Deep Plane Facelift with Lower Blepharoplasty at 48

Patient Overview

• Patient: Marinna

• Age: 48

• Gender: Female

• Procedures: Deep plane facelift, neck lift, lower blepharoplasty

• After photos taken at: 1 month post-op

• Origin: Italy

• Location: Istanbul, Turkey

Facial Rejuvenation in the Late Forties: Timing and Advantage

Forty-eight is younger than most patients associate with facelift surgery, yet it is precisely this timing that often produces the most natural and long-lasting results. At this age, the facial ageing changes — early jowling, loss of jawline crispness, neck laxity, and under-eye puffiness — are established enough to warrant surgical correction but have not yet progressed to the point where extensive tissue manipulation is required. The skin retains good elasticity, the deeper structures respond well to repositioning, and the recovery is typically faster than in older patients. Marinna, a 48-year-old patient who travelled from Italy to Istanbul, exemplifies this advantage.

Dr. Cem Berkay Sinaci, a fellow of the European Board of Plastic Reconstructive and Aesthetic Surgery (FEBOPRAS) and member of ISAPS and ASPS, planned a combination of deep plane facelift, neck lift, and lower blepharoplasty — addressing the lower face, neck, and under-eye area as a unified aesthetic zone.

The Deep Plane Technique: Why the Depth of Dissection Matters

The term "deep plane" refers to the anatomical layer at which the surgeon works during the facelift. In a deep plane approach, the dissection passes beneath the SMAS — the superficial musculoaponeurotic system — releasing the retaining ligaments that tether the facial soft tissues to the underlying bone. This allows the descended cheek fat, jowl tissue, and midface volume to be elevated as a single composite unit, carrying skin, fat, and muscle together rather than pulling the skin separately from the structures beneath it.

The practical difference is visible in the result. Because the deeper tissues are repositioned rather than just the skin, the face does not look tight or pulled. Instead, it looks like the same face with its natural contours restored — as if gravity had simply been reversed by a decade. Marinna's preoperative photographs showed the beginning of jowl formation along the mandibular border and a softening of the jawline-to-neck transition. The deep plane lift addressed this by returning the descended tissue to its original position above the jaw, recreating a defined border without tension on the skin surface.

Having trained in advanced facial rejuvenation through fellowship with Raul Gonzalez in Brazil and cadaver dissection in Bangkok, Dr. Sinaci considers the deep plane approach essential for achieving results that age gracefully rather than deteriorating as skin stretches over time — a common limitation of more superficial techniques.

Neck Lift: Restoring the Cervicomental Angle

The neck ages in concert with the lower face, and treating one without the other produces an incomplete result. Marinna's neck showed early platysmal banding and submental laxity that was blurring the angle between her chin and neck — the cervicomental angle that is one of the strongest visual indicators of a youthful profile. The neck lift component addressed the platysma muscle directly, tightening it in the midline and redraping the neck skin over a restored muscular framework.

The result at one month already shows a markedly cleaner neck contour and a sharper cervicomental angle. This will continue to refine as residual deep swelling resolves over the coming months, with the final neck contour typically establishing itself by three to four months.

Lower Blepharoplasty: Completing the Periorbital Zone

While Marinna's upper eyelids did not require surgical intervention, her lower lids showed the fat herniation and early skin laxity that creates under-eye bags and associated shadowing. Leaving this untreated while rejuvenating the lower face and neck would have created a visible disconnect — a refreshed jawline beneath tired-looking eyes.

The lower blepharoplasty was performed through a subciliary approach, allowing access to the herniated fat compartments and the lower lid skin envelope. The excess fat was addressed conservatively to eliminate the visible bags without creating hollowness, and redundant skin was trimmed to smooth the lower lid surface. Non-dissolvable sutures were used to close the incision, consistent with Dr. Sinaci's standard practice for all eyelid procedures. These stitches generate minimal tissue reaction in the delicate lower lid skin and were removed at four to six days, producing a fine scar line that sits just beneath the lash margin and fades to near-invisibility.

What One Month Reveals About a Deep Plane Facelift

Marinna's before and after photographs at one month provide a transparent window into early facelift recovery. The structural improvement is already dramatic — the jawline is defined, the jowls are corrected, the neck is clean, and the under-eye puffiness is resolved. These changes are permanent and will not regress.

What will continue to change over the following months is the quality and subtlety of the result. At one month, the tissues are still settling. There is residual firmness along the jawline and in front of the ears where the deeper dissection occurred. Mild swelling — sometimes not obvious in photographs but perceptible to the patient — is still present, particularly in the morning hours. Over the next two to five months, this firmness softens, the remaining swelling resolves, and the skin finishes draping naturally over the repositioned deeper structures. The scars, concealed within the hairline and around the natural curves of the ear, will continue to mature and fade for up to a year.

The With and Without Makeup Perspective

One notable aspect of Marinna's result is how it reads both with and without makeup. A well-executed deep plane facelift does not depend on cosmetics to look good — the structural improvement stands on its own. Makeup enhances the result but does not create it. This distinction matters because it reflects the depth of the correction. Superficial techniques that rely on skin tension alone often look acceptable with strategic makeup application but reveal their limitations in bare-faced, natural lighting. The deep plane approach, by restoring the underlying architecture, produces a result that holds up equally well in both contexts.

European Patients Choosing Istanbul for Facial Surgery

Marinna's journey from Italy to Istanbul reflects the growing confidence among European patients in Turkey's facial rejuvenation expertise. The proximity is practical — Istanbul is a short flight from most European capitals — but the decision ultimately rests on finding a surgeon whose training, experience, and aesthetic philosophy align with the patient's goals. For patients seeking a natural result from a board-certified specialist with dedicated expertise in face surgery, Istanbul offers options that match or exceed what is available in many European capitals, within facilities certified by the Turkish Ministry of Health for international health tourism.