The deep plane in facial surgery represents a milestone in the search for more natural and long-lasting rejuvenation results. Unlike superficial techniques that act only on the skin, dissection in the deep plane allows the repositioning of underlying facial structures, such as the Superficial Musculoaponeurotic System (SMAS), muscles, and fat, providing a more comprehensive improvement and minimizing skin tension.
This complete guide, prepared with the expertise of Dr. Robério Brandão, creator of the Modern Face philosophy and the Endomidface by Direct Vision technique, offers a detailed overview of the deep plane, covering everything from essential anatomy to the most modern and safe surgical techniques. Prepare to elevate your results and master the art of facial rejuvenation!
What is the Deep Plane and Why is it Essential?
The deep plane, also known as sub-SMAS dissection, is a surgical approach that involves separating the skin and subcutaneous tissue from deeper facial structures, such as the SMAS, muscles, and ligaments. This technique allows the surgeon to reposition these structures individually, correcting sagging and restoring volume lost with aging.
[Image: Illustration comparing superficial and deep dissection of the face, showing SMAS and underlying structures.]
Advantages of the Deep Plane
More natural results: By repositioning underlying facial structures, the deep plane avoids the “stretched” or artificial look that can occur with superficial techniques.
Greater durability: Repositioning deep structures provides longer-lasting results, as it corrects the underlying cause of sagging.
Less skin tension: By releasing and repositioning the SMAS, the skin can be redraped without excessive traction, resulting in more discreet scars and lower risk of complications.
Comprehensive correction: The deep plane allows treating different areas of the face in an integrated way, such as cheeks, jawline, and neck, providing a more harmonious rejuvenation.
Challenges and Risks
Although the deep plane offers numerous advantages, it is fundamental to be aware of the challenges and risks associated with this technique:
Anatomical complexity: Detailed knowledge of facial anatomy is essential to avoid nerve and vascular injuries.
Learning curve: Dissection in the deep plane requires experience and surgical skill, as the identification and manipulation of structures can be challenging.
Potential risks: Nerve injury, bleeding, hematoma, skin necrosis, and contour irregularities are some complications that can occur if the technique is not mastered correctly.
That is why Modern Face, a philosophy created by Dr. Robério Brandão, prioritizes safety and systematization of learning, seeking to reduce risks and optimize results in the deep plane.
Essential Anatomy for Deep Plane Dissection
Success in deep plane surgery depends on profound knowledge of facial anatomy. It is crucial to master the location and relationship of the following structures:
Superficial Musculoaponeurotic System (SMAS)
The SMAS is a fibromuscular layer that covers facial muscles and plays a fundamental role in skin support and movement. In deep plane surgery, the SMAS is dissected, released, and repositioned to restore facial contour.
[Image: Detailed SMAS diagram, showing its extension and relationship with facial muscles.]
Facial Nerves
Facial nerves are responsible for innervating face and neck muscles. Injury to these nerves can result in facial paralysis, asymmetry, and other serious complications. It is fundamental to know the course of the main branches of the facial nerve to avoid injuries during deep plane dissection.
- Temporal (frontal) branch: Innervates forehead and eyebrow muscles.
- Zygomatic branches: Innervate cheek and upper lip muscles.
- Marginal mandibular branch: Innervates lower lip and chin muscles.
- Cervical branch: Innervates platysma muscle in the neck.
Retaining Ligaments
Retaining ligaments are fibrous structures that connect skin and SMAS to facial skeleton. They provide support and sustenance to facial soft tissues. In deep plane surgery, selective release of these ligaments allows the surgeon to reposition facial tissues more effectively.
- Zygomatic ligaments: Located in cheek region, support SMAS and malar fat.
- Masseteric ligaments: Located in jaw region, support skin and subcutaneous tissue.
- Orbital ligaments: Located around orbit, support lower eyelid and tear trough region.
Fat Compartments
The face contains several fat compartments that contribute to facial volume and contour. With aging, these compartments can undergo atrophy or ptosis, resulting in volume loss and sagging. In deep plane surgery, the surgeon can reposition or remodel these compartments to restore facial volume and improve contour.
- Malar fat: Located in cheek region, contributes to projection and malar contour.
- Suborbicular fat: Located below orbit, fills tear trough region and softens transition between lower eyelid and cheek.
- Buccal fat: Located in lateral face region, contributes to cheek volume and jaw contour.
[Infographic: Facial anatomy map highlighting SMAS, facial nerves, retaining ligaments, and fat compartments.]
Surgical Techniques in the Deep Plane: The Modern Face Approach
Modern Face, conceived by Dr. Robério Brandão, offers an innovative and safe approach to deep plane surgery, focusing on natural and long-lasting results. The Endomidface by Direct Vision technique is one of the pillars of this philosophy.
Endomidface by Direct Vision: The “Video Without Video”
Endomidface by Direct Vision is a minimally invasive technique that allows access to the deep plane through small incisions in the temporal region, without the need for an endoscope. This approach offers several advantages:
Lower risk of nerve injury: By avoiding excessive tissue manipulation, the technique minimizes risk of facial nerve injury. Dr. Robério’s data demonstrate 0% permanent nerve injury in 212 consecutive Endomidface cases.
Faster recovery: Smaller incisions and less tissue manipulation result in shorter recovery time and less post-operative discomfort.
