April 19, 2022
A Deep Dive on Deep Plane Facelift w/ Dr. Jason Bloom
Facelift is the big reset for facial aging. An important event that should be carefully considered. There are different techniques. Which one is best? Why? The big divide in facelift is between SMAS techniques and deep plane facelift. Dr Bass discusses the history of deep plane facelift and then goes back and forth with his guest, facial plastic surgeon Dr. Jason Bloom about how the procedures are performed and which technique they prefer and why. Find out their reasons and hear what they agree on for all facelifts regardless of preferred technique.
Links
- Read more about facelifts
- Read more about the subject of deep plane facelift in Dr. Bass’s blog
About Dr. Lawrence Bass
Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond.
To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc
Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass.
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Welcome to another episode of
Park Avenue Plastic Surgery Class,
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the podcast where we explore controversies
and breaking issues in plastic
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surgery.
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I'm your cohost Doreen Wu I'm excited
to be here with Dr. Lawrence Bass Park
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Avenue plastic surgeon, educator,
and technology innovator.
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Today we have a special
guest Dr. Jason Bloom,
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facial plastic surgeon from
Bryn Mawr Pennsylvania.
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The title of today's episode is a
deep dive on the deep plane facelift.
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Dr. Bass,
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everyone wants the best possible result
when they undergo a major procedure like
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a facelift. The deep plane facelift
seems to be a popular technique.
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Can you tell us more about this approach?
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Sure. Doreen,
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I mean the basic definition
of the deep plane facelift,
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it is a facelift that involves dissecting
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underneath the SMAS, the
connective tissue in the face,
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allowing direct division of
some of the retaining ligaments
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so that all of the soft tissue of
the face can be maximally, mobilized,
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and repositioned.
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The procedure was initially developed
by a surgeon named Sam Hamra
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in 1990 and Dr. Hamra,
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who was trained at NYU in
plastic surgery, where I trained,
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uh, but practiced in Texas
wanted ways to improve
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the facelift.
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And he was hoping to get a more complete
correction by mobilizing the tissues
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more thoroughly and moving them
in a group or a composite state
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over time. However,
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the amount of dissection involved raised
some concerns and studies were done to
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see if it was either giving us a
better correction or a longer lasting
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correction.
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And there were some studies that
followed patients longitudinally
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over time, and some
studies that treated twins,
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one with one facelift technique, a,
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a SMAS multi-component technique,
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and one with a deep plane
technique and those studies
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did not in the end of the day show
that there was an advantage to the
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technique at that point in time.
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And that point in time was
somewhere around the year,
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2000 just to put a round number on
it. So by the end of his career,
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Dr. Hamra had largely abandoned
the technique and agreed
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that it had not shown as much
advantage as he had hoped.
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So plastic surgeons essentially looked
at the technique and in large part moved
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past it, but all this time later,
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the deep plane facelift still seems
to be a crowd pleaser. Why is that?
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I'm gonna let our guest answer that
question, but first let me introduce him.
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Dr. Bloom is a friend
and colleague and we're,
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we're part of this group that
see each other, not at home,
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but about when we're working with
companies, when we're lecturing,
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when we're attending meetings, uh,
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he is in a very experienced
and talented surgeon,
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friend and colleague, uh, with
extensive experience in facelift,
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making him a facelift expert.
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He did his facial
plastic surgery training,
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likewise at NYU and Manhattan
eye, ear, and throat hospital, uh,
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where I did. Uh, so I'll let him add what
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the history of the procedure
is going forward from that,
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that point in time, about 20 years ago.
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Well, first of all, thank you, uh, Larry,
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and thank you Doreen for
having me on your podcast.
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It's certainly a pleasure
and honor to be here. Um,
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I have been doing, um,
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deep plane facelift in
my practice for the past,
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about 12 years. Um, it's
interesting because,
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you know, Hamra originally developed
this technique and he came out with his,
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uh, you know, essential paper in 1990
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and to rejuvenate more
of the nasolabial foldin
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dissecting deeper, he was
saying, you know, it, it,
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it's not a great look to have kind of
a, a tight jaw line and still have some
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laxity or redundancy in
the nasolabial fold. Um,
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his technique is, uh, or as he called it,
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the composite facelift later on involved
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is slightly different than what
I do today. I mean, I think,
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um, what,
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what he did was dissecting
underneath the orbicularis oculi
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muscle. And in, in lifting that up,
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there was concerned about
prolonged swelling around
the eye because that muscle
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is innovated by some of
the nerves from underneath.
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And if you're dissecting
underneath that muscle,
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you can have some weakness in the eye. Um,
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so that definitely caused some
pause for a lot of surgeons. I mean,
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what I do from a technical
standpoint at this time is,
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um, I do a small amount of, um,
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dissection subcutaneously to the level
of what we call the deep plane entry
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point,
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which is basically line from the
lateral can the side of the eye to the
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angle of the mandible. At that point,
we're going underneath the SMAS,
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which is the connective tissues
of the face, really the muscle,
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the musculature of the face.
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And it's important when I'm talking
to patients even is I explain
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to them is facelift facial rejuvenation
surgery and facelift surgery is
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not a surgery of the skin.
It is surgery of the muscle.
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And in order to get the most
amount of lift or excursion of the
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muscle, it's important
to release. And I say,
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good lifting surgery result
starts with really a complete
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release of the retaining
ligaments of the face.
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And that's in the cheek in the,
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along the jawline and then in the neck.
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So by releasing those, those ligaments,
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it allows for more mobilization
of the tissues to resuspend it.
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So what I consider facial
rejuvenation surgery is release
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and resuspension.
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So I do a little bit different than what
Hamra originally talked about because
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I'm going over the eye muscle,
the orbicularis muscle,
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but underneath the SMAS to release it.
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So let me just back up for a second,
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because you raised an
interesting point of history.
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The big thrust on facelift
advances in the 1990s
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was an attempt to make a better
correction of the nasolabial fold.
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I think that's been transcended at
this point by attempts to create better
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facial shaping in the mid
face with cheek shape.
