Deep Plane Facelift Emphasized as Gold Standard, With Fillers Positioned as Complementary

Aesthetic facial rejuvenation requires a tailored approach that balances surgical and nonsurgical techniques, with deep plane facelift emerging as a preferred method for durable, natural results, according to John P. Fezza, MD​, during his presentation, “Scalpel Meets Strategy: ​The Facelift in 2026​.”

His session contrasted fillers and surgical facelift approaches, emphasizing that each serves a distinct role. Fillers offer a “minimal downtime” and “quick, non-surgical option,” but provide “temporary results” with “limited lift and neck correction.” Overuse can lead to “unnatural results,” particularly in patients seeking structural improvement.

In contrast, surgical facelift provides “dramatic, comprehensive results,” including lifting of the face, jowls, and neck, as well as correction of submental fullness. However, surgery requires anesthesia, recovery time, and carries procedural risk.

Central to the presentation was the deep plane facelift technique, described as the preferred surgical approach. This method involves limited skin dissection with tension placed on the deeper superficial musculoaponeurotic system, allowing for “tension-free closure.” Key anatomical steps include release of retaining ligaments and management of subplatysmal fat, particularly in patients with fuller necks.

Adjunctive techniques were also highlighted. Subplatysmal fat removal, submandibular gland and digastric muscle reduction, and conservative fat grafting to the cheeks and chin were emphasized to restore facial contour. Fat injection was noted to “soften the lid-cheek junction” and “create a more convex cheek,” supporting more natural skin redraping.

The presentation underscored increasing relevance in patients experiencing GLP-1–associated weight loss, where volume depletion requires careful correction. However, Dr Fezza cautioned to remain conservative with fat grafting.

Combination approaches were encouraged. Laser resurfacing can enhance skin quality alongside structural lifting, with platelet-derived growth factor noted to reduce recovery time. Brow lift decisions remain surgeon dependent, with emphasis on avoiding overcorrection and prioritizing lateral brow elevation when needed.

Prior filler use, particularly calcium hydroxyapatite, may complicate surgical dissection but is not considered prohibitive.

Dr Fezza concluded that “assessment and knowledge of anatomy is critical” and emphasized that “it’s a scalpel, not a magic wand.” For clinicians, the key takeaway is that fillers and surgery are not competing modalities but synergistic tools, with deep plane facelift offering foundational structural correction when appropriate.

Reference
Fezza JP. Scalpel meets strategy: ​the facelift in 2026. Presented at: Music City SCALE Symposium; May 13–17, 2026; Nashville, TN.