Deep plane facelift through a limited incision, with nanofat

What the case shows

Before: jowling, a blunted mandibular border, marionette grooves, midface volume loss and photo-aged skin. After: a crisp jaw border, softer grooves, a restored cheek and fresher skin texture.

The operation in seven steps

1. 1

   A short, hidden incision

   It starts in the temporal hair tuft, follows the root of the ear, runs behind the tragus and ends at the earlobe, stopping before the skin behind the ear.

2. 2

   Safe entry into the deep layer

   A limited skin flap is raised over the parotid area, then the SMAS is opened along a line from just below the outer eye corner to the angle of the jaw, behind the line that protects the frontal branch of the facial nerve over the cheekbone arch.

3. 3

   The sub-SMAS plane over the masseter

   Blunt spreading in the avascular plane over the masseter fascia lifts the skin–SMAS–platysma unit as one, leaving the facial nerve branches protected beneath the deep fascia.

4. 4

   Release the cheek ligaments

   The zygomatic ligaments are released sharply, with care for the small artery that crosses them, together with the row of masseteric ligaments along the front of the masseter, so the lift reaches the cheek fat, the nasolabial fold and the corner of the mouth.

5. 5

   Free the jowl, define the jawline

   The mandibular ligament is released about 1.5 cm in front of the pre-jowl sulcus to free the jowl and the marionette fold; the side of the platysma is then anchored to the fascia in front of the ear to carve a crisp jaw border.

6. 6

   Lift at about 60° with no skin tension

   The mobilised layer is anchored along a superolateral vector of about 60° to the firm temporal fascia above and the parotid fascia below; excess skin is trimmed and closed without tension, protecting the shape of the tragus and the earlobe.

7. 7

   Nanofat for the skin

   Fat is harvested with a multi-port 2 mm cannula under low pressure, emulsified by repeated passes between connectors (2.4 mm down to 1.2 mm) and a fine mesh (400–600 µm), then injected with a fine cannula or 27G needle into the tear trough, the cheek skin and the lip lines to improve texture and glow.

Protecting the nerves

The SMAS is opened behind the line that protects the frontal branch of the facial nerve as it crosses the cheekbone arch, and the plane over the masseter keeps the buccal and marginal mandibular branches beneath the deep fascia, out of the field.

The incision: short and hidden

The scar follows natural lines — the hairline, the root of the ear and the fold behind the tragus — and does not extend onto the skin behind the ear. Closing without tension preserves the tragal contour and prevents a pulled earlobe.

Nanofat: what it adds

Nanofat is not volume. It is fat broken down to a fine fluid rich in the tissue’s own regenerative cells, placed into the dermis. Its job is skin quality — texture and glow — in the tear trough, the cheek skin and the lip lines. The lift repositions; nanofat refreshes. More on the nanofat page.

Frequently asked questions