From New Zealand to Istanbul: Carolyn's Deep Plane Facelift
Carolyn flew from Auckland to Istanbul for a deep plane facelift, deep neck lift, endoscopic browlift, eyelid and fat transfer with Dr. Cem Berkay Sinaci
Patient: Carolyn | Age: 47 | From: Auckland, New Zealand
Procedures: Deep Plane Face & Neck Lift · Endoscopic Brow Lift · Upper & Lower Eyelid Blepharoplasty · Microfat + Nanofat SVF Injection · CO2 Laser Skin Resurfacing
Surgeon: Dr. Cem Berkay Sinaci (Dr. CBS) — Istanbul, Türkiye
Carolyn travelled almost 18,000 kilometres — from Auckland, New Zealand to Istanbul — for a single-stage full face rejuvenation with Dr. CBS. In one operation she had a deep plane facelift, a deep neck lift with submental platysmaplasty and digastric muscle tightening, an endoscopic brow lift, upper and lower eyelid blepharoplasty, combined microfat and nanofat SVF fat injection, and CO2 laser skin resurfacing. This is her story — and a detailed look at exactly how each of those procedures was performed.
Why Carolyn Travelled from New Zealand to Istanbul for a Facelift
At 47, Carolyn was younger than the average facelift patient — but her face had aged on a different schedule to her calendar. New Zealand sits under one of the highest ultraviolet indices in the world, and Carolyn had spent three decades sailing, hiking and gardening in it. The result was a combination that Dr. CBS sees frequently in patients from New Zealand and Australia: significant photoaging of the skin sitting on top of genuine structural descent.
When she looked in the mirror, she saw four separate problems that no single treatment could solve. Her jawline had softened into early jowling. Her neck had lost its angle, with visible platysmal bands and fullness under the chin that had never responded to weight loss. Her brows had dropped, particularly at the tails, making her upper eyelids look hooded and her expression permanently tired. And her midface had deflated — the cheek fat pads had descended, leaving hollow temples, flattened cheeks and shadowed tear troughs.
"I'd had fillers for about five years and they were starting to work against me," Carolyn says. "My face looked fuller but it didn't look like mine, and nothing was actually lifted. I realised I was paying every year to disguise a problem instead of fixing it."
Like most international patients, she started with search: best deep plane facelift surgeon, deep plane facelift before and after, facelift abroad from New Zealand. She compared surgeons in Auckland, Sydney, Seoul and Istanbul. What narrowed her shortlist was not price — it was specialisation.
"I wanted someone who does faces, not everything," she explains. "When I found Dr. CBS I spent two nights going through his before and after gallery and his surgical videos. He wasn't showing me tight, pulled faces. He was showing me people who looked rested. That's what I wanted."
The Online Consultation: Planning a One-Stage Full Face Rejuvenation
Carolyn's first meeting with Dr. CBS was a video consultation across a nine-hour time difference. He assessed her facial anatomy in layers — a habit that shapes every treatment plan he writes.
"There are four layers that age, and they age independently," Dr. CBS explains. "The skin envelope, the fat compartments, the SMAS and platysma muscle layer, and the bone. If you only treat one layer, the result looks incomplete — and patients can usually tell, even when they can't say why."
His recommendation for Carolyn was a single combined operation rather than a staged series. For a patient flying from New Zealand, this mattered enormously: one anaesthetic, one recovery period, one long-haul trip instead of three.
Deep plane facelift — to reposition the descended midface and jawline at the structural level
Deep neck lift with submental platysmaplasty and digastric muscle tightening — to rebuild the neck from the muscle outward
Endoscopic brow lift — to restore brow position before any eyelid skin was removed
Upper and lower eyelid blepharoplasty — to address hooding and lower lid bags
Microfat and nanofat SVF injection — to restore lost volume and regenerate skin quality
CO2 laser skin resurfacing — to treat three decades of sun damage in the skin itself
"He didn't upsell me — if anything he talked me out of things," Carolyn says. "He told me my chin projection was fine and I didn't need an implant, and that I should stop all filler six months before surgery. That's when I booked."
