# Deep Plane Facelift in Brazil Would you like a more rested face that still looks natural? [Explore my options](https://wa.me/16402248116?text=Hi%21%20I%20came%20from%20the%20deep%20plane%20facelift%20page%20and%20would%20like%20to%20know%20if%20it%20is%20right%20for%20me.) Explore Deep plane facelift ## You feel good. So why does your face always look tired? Maybe it's heavy-looking eyes, a soft jawline or the way your neck looks in photos. You know what bothers you, but you're afraid you'll stop looking like yourself. I want to hear what you would like to change and what you want to keep. Together, we will look at the possibilities for your face. Your path: a conversation with Bruna → a consultation with me and a personalized surgical plan → scheduling and preparation → surgery → recovery and one year of follow-up. 8,000+ Surgeries 22+ Years of experience 4.9 Google rating Former student of Prof. Ivo Pitanguy 8,000+ surgeries over more than 22 years Today, by choice, regenerative deep plane facelift, with fat grafting, makes up more than 90% of my practice Member of the SBCP and International Member of the ASPS Focus on facial surgery, a natural look and individual planning I see patients in Londrina, including many from other cities and from abroad At a glance ## Regenerative deep plane facelift in Londrina: at a glance ### What is a regenerative deep plane facelift? A regenerative deep plane facelift combines repositioning of the deep facial tissues, beneath the SMAS, with fat grafting. It addresses descended cheeks and loss of jawline definition; the neck requires its own planning. In Londrina, this approach accounts for more than 90% of my surgical practice, with individualized planning. - Candidacy: anatomy, health, and expectations, not a fixed age. - Combined procedures: deep neck, blepharoplasty, and fat grafting each have their own indications. - Recovery: in my practice, patients return to social activities after about two weeks; healing continues over the following months. - Follow-up: visits throughout the first year and 24-hour WhatsApp support from my team and me. - Expectations: it involves scars and risks, with no guaranteed result. By [Dr. Walter Zamarian Jr.](https://www.walterzamarianjr.com/us/walter-zamarian/) · CRM-PR 17.388 · [RQE 15.688](https://www.walterzamarianjr.com/us/credentials/) Experience ## Before you entrust your face to me, get to know my story. My father was a plastic surgeon. As a boy, I imagined he revealed beauty by peeling a sheet of plastic off people's faces. I lost my father when I was nine. Years later, when I followed in his footsteps at the Pitanguy school, I met professors who remembered him, and I felt at home. I was one of the two residents in my class chosen to work at Professor Pitanguy's clinic. Caring for people from many countries broadened my understanding of different faces and expectations. I came back to Londrina in 2004 and brought that experience with me. I've held on to the warmth I was shown, and I try to offer it in every consultation: room to tell your story, ask questions and understand each choice. That's how I begin planning your surgery. I earned my medical degree at Universidade Estadual de Londrina (UEL). My plastic surgery training took place at the 38th Ward of Santa Casa de Misericórdia in Rio de Janeiro and at Clínica Ivo Pitanguy, where I was a resident. I am a member of AExPi (Associação dos Ex-Alunos do Professor Ivo Pitanguy, Professor Ivo Pitanguy’s alumni association) and SBCP (Brazilian Society of Plastic Surgery), and an International Member of ASPS (American Society of Plastic Surgeons). I speak five languages: Portuguese, English, Spanish, French, and Italian. I offer in-person consultations Monday through Friday, 8 a.m. to 12 p.m. and 2 p.m. to 6 p.m. Saturday consultations are online only, 8 a.m. to 1 p.m. All times are Londrina time (UTC−03:00), by appointment. [Read about my background and surgical philosophy](https://www.walterzamarianjr.com/us/walter-zamarian/). Former student of Prof. Ivo Pitanguy 8,000+ surgeries over more than 22 years Today, by choice, regenerative deep plane facelift, with fat grafting, makes up more than 90% of my practice Member of the SBCP and International Member of the ASPS Focus on facial surgery, a natural look and individual planning I see patients in Londrina, including many from