Deep Plane Neck and Jawline Lift (DPNJL)
Modern facelifting techniques are the results of evolution of technique over time. While many doctors used a fixed, basic technique over the course of their careers, resulting in consistent but average results, it is critical to continue to update, refine and evolve techniques over the course of one’s practice and research career. The deep plane neck and jawline lift (DPNJL) is the result of a a hybrid procedure between the ideal layer to be in for long-term and natural results (the deep plane), and a focused area of improvement (isolated to the neck and jawline). The reason for these combining these concepts are multiple and are discussed below:
Why use the “deep plane”?
The layer that the facelift or rhytidectomy surgeon operates in, and how extensively he/she uses this layer is very important. The most archaic technique, is, after incisions around the ear to do an undermining below the skin just surrounding the ear, then removing some surrounding skin, to apply tension to the residual skin to tighten it back to the ear incisions. This technique works poorly, results in a tight, or pulled look, results in tension on incisions which both causes pain and worsens scarring. It also has poor durability, usually with any positive result lost within a year. This technique is marketed as a mini-lift, or skin only lift, and sometimes can involve folding of the underlyling soft tissue or SMAS layer (a muscular type layer just below the skin).
Increasing complexity and duration involves further extension of the undermining of the skin into and throughout the neck, that permits full mobilization of the tissue over the neck. This is frequently combined with a limited lift of the underlying SMAS or muscle-layer after an incision into this layer. Adding this complexity requires more experience and results in more longevity and efficacy than the skin-only or SMAS folding lift.
The deep plane layer requires specialized equipment, training, and anatomic background. Typically, it is associated with an extensive undermining of the skin of the neck and jawline area. The deep plane is entered with a specialized lighted device at the corner of the jaw. Using careful technique and direct visualization, an advance is made under the muscle layer of the jowl all the way to the corners of the mouth. This delicate plane allows full release of the tissue of the jowl and neck, and permits complete repositioning of the muscle and tissue WITHOUT TENSION even before the skin is lifted. The tissue and muscle layer can heal into its new position, resulting in a natural repositioning of the sagging tissue in an upward direction instead of a “pull” toward the ears. The results are long-lasting due to longterm healing of tissue into a new position instead of relying on tension of earlier techniques.
Why neck and jawline only?
By using the deep plane as a way to mobilize the loose tissues in order to reposition them to a better, more youthful position, it is now important to determine WHICH areas need to be mobilized, as more facial mobility is NOT necessarily better if not done thoughtfully. An analysis of facial aging shows most of this loose tissue that people seek to correct occurs in the jowl at the jawline approaching the lower lip, and in the loose skin of the neck. While the naso-labial folds, lips, and cheek also can age, these areas typically do not do as well when repositioned, but respond better to volume restoration! We have all seen people with distorted lips, cheeks, and nasolabial folds pulled by bad facelifts. The nasolabials folds, lips, and cheeks do better with volume restoring injectibles like Allergan’s Voluma™ and Juvederm™, when done conservatively, thoughtfully and appropriately. So, by deliberately avoiding repositioning these areas, one can completely avoid the hallmark look of the bad facelift, or the distorted lip or cheek.
We apply the deep plane repositioning exclusively to the jowl, neck, and jawline, thus permitting the most powerful and successful lifting technique to the area that needs it the most, while not mobilizing the areas that do not.
Thus, the evolved technique of the deep plane neck and jawline lift, is the most long-lasting technique focused on the areas that need the most help, while avoiding collateral damage to the areas that can be helped by volumization alone.