Inside the Surgery: A Deep Plane Facelift with Full Retaining Ligament Release
The deep plane facelift is the technique that defines Dr. CBS's practice, and the detail that separates it from older methods is what happens to the facial retaining ligaments.
The face is anchored to the skull and jaw by a set of fibrous ligaments — the zygomatic ligaments over the cheekbone, the masseteric cutaneous ligaments along the masseter muscle, and the mandibular ligament at the jawline. As we age, the soft tissue slides downward but these ligaments stay fixed, which is precisely why deep folds form where they do. The nasolabial fold and the jowl are not random: they form at ligament boundaries.
"In Carolyn's operation I released every one of those retaining ligaments," Dr. CBS says. "Until they are released, the tissue physically cannot move. If you pull without releasing, you don't lift the face — you stretch the skin, and you create that operated look everyone is afraid of."
Once released, the SMAS and the skin are elevated together as one composite flap — they are never separated. That single technical choice is what preserves blood supply to the skin, allows the CO2 laser to be performed safely at the same session, and produces the soft, unstretched quality of a well-executed deep plane result.
The flap is then repositioned along deliberate vectors. "I lift the flap vertically in the face — straight up, against gravity, because that is the direction the tissue fell," Dr. CBS explains. "In the neck the vector changes. There I lift more horizontally, backwards toward and behind the ear. Getting these two vectors right is what gives a sharp jawline without a windswept face. A single-direction pull cannot do both."
This is the fundamental difference between a deep plane facelift and a traditional SMAS facelift or a skin-only facelift, where the skin is lifted separately from the muscle layer and the ligaments are left intact. It is also why the deep plane result lasts substantially longer.
The Deep Neck Lift: Submental Platysmaplasty and Digastric Muscle Shaping
Carolyn's neck was, in her own words, "the thing I'd hated since I was 35." A neck like hers cannot be corrected from the sides alone — it needs to be opened and rebuilt from the midline. Dr. CBS therefore combined the lateral neck lift with a formal deep neck lift through a small incision hidden under the chin.
Working through that submental access, he addressed each structure in sequence:
Subplatysmal fat — the fat that sits beneath the muscle, which liposuction can never reach, was reduced under direct vision
Digastric muscle tightening — the anterior bellies of the digastric muscles, which bulge and blunt the neck angle, were tightened and reshaped
Submandibular glands — assessed directly, as a low-hanging gland will show through even a perfectly tightened neck
Submental platysmaplasty — the two platysma muscle edges were released and sutured together in the midline, creating a continuous internal corset from chin to thyroid cartilage
"A tight skin envelope over an untreated deep neck gives you a smooth neck with no shape," Dr. CBS says. "Patients notice that within a year. When you tighten the digastrics, remove subplatysmal fat and close the platysma in the midline, you are actually rebuilding the cervicomental angle — and that is a permanent architectural change, not a temporary tightening."
Endoscopic Brow Lift and Upper & Lower Eyelid Blepharoplasty
Carolyn's tired expression came mostly from her brows, not her eyelids — a distinction that matters more than most patients realise. Dr. CBS performed an endoscopic brow lift through several short incisions concealed behind the hairline, using a camera to release and elevate the brow without a long coronal scar and without pushing her hairline backwards.
The brow lift was performed before the upper eyelid surgery, deliberately.
"If you remove upper eyelid skin while the brow is still low, you fix the hooding but you also fix the brow in that low position permanently," Dr. CBS explains. "Lift the brow first, then see how much skin is genuinely excess. Almost every over-resected, hollow, surprised-looking upper eyelid I revise was caused by doing these two in the wrong order."
Once the brows were restored, a conservative upper eyelid blepharoplasty removed the true excess skin. The lower eyelids were addressed by repositioning the herniated fat over the orbital rim to soften the tear trough, rather than simply removing it — an approach that avoids the hollow, skeletonised lower lid that aggressive fat removal produces a decade later.
Microfat and Nanofat SVF: Two Types of Fat, Two Different Jobs
Fat injection is often described as a single procedure. In Dr. CBS's hands it is two, performed together in the same session, because microfat and nanofat do completely different things.