other cities and from abroad CRM-PR 17.388 | RQE 15.688 [Explore my options](https://wa.me/16402248116?text=Hi%21%20I%20came%20from%20the%20deep%20plane%20facelift%20page%20and%20would%20like%20to%20know%20if%20it%20is%20right%20for%20me.) Contains AI-generated illustrative scenes. My words and the testimonials are real. The video could not be loaded. [Watch it on YouTube.](https://www.youtube.com/watch?v=K2FP6592dqA) Technique ## What changes in the deep plane? - Identify. I distinguish between tissue descent, volume loss, and changes in the skin. - Reposition. I release selected ligaments and mobilize deep tissues according to your anatomy. - Redrape. I adjust the skin to the treated structure; removing more skin does not replace support. ### What does extended deep plane mean? The term describes a more extensive release, detailed by [Jacono and Bryant (2018)](https://pubmed.ncbi.nlm.nih.gov/30268241/). It does not mean every face needs the same approach. [Roskies, Nayak, and colleagues (2024)](https://pubmed.ncbi.nlm.nih.gov/39072376/) described modifications with less separation between the skin and underlying tissues in 3,964 patients. This retrospective series reflects surgical experience; it does not prove superiority. [The anatomical review](https://pubmed.ncbi.nlm.nih.gov/41100833/) does not establish a universally better technique either. Surgical plan ## A technique only makes sense when it addresses what you are looking for. I map contour, volume, and the eye area. Every combined procedure needs a clear role in your plan. ### Deep plane facelift I reposition the deep tissues to address contour while preserving your features and expression. [Understand the deep plane facelift](#tecnica) ### Deep neck and neck contour I assess the deep structures of the neck. This can improve contour, but it requires a discussion of risks, including nerve injury, as noted in the [review of deep neck lifting](https://pubmed.ncbi.nlm.nih.gov/39652837/). [Learn about deep neck surgery](https://www.walterzamarianjr.com/us/face/neck-lift/) ### Facial fat grafting Fat from your own body replaces lost volume. Retention varies; support and volume are complementary goals, as [Marten and Elyassnia](https://pubmed.ncbi.nlm.nih.gov/25827566/) discuss. [Learn about fat grafting](https://www.walterzamarianjr.com/us/face/fat-grafting/) ### Blepharoplasty and the eyes Treats excess skin and bags, based on an assessment of the eyelids. When indicated, it's included in my facelift. [Learn about blepharoplasty](https://www.walterzamarianjr.com/us/face/blepharoplasty/) ### Facial refinements Lip lift, chin surgery, and buccal fat removal each have their own indications. They are not a mandatory package. [See the combined refinements](#procedimentos-associados) ### Fat grafting to the hands It can complement volume replacement, depending on your needs. It is not part of every plan. [Learn about fat grafting to the hands](https://www.walterzamarianjr.com/us/face/hand-fat-grafting/) Combined procedures ## Lip lift, buccal fat removal and chin implant: when they are part of a facelift They are not a mandatory package. Each one has its own indication and is added to the plan only when it contributes to what you are looking for. ### Lip lift Removes a strip of skin just below the nose to shorten a long upper lip and show more of the vermilion and the teeth. It does not add volume and leaves a scar at the base of the nose. I perform it only together with a facelift, during the same surgery. [Learn about the lip lift](https://www.walterzamarianjr.com/us/face/lip-lift/) ### Buccal fat removal Partial removal of the buccal fat pad, the deep fat of the cheek, through an incision inside the mouth. I do not perform buccal fat removal on its own: only combined with another facial surgery, when a localized excess justifies the reduction. For many people, preserving this fat is the better choice. [Learn about buccal fat removal](https://www.walterzamarianjr.com/us/face/buccal-fat-removal/) ### Chin implant A solid silicone implant, placed through an incision inside the mouth, increases the projection of a small chin when the bite is balanced. Repositioning tissues does not create this projection, so it can accompany a facelift when both needs coexist. [Learn about the chin implant](https://www.walterzamarianjr.com/us/face/chin-implant/) Who