For decades, the standard facelift worked mostly on the surface. Surgeons separated the skin from the superficial musculoaponeurotic system, better known as the SMAS, then pulled that skin upward and backward. The tension it created often gave the result away. Dr. Andrew Jacono, a New York facial plastic surgeon, began developing an alternative in the early 2000s that works from deeper layers of the face.
His method is called the Minimal Access Deep-Plane Extended facelift, or MADE. Instead of peeling skin away from the tissue beneath it, the procedure moves skin, muscle, and fat together as a single structure. Town & Country described the approach plainly: “Jacono keeps the skin, muscle, and fat as one unit.”
Working Beneath the SMAS
The surgery takes place under the SMAS layer. Dr. Andrew Jacono releases four facial ligaments that anchor soft tissue to bone. Once those attachments are freed, fat pads that have slid downward in the midface, jawline, and neck can be repositioned vertically.
The reasoning comes from how faces actually age. Loose skin is part of the picture, but volume loss and the gradual downward drift of tissue matter too. Tightening the surface does little to correct those deeper changes, while lifting the underlying structures gives the face foundational support.
Smaller Incisions, Longer Results
The MADE technique uses incisions about one-third the length of those in a traditional facelift. They sit behind the ear and along the hairline, so patients can pull their hair back without showing scars. Jacono calls the procedure “ponytail-friendly” for that reason.
Durability is another difference. Conventional facelifts generally hold for six to eight years. The extended deep-plane approach can last roughly twice as long as a standard SMAS facelift, and many patients keep their results for more than a decade.
Dr. Andrew Jacono first published the technique in Aesthetic Surgery Journal in 2011, documenting outcomes in 153 patients. He now performs about 250 extended deep-plane facelifts each year at his Manhattan practice and has taught the method at more than 100 international conferences. Visit this page, for related information.
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