After harvesting fat gently from Carolyn's abdomen, the graft was processed into two distinct products:
Microfat — for volume. Intact fat parcels with living adipocytes, injected where structural volume was missing: the temples, the midface and cheek, the tear trough, along the jawline and around the mouth. This is the material that restores the fullness a face loses in its forties, and it does so with the patient's own living tissue rather than a gel that must be repeated indefinitely.
Nanofat with SVF — for skin quality. The same harvested fat, mechanically emulsified until no viable adipocytes remain, leaving the stromal vascular fraction: adipose-derived stem cells, growth factors and regenerative elements. Nanofat adds no volume at all. It is injected superficially into the dermis to improve skin thickness, texture, fine lines, dark under-eye circles and overall quality.
"I perform microfat and nanofat SVF together in every facial fat grafting case, because the questions they answer are different," Dr. CBS says. "Microfat asks: where has this face lost volume? Nanofat asks: where has this skin lost quality? For a patient like Carolyn with heavy sun damage, skipping the nanofat would have left half the job undone — she would have had a well-shaped face with tired skin on it."
CO2 Laser Skin Resurfacing: Treating the Skin Itself
The final stage of Carolyn's operation treated the layer that surgery cannot reach. A facelift repositions structure; it does not change a single sun-damaged skin cell. Fractional CO2 laser resurfacing was performed across her face at the same session, with deeper settings around the mouth and eyes where fine etched lines were concentrated.
Combining ablative laser with a facelift requires the composite flap technique to be safe. Because the deep plane approach keeps skin and SMAS attached as one unit, the skin's blood supply is preserved and can tolerate resurfacing — which is not reliably true after a skin-only or widely undermined SMAS lift.
"Sun damage, pigmentation and fine wrinkles are skin problems, and they need a skin solution," Dr. CBS says. "The CO2 laser is what makes the difference between a lifted face and a rejuvenated one. For patients from New Zealand and Australia in particular, I consider it essential rather than optional."
Recovery Week by Week: What Carolyn's Healing Actually Looked Like
Days 1–3: One night in hospital, then rest at her hotel. Swelling peaked around day three, as expected. Discomfort was described as tightness and pressure rather than pain — a consistent report after deep plane surgery, where the tension sits in the SMAS layer rather than the skin.
Week 1: Sutures around the eyes removed. The laser-treated skin completed its initial peel. Bruising began shifting from purple toward yellow.
Week 2: Remaining sutures out. Carolyn described this as her turning point — the neck contour became visible for the first time. She stayed in Istanbul for a full 14 days, which Dr. CBS requires for combined cases of this size.
Weeks 3–6: Return to normal activity. Residual swelling in the midface and along the jawline, plus the tightness and numbness in front of the ears that always accompanies a deep plane dissection and always resolves.
Month 3: Roughly 80% of the final result visible. Fat grafts fully settled at their permanent volume. Laser-treated skin still actively remodelling collagen.
Months 6–12: The final result. Skin quality continued improving throughout, as both the CO2 laser and the nanofat SVF keep working on the dermis long after the surgical swelling has gone.
Carolyn's Results: A Deep Plane Facelift Before and After From New Zealand
At her twelve-month review, the change in Carolyn's face was structural rather than cosmetic. Her jawline was defined and continuous. Her neck had a genuine cervicomental angle for the first time since her mid-thirties. Her brows sat at a natural height, her upper eyelids were open without looking hollowed, and the shadows under her lower lids had softened rather than been carved out. Her cheeks and temples carried volume again — her own, permanently. Her skin, after thirty years of New Zealand sun, was smoother and more even than it had been in a decade.
"The thing nobody tells you," Carolyn says, "is that people don't say 'you've had work done.' They ask if you've been on holiday, or whether you've changed your hair. My daughter said I look like the photos of me from my thirties — not younger exactly, just properly myself again. And I don't have a filler appointment in my calendar anymore."
See more results in the before and after gallery, or read what other international patients have written in our patient reviews.
Expert Perspective: Why Dr. CBS Combines These Procedures in One Session
"Carolyn's case is a good illustration of why I plan in layers rather than in procedures," Dr. CBS says. "She needed the SMAS and platysma repositioned, the deep neck rebuilt, the brow restored, volume replaced and the skin resurfaced. Doing those one at a time over three years would have meant three anaesthetics, three recoveries and a face that was never in balance in between."