it's for ## What would you like to improve? ### A poorly defined jawline I assess how much the tissues have descended and how much the neck plays a part. ### A heavy or tired-looking face I distinguish between sagging, volume loss, and changes in the eyelids. ### Deep folds I look at both support and volume, without promising to erase every line. ### Spots and fine wrinkles These may need dermatologic care: a facelift doesn't treat everything on the surface. Stages of care ## Your care continues after surgery. You get to know the plan, the team and every step before surgery. Afterward, I follow your progress for one year. Reception Assessment Comfort Guidance I operate at Hospital do Coração Bela Suíça in Londrina under total intravenous anesthesia (TIVA). You arrive at the hospital two hours before surgery. Flávia, my surgical technologist, welcomes you, and I mark your face and the fat donor area. After about two hours in the post-anesthesia recovery unit, you return to your room. Discharge usually takes place the following morning, after my assessment. I plan incisions along the ears and the hairline; the neck may require an incision beneath the chin. There will be scars, and they mature over time. Before surgery, I explain where they will be and how to care for them. [Steps and incisions: ASPS](https://www.plasticsurgery.org/cosmetic-procedures/facelift/procedure). Decision ## To take care of you, I need to know about your life beyond your face. ### What you want to change, and what you want to keep. I want to know your priorities and the features you recognize as your own. ### What your health requires. Your medical history, medications, lab tests and an anesthesia assessment guide the decision. ### What each added procedure contributes. I explain the reason for each procedure, how to prepare and what recovery looks like. ### Who can help you at home. We arrange for someone to stay with you and help with your care during the first few days. ### How it fits your schedule. We plan around work, travel and events with your recovery in mind. ### What you still need to ask. Pain, scars, fees and fears all deserve a place in the consultation. The decision should come from what you want. Health conditions need to be under control; cigarettes, vapes and other sources of nicotine are part of the assessment because they impair healing. [Facelift candidate criteria (ASPS)](https://www.plasticsurgery.org/cosmetic-procedures/facelift/candidates). Patients ## What is it like to experience the kind of care we're talking about? Six patients describe, in their own words, how they experienced this process. As you listen, notice what each of them valued in her care and in her result. These are individual stories: results and recovery vary. The videos are in Portuguese, and the quoted excerpts have been translated. ### Margarete "The experience exceeded what I had imagined. I feel fulfilled. I'd do it all again." ### Maggie "With every year that goes by, my face gets better. The results are extremely natural." ### Linéia "My smile improved, and my face looks more defined. My self-esteem is in a really good place." ### Clair "My self-esteem went way up. Today I feel so, so much happier." ### Mirian "What fascinated me was when he talked about fat grafting." ### Edivânia "I came alone [...] When I got here, I was welcomed so warmly." After hearing these stories, look at the results and think about which questions you want to bring to your consultation. [Explore my options](https://wa.me/16402248116?text=Hi%21%20I%20came%20from%20the%20deep%20plane%20facelift%20page%20and%20would%20like%20to%20know%20if%20it%20is%20right%20for%20me.) Results in context ## Look younger. And still recognize yourself in the mirror. Now that you've heard their stories, look at the contour and expression in the images. What catches your eye? Bring that impression to your consultation: another person's result can help you ask questions, but it doesn't predict yours. A result starts with planning. Bring reference photos: I'll explain which options apply to your face, without turning someone else's photo into a promise. ### Facelift with fat grafting Photos taken at different times, with differences in pose, lighting and presentation. Before After Before After Before After Before After Before After Before After ### What the photo doesn't show