Comparative Effectiveness of Deep Plane and Extended Deep Plane Facelifts in Lower Facial Rejuvenation.

Abstract

Deep-plane facelift (DPF) and its extended modification (EDPF) have been developed to address age-related changes in the lower face, particularly marionette lines, jowls, and neck laxity. Although both techniques provide durable rejuvenation, direct comparative data remain limited. The authors of this study aim to compare the clinical effectiveness of DPF and EDPF in correcting lower facial aging, with emphasis on marionette lines, cervical laxity, and jowling. A prospective cohort study was conducted on 70 patients (mean age: DPF 51.7, EDPF 55.1 years; 95.7% female) between April 2023 and March 2025. Patients were randomized to undergo DPF or EDPF by a single surgeon. Standardized preoperative and 9-month postoperative photographs were independently assessed by 2 blinded ENT surgeons using validated photonumeric scales. Statistical analyses included Wilcoxon signed-rank and Mann-Whitney U tests. Both facelift methods achieved significant postoperative improvements (P < .001). However, EDPF consistently demonstrated superior outcomes in reducing marionette lines (P < .001), improving cervical laxity (P < .01), and correcting jowls (P < .05). No permanent facial nerve injuries or major complications were observed. Although both DPF and EDPF are effective in lower facial rejuvenation, the extended technique provides greater and more consistent improvements, particularly in marionette line correction and jawline-neck contouring. These findings support EDPF as a safe, anatomically sound advancement in facial rejuvenation, warranting further longitudinal and multicenter evaluation.