In Part 1, we talked about how facial ligaments act like nails holding a carpet to the floor. To get a natural, tension-free lift, a surgeon must go deep beneath the muscle to release those "nails."
But here is the catch that few people talk about: not all deep plane facelifts release every nail.
Understanding the difference between a partial release and a true, wide release is the single most important factor in preventing a facelift that drops after two years—or worse, leaves you searching for a revision surgeon - often this is where you are referred to me.
Back-Portion Release vs. Wide Release: What’s the Difference?
When a surgeon performs a deep plane facelift, how far they go across your face matters.
Back-Portion Release (Limited): The surgeon only releases the ligaments near the ear, jaw angle, and outer cheek. It’s faster and stays in a "safer" surgical zone, but it leaves the center of your face tethered.
Wide Release (Extended): The surgeon releases the back ligaments plus the front tethers all the way forward to the corners of your mouth (marionette lines) and the sides of your nose (nasolabial folds).
Who Needs What?
| Patient Profile | Recommended Release | Why? |
|---|---|---|
| Early/Mild Aging (Late 30s–40s with minor jawline laxity) |
Back-Portion Release | The midface and mouth area are still structurally firm, so front tethers don't need to be disturbed. |
| Moderate to Severe Aging (Heavy jowls, deep smile/marionette lines) |
Wide Release | Heavy midface tissue is firmly anchored in front. Without releasing those front nails, the center of the face cannot lift. |
| Post-Weight Loss ("Ozempic Face") |
Wide Release | Significant volume loss creates deep structural deflation that requires a full, un-tethered vertical lift. |
The Surgical Flaw: What Happens When a Release Is Incomplete?
If a patient needs a wide release to lift heavy cheeks and marionette lines, but their doctor only performs a back-portion release, three major problems occur:
1. The Tethered Midface: Because the front "nails" near the mouth were never removed, the center of the face stays stuck. You leave surgery with your jawline slightly improved, but your deep nasolabial folds and marionette lines look almost unchanged.
2. Forced Skin Tension: To compensate for the fact that the deep muscle won't slide forward (because it's still tethered), the surgeon is forced to pull harder on the skin edge. This reintroduces skin tension, and may leave some wider scars.
3. Early Relapse & Revisions: Pulling against an unreleased anchor causes extreme strain. Within 1 to 3 years, the stretched tissue gives out, the face sags back down, and the patient ends up shopping for a revision facelift to fix what was missed the first time. Ask my revision clients - they will tell you they wished they heard about me before they had surgery.
Setting Realistic Expectations: What NO Facelift Can Do
Even a masterfully executed wide-release deep plane facelift has clear anatomical limits. To protect your investment, keep in mind that surgery alone cannot fix everything:
Skin Texture & Quality: Surgery repositions sagging muscle and fat; it does not erase sun spots, fine crinkly surface lines, or lip smoker's lines. (These require lasers, chemical peels, or microneedling). I will always discuss your skin with you, especially if you're menopausal. Skin will stretch, whether you like it or not. Expect 1/4 inch settling along jawline. Ask me for more info on that.
Volume Loss: Lifting tissue restores it to where it used to be, but if aging or weight loss caused significant loss of fat and bone density, surgery won't create new fullness. (This is why surgeons often combine a lift with facial fat transfer).
Dynamic Wrinkles: Expression lines around the eyes (crow's feet) or forehead are caused by muscle movement, not gravity, and still require treatments like Botox.
Ask the Experts LIVE at The Regan House
Navigating these surgical nuances shouldn't feel like a guessing game. The MIRROR ROOM is opening very soon in The Regan House - you will love your facial assessment. NO sales associated with the Mirror Room at all. If you know me, you know I'm all about education, what you do with it is up to you. I don't have an agenda.