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And again, amplifying the degree
of correction in the neck,
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which is really where the money
is in, in face and neck lifting.
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Yeah. I'll totally agree with that. Um,
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mainly because, um,
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having a great sharp jawline and neck will
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far exceed any kind of like
volumization in the mid face in
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most of my patient's minds. Um,
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one of the other reasons why I,
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I like this technique personally,
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is because of the dynamics
of the, um, of, um,
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and really the physics
behind what we're doing.
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Many people use something
called a high SMAS lift.
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And when you're doing
a high SMAS face lift,
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most of the tension or the, uh,
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the resuspension is out over
the zygoma, lateral in the face,
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and then in front of the
ear, like a backward seven,
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but when you're doing like
a deep, plane face lift,
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all of the resuspension is more anterior.
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So it's a simple game
of pulleys and levers.
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If you want to lift
something in this case,
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let's say the jowl or the midface, you get
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more correction.
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If your tension or your resuspension point
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is closer to your target
versus further away,
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if you're pulling away lateral in
the face, you're not, it's harder,
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it's a longer run to address
the jowls and the midface.
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And how and direction
concept has changed. Also,
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probably in the last 20 years. And
Hamra actually talked about that.
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He had much to say in a negative way about
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lateral pull in the face, and some
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of the unnatural changes that could
create and some of the limitations in
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how much correction you could obtain.
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Yeah, definitely. It's more of a,
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what I say is a more vertical
or superolateral kind of, um,
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movement of the SMAS in the face and
more of kind of a lateral movement
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of the SMAS in the neck. So, I mean,
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you can see in some patients where
they maybe have a good correction of
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the jowl, but there's a point where it
hasn't been released in the midface.
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And it tends to give kind
of like a bunching around
the midface or a wind swept
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approach. The more lateral
you bring the face,
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but natural correction and, uh,
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natural facial rejuvenation surgery is
more of that kind of superior lateral
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or vertical vector approach
in the face itself.
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That makes a lot of sense. It sounds
like a great approach, Dr. Bass,
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is that your view as well, or are
you doing something different?
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Well, I'm not using a deep
plane approach per se.
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I mostly do a multiplayer
approach in my facelift
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rather than a single plane lifting.
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So there is extensive
skin undermining within
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some sort of procedure
addressing the deeper layers.
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And that procedure varies depending on
the individual patient's findings and
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what their facial shape is
like, do they have a heavy face?
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Do they have a very gone,
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thinned out face that needs augmentation
and needs a lot of shaping and
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suspension?
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So I like having the ability to go in
different directions with different
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layers and adjusting the amount of
correction rather than correcting
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the entire mass of soft
tissue and a single layer.
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Sometimes I use imbrication sometimes I,
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in addition, add fat grafting,
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depending on the
individual patient's needs.
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I see how you have many different ways
of adjusting for individual faces and
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needs. It's important to customize every
facelift to kind of meet each patient's
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specific needs and their desired outcomes,
which leads me to my next question.
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Dr. Bloom is the deep, plane facelift,
a universal procedure in your practice,
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or is it best for certain kinds of
faces or certain stages of aging?
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In other words, are there some
exceptions to its universal use?
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Yeah, I mean, I would say that nothing
is universal in my practice. Certainly.
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However, I,
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this is my preferred technique
for about 90% of the lifts. I do.
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I think some of the cases that do
well specifically with this approach
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are, um, a heavy jowled patient where
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we're lifting up one
composite flap and, um,
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you need some like a strong SMAS that
you're going to resuspend and it's
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important if someone has heavy
jowling to release completely some
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of the cases that might not need something
is more of a thin skinned patient.
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I think the deep plane face
lift does give you a fair amount
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of mid face augmentation as well. Um,
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so I tend to do less fat grafting,
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but a patient with thinner skin, um,
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just a thinner patient overall.
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That's a great patient for fat grafting
because a deep plane might not give
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you the amount of, as
Larry was saying, like,
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midface augmentation or
facial shaping that they need.
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The one other thing is patients with, um,
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you know, I don't like to
operate on smokers, however, um,
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some patients with maybe wound
healing issues or diabetes,
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things that might not
heal a longer skin flap
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as well.
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Most of the skin is attached to the
underlying tissues with the deeper face
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deeper plain facelift. And
there's less skin undermining,
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which gives, um,
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which allows for a little bit
less risk to the, the skin edges.
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Yeah, that's, that's an
important consideration and
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including various supplemental
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or augmentation type procedures
as appropriate for the patient,
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you know, that that kind of
customization is kind of sinequanone of
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facial rejuvenation.
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We always have to adjust
for the individual patient.
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Both of you mentioned some
other supplemental techniques
or procedures that are
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commonly done with facelifts.
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What are some of these other
ones besides fat grafting?
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I mean, typically when I say most
of the patients in my practice who
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are between the ages of,
uh, mid 50 to mid 60,
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about 85% of those patients in my practice
are seeking some kind of aging face
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surgery. And within that I consider eyelid
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surgery face neck surgery,
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as well as something that's become a
little bit more popular recently is upper
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lip rejuvenation or lip lift
surgery. All three of those are, um,
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signs of aging. So typically I
think it's infrequent this week,
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actually I'm doing two
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face lifts and both of them are just
lower face and neck lifts. It's,
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it's been a while since I've done
that without some kind of periorbital
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rejuvenation surgery. Um,
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additionally I do fat
grafting when needed in
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some of the thinner
patients. And then, um,
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in the patients who have a longer
philtrum or a longer upper lip,
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I will shorten that with like a
modified Bullhorn lip lift surgery.
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I also think energy based
treatments to try to take aging
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skin and make it look more youthful, uh,
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especially ironing out wrinkles,
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because that obviously creates
a lot of aging appearance,
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but that older skin,
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even though we get it in the
right place with the facelift, uh,
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it's still older skin and we need to
work on that either can confidently
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or at another sitting or a
series of treatments to try to
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improve the youthful
character of that skin.
