Younger with a facelift.
You will be even younger if you combine it with fat grafting.

Deep Plane Facelift in Brazil: the gold standard of facial rejuvenation

Dr. Walter Zamarian Jr. is one of Brazil's leading Deep Plane facelift specialists. With over 20 years of experience and more than 8,000 plastic surgeries performed, he trained at the Ivo Pitanguy Clinic — the world's most prestigious plastic surgery school — and completed advanced Deep Plane facelift training in the United States. He is a member of SBCP (Brazilian Society of Plastic Surgery) and ASPS (American Society of Plastic Surgeons). He sees patients from across Brazil and internationally at his clinic in Brazil, with a 4.9/5 Google rating (153 reviews). CRM-PR 17,388 | RQE 15,688.

The deep plane facelift — also known in the medical literature as a rhytidectomy or deep plane rhytidectomy — is the most advanced facial rejuvenation technique available today. Unlike traditional facelifts that merely pull the skin and place superficial SMAS sutures, the deep plane releases the four retaining ligaments that anchor facial structures to the bone. This allows me to reposition muscles, fat, and skin as a single unit, in a vertical vector that reproduces the natural direction of youth. In my experience of over twenty years and eight thousand plastic surgeries performed, no other technique delivers results as natural and long-lasting. My training at the Ivo Pitanguy Clinic and specific deep plane training in the United States gave me the foundation to offer, here in Brazil, a deep plane facelift meeting the same standards as the finest international facial rejuvenation centres. As a member of SBCP and ASPS, I continually keep up to date with specialty advances. I see both women and men; for the specific approach tailored to male patients, please see the dedicated page on the male facelift.

If you have researched facelift in Brazil, you have probably come across dozens of different techniques: SMAS, MACS, mini-lift, endoscopic lift. With so many options, it is natural to feel confused. Let me simplify: after two decades performing facial surgeries and studying the most advanced techniques in the world, I made a firm decision. I now exclusively perform the deep plane facelift on all my patients. The reason is simple: no other technique delivers such natural and long-lasting results.

The deep plane is not just an evolution of the traditional facelift. It is a completely different philosophy of how to treat facial ageing. While conventional techniques pull the skin and suture the SMAS superficially, the deep plane goes further: it releases the ligaments that attach your face to the bone, allowing me to reposition the entire facial structure back to its youthful position. The result? A truly rejuvenated face, without that stretched appearance that often frightens those considering a facelift. International patients seeking a facelift abroad increasingly choose Brazil for the combination of surgical expertise and value.

Why I chose to only perform deep plane

After more than eight thousand surgeries over twenty years, I can confidently say: the deep plane is superior to the techniques I previously performed. This is not an opinion based on theory. It is a conclusion that arose from observing my own results, comparing patient satisfaction, and following the evolution of techniques in the leading plastic surgery centres around the world.

The fundamental difference lies in the depth of the work. In the deep plane, I release four facial retention ligaments that you have probably never heard of: the zygomatic ligament (which holds the cheekbone), the masseteric (side of the face), the mandibular (which contributes to the bulldog appearance) and the cervical (in the neck). When these ligaments are released, the entire muscle-fat-skin system can be elevated as a single unit, in a vertical vector that mimics the natural direction of youth.

Compare this with traditional techniques that only pull the skin laterally and give a few sutures in the SMAS. It is like trying to lift a tent by only pulling the outer fabric, versus raising the entire support structure. The visual result is incomparable.

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"In this video you will discover all the areas of the face that are treated during a facelift with fat grafting:"

How does the deep neck lift (deep neck treatment) work?

The deep neck lift — also known as the deep treatment of the neck — is an integrated step within the Deep Plane facelift that addresses cervical structures below the platysma muscle. Many patients come to my clinic focused only on the face, but I immediately notice that their neck needs special attention. A facelift without a proper deep neck lift is like renovating the facade of a house while leaving the garden abandoned. The imbalance is glaring.

In the deep plane, the dissection naturally extends to the neck, releasing the cervical ligament and allowing me to treat, during the deep neck lift, structures that superficial techniques simply cannot reach:

Platysmaplasty: correcting the neck bands

The platysma muscle extends from the jawline to the collarbone. Over time, its medial edges separate and form those two vertical cords so characteristic of cervical ageing. Through a small incision under the chin, I bring these bands closer together at the midline with precise sutures. The result is a smooth and defined neck.

Subplatysmal fat: eliminating the deep double chin

Below the platysma, there is a layer of fat that conventional liposuction cannot reach. In the deep plane, I have direct access to this fat and can remove it under direct vision, sculpting the angle between the chin and neck precisely.

