The deep plane facelift is an advanced approach to facial rejuvenation, a facelift technique that repositions the deep tissues of the face by acting on the SMAS rather than tightening the skin. The skin, fat and musculo-aponeurotic layer are lifted together, as a single unit, respecting the identity of the face: the goal for the patient is to achieve a more natural result, with sharper contours, while preserving expression and avoiding an artificial or “pulled” appearance. The result is also more durable, and recovery faster, than with a traditional subcutaneous facelift.
\nIn Paris, Dr Cédric Kron has developed the LVPA (Anterior Vertical Deep Plane lift), his personal technique of vertical deep plane facelift, which he has presented at several international scientific congresses as well as at the French National Academy of Surgery. The LVPA facelift achieves a natural and durable result with generally simple recovery.
\nThe term “deep plane” refers to the anatomical level at which the surgeon operates during a facelift.
\nUnlike an approach based mainly on skin tension, a deep plane facelift does not consist of retightening the skin, but of repositioning the deep structures of the face that have shifted downward under the effect of gravity over time.
\nThe skin follows this movement without becoming the main support of the correction: this is one of the foundations of a harmonious, durable result.
\nThese two facelift techniques target the same tissues, but approach them differently.
\nBy preserving the connections between the skin and the SMAS, the deep plane facelift allows the correction to be carried by the deep tissues rather than by the skin.
\nThis approach favors a redraping without excessive tension, calmer healing and a result that better respects facial expressions. The duration and after-effects nonetheless remain specific to each patient and depend in particular on their anatomy, skin quality and any associated procedures.
\nThe term “deep plane” describes a plane of dissection, not a direction of traction. It does not tell the whole story of the surgical strategy. The direction of re-tensioning, known as the vector, directly influences the position of the volumes and the balance of facial features. Two facelifts both described as deep plane can therefore follow very different logics and largely determine the visible result.
\nDepending on the technique, tissue repositioning can be oblique (upward and backward, which corresponds to most deep plane facelifting techniques), toward the ear, or vertical (upward).
\nIt is from these anatomical and biomechanical observations that Dr Kron progressively developed the LVPA: a vertical deep plane facelift designed to correct tissue descent in the direction opposite to that of aging. This thinking forms the signature of his approach to facial rejuvenation.
\n“I do not seek to change a face, but to find again the one that time has gradually blurred.” This philosophy guides every indication: the best result does not impose a new identity, it restores a rested, coherent and recognizable version of the face.
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In Paris, Dr Cédric Kron has developed the LVPA (Anterior Vertical Deep Plane lift), his personal technique of vertical deep plane facelift, presented at international scientific congresses as well as at the French National Academy of Surgery. Its distinctiveness rests on three principles:
\nEach of the three terms (Vertical, Deep, Anterior) describes a precise surgical choice.
\nInitial state + skin incisions
\nSkin undermining + SMAS exposure
\nPosterior repositioning + SMAS fixation
\nIn “high SMAS” facelifting, the SMAS fixation line is placed higher, very close to the upper edge of the zygomatic arch. This allows for greater mobilization of the mid-face, cheek and malar compartment, with a vector that is often more effective upward. The goal is to achieve a more effective cheekbone-cheek-jowl correction.
\nAn important point: High-SMAS does not mean Deep Plane. These are two different concepts, although they can be combined technically. A facelift can be high-SMAS without being a true deep plane, and a deep plane can be performed with different dissection heights and extents, and thus without high-SMAS.
\n“High SMAS”-type facelift techniques correct another shortcoming of traditional facelift techniques, which targeted the facial oval and neck while sometimes neglecting the central part of the face (cheekbones and jowls), which could produce a less natural result. The High SMAS technique included in the LVPA allows better treatment of the central part of the face and the junction between under-eye area, cheekbones, cheeks, nasolabial folds and jowls, in addition to the oval and neck, within a single procedure, for a more homogeneous result across the whole face.
\nThe LVPA facelift is thus a deep (“deep plane”) “High SMAS” facelift, limiting skin undermining, which is lifted while remaining attached to the SMAS, with an upward vertical anterior vector and an oblique cervical vector directed upward and backward.
\nAn LVPA facelift can correct aging at the junction of the lower eyelids, cheekbones, cheeks, nasolabial folds, jowls and neck down to the collarbones in a single procedure. It can also combine techniques to correct the temples, eyebrows, forehead and eye area (eyelids, under-eye circles).
\nIn the LVPA facelift, the SMAS is extensively undermined at depth and re-tensioned vertically, without undermining the skin above it. The skin and deep tissues thus rise together as a single unit, without skin traction being used to carry the result.
\nPreserving these attachments has very concrete consequences for recovery. This preservation serves a dual purpose: respecting the skin's blood supply and innervation, and simplifying recovery as much as possible. By limiting undermining and the cutting of small vessels, the technique aims to reduce bruising and swelling. Return to social life is often possible in under two weeks, depending on individual healing and any associated procedures.
\nIn addition, Dr Kron has shown through preliminary studies that deep plane undermining techniques that preserve skin attachments have a beneficial effect on several markers of skin aging: reduction of vascular lesions, reduction of pore dilation, improved skin texture, and reduction of superficial spots.