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I, I totally agree with that. I mean,
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I can't tell you how many times
patients have come in and they want
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facial rejuvenation surgery, but
they're very concerned for example,
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about their perioral wrinkles
and rhytids. And I say, well,
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this surgery is not gonna improve that.
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You need some kind of resurfacing
or laser technique or deep
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chemical peel, something like
that to improve the skin envelope.
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00:16:38,650 --> 00:16:43,340
So doing that can confidently or
as a stage procedure with facial
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00:16:43,341 --> 00:16:45,380
rejuvenation surgery
is extremely important.
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00:16:46,570 --> 00:16:47,470
So Dr. Bass,
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after extensive discussion of all of
these different techniques and other
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00:16:52,591 --> 00:16:53,424
procedures,
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what are the important
takeaways for people to know
when considering a facelift?
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Well, you know, people ask what's the
right technique or the best technique.
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And it's really hard to do a large study
and prove the benefits of one technique
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00:17:07,790 --> 00:17:08,623
over another.
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00:17:08,710 --> 00:17:12,870
So it means it's hard to make hard
claims about the advantages of one
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00:17:13,870 --> 00:17:14,270
technique,
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00:17:14,270 --> 00:17:18,670
but we're expressing our individual
clinical opinions about what works well in
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00:17:19,260 --> 00:17:22,300
our hands, uh, experienced
facelift surgeons,
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00:17:22,540 --> 00:17:27,180
each use their own individual
modifications of general
techniques and they
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00:17:27,500 --> 00:17:31,100
further modify for the individual
patient to customize the result because
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00:17:32,140 --> 00:17:32,980
everyone's face is different.
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00:17:34,260 --> 00:17:38,490
A talented facelift surgeon is
more important than an individual
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00:17:39,330 --> 00:17:42,850
technique doing something extraordinarily
well and having the clinical
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00:17:43,210 --> 00:17:47,970
experience and judgment to apply it
appropriately to the individual face
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00:17:48,490 --> 00:17:50,520
is really the key to
getting great results.
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00:17:50,521 --> 00:17:55,440
This is very different from device
based treatments where the special
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sauce is in the device,
more than in the operator,
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00:17:59,080 --> 00:18:00,560
but with facelift,
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it's really the experience
of the operator regardless of
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00:18:05,641 --> 00:18:06,474
the individual technique.
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00:18:06,840 --> 00:18:11,750
The modern facelift is
an unrivaled way to make
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00:18:11,751 --> 00:18:15,830
a major reset for facial
aging and in skillful hands,
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it leaves you looking perfectly natural,
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rested and looking like yourself,
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Dr. Bloom,
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do you have any to add
to the list of takeaways?
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00:18:27,860 --> 00:18:31,860
I mean, I could not agree more with
what you're saying. Um, patients
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trust the surgeon, they
don't trust a name procedure,
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00:18:39,861 --> 00:18:44,300
and that's why some
companies that try to make a,
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00:18:44,460 --> 00:18:49,330
the facelift or mini face lifts
into a small procedure where they
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00:18:49,331 --> 00:18:52,770
didn't even meet the
patients. I tell patients,
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let me, if, if you trust me to do your
surgery, let me do what I do best.
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Don't try to fit a surgeon
into a different box,
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00:19:03,500 --> 00:19:08,370
allow them to do what
gets them a great result.
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You wouldn't want me doing a surgery that
I'm not comfortable with just for the
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00:19:13,051 --> 00:19:14,330
sake of doing that surgery.
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00:19:15,190 --> 00:19:20,170
So patients should pick a
surgeon that they trust that
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00:19:20,350 --> 00:19:25,240
has reputable results and, and
trust that they're going to look,
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00:19:25,920 --> 00:19:27,520
um, rejuvenated and natural.
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00:19:27,900 --> 00:19:31,800
And the beauty of today's modern
facelift surgery and facial rejuvenation
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00:19:31,801 --> 00:19:33,720
surgery is that, um,
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00:19:34,330 --> 00:19:39,000
we've seen and these things
have evolved and, you know,
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00:19:39,190 --> 00:19:43,430
gone are the days of
like skin only facelifts,
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00:19:43,431 --> 00:19:47,110
which looked very wind
swept and pulled to a really
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00:19:47,940 --> 00:19:51,110
naturally rejuvenating
procedure that we do today.
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00:19:53,690 --> 00:19:58,110
I'd like to thank Dr. Jason Bloom for
joining us for this episode and for his
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00:19:58,111 --> 00:20:00,660
very thoughtful expert commentary.
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00:20:01,790 --> 00:20:06,740
Thank you guys so much Dr. Bass
Doreen for having me today.
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It's always good to see you. Um,
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I look forward to seeing you guys
in person some day soon. But again,
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00:20:15,020 --> 00:20:19,250
thanks for having me. I always
enjoy talking to you guys.
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I'll also add my thank you to Dr.
Bloom for his thoughts and insight.
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00:20:23,630 --> 00:20:27,570
It has been a pleasure having you on here
and thank you for being our very first
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00:20:27,571 --> 00:20:28,410
guest on the podcast.
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00:20:29,210 --> 00:20:32,290
I hope this episode has provided
you with lots of food for thought,
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00:20:32,530 --> 00:20:36,850
thinking about having a facelift is
often an anxiety provoking experience,
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00:20:37,030 --> 00:20:41,280
and there are many things to consider
having some basis for understanding the
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00:20:41,281 --> 00:20:43,360
different options
available is very useful.
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00:20:44,140 --> 00:20:47,160
If you have any remaining questions
for Dr. Bass and Dr. Bloom,
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00:20:47,180 --> 00:20:49,400
please reach out via email or Instagram,
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00:20:49,460 --> 00:20:54,290
and we would be happy to answer them
in a future episode. This is Doreen Wu,
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00:20:54,291 --> 00:20:56,930
thanking you for joining
Dr. Bass, Dr. Bloom,
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00:20:56,931 --> 00:21:00,650
and me for this engaging discussion
of the deep plane facelift.