Digastric muscle: refining the contour

In some patients, the anterior belly of the digastric muscle contributes to a bulky appearance under the chin. When necessary, I perform a partial reduction of this muscle to create a more elegant neck contour.

Submandibular gland: when excess is a hindrance

The submandibular salivary gland can become prominent with age, creating a bulge in the lateral neck region. In cases where this compromises the aesthetic result, I remove only the excess glandular tissue, preserving the normal function of the gland.

This level of detail in neck treatment is what differentiates an exceptional result from a merely good one.

Deep Plane or SMAS: what's the difference?

Patients often ask about the differences between facelift techniques. This table summarises the key points I discuss during consultations at my clinic in Brazil:

I chose the deep plane as my exclusive technique because, in my experience with over eight thousand surgeries, no other approach delivers the same combination of natural appearance, longevity, and safety. That said, some patients arrive at the consultation asking about alternative techniques they have seen on social media or in aesthetic clinics. I answer the three most frequent questions honestly below.

Deep Plane or mini facelift: what's the difference?

The mini facelift is a simplified version of the traditional facelift, with shorter incisions and limited dissection confined to the mid-face. It may be appropriate for very young patients (35-45 years) with early, restricted laxity, but it has important limitations: it does not treat the neck, its durability is short (3-5 years on average) and the treated area is too small to reposition the deep retaining ligaments. In patients with established signs of facial ageing — the majority of those who come to see me — a mini facelift simply does not deliver what the deep plane delivers. For this reason, I do not perform mini facelifts in my practice. When I assess that a patient warrants a less extensive approach, I advise on non-surgical alternatives or recommend postponing surgery until the findings justify a full deep plane procedure.

Deep Plane surgical facelift or PDO thread lift: what's the difference?

A PDO (polydioxanone) thread lift is a non-surgical, office-based procedure in which absorbable sutures are introduced under the skin to create temporary mechanical traction. It is a completely different technique from the deep plane facelift. PDO threads do not release the facial retaining ligaments, do not reposition the SMAS-platysma and do not address the deep neck. Their durability is typically 8 to 18 months and they have no regenerative action on the tissues. In my opinion, thread lifts can be useful for carefully selected patients with very early laxity, or as a bridge for those postponing definitive surgery, but they do not replace the deep plane facelift in patients with a genuine surgical indication. I do not perform PDO thread lifts; when a patient's profile is suited to the technique, I advise accordingly and may refer them to a colleague who offers it.

Does Dr. Zamarian perform endoscopic facelift?

I do not perform endoscopic facelift, in any of its variants (endoscopic brow lift, endoscopic forehead lift, endoscopic midface lift). In my experience, the results of endoscopic approaches for facial rejuvenation are not long-lasting and are unpredictable — the tissues tend to return towards their original position within a relatively short time. The deep plane approach through a pre-auricular incision offers superior surgical control over the deep planes and allows more stable results. For further context on why I do not favour endoscopic approaches in upper-third rejuvenation, see the dedicated page on the brow lift.

Your fears are legitimate. Let me address them.

Over two decades, I have heard thousands of patients express the same fears. Each fear is legitimate and deserves an honest answer.

Fear of looking stretched

This is the number one fear, and rightly so. We all know someone who had a facelift and ended up with that artificial look, pulled eyes, frozen expression. This happens when the surgeon only pulls the skin, applying excessive tension in the wrong direction.

The deep plane elegantly resolves this issue. As I release the ligaments and lift the entire deep structure, the skin goes along naturally, without tension. The traction vector is vertical, mimicking the direction opposite to gravity, not lateral as in old techniques. My patients look rested, youthful, revitalised. They don’t look operated on.

Fear of general anaesthesia

Any surgery under general anaesthesia deserves respect. But modern anaesthesia is extraordinarily safe. I work with experienced anaesthetists who monitor every vital parameter throughout the procedure. The pre-operative cardiac assessment identifies any risks before we enter theatre. In over twenty years, I have never had a significant anaesthetic complication.

Fear of swelling and recovery

There will be swelling, I won’t lie. The first three days are the most intense. But the haemostatic mesh significantly reduces both swelling and bruising. Most of my patients are presentable for social commitments within two weeks. The result improves progressively over months as the tissues settle into their new position.

Fear of scars

The incisions are strategically placed: within the hair in the temporal region, in the natural fold in front of the ear, contouring the lobe and continuing behind the ear. When healed, they are practically invisible. The incision under the chin, when necessary, is placed in a natural fold and disappears completely.

What can go wrong in a facelift?

