Deep Plane Facelift with CO2 Laser and Fat Grafting

Patient Overview

• Patient: Yana

• Age: 62

• Gender: Female

• Procedures: Preservation deep plane facelift, neck lift, fat grafting, upper blepharoplasty, CO2 laser skin resurfacing

• After photos taken at: 5 months post-op

• Origin: New York, United States

• Location: Istanbul, Turkey

Structure, Volume, and Surface: A Three-Layer Approach to Facial Ageing

Facial ageing does not happen in a single dimension. It occurs simultaneously across three distinct layers: the structural layer, where the SMAS, ligaments, and deeper tissues loosen and descend; the volume layer, where subcutaneous fat depletes, leaving hollows and deflated contours; and the surface layer, where the skin itself deteriorates — accumulating fine lines, textural irregularity, sun damage, and loss of luminosity. A facelift, no matter how technically refined, addresses only the first of these three layers. For Yana, a 62-year-old patient from New York, Dr. Cem Berkay Sinaci planned a combination that targeted all three: preservation deep plane facelift and neck lift for structural repositioning, fat grafting for volume restoration, upper blepharoplasty for eyelid rejuvenation, and CO2 laser skin resurfacing for surface-level renewal.

Dr. Sinaci, a fellow of the European Board of Plastic Reconstructive and Aesthetic Surgery (FEBOPRAS) and member of ISAPS and ASPS, considers this multi-layer philosophy essential for patients in their sixties, where all three dimensions of ageing have progressed substantially. Treating structure alone leaves the face looking lifted but still aged in its surface quality. Treating the surface alone leaves the skin smooth over descended, deflated tissue. The combination produces a result that is greater than the sum of its individual components.

The Preservation Deep Plane Facelift and Neck Lift

The structural foundation of Yana's rejuvenation was the preservation deep plane facelift with neck lift. The deep plane technique works beneath the SMAS layer, releasing the retaining ligaments and elevating the descended midface, jowl, and cheek tissue as a single composite flap. The preservation approach maintains the natural ligamentous attachments and vascular supply where possible, minimising tissue disruption while achieving powerful repositioning.

For the neck, platysmal laxity and skin excess were addressed through direct muscle tightening and skin redraping, restoring the cervicomental angle and eliminating the soft, undefined transition between jaw and neck that had developed over time. Having trained in advanced facial rejuvenation through fellowship with Raul Gonzalez in Brazil and cadaver dissection courses in Bangkok, Dr. Sinaci approaches the face and neck as a continuous structural unit, ensuring the lift vector and tissue tension are balanced across the entire lower two-thirds of the face and cervical region.

Fat Grafting: Restoring What Time Has Taken

Volume loss is one of the most ageing changes that occurs in the face, yet it is frequently undertreated in facial rejuvenation surgery. The temples hollow, the cheeks deflate, the perioral region thins, and the overall facial contour shifts from convex and youthful to concave and aged. A facelift repositions what remains but cannot replace what has been lost.

Fat grafting addresses this directly. A small volume of Yana's own fat was harvested — typically from the abdomen or inner thigh — processed to isolate viable fat cells, and injected into the areas of the face where volume depletion was most pronounced. The grafted fat integrates with the existing tissue, re-establishing the fullness that characterises a youthful facial contour. Unlike synthetic fillers, which are temporary and require repeated treatments, grafted fat is living tissue that maintains its volume long-term once the initial integration period is complete. Approximately sixty to seventy percent of the transferred fat typically survives permanently, providing a durable and natural-feeling restoration.

Beyond pure volume, fat grafting carries a regenerative benefit. The adipose tissue contains stem cells and growth factors that improve the quality of the overlying skin — enhancing thickness, elasticity, and texture in the areas where the fat is placed. This regenerative effect complements both the structural lift and the CO2 laser treatment, creating a layered approach to skin quality improvement.

Upper Blepharoplasty

Yana's upper eyelids showed the skin redundancy and hooding typical of the sixth decade — excess tissue folding over the natural crease, making the eyes appear smaller and more fatigued. The upper blepharoplasty removed this redundancy through an incision within the eyelid crease, restoring a clean, defined lid platform. Non-dissolvable sutures were used for the closure, generating minimal inflammatory reaction in the delicate eyelid skin and producing a finer scar than dissolvable alternatives. The stitches were removed at four to six days in a brief clinic visit.

CO2 Laser Skin Resurfacing: Renewing the Surface

The final component of Yana's rejuvenation addressed the one dimension that no surgical procedure can correct: the intrinsic quality of the skin itself. Years of sun exposure, environmental ageing, and the natural decline in collagen and elastin production leave the skin with fine lines, textural irregularity, pigmentation changes, and a dull, uneven tone. These surface-level changes persist even after the most technically perfect facelift because they exist within the skin layers themselves rather than in the deeper structures that surgery repositions.

CO2 laser resurfacing works by delivering precisely controlled laser energy to the skin surface, vaporising the damaged outer layers and triggering a controlled wound healing response in the deeper dermis. As the skin heals over the following weeks, new collagen is synthesised, the surface texture becomes smoother, pigmentation evens out, and fine lines diminish or disappear. The result is skin that not only sits on a lifted structural framework but looks genuinely renewed in its own right — smoother, tighter, more luminous, and more uniform in colour and texture.

The timing of laser resurfacing in combination with a facelift requires careful planning. The laser is applied after the facelift flaps have been elevated and repositioned, taking advantage of the controlled surgical environment and the single recovery period. The healing from the laser — typically involving a week to ten days of visible skin recovery followed by gradual improvement over three to six months — runs concurrently with the facelift recovery, meaning the patient does not face a separate downtime for the skin treatment.

The Five-Month Combined Result

Yana's before and after photographs at five months capture a result that is very close to fully mature. The deep plane facelift and neck lift have settled completely — the jawline is sharply defined, the jowls corrected, the neck clean and contoured. The fat grafting has integrated, restoring the facial volume that gives the rejuvenated contours a natural fullness rather than the slightly hollow appearance that a lift alone can sometimes produce. The upper blepharoplasty shows open, refreshed eyes with a defined crease.

Most strikingly, the CO2 laser resurfacing has produced its full effect by this stage. The skin quality transformation is visible across the entire treated surface — smoother texture, reduced fine lines, more even pigmentation, and an overall luminosity that complements the structural lifting. This is the dimension of improvement that separates a facelift-only result from a comprehensive multi-layer rejuvenation. The face does not simply look lifted — it looks younger in every measurable parameter.

Why Multi-Layer Rejuvenation Produces Superior Results

Each of Yana's four procedures addressed a different aspect of facial ageing, and none could have achieved this result alone. The deep plane facelift restored structural position. The fat grafting restored volume. The blepharoplasty restored eyelid definition. The CO2 laser restored skin quality. Together, they produced a result that reads not as someone who has had surgery but as someone who appears comprehensively younger — because every layer of ageing has been corrected simultaneously.

For patients from New York and internationally who are researching facial rejuvenation options in Istanbul, Yana's case illustrates the importance of choosing a surgeon who thinks beyond a single procedure. A board-certified plastic surgeon with the training and experience to plan and execute a multi-layer approach can deliver a result that no individual technique — however expertly performed — could achieve on its own.