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00:21:01,150 --> 00:21:05,570
Be sure to tune into our next episode
where we explore the double edged sword of
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00:21:05,610 --> 00:21:09,680
injectable fillers in facial
rejuvenation. As always,
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00:21:09,930 --> 00:21:11,680
don't forget to subscribe to our podcast,
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00:21:12,020 --> 00:21:15,160
to keep up with all of the exciting
content that is coming your way.
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00:21:16,290 --> 00:21:20,240
Thank you for joining us in this episode
of the Park Avenue Plastic Surgery
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00:21:20,330 --> 00:21:24,950
Class podcast with Dr. Lawrence
Bass Park Avenue plastic surgeon,
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00:21:25,790 --> 00:21:27,670
educator, and technology innovator.
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00:21:27,970 --> 00:21:30,470
The commentary in this
podcast represents opinion.
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00:21:30,660 --> 00:21:33,110
This podcast does not
present medical advice,
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00:21:33,450 --> 00:21:37,390
but rather general information about
plastic surgery that does not necessarily
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00:21:37,450 --> 00:21:40,470
relate to the specific conditions
of any individual patient.
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00:21:40,890 --> 00:21:45,700
No doctor patient relationship
is established by listening
to or participating
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00:21:45,840 --> 00:21:46,673
in this podcast,
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00:21:46,930 --> 00:21:50,980
consult your physician to advise you
about your individual healthcare.
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00:21:51,240 --> 00:21:52,660
If you enjoyed this episode,
328
00:21:52,880 --> 00:21:56,420
please share it with your friends and
be sure to subscribe to our podcast on
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00:21:56,720 --> 00:22:00,780
Apple Podcasts, Google, Spotify, Stitcher,
330
00:22:00,960 --> 00:22:03,490
or wherever you listen to podcasts.
00:00:00,790 --> 00:00:04,640
Welcome to another episode of
Park Avenue Plastic Surgery Class,
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00:00:04,900 --> 00:00:08,600
the podcast where we explore controversies
and breaking issues in plastic
3
00:00:08,601 --> 00:00:09,434
surgery.
4
00:00:09,620 --> 00:00:14,400
I'm your cohost Doreen Wu I'm excited
to be here with Dr. Lawrence Bass Park
5
00:00:14,400 --> 00:00:17,840
Avenue plastic surgeon, educator,
and technology innovator.
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00:00:17,841 --> 00:00:21,230
Today we have a special
guest Dr. Jason Bloom,
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00:00:21,490 --> 00:00:24,310
facial plastic surgeon from
Bryn Mawr Pennsylvania.
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00:00:25,210 --> 00:00:29,670
The title of today's episode is a
deep dive on the deep plane facelift.
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00:00:29,671 --> 00:00:31,710
Dr. Bass,
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00:00:32,470 --> 00:00:36,070
everyone wants the best possible result
when they undergo a major procedure like
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00:00:36,071 --> 00:00:40,180
a facelift. The deep plane facelift
seems to be a popular technique.
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00:00:40,680 --> 00:00:42,180
Can you tell us more about this approach?
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00:00:43,210 --> 00:00:44,043
Sure. Doreen,
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00:00:44,260 --> 00:00:48,380
I mean the basic definition
of the deep plane facelift,
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00:00:48,381 --> 00:00:53,020
it is a facelift that involves dissecting
16
00:00:53,190 --> 00:00:56,930
underneath the SMAS, the
connective tissue in the face,
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00:00:57,970 --> 00:01:02,090
allowing direct division of
some of the retaining ligaments
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00:01:02,870 --> 00:01:07,810
so that all of the soft tissue of
the face can be maximally, mobilized,
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00:01:08,110 --> 00:01:09,370
and repositioned.
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00:01:11,070 --> 00:01:15,090
The procedure was initially developed
by a surgeon named Sam Hamra
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00:01:15,900 --> 00:01:19,440
in 1990 and Dr. Hamra,
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00:01:20,540 --> 00:01:24,800
who was trained at NYU in
plastic surgery, where I trained,
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00:01:25,840 --> 00:01:30,720
uh, but practiced in Texas
wanted ways to improve
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00:01:30,940 --> 00:01:31,773
the facelift.
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00:01:32,380 --> 00:01:36,830
And he was hoping to get a more complete
correction by mobilizing the tissues
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00:01:36,831 --> 00:01:41,270
more thoroughly and moving them
in a group or a composite state
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00:01:42,140 --> 00:01:43,190
over time. However,
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00:01:43,410 --> 00:01:48,150
the amount of dissection involved raised
some concerns and studies were done to
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00:01:48,151 --> 00:01:52,580
see if it was either giving us a
better correction or a longer lasting
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00:01:52,870 --> 00:01:53,703
correction.
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00:01:54,440 --> 00:01:59,140
And there were some studies that
followed patients longitudinally
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00:01:59,170 --> 00:02:02,220
over time, and some
studies that treated twins,
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00:02:02,480 --> 00:02:05,060
one with one facelift technique, a,
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00:02:05,740 --> 00:02:07,820
a SMAS multi-component technique,
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00:02:07,880 --> 00:02:12,570
and one with a deep plane
technique and those studies
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00:02:13,230 --> 00:02:18,090
did not in the end of the day show
that there was an advantage to the
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00:02:18,370 --> 00:02:20,210
technique at that point in time.
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00:02:20,390 --> 00:02:23,290
And that point in time was
somewhere around the year,
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00:02:23,350 --> 00:02:27,650
2000 just to put a round number on
it. So by the end of his career,
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00:02:27,870 --> 00:02:32,160
Dr. Hamra had largely abandoned
the technique and agreed
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00:02:33,230 --> 00:02:36,960
that it had not shown as much
advantage as he had hoped.
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00:02:37,780 --> 00:02:42,240
So plastic surgeons essentially looked
at the technique and in large part moved
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00:02:42,241 --> 00:02:44,160
past it, but all this time later,
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00:02:44,260 --> 00:02:48,390
the deep plane facelift still seems
to be a crowd pleaser. Why is that?