"Combining them is only safe if the technique supports it. The composite deep plane flap preserves skin perfusion, which is what allows CO2 laser at the same session. Full retaining ligament release is what allows a tension-free closure, which is what protects the scars. Every one of these decisions makes the next one possible — that is what a combined plan actually means. It is not a package. It is a sequence."
He also notes that age is a poor guide on its own: "Carolyn was 47. I have declined to operate on patients of 60 and recommended surgery for patients of 44. What I assess is tissue descent, ligament laxity, skin quality and neck anatomy — not the number on the passport."
Travelling from New Zealand for Facelift Surgery: Practical Notes
The Auckland–Istanbul journey is roughly 26–30 hours with one connection. Dr. CBS's guidance for patients making it:
Arrive two days before surgery — for in-person examination, blood work and recovery from the flight
Plan 14 nights in Istanbul minimum for a combined case at this scale
Stop all fillers six months beforehand, and stop smoking and nicotine products entirely
Fly home in compression garments, walk the cabin hourly, hydrate continuously
Bring high-factor sunscreen and a wide-brimmed hat — post-CO2 skin is highly photosensitive, and this matters more for New Zealand patients than almost anyone else
Follow-up continues by video at 1, 3, 6 and 12 months
Full logistics, hospital details and accommodation guidance are in our guide for international patients.
Frequently Asked Questions
How long does a deep plane facelift last?
Because the deep plane technique repositions the SMAS and releases the retaining ligaments rather than tightening skin, results typically last 10–15 years. Skin-only and simple SMAS plication lifts commonly relapse within 5–7 years. Ageing continues either way — but it continues from a corrected position.
Is it safe to combine a facelift, neck lift, brow lift, eyelid surgery, fat grafting and CO2 laser in one operation?
In an appropriately selected, medically fit patient and with a composite deep plane flap that preserves skin blood supply, yes. Patient selection and technique are what determine safety, not the number of procedures. Every combined plan is confirmed after in-person examination and pre-operative testing.
What is the difference between a deep plane facelift and a SMAS facelift?
A SMAS facelift lifts the skin and the SMAS as two separate layers and generally does not release the retaining ligaments. A deep plane facelift releases the ligaments and moves skin and SMAS together as one composite unit — producing more genuine repositioning, less skin tension, and a longer-lasting, more natural result.
How soon can I fly home to New Zealand after a facelift?
Dr. CBS asks combined-surgery patients to stay 14 nights in Istanbul. Long-haul flights are permitted from day 14–16 with compression, hourly mobilisation and adequate hydration.
Is 47 too young for a deep plane facelift?
No. Suitability is determined by tissue descent, ligament laxity, neck anatomy and skin quality — not age. Patients in their forties often achieve the most natural results, because tissue quality is better and less correction is needed.
Do I still need fat injection if I'm having a facelift?
Usually, yes. A facelift repositions tissue but does not replace lost volume, and it does not improve skin quality. Microfat restores volume; nanofat SVF improves the skin. Lifting a deflated face without replacing volume is one of the most common causes of a pulled, gaunt result.
Conclusion: One Trip, One Operation, One Complete Result
Carolyn's journey from Auckland to Istanbul shows what a properly planned full face rejuvenation can achieve when every layer of facial ageing is addressed in a single, well-sequenced operation. A deep plane facelift with complete retaining ligament release. A deep neck lift with digastric tightening and submental platysmaplasty. An endoscopic brow lift performed before eyelid surgery. Microfat and nanofat SVF fat injection for volume and skin regeneration together. And CO2 laser resurfacing for skin that three decades of sun had changed.
"I flew eighteen thousand kilometres and I'd do it again tomorrow," Carolyn says. "Find the surgeon who does exactly what you need, and then go to them — wherever they are."
More Patient Stories
Book Your Deep Plane Facelift Consultation
Dr. Cem Berkay Sinaci performs deep plane facelift and deep neck lift surgery in Istanbul for patients travelling from New Zealand, Australia, the UK, Europe and North America. Learn more about Dr. CBS, browse the before and after gallery, or book your online consultation today.
