Deep Plane Face & Neck Lift with Upper Eyelid Surgery:47-Year-Old Patient from Estonia, Photographed at 1 Month

The Patient's Goals

This 47-year-old woman from Estonia came to AKM Clinic with sagging of the face and neck and with drooping of the upper eyelids. Neither is unusual in the late forties. Together, though, they meant the change was not confined to a single area. The lower face and neck and the upper face were both shaping how she looked, and the plan had to account for each of them.

In surgical terms, sagging of the face and neck is a problem of support, not of skin alone. When the deeper soft tissues of the cheek and jaw descend, the jawline loses its edge and the transition from chin to neck softens. Treating only the skin of such a face leaves that descent in place. The depth at which to lift was therefore the central planning question for the face and neck.

The upper eyelids were a separate question. A face and neck lift works on the cheek, jawline and neck; it does not reach the eyelids. Had the drooping lids been left as they were, a lifted lower face would have sat beneath an unchanged upper face. For that reason the eyelids were treated as part of the same plan.

Surgeon's Expert Approach

Assessment

The assessment centred on the concerns she came with: sagging across the face and neck, and drooping of the upper eyelids. In a case like this the useful questions are which tissue layer the change sits in, and which areas a given operation actually reaches. Those questions decided the combination of procedures.

Why a deep plane face and neck lift

Sagging that comes from descent of the deeper facial tissues is treated at that depth. A deep plane facelift works beneath the SMAS, the fibromuscular layer that carries the soft tissue of the cheek and jowl. The descended tissue is moved back as a single unit instead of the skin being pulled over it. Skin-only tightening can make a face look stretched while the descent underneath remains. Working at depth avoids that trade-off.

The neck belongs in the same operation because, anatomically, face and neck are not separate. The SMAS of the lower face continues into the platysma, the thin muscle sheet of the neck. Lifting the lower face over an unchanged, sagging neck would leave a visible step at the jawline. Treating both as a continuous unit keeps the line from cheek to jaw to neck coherent.

Why upper eyelid surgery

A facelift does not reach the upper eyelid. Its lifting vectors act on the cheek, jawline and neck, so the drooping upper lids would have stayed exactly as they were. Upper eyelid surgery addressed the other area she came with. The upper and lower face were treated together, rather than one being corrected and the other left behind.

How the techniques work

• Deep plane facelift: Through incisions placed around the ear, the surgeon enters the plane beneath the SMAS. There the retaining ligaments that tether the descended tissue, such as the zygomatic and masseteric ligaments, are released. The skin, fat and SMAS then move together as a composite flap and are repositioned. Because the deeper layer carries the support, the skin can be closed without tension.
• Neck lift: The platysma is tightened and repositioned, laterally toward the area behind the ear and, where needed, centrally through a small incision under the chin. This redefines the line between jaw and neck.
• Upper eyelid surgery: The incision lies in the natural crease of the upper lid, where the scar is hidden when the eyes are open. Excess skin is removed, and where indicated a strip of muscle or fat. When the droop involves the lid margin itself rather than the skin above it, the muscle that raises the lid is addressed instead. Telling these situations apart is part of the eyelid examination.

Doctor's note

A deep plane face and neck lift and an upper eyelid procedure were performed in May 2026, and recovery was uneventful. The after photographs were taken one month after surgery. At that stage a face and neck lift is still within its healing period, and the tissues continue to settle over the following months.

The patient was operated on by Op. Dr. Göknil Gültekin.