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00:02:49,130 --> 00:02:53,790
I'm gonna let our guest answer that
question, but first let me introduce him.
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00:02:53,791 --> 00:02:57,030
Dr. Bloom is a friend
and colleague and we're,
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00:02:57,031 --> 00:03:00,200
we're part of this group that
see each other, not at home,
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00:03:00,260 --> 00:03:05,000
but about when we're working with
companies, when we're lecturing,
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00:03:05,110 --> 00:03:07,280
when we're attending meetings, uh,
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00:03:07,460 --> 00:03:10,680
he is in a very experienced
and talented surgeon,
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00:03:12,060 --> 00:03:16,000
friend and colleague, uh, with
extensive experience in facelift,
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00:03:16,001 --> 00:03:17,990
making him a facelift expert.
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00:03:18,290 --> 00:03:21,110
He did his facial
plastic surgery training,
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00:03:21,950 --> 00:03:26,590
likewise at NYU and Manhattan
eye, ear, and throat hospital, uh,
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00:03:26,640 --> 00:03:30,350
where I did. Uh, so I'll let him add what
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00:03:32,970 --> 00:03:37,780
the history of the procedure
is going forward from that,
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00:03:37,781 --> 00:03:40,260
that point in time, about 20 years ago.
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00:03:41,460 --> 00:03:45,710
Well, first of all, thank you, uh, Larry,
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00:03:45,850 --> 00:03:48,310
and thank you Doreen for
having me on your podcast.
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00:03:48,740 --> 00:03:52,350
It's certainly a pleasure
and honor to be here. Um,
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00:03:53,590 --> 00:03:56,540
I have been doing, um,
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00:03:57,530 --> 00:04:00,700
deep plane facelift in
my practice for the past,
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00:04:01,350 --> 00:04:05,940
about 12 years. Um, it's
interesting because,
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00:04:06,720 --> 00:04:11,580
you know, Hamra originally developed
this technique and he came out with his,
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00:04:12,100 --> 00:04:13,260
uh, you know, essential paper in 1990
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00:04:15,950 --> 00:04:19,410
and to rejuvenate more
of the nasolabial foldin
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00:04:21,130 --> 00:04:24,050
dissecting deeper, he was
saying, you know, it, it,
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00:04:24,080 --> 00:04:28,290
it's not a great look to have kind of
a, a tight jaw line and still have some
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00:04:30,070 --> 00:04:34,640
laxity or redundancy in
the nasolabial fold. Um,
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00:04:34,860 --> 00:04:37,400
his technique is, uh, or as he called it,
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00:04:37,420 --> 00:04:41,360
the composite facelift later on involved
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00:04:41,361 --> 00:04:46,000
is slightly different than what
I do today. I mean, I think,
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00:04:46,680 --> 00:04:47,640
um, what,
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00:04:47,641 --> 00:04:52,430
what he did was dissecting
underneath the orbicularis oculi
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00:04:52,431 --> 00:04:56,590
muscle. And in, in lifting that up,
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00:04:56,720 --> 00:05:01,550
there was concerned about
prolonged swelling around
the eye because that muscle
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00:05:01,850 --> 00:05:04,350
is innovated by some of
the nerves from underneath.
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00:05:04,351 --> 00:05:06,550
And if you're dissecting
underneath that muscle,
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00:05:07,090 --> 00:05:10,020
you can have some weakness in the eye. Um,
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00:05:10,120 --> 00:05:14,020
so that definitely caused some
pause for a lot of surgeons. I mean,
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00:05:14,021 --> 00:05:18,540
what I do from a technical
standpoint at this time is,
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00:05:19,420 --> 00:05:23,660
um, I do a small amount of, um,
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00:05:23,910 --> 00:05:28,490
dissection subcutaneously to the level
of what we call the deep plane entry
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00:05:28,491 --> 00:05:29,220
point,
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00:05:29,220 --> 00:05:33,850
which is basically line from the
lateral can the side of the eye to the
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00:05:34,220 --> 00:05:38,930
angle of the mandible. At that point,
we're going underneath the SMAS,
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00:05:39,220 --> 00:05:42,250
which is the connective tissues
of the face, really the muscle,
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00:05:42,910 --> 00:05:44,530
the musculature of the face.
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00:05:44,870 --> 00:05:49,840
And it's important when I'm talking
to patients even is I explain
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00:05:49,860 --> 00:05:54,800
to them is facelift facial rejuvenation
surgery and facelift surgery is
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00:05:54,801 --> 00:05:58,320
not a surgery of the skin.
It is surgery of the muscle.
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00:05:59,220 --> 00:06:04,120
And in order to get the most
amount of lift or excursion of the
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00:06:04,121 --> 00:06:08,120
muscle, it's important
to release. And I say,
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00:06:08,121 --> 00:06:12,760
good lifting surgery result
starts with really a complete
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00:06:12,761 --> 00:06:15,560
release of the retaining
ligaments of the face.
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00:06:15,690 --> 00:06:18,030
And that's in the cheek in the,
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00:06:18,080 --> 00:06:20,870
along the jawline and then in the neck.
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00:06:21,650 --> 00:06:25,030
So by releasing those, those ligaments,
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00:06:25,130 --> 00:06:30,030
it allows for more mobilization
of the tissues to resuspend it.
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00:06:30,610 --> 00:06:34,780
So what I consider facial
rejuvenation surgery is release
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00:06:35,480 --> 00:06:36,740
and resuspension.
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00:06:37,920 --> 00:06:41,740
So I do a little bit different than what
Hamra originally talked about because
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00:06:41,760 --> 00:06:45,060
I'm going over the eye muscle,
the orbicularis muscle,
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00:06:45,440 --> 00:06:48,420
but underneath the SMAS to release it.
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00:06:49,200 --> 00:06:51,260
So let me just back up for a second,
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00:06:51,970 --> 00:06:54,970
because you raised an
interesting point of history.
