Most people picture facial aging as loose skin. The anatomy tells a fuller story. Faces lose volume over time, and the tissue beneath the skin migrates downward. Skin laxity is only one piece. That observation sits at the center of the facelift technique developed by Dr. Andrew Jacono.
Traditional facelifts focus on the surface. Surgeons lift the skin off the superficial musculoaponeurotic system (SMAS) and pull it up and back. The skin looks tighter, yet the deeper structures that have shifted stay where they are. Results from this method typically last six to eight years before gravity takes over again.
Treating the Source
Dr. Andrew Jacono’s Minimal Access Deep-Plane Extended (MADE) facelift goes underneath the SMAS. Four key ligaments hold facial tissue to bone, and releasing them allows descended fat pads in the midface, jawline, and neck to be moved vertically back toward where they once sat.
Throughout the operation, skin, muscle, and fat stay connected. Town & Country captured the idea when it wrote that “Jacono keeps the skin, muscle, and fat as one unit.” Because the layers are not separated and stretched, the result avoids the taut appearance that often signals an older-style facelift.
Why Deeper Support Lasts
Lifting foundational structures gives the face support that surface tightening cannot supply. The extended deep-plane approach can last about twice as long as a standard SMAS facelift. Many patients keep their results for over a decade, and some see them extend past 12 years. Technique, lifestyle, skin quality, and ongoing care all influence how long a given result endures.
Dr. Andrew Jacono published the method in Aesthetic Surgery Journal in 2011 after documenting 153 patients. Incisions are about one-third the length of conventional ones and hide behind the ear and along the hairline. He now performs around 250 of these procedures every year in Manhattan, has presented the technique at over 100 international conferences, and summarized more than 2,000 cases in a 2021 medical textbook. Read this article for additional information.
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