Behind the image, there are lab tests, anesthesia, choices of technique and a recovery that takes time. The risks of surgery and anesthesia also need to be part of the conversation. ### What caught your eye? Tell me what you noticed. I'll connect your expectations to what may make sense for your face, without treating someone else's result as a promise. [Explore my options](https://wa.me/16402248116?text=Hi%21%20I%20came%20from%20the%20deep%20plane%20facelift%20page%20and%20would%20like%20to%20know%20if%20it%20is%20right%20for%20me.) Evidence ## Is deep plane better than SMAS? Different approaches to support | SMAS plication | Deep plane | | --- | --- | | Folds and secures the SMAS with sutures. | Mobilizes tissues beneath the SMAS, releasing ligaments. | | Extent and direction depend on the plan. | Releases vary with the face and neck. | SMAS is also the name of an anatomical structure, and several techniques involve it. [Vayalapra et al. (2025)](https://pubmed.ncbi.nlm.nih.gov/40600822/) pooled 47 studies and 10,766 patients, with few direct comparisons. [Neel et al. (2026)](https://pubmed.ncbi.nlm.nih.gov/42384060/) followed 166 patients and found no significant differences in early outcomes. A median follow-up of three months cannot answer questions about durability. I choose the approach based on anatomy and goals, not on the most heavily promoted name. ### Which approach makes sense for your face? In the consultation, I relate these differences to your anatomy and to what you want to improve. [Explore my options](https://wa.me/16402248116?text=Hi%21%20I%20came%20from%20the%20deep%20plane%20facelift%20page%20and%20would%20like%20to%20know%20if%20it%20is%20right%20for%20me.) Safety ## The hemostatic net: prevention with follow-up The net temporarily holds the skin against the treated tissues to reduce spaces where blood could collect. It does not eliminate the risk of hematoma and may leave temporary red marks. [Ribeiro et al. (2026)](https://pubmed.ncbi.nlm.nih.gov/41936137/) pooled eight studies and 1,617 patients and found a low incidence of hematoma. As a single-arm analysis, it does not prove superiority over other measures. [Azzi et al.](https://pubmed.ncbi.nlm.nih.gov/41203255/) analyzed 31 deep plane studies with 8,841 patients: hematoma in 2.7% and major hematoma in 0.97%, with no clear superiority among the net, tissue sealants, and tranexamic acid. These are estimates from the literature, not my own rates, and not figures specific to the net. Recovery ## One step at a time. - ### The first days In my practice, the net is removed at my office 48 hours after surgery. Sutures are removed at 7, 10, and 14 days. - ### Two weeks You can usually return to social activities at this stage, possibly with some swelling still present. Work and events need individual planning. - ### The first month I ask you to sleep on your back, avoid exercise for one month, and not drive for ten days. - ### One to two months After one month, you can sleep on your side and resume light activities; at two months, strenuous activities, depending on the progress I assess at your follow-up visits. - ### Up to one year I see you for follow-up visits at 7, 14, and 30 days, at 2 and 6 months, and after one year, at a minimum. Photographs at 2, 6, and 12 months document your progress. Isanna and I provide 24-hour WhatsApp support. These timelines describe my usual practice and do not replace your individual instructions. [See the full patient journey](https://www.walterzamarianjr.com/us/patient-journey/). Longevity ## How to assess the result and how long it lasts Compare photographs taken with similar lighting, distance, and position. Note when they were taken and which procedures were part of the plan. Early swelling does not represent the settled result. Aging continues; a facelift has no fixed expiration date. Skin, anatomy, and habits influence how your face changes over time. [Results: ASPS](https://www.plasticsurgery.org/cosmetic-procedures/facelift/results). Traveling patients ## Planning a facelift in Brazil from abroad ### Begin before booking your trip An initial video consultation lets us discuss your goals, history, and possible plan. It is a preliminary assessment. I examine you in person before surgery to confirm the plan, review tests, answer further questions, and take photographs. After the consultation, João