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00:06:55,490 --> 00:07:00,170
The big thrust on facelift
advances in the 1990s
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00:07:00,650 --> 00:07:04,210
was an attempt to make a better
correction of the nasolabial fold.
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00:07:05,130 --> 00:07:10,090
I think that's been transcended at
this point by attempts to create better
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00:07:10,570 --> 00:07:14,400
facial shaping in the mid
face with cheek shape.
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00:07:15,320 --> 00:07:18,880
And again, amplifying the degree
of correction in the neck,
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00:07:19,240 --> 00:07:23,440
which is really where the money
is in, in face and neck lifting.
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00:07:24,930 --> 00:07:28,620
Yeah. I'll totally agree with that. Um,
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00:07:28,920 --> 00:07:31,050
mainly because, um,
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00:07:31,051 --> 00:07:35,810
having a great sharp jawline and neck will
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00:07:36,190 --> 00:07:40,370
far exceed any kind of like
volumization in the mid face in
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00:07:42,090 --> 00:07:46,010
most of my patient's minds. Um,
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00:07:46,370 --> 00:07:49,400
one of the other reasons why I,
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00:07:50,140 --> 00:07:51,880
I like this technique personally,
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00:07:52,120 --> 00:07:56,680
is because of the dynamics
of the, um, of, um,
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00:07:56,960 --> 00:08:00,720
and really the physics
behind what we're doing.
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00:08:01,000 --> 00:08:04,120
Many people use something
called a high SMAS lift.
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00:08:04,320 --> 00:08:08,110
And when you're doing
a high SMAS face lift,
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most of the tension or the, uh,
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the resuspension is out over
the zygoma, lateral in the face,
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and then in front of the
ear, like a backward seven,
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00:08:22,150 --> 00:08:24,830
but when you're doing like
a deep, plane face lift,
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all of the resuspension is more anterior.
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So it's a simple game
of pulleys and levers.
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If you want to lift
something in this case,
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let's say the jowl or the midface, you get
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more correction.
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If your tension or your resuspension point
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is closer to your target
versus further away,
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if you're pulling away lateral in
the face, you're not, it's harder,
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it's a longer run to address
the jowls and the midface.
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And how and direction
concept has changed. Also,
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probably in the last 20 years. And
Hamra actually talked about that.
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He had much to say in a negative way about
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lateral pull in the face, and some
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of the unnatural changes that could
create and some of the limitations in
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how much correction you could obtain.
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00:09:27,460 --> 00:09:29,870
Yeah, definitely. It's more of a,
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what I say is a more vertical
or superolateral kind of, um,
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movement of the SMAS in the face and
more of kind of a lateral movement
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of the SMAS in the neck. So, I mean,
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you can see in some patients where
they maybe have a good correction of
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the jowl, but there's a point where it
hasn't been released in the midface.
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And it tends to give kind
of like a bunching around
the midface or a wind swept
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approach. The more lateral
you bring the face,
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but natural correction and, uh,
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natural facial rejuvenation surgery is
more of that kind of superior lateral
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or vertical vector approach
in the face itself.
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That makes a lot of sense. It sounds
like a great approach, Dr. Bass,
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is that your view as well, or are
you doing something different?
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Well, I'm not using a deep
plane approach per se.
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I mostly do a multiplayer
approach in my facelift
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rather than a single plane lifting.
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So there is extensive
skin undermining within
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some sort of procedure
addressing the deeper layers.
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And that procedure varies depending on
the individual patient's findings and
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what their facial shape is
like, do they have a heavy face?
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Do they have a very gone,
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thinned out face that needs augmentation
and needs a lot of shaping and
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suspension?
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So I like having the ability to go in
different directions with different
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layers and adjusting the amount of
correction rather than correcting
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the entire mass of soft
tissue and a single layer.
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Sometimes I use imbrication sometimes I,
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in addition, add fat grafting,
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depending on the
individual patient's needs.
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I see how you have many different ways
of adjusting for individual faces and
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needs. It's important to customize every
facelift to kind of meet each patient's
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specific needs and their desired outcomes,
which leads me to my next question.
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Dr. Bloom is the deep, plane facelift,
a universal procedure in your practice,
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or is it best for certain kinds of
faces or certain stages of aging?
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In other words, are there some
exceptions to its universal use?
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Yeah, I mean, I would say that nothing
is universal in my practice. Certainly.
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However, I,
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this is my preferred technique
for about 90% of the lifts. I do.
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I think some of the cases that do
well specifically with this approach
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are, um, a heavy jowled patient where
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we're lifting up one
composite flap and, um,
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you need some like a strong SMAS that
you're going to resuspend and it's
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important if someone has heavy
jowling to release completely some
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of the cases that might not need something
is more of a thin skinned patient.
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00:12:39,261 --> 00:12:44,260
I think the deep plane face
lift does give you a fair amount
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of mid face augmentation as well. Um,
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so I tend to do less fat grafting,
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00:12:50,010 --> 00:12:53,730
but a patient with thinner skin, um,
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just a thinner patient overall.
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That's a great patient for fat grafting
because a deep plane might not give
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00:13:00,790 --> 00:13:05,230
you the amount of, as
Larry was saying, like,
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00:13:06,180 --> 00:13:09,420
midface augmentation or
facial shaping that they need.
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The one other thing is patients with, um,
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you know, I don't like to
operate on smokers, however, um,
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00:13:19,330 --> 00:13:22,900
some patients with maybe wound
healing issues or diabetes,
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00:13:24,360 --> 00:13:28,970
things that might not
heal a longer skin flap
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as well.
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Most of the skin is attached to the
underlying tissues with the deeper face
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deeper plain facelift. And
there's less skin undermining,
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00:13:39,611 --> 00:13:41,090
which gives, um,
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00:13:42,140 --> 00:13:46,920
which allows for a little bit
less risk to the, the skin edges.
