Are Deep Plane Facelifts Obsolete? Understanding the Evolution of Modern Facelift Surgery
“Deep plane facelifts are obsolete.”
It is a provocative statement — and one that has generated plenty of discussion among facial plastic surgeons.
Dr. Mike Nayak recently made the statement while discussing the evolution of facelift surgery. Dr. Rian A. Maercks wanted to respond, but perhaps surprisingly, the response isn't simply disagreement.
In fact, there is far more agreement than disagreement.
Both surgeons are questioning whether simply entering the deep plane is enough to produce a truly structural facelift.
The important question isn't just:
“How deep did the surgeon go?”
It is:
“What ultimately carries the support and vector of the facial restoration?”
That distinction is at the heart of modern facelift surgery.
What Is a Deep Plane Facelift?
The term deep plane facelift has become increasingly familiar to patients.
Unlike older facelift techniques that relied heavily on skin tightening, a deep plane facelift involves working beneath the superficial musculoaponeurotic system (SMAS) and releasing deeper facial attachments so that the tissues can be repositioned.
The goal is generally to address facial aging at a deeper structural level rather than simply pulling the skin tighter.
But there is an important problem:
Not every operation described as “deep plane” necessarily works in exactly the same way.
The terminology can describe a surgical plane or approach without fully explaining what the surgeon ultimately does with the deeper structures.
This is where the conversation becomes more interesting.
Going Deep Doesn't Automatically Mean Structural Restoration
Simply entering a deeper anatomical plane does not, by itself, guarantee that the face is being structurally restored.
The question becomes:
What happens after the tissues are released?
How are they repositioned?
Where is the tension placed?
What structures carry the load?
And what ultimately determines the facial vector?
This is the distinction Dr. Maercks is highlighting.
The Maercks Institute describes its approach as working in the deep plane while using ligamentous suspension and the KEDGE Suspension™ system to reposition deeper facial structures.
The philosophy is fundamentally about restoring structure rather than simply creating tension.
Deep Plane vs. Deep Structural Support
It is easy to assume that the deeper the facelift, the more advanced it must be.
But depth alone isn't the objective.
A surgeon could perform a technically deep dissection and still rely heavily on lateral SMAS tension to create the final result.
That is the paradigm Dr. Maercks challenges.
In his view, the deeper structures themselves should play a meaningful role in carrying the restorative vector.
The MAERCKS Lift™ with KEDGE Suspension™ approaches this by identifying, releasing and preserving the retaining ligaments and using that deeper ligamentous framework to provide structural support. The SMAS is then contoured around the restored architecture.
The underlying philosophy can be simplified to:
Restore the roots first. Let everything else follow.
What Are the Retaining Ligaments?
To understand this approach, it helps to understand the role of the facial retaining ligaments.
The face isn't simply a collection of loose layers that can be pulled upward.
It has a complex anatomical framework involving:
Skin
Fat compartments
Fascia
Muscles
SMAS
Retaining ligaments
Deeper facial structures
The retaining ligaments help connect and stabilise the soft tissues of the face.
As the face ages, changes occur throughout these structures, contributing to descent and changes in facial contour.
Modern deep-plane approaches increasingly focus on understanding these deeper relationships rather than treating facial aging as a problem of excess skin alone.
The MAERCKS Lift™: A Different Way of Thinking About Support
The MAERCKS Lift™ takes the structural concept further through KEDGE Suspension™.
Rather than relying primarily on lateral tension, Dr. Maercks describes using the patient's deeper ligamentous framework to carry the principal restorative vector.
The objective is to reposition the deeper facial structures and allow the surface tissues to settle around that restored architecture.
The Maercks Institute describes this as a tissue-centric approach designed to restore youthful contours while preserving natural facial expression.
This is an important philosophical difference.
The question becomes less about:
“How much can we pull?”
and more about:
“What should actually be restored?”
The Difference Between Pulling and Repositioning
Patients sometimes imagine a facelift as a simple process:
Loose skin → pull it tighter → remove the excess.
Modern structural facelift surgery is considerably more complicated.
If the deeper facial tissues have descended, simply tightening the surface may not recreate the youthful relationships between the different facial compartments.
It can also create tension that doesn't necessarily correspond to the natural anatomy of the face.
The goal of structural repositioning is different.
Instead of treating the skin as the primary lifting mechanism, the surgeon addresses the deeper support system and allows the skin to redrape around the new architecture.
The Maercks Institute describes its approach as repositioning rather than simply pulling the surface.
What About Dr. Nayak's Approach?
This is where the conversation becomes particularly interesting.
Dr. Maercks is not arguing that Dr. Nayak's work is poor.
Quite the opposite.
He describes Dr. Nayak as an accomplished, high-volume facial surgeon producing excellent results.
The disagreement is about mechanics.
According to the discussion, Dr. Nayak describes tightening deeper structures including the parotidomasseteric fascia, deep facial fat and zygomaticus complex, with final vectoring carried through the SMAS.
