A Better, Safer Facelift Smooths Nasolabial Folds and Marionette Lines that Others Can’t

facelift Inland Empire, nasolabial folds, marionette lines, deep plane facelfit, Inland Empire, deep plane facelift, Dr. Brian Machida
Before and After Deep Plane Facelift by Dr. Brian Machida, MD, FACS - 1 week after procedure

People with significant facial aging, deep nasolabial folds and marionette lines want to look years younger.  Unfortunately, the facelift technique used by many surgeons is limited when it comes to bulkier faces, marionette lines and deeper nasolabial folds.  Now, a better facelift technique is being performed using what one expert called, “the safest method available.”  It is much more effective in treating advanced facial aging, facial bulkiness, prominent nasolabial folds, and marionette lines.


Editor’s Note:  Dr. Brian Machida is a double board-certified facial plastic surgeon with an unusually high level of experience.  In his career he has performed more than 4,000 facelifts, beside other cosmetic surgical and non-surgical procedures. He taught facial plastic surgery for years at the University of Southern California’s Keck School of Medicine.  He now practices at STC Plastic Surgery in Ontario, Inland Empire, California.


Developing a Better Facelift – Step One

Facelifts, which first became popular after World War I, originally only tightened sagging skin.  This helped some, but the results often didn’t last long enough.  And skin was sometimes tightened too much, resulting in a “worked on” or windblown look.  Patients rightly wanted something better.

Then, in the 1970s, doctors discovered a system of connective tissue that helps support the face.   Its official name, the superficial musculoaponeurotic system, is usually called by its acronym, SMAS.  It’s directly connected or “tethered” to the skin.  Thus, tightening the SMAS firmed up the face’s underlying structures while also tightening the skin.

Soon, facial plastic and plastic surgeons found that tightening the SMAS could result in a more effective facelift with natural-looking results. Surgeons using this technique cut a quarter-inch diagonal strip out of the SMAS and suture the top and bottom sections together.  Or surgeons make a similar sized diagonal fold and suture it tight.  This lifts sagging muscles and skin together.  The result is a natural-looking facelift, the SMAS Facelift.

Before and After facelift, platysmaplasty, laser resurfacing and fat transfer by Dr. Sadi Erfani, MD (Creative Commons)

Step Two – Making a Safer Facelift    CONTACT Dr. Machida Inland Empire, CA 

Facelifts performed by board-certified plastic and facial plastic surgeons are one of the safest surgical procedures.  However, problems occasionally arise.  A State of Florida study showed that the vast majority of problems with facelifts were caused by using general anesthesia in an office surgical setting.  There were virtually no issues associated with using local anesthesia.  Dentists routinely use local anesthetics with no problems.

Surgeons at one large facial plastic surgery practice developed a way to perform SMAS facelifts using local anesthetics and oral sedation.  Patients comfortably slept through their procedures but required no special recovery arrangements to wake up afterwards.  Just as in the Florida study, there were very few problems associated with this method.  I ought to know – I performed over 4,000 facelifts using this approach.  It really was, an expert surgeon stated, “the safest method available.”

There was just one problem.  Results were good and natural-looking but limited.  People with advanced facial aging could look years younger – but often not as many years as they would have liked.  Those with deep nasolabial folds and marionette lines looked better – but the improvement fell short of their desires.

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Before and After SMAS facelift and laser resurfacing by Dr. Brian Machida

Step 3:  Better Results for those with Deeper Nasolabial Folds and Marionette Lines

People who wanted more substantial results needed a better facelift technique.  This is particularly true for those with more advanced facial aging and deeper nasolabial folds and marionette lines.  Sagging cheeks produce more pronounced nasolabial folds.  But the SMAS facelift does not lift the cheeks.  It doesn’t do much for those with bulkier faces.  People with advanced facial aging needed something better.

The Deep Plane Facelift is the better surgical technique needed to lift sagging cheeks and smooth deeper nasolabial folds and marionette lines.  With the deep plane facelift, the surgeon’s incision goes below the SMAS layer.  It goes through the fat layer and into the deeper muscle.  The surgeon will release key facial muscle ligaments and reattach them at new anchor points that lift the cheeks, mid-face, and jawline.

This effectively repositions the facial muscles vertically.  Your surgeon can adjust the “pull” to give you the greatest improvement.  And since the SMAS is still attached to your skin, lifting and repositioning the SMAS layer also lifts the skin.  The deep plane facelift helps avoid the risk of hematoma inherent in SMAS facelifts while achieving a natural look.

At the same time, the deep plane facelift allows your surgeon to smooth out 3 to 4 times more skin laxity than the SMAS facelift.  Surgeons performing a SMAS facelift can lift no more than 1 centimeter (1/3 of an inch) to avoid injuring the facial nerve.  Surgeons performing a deep plane facelift can safely achieve a far greater lift and much more substantial results.  The deep plane facelift can “roll the clock” back farther than the SMAS facelift.

The Deep Plane Facelift must be performed by an expert.  One highly experienced facial plastic surgeon said it has a “steep learning curve.”  This is why choosing an experienced facial plastic surgeon or a plastic surgeon that specializes in facial procedures is crucial.  Good schooling is important, but there is no substitute for experience – especially when it comes to your face.

nasolabial folds, facelift before and after, facelift Inland Empire
Before and After facelift to improve nasolabial folds – stock photo

Step 4:  A Better Facelift Using “The Safest Method Available”

Besides having a detailed knowledge of the face and neck, those of us who have performed thousands (or at least hundreds) of facelifts offer patients an additional advantage.  We can do your procedure under safer local anesthesia and oral sedation.  You’ll sleep through your facelift, but without the sickness and potentially serious complications of general anesthesia.

Only surgeons with lots of experience can offer this safer option.  General anesthesia, while less safe in the office, allows surgeons much more time to perform procedures.  This permits less experienced surgeons to perform facelifts at a slower pace.  In contrast, safer local anesthesia generally has a 3-hour time limit.  Highly experienced surgeons can perform deep plane facelift procedures in less than 3 hours without rushing.  Thus, some of my colleagues and I offer both a deep plane facelift and safer local anesthesia with oral sedation.  It’s a better and safer facelift than most plastic and facial plastic surgeons provide today.

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Before and After Deep Plane Facelift by Dr. Brian Machida, MD, FACS – just one week after surgery. Please Note improvement in nasolabial folds and marionette lines

How to get a better, safer facelift to smooth nasolabial folds and marionette lines

To get the best and safest facelift, start by looking for board-certified facial plastic surgeons or plastic surgeons who specialize in facelifts. (See “Need a Facelift, Neck Lift, Filler or Blepharoplasty? How to Find a Facial Plastic Surgeon Online”) Check their websites for Before and After facelift photos that show substantial improvement.  Pay attention to changes in nasolabial folds and marionette lines.  The site may specifically mention Deep Plane Facelifts.

Ask the office how many facelifts the surgeon has performed. Then ask if the surgeon offers deep plane facelifts as well as local anesthesia with oral sedation.  Highly experienced specialists around the country offer both.  If you’re in Inland Empire, California, you can find me at STC Plastic Surgery in Ontario.                                                      CONTACT Dr. Machida Inland Empire, CA

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About Dr. Brian Machida, MD, FACS

Dr. Brian K. Machida, MD, FACS is a double board certified facial plastic surgeon. He has an exceptional level of experience, having performed ( read more )

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