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00:13:48,640 --> 00:13:51,730
Yeah, that's, that's an
important consideration and
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including various supplemental
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00:13:56,430 --> 00:14:01,250
or augmentation type procedures
as appropriate for the patient,
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00:14:01,270 --> 00:14:05,920
you know, that that kind of
customization is kind of sinequanone of
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facial rejuvenation.
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00:14:08,841 --> 00:14:12,400
We always have to adjust
for the individual patient.
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00:14:13,070 --> 00:14:17,480
Both of you mentioned some
other supplemental techniques
or procedures that are
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00:14:17,481 --> 00:14:18,920
commonly done with facelifts.
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00:14:18,921 --> 00:14:21,720
What are some of these other
ones besides fat grafting?
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00:14:23,180 --> 00:14:27,820
I mean, typically when I say most
of the patients in my practice who
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00:14:29,380 --> 00:14:32,580
are between the ages of,
uh, mid 50 to mid 60,
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00:14:33,380 --> 00:14:38,300
about 85% of those patients in my practice
are seeking some kind of aging face
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surgery. And within that I consider eyelid
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00:14:44,330 --> 00:14:47,360
surgery face neck surgery,
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00:14:47,960 --> 00:14:52,840
as well as something that's become a
little bit more popular recently is upper
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00:14:53,000 --> 00:14:57,120
lip rejuvenation or lip lift
surgery. All three of those are, um,
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signs of aging. So typically I
think it's infrequent this week,
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00:15:03,280 --> 00:15:04,113
actually I'm doing two
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00:15:06,360 --> 00:15:10,430
face lifts and both of them are just
lower face and neck lifts. It's,
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00:15:10,710 --> 00:15:14,470
it's been a while since I've done
that without some kind of periorbital
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rejuvenation surgery. Um,
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00:15:18,190 --> 00:15:21,830
additionally I do fat
grafting when needed in
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00:15:25,190 --> 00:15:27,390
some of the thinner
patients. And then, um,
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00:15:28,190 --> 00:15:31,220
in the patients who have a longer
philtrum or a longer upper lip,
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I will shorten that with like a
modified Bullhorn lip lift surgery.
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I also think energy based
treatments to try to take aging
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skin and make it look more youthful, uh,
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especially ironing out wrinkles,
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00:15:48,310 --> 00:15:51,810
because that obviously creates
a lot of aging appearance,
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but that older skin,
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00:15:55,200 --> 00:16:00,010
even though we get it in the
right place with the facelift, uh,
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00:16:00,120 --> 00:16:04,850
it's still older skin and we need to
work on that either can confidently
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00:16:05,140 --> 00:16:09,880
or at another sitting or a
series of treatments to try to
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00:16:09,881 --> 00:16:12,600
improve the youthful
character of that skin.
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00:16:13,480 --> 00:16:15,360
I, I totally agree with that. I mean,
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00:16:15,400 --> 00:16:20,040
I can't tell you how many times
patients have come in and they want
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00:16:20,060 --> 00:16:23,480
facial rejuvenation surgery, but
they're very concerned for example,
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00:16:23,640 --> 00:16:27,350
about their perioral wrinkles
and rhytids. And I say, well,
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00:16:27,351 --> 00:16:29,430
this surgery is not gonna improve that.
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00:16:29,770 --> 00:16:34,630
You need some kind of resurfacing
or laser technique or deep
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00:16:34,870 --> 00:16:38,310
chemical peel, something like
that to improve the skin envelope.
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00:16:38,650 --> 00:16:43,340
So doing that can confidently or
as a stage procedure with facial
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00:16:43,341 --> 00:16:45,380
rejuvenation surgery
is extremely important.
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00:16:46,570 --> 00:16:47,470
So Dr. Bass,
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00:16:47,840 --> 00:16:52,590
after extensive discussion of all of
these different techniques and other
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00:16:52,591 --> 00:16:53,424
procedures,
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00:16:53,580 --> 00:16:57,190
what are the important
takeaways for people to know
when considering a facelift?
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00:16:57,990 --> 00:17:02,710
Well, you know, people ask what's the
right technique or the best technique.
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00:17:02,950 --> 00:17:07,390
And it's really hard to do a large study
and prove the benefits of one technique
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00:17:07,790 --> 00:17:08,623
over another.
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00:17:08,710 --> 00:17:12,870
So it means it's hard to make hard
claims about the advantages of one
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00:17:13,870 --> 00:17:14,270
technique,
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00:17:14,270 --> 00:17:18,670
but we're expressing our individual
clinical opinions about what works well in
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00:17:19,260 --> 00:17:22,300
our hands, uh, experienced
facelift surgeons,
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00:17:22,540 --> 00:17:27,180
each use their own individual
modifications of general
techniques and they
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00:17:27,500 --> 00:17:31,100
further modify for the individual
patient to customize the result because
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00:17:32,140 --> 00:17:32,980
everyone's face is different.
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00:17:34,260 --> 00:17:38,490
A talented facelift surgeon is
more important than an individual
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00:17:39,330 --> 00:17:42,850
technique doing something extraordinarily
well and having the clinical
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00:17:43,210 --> 00:17:47,970
experience and judgment to apply it
appropriately to the individual face
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00:17:48,490 --> 00:17:50,520
is really the key to
getting great results.
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00:17:50,521 --> 00:17:55,440
This is very different from device
based treatments where the special
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00:17:55,441 --> 00:17:58,760
sauce is in the device,
more than in the operator,
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00:17:59,080 --> 00:18:00,560
but with facelift,
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00:18:00,720 --> 00:18:05,640
it's really the experience
of the operator regardless of
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00:18:05,641 --> 00:18:06,474
the individual technique.
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00:18:06,840 --> 00:18:11,750
The modern facelift is
an unrivaled way to make
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00:18:11,751 --> 00:18:15,830
a major reset for facial
aging and in skillful hands,
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00:18:15,840 --> 00:18:18,190
it leaves you looking perfectly natural,
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00:18:18,191 --> 00:18:21,310
rested and looking like yourself,
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00:18:21,311 --> 00:18:23,670
Dr. Bloom,
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00:18:23,671 --> 00:18:26,740
do you have any to add
to the list of takeaways?