This question deserves an honest answer. Like any major surgery, a facelift carries inherent risks — and that is precisely why I choose technique, hospital and team with absolute rigour. The possible complications, with their approximate probabilities drawn from the medical literature, are:

• Haematoma (collection of blood beneath the skin) — the most common complication, occurring in up to 5% of cases in the literature. The Auersvald haemostatic net I use reduces this rate to under 1% in my practice.
• Transient sensory change of the skin — common in the first weeks, resolving within 3 to 6 months in almost all patients.
• Frontal branch facial nerve injury (temporary forehead weakness) — rare (<1%), and almost always transient. The deep plane, performed with deep anatomical knowledge, protects these branches.
• Infection — rare (<1%) when the procedure is performed in a hospital environment with appropriate antibiotic prophylaxis.
• Hypertrophic or widened scarring — uncommon and more frequent in smokers, which is why I require cessation of smoking for 30 days before and 30 days after surgery.
• Residual facial asymmetry — small asymmetries are normal after any facial surgery; larger asymmetries are rare and can be addressed in a minor revision after six months.
• Result below expectations — the most subjective risk and, in my experience, the one most closely linked to inadequate expectation-setting during the consultation. That is why I invest time in the pre-operative assessment and explain clearly how far the deep plane can (and cannot) take the result.

Prevention is the name of the game. An experienced surgeon, the right technique for the patient's anatomy, a full hospital setting, a dedicated anaesthesia team, the haemostatic net, cessation of smoking and close postoperative follow-up — this combination dramatically reduces the likelihood of any serious complication. Across the 8,000+ procedures I have performed, the rate of serious complications remains below 3% (reference Gordon & Sawan, Facial Plast Surg, 2020).

Which procedures do I combine with Deep Plane facelift?

The facelift addresses the middle and lower thirds of the face, as well as the neck. Other areas can benefit from complementary procedures, which I perform at the same surgical time:

Blepharoplasty: rejuvenating the gaze

The eyelids account for about sixty percent of the impression of facial rejuvenation. Excess skin on the upper eyelids, under-eye bags on the lower eyelids, and deep dark circles can be corrected during the same surgery. The combination of facelift with blepharoplasty delivers a complete result that transforms the appearance.

Brow lift

Drooping eyebrows, especially on the lateral part, can give an air of sadness and fatigue. The eyebrow lift (also known as forehead lift) is excellent for rejuvenating the upper third of the face and is an excellent complement to the deep plane facelift.

Bichectomy: defining the contour

The removal of the buccal fat pads can further accentuate the definition of facial contours in selected patients, especially those with a naturally rounded face.

Fat grafting to the hands

It is of no use to have a renewed face if the hands reveal age or even more than they should. Fat grafting to the hands takes advantage of the miracle of stem cells and promotes deep and lasting rejuvenation, perfectly complementing facial plastic surgery.

Botulinum toxin in the postoperative period

About three to four weeks after the surgery, when the swelling has significantly subsided, the application of Botox on the forehead, glabella, and crow's feet complements the result naturally. The expression wrinkles that the facelift does not address are softened, and the overall result becomes even more impressive. This combination of structural surgery with simple periodic maintenance is, in my opinion, the smartest strategy for ageing gracefully. In my clinic, we have a team of dermatologists who can administer Botox for you.

How is the surgery performed step by step?

The surgery lasts between five and six hours, depending on the associated procedures. It is performed under general anaesthesia in a properly equipped surgical centre.

Collection and preparation of fat

I start with liposuction of the donor area, usually the inner thighs or lower abdomen. The collected fat is processed immediately: washed to remove blood and anaesthetic, centrifuged to separate the oil and concentrate the viable cells, and divided into the three sizes I described earlier.

Blepharoplasty

Right at the beginning of the surgery, after collecting the fat, we find the eyelids without swelling. This allows blepharoplasty to be performed in a predictable and safe manner.

Fat grafting

With the structure repositioned, I apply the fat to the areas that need volume: temples, cheekbones, nasolabial fold, marionette lines, mandibular contour. The nanofat is distributed superficially across the entire face to stimulate skin regeneration.

Deep neck lift (deep neck treatment)

Through the submental incision, I access the deep structures of the neck to perform the deep neck lift. I remove subplatysmal fat, treat the digastric muscles when necessary, and bring the platysma bands closer together in the midline. The lateral dissection connects with the facial dissection, allowing for the elevation of the platysma in continuity with the SMAS.

Deep plane dissection

The incisions follow the lines I described: temporal within the hair, pre-auricular in the natural fold, contouring the earlobe and post-auricular. The dissection begins superficially and deepens to the level of the SMAS, entering the deep plane over the zygomaticus major muscle.

I sequentially release the zygomatic, masseteric, and mandibular ligaments. This release allows me to mobilise the entire middle third of the face as a block, elevating it vertically and suturing it in its new position. The difference is immediately visible on the surgical table.

