How Dr. Andrew Jacono Works Beneath the SMAS Layer
Just under the skin of the face sits a sheet of tissue called the superficial musculoaponeurotic system, usually shortened to SMAS. It links the facial muscles to the skin above them, and it plays a central role in how a face ages. Where a surgeon chooses to operate in relation to this layer shapes the entire result of a facelift.
Traditional facelifts tighten the SMAS from above. Dr. Andrew Jacono, a facial plastic surgeon based in New York, works underneath it instead. That choice defines the extended deep-plane facelift, a technique he introduced in the early 2000s.
Releasing the Ligaments
Certain facial ligaments act like anchors, holding tissue in place. Over decades they stretch, and the fat pads they once supported drift downward. Dr. Andrew Jacono releases these key ligaments during surgery, which frees the deeper tissue to move. He then repositions the midface, jawline, and neck vertically, returning those structures to a more youthful position.
Throughout this process, skin, muscle, and fat stay connected. Older methods split the skin away from what lies beneath and moved only the surface. Keeping the layers together means the face is lifted as a whole rather than stretched at its outermost edge.
Why Depth Matters
Working at this depth has practical benefits beyond appearance. Later research found that deep-plane techniques are less likely to injure the facial nerve than superficial facelifts. The dissection preserves anatomical relationships and blood supply, two factors that protect the tissue.
Dr. Andrew Jacono’s own early study, published in Aesthetic Surgery Journal in 2011, followed 153 patients. It reported temporary facial nerve injury in 1.3% of cases and a hematoma rate of about 1.9%. Both figures sit below industry averages for facelift procedures.
Depth also affects durability. Because the structural causes of aging are corrected at their source, published outcomes show results lasting 12 to 15 years. For readers new to the subject, that anatomical detail explains much of the method’s reputation: the lift happens where the sagging begins. See related link for additional information.
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