\nA deep plane facelift is intended for women and men who wish to restore the contour of their face and/or neck. This type of facelift can lift cheeks that have gradually sagged, restore more defined cheekbones, and correct jowls, nasolabial folds or a somewhat lax neck.
\nThe procedure can concern any patient from the earliest signs of aging of the face or neck, from the second half of their thirties onward.
\nA facelift performed between 40 and 60 years old will generally give the most durable and natural results.
\nThe goal is not to transform the face or reproduce an aesthetic model. It is to restore its proportions, its volumes and its light while preserving what makes it unique. This search for a result without “surgical signature” is at the heart of Dr Kron's philosophy: looking rested and rejuvenated, without the procedure itself being identifiable. Each area of the face can be reshaped in a specific way to preserve its authenticity and uniqueness, and avoid the trap of standardization.
\nA deep plane facelift is not always the most suitable answer. When the face “hollows” without sagging (temples, cheekbones, lips), techniques such as lipofilling or filling with hyaluronic acid may be indicated. Laser skin treatments, such as the UltraClear laser, which restore firmness and elasticity, can also be a good option to delay the need for a facelift.
\nThe initial consultation is an essential time for listening and analysis. Dr Kron studies the anatomy, the individual mechanisms of aging and the expectations of each patient in order to propose a tailored plan — or to explain why another approach would be preferable, or a possible alternative. The procedure, the reasonably expected result, the recovery and the risks, even exceptional ones, are explained precisely. A legal reflection period of at least two weeks precedes any confirmation of surgery.
\nA vertical deep plane facelift lasts on average two hours, a duration that may vary depending on the anatomy and any associated procedures. It takes place in a clinic accredited for cosmetic surgery, in Paris.
\nThe care pathway is designed to offer discreet, personalized and rigorous support, from the first consultation to postoperative follow-up.
\nThe procedure can be performed under light general anesthesia or under so-called deep local anesthesia combined with light sedation.
\nSince 2008, Dr Kron and his anesthesiologist have developed an internationally recognized anesthesia protocol that combines general anesthesia via laryngeal mask, performed by the anesthesiologist, with local anesthesia, performed by the surgeon once you are asleep. This protocol helps to limit as much as possible the risks and discomforts associated with each type of anesthesia taken separately.
\nSimilarly, under deep local anesthesia, Dr Kron's anesthesiologist administers sedation that varies according to the different moments of the procedure, so that you do not feel the local anesthesia injections at the start and have no unpleasant moment, even during the length of the procedure.
\nThe principle of the procedure is to approach the deep plane, undermine the SMAS, then re-tension it vertically on the face in a high-SMAS fashion, and obliquely on the neck, while preserving the skin's attachments. Since skin undermining is limited, the procedure can be performed on an outpatient basis: the patient goes home the same evening, after showering at the clinic, without any dressing other than a compression headband worn vertically for 5 days to protect the scars and prevent swelling from moving down toward the neck. Recovery is therefore even faster.
\nA deep plane facelift can be combined, during the same procedure, with other surgical steps when the anatomy warrants it:
\nAs a reminder, Dr Kron's LVPA deep plane facelift includes: a vertical anterior deep plane facelift (from the cheekbones to the horizontal portion of the neck), and an oblique deep plane lift of the neck angle.
\nRecovery from a vertical deep plane facelift is generally simple, but remains specific to each patient. It is important to rest as much as possible during the first five days following the procedure. Following the instructions and the availability of the team for follow-up fully contribute to the quality of recovery.
\nThe appearance of swelling (edema) is normal from the end of the procedure. However, this swelling is limited with the LVPA technique: it is observed mainly around the ears, because skin undermining has been limited. It gradually disappears in the days following the procedure.
\nBruising on the face is almost absent, since the procedure preserves the vascular attachments between the skin and the deep plane. Here too, when bruising appears, it is mainly around the ears.
\nRecovery generally takes between 5 and 14 days. Return to daily activities is generally possible in under a week. Return to sport is possible after 2-3 weeks, subject to progress observed at follow-up. These timeframes are indicative and can vary from one patient to another.
\nThe incisions of the LVPA facelift are designed to be discreetly hidden within the hairline and the natural contours of the ear. Their final appearance depends on individual healing and on following postoperative care instructions.
\nIn the original LVPA facelift technique, there is no visible scar behind the ears (just around the earlobe) nor in the nape of the neck, since the vertical lift of the procedure makes these incisions unnecessary. This technique therefore does not inconvenience patients with short hair or those wearing their hair up.
\nThat said, when performing the oblique re-tensioning of the neck angle, it may be necessary to extend the scar within the retro-auricular groove to a greater or lesser height. In cases combined with an extended posterior cervical deep plane lift, the scar extends into the hair behind the ears.
\nDr Kron uses intradermal suture systems that leave no visible trace on the face. The threads dissolve naturally under the skin during recovery. Only a few very fine stitches are used in delicate areas to perfectly adjust the skin, and are removed at the follow-up visit on day 5.
