# DEEPPLANE™ — /what-is-deep-plane-facelift/safe

> Machine-readable markdown summary. Full article: https://deepplane.com/what-is-deep-plane-facelift/safe
> Last built: 2026-10-18 · Editorial standard: DEEPPLANE™ Review Council.
> License: CC BY 4.0 — Source: DEEPPLANE™

## Frequently asked questions

### Is deep plane facelift safe?

Serious complications are uncommon. In a prospective database of 11,300 facelifts, 1.8% had a major complication (an ER visit, admission or reoperation within 30 days), most often hematoma (1.1%) (Gupta 2016, PMID 26578747). Counting every recorded adverse event (severity not graded), a 2025 pooled review recorded 17.2% for deep plane and 10.3% for SMAS facelifts (Khoury 2025, PMID 40801931). A 183-study meta-analysis found major hematoma in 1.22% of deep plane facelifts and no difference among techniques in permanent facial nerve injury (Jacono 2019, PMID 30768122). Surgeon experience with the technique and an accredited facility matter.

*Topics: safety, risk, complications*

### What are the risks of a deep plane facelift?

Hematoma is the most common: major hematoma in 1.22% of deep plane facelifts across 183 studies (Jacono 2019, PMID 30768122). Facial nerve injury was reported in 0.5-5% across studies, and about 70% of those patients fully recovered within six months (Arianpour 2025, PMID 41273502). Major infection occurred in 0.3% of 11,300 facelifts (Gupta 2016, PMID 26578747). Smoking raises the risk of skin necrosis. Proper surgeon selection is the single biggest risk-reduction factor.

*Topics: safety, risk, complications*

### What are the risks of deep plane facelift?

Major hematoma occurred in 1.22% of deep plane facelifts across 183 studies (Jacono 2019, PMID 30768122). Facial nerve injury was reported in 0.5-5% across studies, and about 70% of those patients fully recovered within six months (Arianpour 2025, PMID 41273502). In 11,300 facelifts, 1.8% had a major complication and 0.3% a major infection (Gupta 2016, PMID 26578747). Smoking raises the risk of skin necrosis. Numbness near the ears is common and usually temporary.

*Topics: safety, complications*

### Can smokers get a deep plane facelift?

Most surgeons will not operate on active smokers because nicotine causes vasospasm that reduces skin-flap blood supply by up to 40%, raising skin-necrosis risk 3-4× (from 1% to 3-4%). Smoking cessation 4-6 weeks pre-op and 4-6 weeks post-op is the standard protocol. Nicotine patches, gum, and vapes contain nicotine and must also be stopped.

*Topics: safety, smoking*

### What health conditions affect deep plane facelift candidacy?

Key contraindications: uncontrolled hypertension (must normalize pre-op), type-2 diabetes with HbA1c > 7 (requires optimization), active smoking within 6 weeks, connective-tissue disease with poor wound healing, BMI > 35 (anesthesia risk), active cardiovascular disease, bleeding disorders, body dysmorphic disorder. Controlled conditions (well-managed hypertension, diabetes, asthma) are generally fine with medical clearance.

*Topics: candidacy, contraindications*

### Can I get a deep plane facelift with Botulinum toxin beforehand?

Yes — prior Botulinum toxin or hyaluronic-acid filler use does not contraindicate deep plane facelift. Most surgeons recommend letting Botulinum toxin fully wear off (3-4 months after last injection) so they can see your natural resting muscle activity during planning. Fillers may be dissolved 2-4 weeks pre-op for accurate tissue assessment. Tell your surgeon your complete injectable history during consultation.

*Topics: injectables, timing*

### What pre-op tests do I need for a deep plane facelift?

Standard pre-op workup: complete blood count (CBC), comprehensive metabolic panel (CMP), coagulation panel (PT/INR), EKG for patients over 50, chest X-ray if cardiopulmonary history, pregnancy test for women of childbearing age. Patients on blood thinners need clearance from prescribing physician. Smoking and nicotine screening (cotinine test) is increasingly used to verify cessation. Tests done 2-4 weeks before surgery.

*Topics: pre-op, tests*

### What medications must I stop before a deep plane facelift?

Stop 2 weeks before surgery: aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), other NSAIDs, fish oil, vitamin E, garlic supplements, ginkgo biloba, ginseng, turmeric supplements. Stop 5 days before: SSRIs require physician guidance (don't stop abruptly). Continue: blood pressure meds, thyroid meds, asthma inhalers, statins. Always provide your surgeon a complete medication list including OTC and supplements.

*Topics: pre-op, medications*

### Are post-op drains necessary after deep plane facelift?

Drains are surgeon-preference, not mandatory. Traditional deep plane facelift uses thin drains for 24-48 hours post-op to evacuate fluid. Modern drainless technique uses fibrin tissue sealant (Tisseel, Evicel) between dissected tissue planes to manage fluid collection. Drainless approach reduces patient discomfort and skips the day-1 drain-removal visit. Surgeons choose between them by preference; neither removes the need for careful bleeding control. Both produce same final aesthetic result.

*Topics: technique, drainless*

### How do I read a facelift surgeon's published complication rates?

Ask for the surgeon's own hematoma, infection, permanent nerve injury and revision rates, how many patients they cover and how they were counted. For context, a prospective database of 11,300 facelifts recorded a major complication in 1.8% and a hematoma needing care in 1.1% (Gupta 2016, PMID 26578747); a surgeon's own figures will differ with case mix and how complications are defined. Watch for: quoted rates 'below industry average' without specific numbers (vague), missing revision rate entirely (suspicious), or claimed zero-complication rates (implausible). A surgeon transparent about their actual complication data signals confidence; one who cannot provide specifics may not be tracking outcomes.

