change in the face over time, usually together.

The deeper support layer descends. It has a name, the superficial musculoaponeurotic system, or SMAS, and it is the sheet of tissue that carries the fat pads of the cheek. When it slides down and forward, you get jowls, deep folds beside the nose, and a cheek that has gone flat because its fat is now sitting lower than it used to.

The neck loosens. The platysma muscle separates and bands, and the angle between chin and neck blunts.

Volume is lost. Under the eyes, in the cheeks, at the temples. This is why a face can look tired even when nothing has sagged much yet.

Skin excess is the result of all three, not the cause. A procedure that only tightens skin treats the symptom, and the symptom comes back.

What “deep plane” means

In a deep plane facelift, the SMAS layer and the skin are lifted together as one unit, rather than the skin being separated from it and pulled independently. The ligaments that tether the cheek and jowl to the bone are released so the whole layer can move up and back to where it sat before. Because the skin is not pulled on its own, there is no tension at the incision line and no stretched look. The skin simply follows the tissue underneath it.

The neck is treated in the same operation. The platysma bands are addressed under direct vision, and the cervicomental angle is restored. A facelift that stops at the jawline reads as a facelift. The face and neck are one unit and I treat them as one.

This is my default technique, not an upgrade tier. Occasionally, for a patient with early laxity and good skin, a more limited SMAS plication is the right operation and I will say so. But the default is deep plane, because for moderate to advanced aging it is the operation that addresses what has actually happened.

Who should not have this operation

This section comes before the reassuring parts on purpose.

You should not have a facelift if you use nicotine in any form and are not willing to stop it completely for four weeks before and four weeks after surgery. Cigarettes, vaping, patches, gum, pouches. Nicotine constricts the small blood vessels that keep the lifted skin alive. Skin loss after a facelift is uncommon, and most of the cases you read about are smokers. I will not operate on an active nicotine user.

Blood thinners that cannot be safely paused, uncontrolled blood pressure, uncontrolled diabetes, and certain autoimmune or wound-healing conditions all need clearance, and some of them are a no.

And then there are expectations. If you want a specific face rather than a rested version of your own, or if you are being asked to have surgery by someone other than yourself, this is not the right operation, and I will tell you that at consultation. I decline cases. It happens more often than you would expect, and it costs me a case every time.

What happens on the day

Surgery is performed under IV sedation, not general anesthesia. Every anesthetic in my practice is administered by a physician anesthesiologist certified by the American Board of Anesthesiology. Sedation is propofol-based and combined with regional nerve blocks, so there is no breathing tube, and most patients wake up clear-headed within minutes of the end of the case. We use an opioid-sparing protocol: the nerve blocks plus non-opioid medications keep narcotic use to a minimum afterward, which is the main reason our patients are not nauseated and groggy for days.

The incision runs along the natural creases in front of the ear, around the earlobe, and behind the ear into the hairline. Placed correctly, it is hard to find once healed. Through it, the deep plane is entered, the retaining ligaments are released, the cheek and jowl tissue is repositioned, and the neck is treated.

Two things I do that you should ask any surgeon about.

First, no drains. Instead of tubes, I use a hemostatic net, a pattern of temporary sutures that holds the lifted skin against the tissue beneath it so that no fluid can collect in the space. The sutures come out in a few days. It replaces drains and it also reduces the risk of a hematoma, which is the most common serious complication after a facelift.

Second, at the end of every facelift, including revisions, I stimulate every branch of the facial nerve and watch it fire. This is a direct check that the nerve is intact before you leave the operating room. It takes a few minutes and it is not standard.

Fat grafting and skin resurfacing

A lift repositions tissue. It does not replace volume, and it does nothing for the surface of the skin. Most of my facelift patients have some of both problems, so most of my facelifts include one or both of these at the same operation.

Fat grafting takes a small amount of your own fat, usually from the abdomen or thigh, and places it where volume has been lost: under the eyes, in the cheeks, at the temples. A lift alone will leave a hollow face looking hollow.