\nSmoking increases the risk of surgical complications in any type of surgery. Stopping smoking 6-8 weeks before the procedure eliminates this additional risk. If you smoke, talk to your doctor, surgeon and anesthesiologist, or call a smoking cessation helpline to help reduce risks and give yourself the best chances.
\nAfter the procedure, the result is not immediately visible because of postoperative swelling, although this is limited by the LVPA technique. The result gradually reveals itself as the swelling subsides. A natural appearance is generally regained between 5 and 14 days, while the tissues continue to soften and stabilize over several months. The result is usually considered to be in its final form around 6 months.
\nA natural facelift, free of surgical signature and with concealed scars, achieves a “rejuvenation” effect of 5 to 10 years. A successful result is measured by how faithfully the face regains its contours without losing its expression.
\nBy carrying the correction through the deep plane, the LVPA seeks a durable, natural rejuvenation free of surgical signature — the face looks more rested, without appearing transformed.
\nIt should nonetheless be kept in mind that the same operation will not give an identical result in different patients, whose anatomies are, by nature, different. The durability of the result also depends on the quality of your initial anatomy (particularly the quality of your skin) and your lifestyle. It depends on intrinsic factors such as genetics and heredity, and extrinsic factors, mainly smoking and aging linked to sun exposure, but also lifestyle, chronic conditions, etc.
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By limiting subcutaneous undermining and preserving the vascular and nerve attachments between the skin and the SMAS, the deep plane facelift aims to reduce certain side effects observed after more superficial facelifts, notably bruising, swelling and sensitivity disorders.
\nWhile a deep plane facelift is a safe procedure that achieves very good results, it should be kept in mind that it is an operation that carries the inherent risks of all cosmetic surgery procedures. These risks, although rare, must be understood. They will be explained by the surgeon during the initial consultation.
\nIn a classic, so-called “subcutaneous” facelift, the skin is undermined. Many surgeons stop there. For Dr Kron (and others), this has the drawback of not repositioning the deep tissues and of placing all the tension on the skin.
\nSome combine plication procedures to tighten the SMAS. For Dr Kron (and others), this has the drawback of being of limited effectiveness in re-tensioning the deep tissues, since the ligaments that hold the SMAS beneath its plane are not divided, and it requires more extensive skin undermining to access the SMAS from its superficial side. In addition, the superficial surface of the SMAS is fatty and “adheres” less quickly than the deep surface (collagen against collagen).
\nOthers perform a deep plane in addition (referred to as a dual plane facelift) (skin + SMAS) re-tensioned separately: the two layers are treated one after the other.
\nIn an LVPA deep plane facelift, the dissection passes beneath the SMAS and the skin-fat-SMAS unit is repositioned as a single block. The result is generally more natural, with better preservation of facial features, more durable, and improving skin quality (instead of devascularizing it), because traction is not exerted on the skin, which retains its vascular and nerve attachments to the deep plane (the SMAS that “feeds” it).
\nScars are hidden within the hairline and the contours of the ears. In the LVPA facelift technique, the vertical lift helps limit scars behind the ears. Intradermal sutures and careful scar follow-up aim to make the marks as discreet as possible, although their evolution remains individual.
\nThe discomfort felt is generally rated between 1 and 3 out of 10. Recovery is generally simple. It is important to rest as much as possible during the first days following the procedure.
\nReturn to social life is generally possible in under two weeks, sometimes after just one week. Limiting skin undermining aims to reduce bruising and swelling, but the pace of recovery varies from patient to patient and depending on any associated procedures. Return to sport usually occurs after 2 to 3 weeks, with the surgeon's approval.
\nSince repositioning is carried out on the SMAS, a solid, collagen-based tissue, the result is designed to last for many years. The durability of the result nonetheless depends on the quality of your skin, your lifestyle and factors specific to each individual. The natural aging process continues after the procedure.
\nThere is no universal age for a deep plane facelift. The indication depends more on the degree of sagging observed, tissue quality and the patient's wishes than on age itself. In some patients, a procedure performed between 40 and 50 years old allows for an early, particularly natural correction; only a personalized consultation can confirm whether the procedure is appropriate.
\nNo, not necessarily. The procedure can be performed under light general anesthesia with a laryngeal mask or under deep local anesthesia. Dr Kron uses a protocol combining both, developed with his anesthesiologist since 2008, which helps to limit as much as possible the risks and discomforts associated with each type of anesthesia taken separately.
\nThis look can appear when the correction relies too heavily on the skin, or when the vector moves the features laterally. The LVPA, by contrast, aims to have the deep plane carry the re-tensioning and to reposition tissues vertically, in order to preserve mobility, the orientation of the mouth and the identity of the face.
\nNo single technique is superior in every situation. The choice depends on the anatomy, the degree of sagging, the areas to be corrected and the surgeon's experience. The term “deep plane” alone is not enough to predict the result: the vector, the extent of undermining and the precision of the indication are equally important.
\nFor a French or international patient, the choice should first rest on understanding the surgical plan, the quality of the information provided and the organization of follow-up. In Paris, Dr Kron offers a personal approach to the vertical deep plane facelift — the LVPA — based on verticality for the face, obliquity for the neck angle, High SMAS, preservation of skin attachments and individualized support.
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