explains the individual quote, tests, admission arrangements, and booking process. Confirm those details with the team before committing to flights. A surgical quote is not an all-inclusive travel package: accommodation, transport, and other travel expenses must be planned separately. ### Allow time for care in Londrina Plan to arrive two days before surgery, with the in-person visit on the preceding day. After a facelift, I ask patients visiting from abroad to allow at least 12 days locally; 14 days is preferable. This gives us time for early assessments and suture removal. These are planning requirements, not an automatic fit-to-fly date. My team can recommend accommodation, a driver, and a caregiver. Discuss the help you will need, who will accompany you, and the cost of separately hired services before you arrive. If recovery requires a longer stay, the schedule must allow for that. ### Know what happens after you return home I follow patients through the first year. Some later visits can take place online when appropriate, but video contact cannot replace every examination or emergency service. We discuss the follow-up plan before you leave Brazil. [See the full patient journey, team, and timeline.](https://www.walterzamarianjr.com/us/patient-journey/) Risks ## Risks we need to talk about They include hematoma, infection, altered sensation, asymmetry, unfavorable scarring, skin loss, changes in the hairline, and the need for revision. Nerve injuries may be temporary or permanent. Anesthesia and surgery also carry heart and lung risks and the risk of blood clots. [Risks: ASPS](https://www.plasticsurgery.org/cosmetic-procedures/facelift/safety). Increasing pain with rapid swelling means you should contact us immediately. Shortness of breath, chest pain, or a sudden change in speech or strength requires emergency care: do not wait for a WhatsApp reply. [Warning signs: Mayo Clinic](https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113). ### Understand the plan before you decide. Bring your questions about safety, preparation and recovery to a consultation with me. Bruna can help you schedule it. [Explore my options](https://wa.me/16402248116?text=Hi%21%20I%20came%20from%20the%20deep%20plane%20facelift%20page%20and%20would%20like%20to%20know%20if%20it%20is%20right%20for%20me.) Questions ## Questions and quotes How do I know if the time is right? Your concerns, your anatomy, and your health guide the assessment. There is no required age for surgery. Can I look more rested and still look like myself? I plan contour and volume while respecting your features. A natural look is the goal; I cannot guarantee that nobody will notice the surgery. Do I need every procedure? No. Each combined procedure needs its own indication. I explain what it adds and what can be left out. Can I have a facelift without fat grafting? In my practice, I reserve that option mainly for younger patients without volume loss. When volume has been lost, I prefer to combine the facelift with fat grafting. How does the quote work? Each quote is individual and is given after an evaluation. Blepharoplasty, lip lift, brow lift, buccal fat removal, and chin surgery do not increase the cost of the surgery when they are indicated together with the facelift; for chin surgery, only the cost of the solid silicone implant is added. I quote a facelift with fat grafting differently from one without, because grafting adds about two hours to the procedure in my practice; without grafting, the quote is lower. I am afraid of anesthesia. What now? Bring that concern with you. A clinical evaluation, tests, and a conversation with the anesthesiologist take place before surgery. When can I go back to work? It depends on your work and your progress. Returning to social activities at around two weeks does not automatically clear you for physical exertion. How will my pain be managed? You receive medication and individualized instructions. Increasing pain needs to be reported so it can be assessed. Who handles my follow-up visits? I follow you for one year with the help of my team, and my team and I provide 24-hour WhatsApp support. Where are the scars? Near the ears and the hairline; there may be an incision beneath the chin. Appearance and maturation vary. When will I see the result? Changes become clearer as the swelling goes down. Settling