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00:18:27,860 --> 00:18:31,860
I mean, I could not agree more with
what you're saying. Um, patients
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00:18:35,060 --> 00:18:39,860
trust the surgeon, they
don't trust a name procedure,
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00:18:39,861 --> 00:18:44,300
and that's why some
companies that try to make a,
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00:18:44,460 --> 00:18:49,330
the facelift or mini face lifts
into a small procedure where they
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00:18:49,331 --> 00:18:52,770
didn't even meet the
patients. I tell patients,
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00:18:54,440 --> 00:18:58,900
let me, if, if you trust me to do your
surgery, let me do what I do best.
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00:18:59,390 --> 00:19:02,620
Don't try to fit a surgeon
into a different box,
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00:19:03,500 --> 00:19:08,370
allow them to do what
gets them a great result.
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00:19:08,950 --> 00:19:13,050
You wouldn't want me doing a surgery that
I'm not comfortable with just for the
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00:19:13,051 --> 00:19:14,330
sake of doing that surgery.
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00:19:15,190 --> 00:19:20,170
So patients should pick a
surgeon that they trust that
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00:19:20,350 --> 00:19:25,240
has reputable results and, and
trust that they're going to look,
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00:19:25,920 --> 00:19:27,520
um, rejuvenated and natural.
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00:19:27,900 --> 00:19:31,800
And the beauty of today's modern
facelift surgery and facial rejuvenation
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00:19:31,801 --> 00:19:33,720
surgery is that, um,
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00:19:34,330 --> 00:19:39,000
we've seen and these things
have evolved and, you know,
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00:19:39,190 --> 00:19:43,430
gone are the days of
like skin only facelifts,
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00:19:43,431 --> 00:19:47,110
which looked very wind
swept and pulled to a really
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00:19:47,940 --> 00:19:51,110
naturally rejuvenating
procedure that we do today.
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00:19:53,690 --> 00:19:58,110
I'd like to thank Dr. Jason Bloom for
joining us for this episode and for his
296
00:19:58,111 --> 00:20:00,660
very thoughtful expert commentary.
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00:20:01,790 --> 00:20:06,740
Thank you guys so much Dr. Bass
Doreen for having me today.
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00:20:06,770 --> 00:20:09,180
It's always good to see you. Um,
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00:20:09,780 --> 00:20:13,980
I look forward to seeing you guys
in person some day soon. But again,
300
00:20:15,020 --> 00:20:19,250
thanks for having me. I always
enjoy talking to you guys.
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00:20:20,240 --> 00:20:23,530
I'll also add my thank you to Dr.
Bloom for his thoughts and insight.
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00:20:23,630 --> 00:20:27,570
It has been a pleasure having you on here
and thank you for being our very first
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00:20:27,571 --> 00:20:28,410
guest on the podcast.
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00:20:29,210 --> 00:20:32,290
I hope this episode has provided
you with lots of food for thought,
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00:20:32,530 --> 00:20:36,850
thinking about having a facelift is
often an anxiety provoking experience,
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00:20:37,030 --> 00:20:41,280
and there are many things to consider
having some basis for understanding the
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00:20:41,281 --> 00:20:43,360
different options
available is very useful.
308
00:20:44,140 --> 00:20:47,160
If you have any remaining questions
for Dr. Bass and Dr. Bloom,
309
00:20:47,180 --> 00:20:49,400
please reach out via email or Instagram,
310
00:20:49,460 --> 00:20:54,290
and we would be happy to answer them
in a future episode. This is Doreen Wu,
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00:20:54,291 --> 00:20:56,930
thanking you for joining
Dr. Bass, Dr. Bloom,
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00:20:56,931 --> 00:21:00,650
and me for this engaging discussion
of the deep plane facelift.
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00:21:01,150 --> 00:21:05,570
Be sure to tune into our next episode
where we explore the double edged sword of
314
00:21:05,610 --> 00:21:09,680
injectable fillers in facial
rejuvenation. As always,
315
00:21:09,930 --> 00:21:11,680
don't forget to subscribe to our podcast,
316
00:21:12,020 --> 00:21:15,160
to keep up with all of the exciting
content that is coming your way.
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00:21:16,290 --> 00:21:20,240
Thank you for joining us in this episode
of the Park Avenue Plastic Surgery
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00:21:20,330 --> 00:21:24,950
Class podcast with Dr. Lawrence
Bass Park Avenue plastic surgeon,
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00:21:25,790 --> 00:21:27,670
educator, and technology innovator.
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00:21:27,970 --> 00:21:30,470
The commentary in this
podcast represents opinion.
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00:21:30,660 --> 00:21:33,110
This podcast does not
present medical advice,
322
00:21:33,450 --> 00:21:37,390
but rather general information about
plastic surgery that does not necessarily
323
00:21:37,450 --> 00:21:40,470
relate to the specific conditions
of any individual patient.
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00:21:40,890 --> 00:21:45,700
No doctor patient relationship
is established by listening
to or participating
325
00:21:45,840 --> 00:21:46,673
in this podcast,
326
00:21:46,930 --> 00:21:50,980
consult your physician to advise you
about your individual healthcare.
327
00:21:51,240 --> 00:21:52,660
If you enjoyed this episode,
328
00:21:52,880 --> 00:21:56,420
please share it with your friends and
be sure to subscribe to our podcast on
329
00:21:56,720 --> 00:22:00,780
Apple Podcasts, Google, Spotify, Stitcher,
330
00:22:00,960 --> 00:22:03,490
or wherever you listen to podcasts.
Jason Bloom, MD
Plastic Surgeon
Located in Bryn Mawr, Pennsylvania, Dr. Jason Bloom is a double board certified facial plastic and reconstructive surgeon. He is an Adjunct Assistant Professor of Otorhinolaryngology – Head & Neck Surgery at the University of Pennsylvania and Clinical Assistant Professor (Adjunct) of Dermatology at the Temple University School of Medicine.