*Topics: surgeon-selection, outcomes*

### What happens if I get Covid or flu right before my scheduled facelift?

Most surgeons postpone elective facelift if the patient has an active upper-respiratory infection within 2 weeks of surgery. Specific reasons: (1) General anesthesia on inflamed airways raises laryngospasm risk 4-5×, (2) Post-op coughing raises hematoma risk dramatically (blood-pressure spikes from coughing), (3) Immune system diverted from healing increases infection risk, (4) Residual cough can disrupt incision healing. Protocol: symptom-free for 10-14 days plus negative rapid test before rescheduled date. Rescheduling fee varies by practice — some absorb it as goodwill, others charge 10-25% of the deposit. If you develop symptoms en route to an international surgery, contact the clinic BEFORE boarding — they would rather delay than operate in unsafe conditions.

*Topics: safety, illness, rescheduling*

### Should I pay extra for an MD anesthesiologist instead of a CRNA?

For ASA I-II healthy patients (no major cardiac/pulmonary/hepatic comorbidity, BMI under 35), outcomes are comparable in published studies — CRNA-led care is acceptable. For ASA III+ patients, an ABA-certified MD anesthesiologist's broader differential-diagnosis training matters. ABA cases run $2,500-$5,000 anesthesia fee; CRNA-led $1,000-$2,500. US: ask whether the lead anesthesia provider is ABA or CRNA, and confirm whether an MD anesthesiologist is supervising the CRNA in real-time. Turkish and other medical-tourism markets typically use full MD anesthesiologists by default.

*Topics: anesthesia, credentialing*

## Fact-checked claims on this page

- **False** — Women with darker skin tones are not good candidates for deep plane facelift
  - Source: The deep plane technique preserves the sub-dermal vascular plexus and produces inconspicuous scars in Fitzpatrick III-VI skin; keloid screening and trichophytic closure are the relevant adjustments
- **False** — Facelift surgery always causes visible permanent nerve damage
  - Source: Permanent facial-nerve injury occurs in under 0.1% of cases with experienced deep plane surgeons; temporary weakness 1-2% resolves within 4-12 weeks
- **False** — You cannot have a deep plane facelift if you have had Botulinum toxin or fillers
  - Source: Prior Botulinum toxin and filler use does not contraindicate deep plane facelift; surgeons often recommend dissolving fillers 2-4 weeks before surgery for accurate planning
- **Mostly False** — Operating out of an office-based OR is as safe as a hospital OR
  - Source: Office-based ORs without accreditation (AAAHC, AAAASF, or state-licensed) carry higher complication rates. Accredited office ORs perform comparably to hospitals for healthy ASA I-II patients. Confirm accreditation status during consultation
- **False** — Aspirin is safe to continue taking right up to surgery day
  - Source: Aspirin must be stopped 14 days pre-op due to irreversible platelet inhibition that increases hematoma risk 2-3×. NSAIDs (ibuprofen, naproxen) stop 7-10 days pre-op. Patients on cardiac aspirin require physician clearance before stopping. Acetaminophen (Tylenol) is the only acceptable analgesic in the pre-op window
- **False** — Deep plane facelift cannot be performed on patients taking finasteride or other 5-alpha-reductase inhibitors
  - Source: 5-alpha-reductase inhibitors (finasteride, dutasteride) used for male-pattern hair loss or BPH are not a contraindication to facelift. They don't affect wound healing, coagulation, or anesthesia safety. Common medications requiring pre-op adjustment: anticoagulants (warfarin, DOACs), antiplatelets (aspirin, clopidogrel), GLP-1 agonists (Semaglutide, Tirzepatide), certain retinoids (isotretinoin within 6 months), high-dose vitamin E supplements, and herbal blood thinners (garlic, ginkgo, fish oil high-dose). 5-ARIs are safe to continue throughout the perioperative period
- **True** — Active upper-respiratory infection within 2 weeks of facelift is an absolute reason to reschedule
  - Source: General anesthesia on inflamed airways raises laryngospasm risk 4-5x; post-op coughing spikes blood pressure and dramatically elevates hematoma risk. Standard protocol: symptom-free for 10-14 days + negative rapid test before any rescheduled operative date. Most reputable practices will not operate in an active-URI window regardless of financial pressure
- **True** — An ABA-certified anesthesiologist costs ~$1,500-$3,000 more than a CRNA-led case, and the difference matters
  - Source: ABA-certified anesthesiologist (MD with anesthesia residency) vs CRNA-led (Certified Registered Nurse Anesthetist) is a real cost-quality decision in deep plane facelift. ABA-anesthesiologist cases run $2,500-$5,000 anesthesia fee; CRNA-led $1,000-$2,500. The clinical difference: ABA-trained anesthesiologists have 4 years of post-medical-school anesthesia training vs CRNA's 2-3 year masters program; for ASA I-II healthy patients undergoing routine cases, outcomes are comparable in published studies; for ASA III+ patients (cardiac/pulmonary/hepatic comorbidity, BMI 35+, complex airway) the MD's broader differential-diagnosis training matters. US standard: facility decides; ask whether the lead anesthesia provider is ABA or CRNA, and confirm whether an MD anesthesiologist is supervising the CRNA in real-time. Turkish and other medical-tourism markets typically use full MD anesthesiologists by default.

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