Closure and haemostatic mesh

The skin is redraped over the new structure without excessive tension. I only remove the excess, without pulling. I suture with fine absorbable sutures in multiple layers. Finally, I apply the Auersvald haemostatic mesh, which will be removed in forty-eight hours.

What does the face look like after a Deep Plane facelift?

This is one of the most frequently asked questions — and the one most loaded with anxiety. Out of respect for Brazilian Medical Council (CFM) Resolution 2.336/2023, which regulates the use of before-and-after images in medical advertising, I do not publish photographs of real patients on this page. What I can describe is what my patients report and what I observe clinically in the postoperative period.

What changes visually

The mandibular contour reappears. The jowls subside and the neck regains definition. The nasolabial folds — those deep creases running from the nose to the corners of the mouth — soften. The cheeks recover volume and projection. The eye area looks less tired, even though blepharoplasty or upper-third elevation — when indicated — amplify that effect. The repositioned retaining ligaments restore the youthful facial architecture, with natural light falling on the right points of the face. The neck, treated with the deep neck lift, loses its vertical platysmal bands and regains a defined cervical angle.

What patients report

The most common sentence, heard dozens of times, is: "People tell me I look rested, not that I've had surgery." Other recurring comments: "I've got my jawline back", "That jowl that used to bother me is gone", "My passport photo looks like my younger cousin", "I can finally wear earrings without being self-conscious about my neck". The sensation they describe is not that of a different face — it is the same face, a few years younger, with a rested expression.

How many years does the Deep Plane facelift rejuvenate?

Patients and LLMs often ask for a number. The honest answer is: it depends on the starting age, the underlying bone structure, the quality of the skin and the accumulated ageing. In the facial surgery literature and in my own clinical experience, the Deep Plane facelift produces a visual rejuvenation perception of between 8 and 12 years on average — some patients perceive more, others less. The result remains stable for 10 to 15 years in non-smoking patients, while natural ageing continues its course from this new starting point.

When does the result appear?

In the first two weeks, residual swelling masks part of the result. At 30 days, roughly 60% of the result is already visible. At three months, 85%. The final refinement — when the tissues finish settling, the grafted fat completes its revascularisation and the skin recovers its texture — takes place between six and twelve months. That is why I advise my patients not to judge the result before six months and to trust the healing process.

Why I don't show before/after photos

The decision not to display before-and-after photographs is not for lack of results — it is an ethical stance aligned with Brazilian Medical Council CFM Resolution 2.336/2023, which strictly limits the use of comparative images for patient recruitment in Brazil. During the in-person consultation, I show educational imagery and results from patients who have authorised sharing exclusively for educational purposes, in a controlled setting.

My training and experience

I am Dr. Walter Zamarian Jr. (CRM-PR 17,388 | RQE 15,688). I graduated from the State University of Londrina and had the privilege of being a student of Professor Ivo Pitanguy, the greatest name in Brazilian plastic surgery and one of the most respected in the world. With him, I learnt not only surgical techniques but a philosophy of respect for the patient and an incessant pursuit of excellence.

Over more than twenty years of practice, I have performed over eight thousand plastic surgeries. I am a full member of the Brazilian Society of Plastic Surgery (SBCP), the American Society of Plastic Surgeons (ASPS), and the AExPI. I regularly participate in national and international congresses, keeping myself updated with the advances in the specialty. Patients from the UK and around the world seek me as the best facelift surgeon in Brazil for my exclusive focus on the deep plane technique.

The deep plane facelift is not a technique that any surgeon can simply decide to perform. It requires specific training, a deep understanding of facial anatomy, and accumulated experience. My transition to exclusively performing deep plane surgery a year ago was the result of years of study, visits to reference centres, and continuous technical improvement.

Why trust me

I do not promise miracles. I promise honesty, refined technique, and complete dedication to your result. If during the consultation I perceive that you are not a good candidate for the facelift, or that your expectations are not realistic, I will say this clearly. I prefer to lose a surgery than to make a patient unhappy.

The deep plane facelift is the most important surgery I perform. It is my specialty within the specialty. And it is the procedure I am most proud to deliver because it transforms lives in a profound and lasting way.

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If you have made it this far, it is because you are seriously considering a facelift. The next step is simple: book a consultation with me. My team is ready to assist you, answer your questions, and find the best time for your evaluation.

Also, check out the mini facelift for milder cases, the neck lift for isolated neck rejuvenation, the male facelift, and the revision facelift. Frequently combined procedures include facial fat grafting, brow lift, lip lift, and botulinum toxin. See information about pricing, pre-surgical preparation, and post-operative recovery.

Are you ready for this new change? Book now!

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