Dr. Maercks' approach differs in where the principal structural load is placed: the MAERCKS Lift™ uses the deeper ligamentous framework itself through KEDGE Suspension™ before contouring the SMAS around the restored anatomy.
Different mechanics.
Different techniques.
But an important shared conclusion:
Simply going deep isn't enough.
So, Are Deep Plane Facelifts Obsolete?
The answer depends on what you mean by “deep plane facelift.”
If the phrase means an older interpretation in which the surgeon simply enters a deeper plane, releases tissue and then relies primarily on lateral SMAS tension to create the lift, Dr. Maercks believes that paradigm deserves to be questioned.
But if “deep plane” means genuinely addressing and restoring deeper facial structures, then the deep plane is anything but obsolete.
In fact, it may represent an important part of where facelift surgery is heading.
The evolution isn't necessarily:
Superficial → deep → something else.
It is more accurately:
Pulling → repositioning → structural restoration.
The Goal Isn't to Make the Face Look “Pulled”
One of the biggest concerns patients have about facelift surgery is the fear of looking operated on.
They don't necessarily want to look younger at any cost.
They want to look like themselves — just restored.
This is why vector matters.
A face has natural proportions and relationships.
If tissues are moved in ways that don't respect those relationships, the result may look unnatural even if the skin is technically tighter.
The Maercks Institute's philosophy is that restoring deeper architecture should allow the facial surface to follow rather than forcing the surface into an unnatural position.
From Rectangle to Heart
There is another fascinating point of agreement in this discussion: the shape of the cheek.
Dr. Nayak has discussed creating a more youthful heart-shaped cheek through deeper structural modification.
This is a concept that has long been central to the Maercks Institute's philosophy.
As the face ages, the youthful cheek can lose projection and definition, contributing to a broader or more rectangular appearance.
The goal isn't simply to make the face smaller.
It is to restore the relationships and contours associated with a youthful face.
Think:
Rectangle → Heart. 🤍
The point isn't to create a completely different face.
It is to restore the architecture that made the face look youthful in the first place.
Why Terminology Can Be Confusing for Patients
This conversation also highlights a problem patients frequently encounter when researching facelift surgery.
Terms such as:
Deep plane facelift
SMAS facelift
Composite facelift
Deep-plane facelift
Structural facelift
Ligamentous suspension
can sound highly specific.
But the terminology alone doesn't necessarily tell you exactly what a surgeon will do.
Two surgeons may both describe their procedure as “deep plane” while using different techniques, different vectors and different fixation strategies.
That is why patients shouldn't choose a surgeon based solely on the name of a procedure.
Ask:
What structures are being released?
What structures are being repositioned?
What carries the lift?
Where is the tension placed?
How is the midface being supported?
Why is this technique appropriate for my anatomy?
Those questions are far more revealing than a procedure name.
What Should Patients Look for in a Modern Facelift?
If you're considering facelift surgery, don't simply ask whether your surgeon performs a “deep plane facelift.”
Ask them to explain their philosophy.
Understand the anatomy
Ask what structures are changing as the face ages and what the surgery is designed to restore.
Understand the vector
Where is the tissue being moved?
Upward?
Laterally?
Medially?
Along the natural anatomical vectors?
Understand the support
What structure actually holds the repositioned tissue?
This is one of the most important questions in understanding different facelift techniques.
Look at results
Before-and-after photography can help you understand whether a surgeon's aesthetic philosophy aligns with your own.
Ask why
Perhaps the most valuable question is simply:
“Why are you recommending this technique for me?”
A good consultation should give you an opportunity to understand the reasoning behind the proposed procedure.
The Deep Plane Isn't Dead. The Conversation Has Evolved.
The headline “Deep Plane Facelifts Are Obsolete” is designed to provoke.
But perhaps the more useful conclusion is this:
The deep plane itself isn't obsolete.
What may be becoming obsolete is the idea that simply operating in a deeper plane automatically makes a facelift structurally superior.
Modern facial rejuvenation is moving toward a more sophisticated understanding of anatomy, vectors and structural support.
The Maercks Institute's approach takes that philosophy into the MAERCKS Lift™ and KEDGE Suspension™, using deeper ligamentous structures as part of the framework for facial restoration.
The objective is not simply to make the face tighter.
It is to make the face better supported, better balanced and naturally rejuvenated.
Different Techniques. Different Mechanics. Similar Evolution.
Perhaps that is the most interesting part of this entire discussion.
This doesn't have to be a debate about Maercks vs. Nayak.
It doesn't have to be about one surgeon being right and another being wrong.
Both are contributing to a broader evolution in how facial surgeons think about the deep structures of the face.
The question isn't simply:
“Is it deep plane?”
The better question is:
“What is actually being restored?”
And for Dr. Maercks, the answer begins with the structural framework of the face.
Go deeper. Restore structure. Stop relying on lateral pull.
The deep plane isn't dead.
The superficial interpretation of the deep plane may be.
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