Most people assume a facelift is fundamentally about skin: tightening it, smoothing it, removing the excess that gathers with age. Dr. Andrew Jacono starts from a different premise, one that has shaped his entire surgical approach.

Faces age through volume loss and the downward migration of tissue, not skin laxity alone. Treating the skin as the primary target, as conventional SMAS facelifts do, leaves the deeper cause of sagging in place. That is why traditional results tend to fade within six to eight years.

Correcting the Source

Dr. Andrew Jacono’s Minimal Access Deep-Plane Extended facelift addresses that structural cause directly. By operating beneath the superficial musculoaponeurotic system and releasing the ligaments that anchor tissue to bone, the technique allows descended fat in the midface, jawline and neck to be repositioned vertically, restoring volume where it has been lost rather than merely pulling skin over the deficit.

Skin, muscle and fat move as one connected unit throughout the procedure, which is part of why results avoid the stretched, overworked appearance associated with skin-only tightening. It is a foundational fix rather than a surface patch.

A Framework Built on Evidence

Jacono introduced the approach in the early 2000s and published outcomes from 153 patients in the Aesthetic Surgery Journal in 2011, giving the profession documented support for a premise that was, at the time, a departure from convention. He continues to perform around 250 of these procedures annually at his Manhattan practice.

Understanding aging as a structural shift rather than a cosmetic surface issue reframes what patients should expect from surgery, and what long-term maintenance actually requires.

This structural framing also changes how patients should think about timing. Waiting until skin laxity becomes severe often means the underlying volume loss and tissue migration have progressed further as well, which can make correction more involved. Surgeons who take this structural view generally encourage patients to consider deeper anatomical changes, not just visible wrinkles, when deciding whether and when to pursue surgery.

Consultations that address both surface concerns and underlying structure tend to give patients a clearer sense of realistic outcomes than those focused on skin alone. See related link for more information.

Follow Dr. Andrew Jacono on https://www.youtube.com/c/drandrewjacono