The Goals of a Deep Plane Facelift and the Concept of Shape Surgery
March 02, 2026 | Facelift
In this blog, we will discuss the goals of a deep plane facelift, with a heavy emphasis on the concept of shape surgery. I will walk through the specific elements of shape surgery in a way that helps you, the reader, understand this complex topic and apply it when discussing your goals and objectives for facial rejuvenation with me, Adam Bryce Weinfeld, MD, an aesthetic facial plastic surgeon located in Austin, Texas.
While the concept of shape surgery is one I developed to create a systematic approach to facial rejuvenation, these concepts can also help anyone organize their interactions with surgeons if they are seeking care elsewhere.
Key Definitions
Before we begin, we need to define a couple of terms.
Deep Plane Facelift: When I speak of a deep plane facelift, I am most frequently referring to a facelift combined with a neck lift. In most individuals, if I am performing a deep plane facelift, I am also performing a deep plane neck lift.
Facial Rejuvenation: When I speak of facial rejuvenation, I am referring to a deep plane face and neck lift, and potentially a brow lift—which you can think of as an upper-third facelift—in addition to upper and lower lid blepharoplasties, a lip lift, and fat grafting.
The Four Pillars of Shape Surgery
Let’s discuss the four core pillars of shape surgery:
- Proportion, Contour, and Balance
- Release and Reposition
- Addition and Subtraction
- Aesthetic Prime
Pillar One: Proportion, Contour, and Balance
Proportion, contour, and balance are the three visual elements that facial rejuvenation in my hands is designed to provide. Together, they describe what constitutes shape surgery.
Proportion
Proportion refers to shape and size. I aim to modify structures in a way that still falls within the realm of biological possibility—meaning I do not want any feature to appear so unnaturally large or distorted that it could not have occurred spontaneously during the natural development of a patient’s face.
For example, my goal is to keep the results of a facelift very natural. If a patient would like cheek implants as part of a facelift, I would not use implants so large that the result creates cheeks that could not have occurred naturally. In terms of shape, I pay close attention to the vectors of tissue repositioning to ensure we do not pull the corners of the mouth outward, which would create a smile that is too wide—something that could not arise through natural development.
Contour
Contour approaches facial shape goals differently than proportion. When thinking about contours, we seek an ogee curve when transitioning from one important facial feature to another. An ogee curve is an architectural and geometric term referring to the transition from a convexity to a concavity—in other words, from a curve that bows outward to one that curves inward. Another way to visualize this is the transition from a gentle hill to a gentle valley.
The best example of this is the relationship between the upper cheek, where the cheekbone sits, and the area just below it, known as the mid-cheek. Our eyes perceive an ogee curve as attractive. The transition from a gentle hill in the cheekbone region to a gentle valley in the mid-cheek is what the eye reads as youthful and beautiful. The technical terms for these anatomical features are the malar area (the cheekbone) and the sub-malar area (the mid-cheek below it).
Balance
Balance refers to the relationship between the sizes of the facial features and ensuring they are complementary to one another. Small cheeks paired with a large chin create imbalance; large cheeks paired with a small chin create imbalance.
This is where fat grafting and, on rare occasions, facial implants can improve facelift results. For example, if someone has cheeks that are slightly small relative to their jawbone, facelift repositioning combined with the addition of fat graft to the cheeks can create proportions that are in better balance with the chin. On the other hand, if the chin is small and fat grafting alone will not achieve the appropriate result, an osteoplastic genioplasty—moving the chin bone forward after a precise cut—can restore balance. A chin implant is another available approach.
Pillar Two: Release and Reposition
Most people now recognize that a facelift should not involve significant tension. To achieve natural results that do not create distortion, the tissues—especially in the mid-portion of the cheek—need to be repositioned. They must be elevated to restore their previous youthful location, in particular the malar fat pad.
In order to reposition tissues without significant pull or tension, the mid-cheek and upper cheek tissues must first be released by precisely dividing the ligaments that tether them to the bones in a lower position. The most important of these are the malar retaining ligament and the mandibular retaining ligament.
The overlying SMAS tissue supporting the malar fat pad must also be gently separated from the underlying smile muscles—in particular, the zygomaticus major—so that the fat pad can be elevated without tension and without distorting that primary smile muscle. Once appropriate release has been achieved, there is no need to pull the tissues. They are simply repositioned and anchored to strong structures higher on the face, most notably the deep temporal fascia and sometimes even the bone itself.
Pillar Three: Addition and Subtraction
To understand this pillar, we must first consider the relative volumes of the upper and lower halves of the face when restoring femininity to an aged face. This is where the concept of neoteny plays a role. Neoteny refers to the retention of youthful characteristics. In the context of facial aesthetics, it means that feminine faces are perceived as attractive when they are top-heavy—that is, when they carry more volume in the upper half of the face than in the lower half.
A youthful, feminine face is slightly wider in the upper half—in the temples and cheek region—than in the lower cheek and jaw region. However, with age, the temples hollow, the cheek tissue descends onto the jawbone creating jowls, and the lower face widens and takes on a more masculine, square appearance.
We have already discussed how releasing and repositioning can elevate the cheek tissue, but additional volume often needs to be restored to the upper face. This most commonly takes the form of fat grafting into the temples and the upper and outer cheeks.
As for subtraction, this occurs in the form of buccal fat pad reduction, which can be used conservatively to reduce volume in the mid-to-lower cheek. This can gently enhance the valley in the sub-malar area, facilitating the creation of the ogee curve. Additionally, micro-liposuction can be used to reduce any residual jowling or heaviness of the nasolabial fold—both of which contribute to the perception of excess volume in the lower face.
Pillar Four: Aesthetic Prime
The final pillar is what I call the Aesthetic Prime. This concept refers to achieving a natural and youthful appearance with the least number of procedures necessary. It also means employing the concepts of shape surgery in a way that does not alter the overall identity of the patient undergoing facial rejuvenation.
The aesthetic prime is the target: a natural, youthful appearance achieved with the minimum number of procedures. In a consultation, the patient’s goals are the first order of guidance. But I also counsel patients on how the features of the face work together—how we should seek proportion, how we aim to enhance contours, and how the features of the face must be balanced to maintain a natural result, one that does not appear to be the product of surgery.
Frequently Asked Questions
Where does fat grafting play an important role in the deep plane facelift?
Fat grafting is performed most frequently in the temples and cheeks. Many patients also desire fat grafting to the lips, which can reduce the need for fillers—fillers that can sometimes have an unnatural appearance over time.
How do we actually lift the face in a facelift?
A facelift should not involve significant pulling or tension. To create the most natural result, retaining ligaments—such as the malar retaining ligament and the mandibular retaining ligament—must be released so that the tissues can be repositioned without distorting the SMAS or the underlying muscles, which would create an unnatural appearance and an unnatural smile.
How are repositioned tissues maintained in their new location to prevent recurrent sagging?
The SMAS holding the malar fat pad, along with the skin above it, is repositioned and secured using sutures to the deep temporal fascia—a firm tissue in the temple region—and sometimes even to the bone itself. This provides a durable anchor that maintains the lifted position long-term.
Author – Dr. Adam Bryce Weinfeld, M.D., Aesthetic Facial Plastic Surgeon, Austin, Texas. For more information about deep plane facelifts, shape surgery or for a consultation visit the contact page.