Comparative Effectiveness of Deep Plane and Extended Deep Plane Facelifts in Lower Facial Rejuvenation.

BACKGROUND: Deep-plane facelift (DPF) and its extended modification (EDPF) have been developed to address age-related changes in the lower face, particularly marionette lines, jowls, and neck laxity. Although both techniques provide durable rejuvenation, direct comparative data remain limited.
OBJECTIVES: The authors of this study aim to compare the clinical effectiveness of DPF and EDPF in correcting lower facial aging, with emphasis on marionette lines, cervical laxity, and jowling.
METHODS: A prospective cohort study was conducted on 70 patients (mean age: DPF 51.7, EDPF 55.1 years; 95.7% female) between April 2023 and March 2025. Patients were randomized to undergo DPF or EDPF by a single surgeon. Standardized preoperative and 9-month postoperative photographs were independently assessed by 2 blinded ENT surgeons using validated photonumeric scales. Statistical analyses included Wilcoxon signed-rank and Mann-Whitney U tests.
RESULTS: Both facelift methods achieved significant postoperative improvements (P < .001). However, EDPF consistently demonstrated superior outcomes in reducing marionette lines (P < .001), improving cervical laxity (P < .01), and correcting jowls (P < .05). No permanent facial nerve injuries or major complications were observed.
CONCLUSIONS: Although both DPF and EDPF are effective in lower facial rejuvenation, the extended technique provides greater and more consistent improvements, particularly in marionette line correction and jawline-neck contouring. These findings support EDPF as a safe, anatomically sound advancement in facial rejuvenation, warranting further longitudinal and multicenter evaluation.