Natural results: Endomidface allows repositioning facial structures individually, providing deeper, more natural, and harmonious results.
Safe access to mobile SMAS: In patients with history of fillers, the technique avoids area of fibrosis in fixed SMAS, common in other approaches.
[Video: Demonstration of Endomidface by Direct Vision technique, showing incision, deep plane dissection, and repositioning of facial structures.]
Deep Neck: Harmonizing Cervical Contour
Deep Neck is a surgical technique aimed at improving neck contour, eliminating double chin, defining jawline, and softening neck lines. In Modern Face, Deep Neck is performed with a minimally invasive approach and focus on safety.
Preservation of submandibular gland: Unlike some traditional techniques, Modern Face Deep Neck avoids removing submandibular gland, minimizing risk of nerve injuries and other complications.
Treatment of deep structures: The technique concentrates on removing deep fat, treating platysma muscle, and plicating underlying structures, providing longer-lasting and natural result.
Combination with other techniques: Deep Neck can be combined with Endomidface for complete and harmonious facial rejuvenation.
Step-by-Step Deep Plane Surgery (Endomidface Technique)
To illustrate practical application of discussed concepts, we present simplified step-by-step Endomidface by Direct Vision technique:
Marking: Surgeon marks areas to be treated and course of facial nerves.
Anesthesia: Local anesthesia with sedation is performed.
Incision: Small incision is made in temporal region, within hairline.
Dissection: Surgeon uses delicate instruments to dissect deep plane, separating skin and subcutaneous tissue from SMAS and underlying structures.
Release: Retaining ligaments are released to allow mobilization of facial tissues.
Repositioning: SMAS and facial structures are repositioned to restore facial volume and contour.
Fixation: Tissues are fixed in new position with sutures.
Closure: Incision is closed with sutures.
[Image: Sequence of photos illustrating each step of Endomidface technique, from marking to incision closure.]
Safe Navigation in Deep Plane: Knowing Anatomical Landmarks
To operate safely in deep plane, it is essential to know anatomical landmarks guiding surgeon during dissection. Dr. Robério Brandão uses a “Tactile GPS” system based on five fundamental bony landmarks:
- Zygomatic Arch: Delimits lower region of dissection.
- Orbital Rim: Defines upper limit of area to be treated.
- Temporal Crest: Indicates transition between temporal region and forehead.
- Mentum: Reference for chin projection.
- Mandibular Angle: Defines jaw contour and lower limit of dissection.
By knowing these landmarks, surgeon can navigate safely in deep plane, avoiding nerve and vascular injuries.
Dr. Robério Brandão’s Tips and Tricks for Exceptional Results
Besides anatomical knowledge and surgical technique, Dr. Robério Brandão shares some tips and tricks that can optimize results in deep plane:
- Use direct vision: Whenever possible, operate with direct vision, using retractors and adequate light sources. Avoid relying excessively on endoscopes, which can distort perception and increase risk of injuries.
- Master undermining technique: Dissection in deep plane must be precise and delicate, avoiding excessive tissue traction.
- Respect anatomical limits: Know safety limits of deep plane and avoid invading areas where there is risk of nerve or vascular injury.
- Personalize technique: Adapt technique to individual needs and characteristics of each patient, taking into account age, degree of sagging, and expectations.
- Perform rigorous follow-up: Follow your patients closely in post-operative period, monitoring evolution, preventing complications, and ensuring satisfaction with results.
Conclusion: Due Future of Facial Rejuvenation is in the Deep Plane
Deep plane surgery represents future of facial rejuvenation, offering more natural, long-lasting, and harmonious results. By mastering anatomy, surgical techniques, and Modern Face principles, you will be prepared to offer your patients the most modern and safe in facial surgery.
Always remember Dr. Robério Brandão’s words:
“The key to success in deep plane surgery is respect for anatomy, precision in technique, and constant search for patient safety.”
Related Content
- Endomidface by Direct Vision: The Complete Guide
- SMAS Anatomy: Unveiling Secrets of Facial Support
- Deep Neck: Complete Guide for Perfect Cervical Contour
Frequently Asked Questions (FAQ)
What is the deep plane in facial surgery?
It is the dissection below the SMAS, allowing the repositioning of deep facial structures.
What are the advantages of the deep plane?
More natural and long-lasting results, with less tension on the skin.
What are the risks of the deep plane?
Nerve injury, bleeding, and necrosis if not mastered correctly.
Does the Endomidface technique use the deep plane?
Yes, Endomidface accesses the deep plane in a minimally invasive way.
What structures are treated in the deep plane?
SMAS, facial muscles, retaining ligaments, and deep fat.
Is it possible to do a full facelift only in the superficial plane?
No. For long-lasting results, it is necessary to act in the deep plane.
What is the importance of knowing anatomy to operate in the deep plane?
It is fundamental to avoid injuries and ensure patient safety.
Conclusion
Mastering the deep plane is essential to offer excellent results in facial surgery. With this guide and Dr. Robério Brandão’s expertise, you are ready to elevate your technical level and transform your patients’ lives.
Want to learn the Endomidface by Direct Vision technique and master the deep plane safely?
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⚠️ Disclaimer
This content is educational and represents the author’s technical opinion based on documented clinical experience. Surgical decisions must be individualized.
Author: Dr. Robério Brandão, CRM-CE 8596 Last update: January 2026