Skin resurfacing treats the texture, the fine lines, and the sun damage that no lift touches. My preferred method is a croton oil phenol peel, which is a deep chemical peel with a long track record. It is not subtle, and the recovery from the peel is its own thing, but it does what lasers at comparable depth do not.

Both are planned into the operation at consultation rather than added later.

A wide shot of Dr. Randy Craft in black scrubs, sitting next to a smiling female patient, who is seated in a gray armchair. Dr. Craft is holding an open laptop and looking down at it, while the patient is looking to her left and laughing brightly. The background features a white wall with abstract black line-art of a face, and a large sign with the text "CRAFT AESTHETICS / WELLNESS" partially visible.

What recovery is actually like

I will tell you now what I tell every patient in the room: you will be swollen for three weeks and firm for three months. Anyone who tells you otherwise is selling the recovery, not the operation.

The first week is bandages, sleeping upright, and looking worse than you expected. Bruising peaks around day three and starts to fade. The net sutures come out in the first several days. Most patients are comfortable in public, with makeup and a little explaining, at ten to fourteen days. For a deep plane lift with the neck, plan on three weeks before you feel like yourself in a room full of people who know you.

Swelling continues to settle for months. Numbness of the cheek and the ear is normal and lasts months. The final result is at six to twelve months. Revisions and secondary facelifts often take longer.

If you have added a phenol peel, add the peel’s recovery on top: the treated skin is raw for about a week and pink for several weeks after that.

Black and white texture background overlay

Deep Plane Facelift FAQ’S

Bleeding under the skin, a hematoma, that requires a return to the operating room. This is the most common serious complication of any facelift; the hemostatic net reduces it but does not eliminate it.

Temporary weakness of a branch of the facial nerve. Uncommon, usually resolves over weeks to months. Permanent injury is rare, and the nerve check at the end of the case exists because rare is not zero.

Numbness of the cheek and ear for months. Expected.

Visible scarring or a shifted hairline. Placement matters, and healing varies.

Asymmetry. Faces are not symmetric before surgery and will not be after.

Skin healing problems, much more likely in nicotine users, which is why the nicotine rule is a rule.

The need for a revision. Some percentage of facelifts need a touch-up, mine included. When I judge that a revision is indicated within the first year, my surgeon fee is waived; facility and anesthesia costs apply. That policy is in writing before surgery.

And the one nobody puts on a list: a facelift does not stop aging. It resets the clock; it does not stop it.
Longer than a skin-only lift, because the tissue that is repositioned is the tissue that dropped, and it is held by released-and-reset ligaments rather than by tension on the skin. Most patients are still clearly ahead of where they would otherwise have been a decade later. But “ahead” is the honest word. You keep aging from the new starting point, and the rate depends on your skin, your sun, your weight, and your genetics more than on me.
A meaningful part of my practice is secondary facelifts: people who had a facelift somewhere else and are unhappy with the result, or who had a good result fifteen years ago and want it addressed again. These are harder operations. The scar tissue changes the anatomy, the earlier incisions constrain where the new ones can go, and the nerve is at more risk. They are also the cases I find most worthwhile, and a good number of the patients who travel to Phoenix for surgery are coming for exactly this. If this is you, bring your operative report from the first surgery if you can get it.

Fees

Facelift fees are quoted in writing at consultation and are a fixed fee for the procedure agreed before surgery. The fee covers the operation, not a result, and I will not pretend otherwise; you sign a document saying the same thing before we operate.

The consultation

History, examination, photographs, and a direct recommendation, including the option of not operating. If I think a lift is not the answer, I will say so, and if I think a smaller operation is the right one, I will say that too. You leave with a written quote and a plan.

Virtual consultations are available and are how most out-of-state patients begin. Surgical patients are examined in person before any date is scheduled.

About the surgeon

Board certified by the American Board of Plastic Surgery and the American Board of Surgery. General surgery residency at Mayo Clinic, plastic surgery residency at Harvard, microsurgery fellowship at the Bernard O’Brien Institute in Melbourne. Clinical Assistant Professor at the University of Arizona College of Medicine, Phoenix. I practice in Phoenix and Scottsdale.

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