continues for months, and aging does not stop. Can I have an online consultation? Yes, for a preliminary assessment. I confirm the plan in person before surgery, and we arrange your follow-up visits. How do I choose a surgeon? Check the surgeon’s CRM and RQE, training, facial surgery experience, hospital facilities, and follow-up. Ask for explanations of limits and risks. Does a deep plane facelift replace skin care? No. Pigmentation, texture, and fine lines may need complementary treatment. Is a regenerative facelift the same procedure? In my approach, the term describes a facelift combined with fat grafting. It does not mean guaranteed regeneration or a halt to aging. Can I have a consultation without deciding on surgery? Yes. The consultation is for understanding your options and answering your questions. You do not need to arrive with your decision made. To understand costs before the consultation, read [how much a facelift costs and what goes into the quote](https://www.walterzamarianjr.com/blog/quanto-custa-um-lifting-facial/). To learn about the stages of planning and surgery, read [how a facelift is performed](https://www.walterzamarianjr.com/blog/como-e-feito-o-lifting-facial/). Contact us ## Would you like to talk about your facelift? I want to understand what you are looking for, examine your face, and answer your questions. If you would like to take that next step, contact my team to schedule your consultation with me. Address Rua Engenheiro Omar Rupp, 186 Londrina, PR CEP 86015-360, Brazil Phone [+55 (43) 99192-2221](tel:+554399192-2221) Hours Mon–Fri: 8 a.m. to 12 p.m. and 2 p.m. to 6 p.m. Instagram [@drwalterzamarianjr](https://www.instagram.com/drwalterzamarianjr) WhatsApp [Send a message](https://wa.me/16402248116?text=Hi%21%20I%20came%20from%20the%20deep%20plane%20facelift%20page%20and%20would%20like%20to%20know%20if%20it%20is%20right%20for%20me.) ★★★★★ 4.9 on Google (207 reviews) References ## References References reviewed September 29, 2026. Sources for technique, risks, and limits. The timelines and steps of my care describe my usual practice. Summaries are based on the indexed abstracts and the public guidance cited. - Schultz KP, Sherif R, Ganesh Kumar N et al. [Demystifying Deep Layer Face-Lift Techniques: A Systematic Review of Superficial Musculoaponeurotic System Techniques.](https://pubmed.ncbi.nlm.nih.gov/41100833/) Plastic and reconstructive surgery. 2026. DOI: 10.1097/prs.0000000000012526. - Vayalapra S, Guerero DN, Sandhu V et al. [Comparing the Safety and Efficacy of Superficial Musculoaponeurotic System and Deep Plane Facelift Techniques: A Systematic Review and Meta-analysis.](https://pubmed.ncbi.nlm.nih.gov/40600822/) Annals of plastic surgery. 2025. DOI: 10.1097/sap.0000000000004454. - Neel OF, Alsubhi MN, Alotaibi H et al. [Deep Plane Versus SMAS Plication Facelift: A Prospective Cohort Study of Clinical Outcomes and Complication Rates.](https://pubmed.ncbi.nlm.nih.gov/42384060/) Aesthetic plastic surgery. 2026. DOI: 10.1007/s00266-026-06115-4. - Chinta SR, Brydges HT, Laspro M et al. [Current Trends in Deep Plane Neck Lifting: A Systematic Review.](https://pubmed.ncbi.nlm.nih.gov/39652837/) Annals of plastic surgery. 2025. DOI: 10.1097/sap.0000000000004163. - Ribeiro LF, De Freitas LR, Udoma-Udofa OC et al. [Efficacy and safety of hemostatic net in facelift and rejuvenation surgeries (browlift and necklift): A systematic review and meta-analysis.](https://pubmed.ncbi.nlm.nih.gov/41936137/) Journal of plastic, reconstructive & aesthetic surgery : JPRAS. 2026. DOI: 10.1016/j.bjps.2026.03.029. - Azzi JL, Hadian A, Zabihi-Pour D et al. [Prevention of Hematoma in Patients Undergoing Facelift (Rhytidectomy): A Systematic Review and Meta-Analysis.](https://pubmed.ncbi.nlm.nih.gov/41203255/) Facial plastic surgery & aesthetic medicine. 2026. DOI: 10.1177/26893614251393166. - Roskies M, Bray D, Gordon NA, Gualdi A, Nayak LM, Talei B. [Limited Delamination Modifications to the Extended Deep Plane Rhytidectomy: An Anatomical Basis for Improved Outcomes.](https://pubmed.ncbi.nlm.nih.gov/39072376/) Facial plastic surgery & aesthetic medicine. 2024;26(6). DOI: 10.1089/fpsam.2024.0018. - Jacono A, Bryant LM. [Extended Deep Plane Facelift: Incorporating Facial Retaining Ligament Release and Composite Flap Shifts to Maximize Midface, Jawline and Neck Rejuvenation.](https://pubmed.ncbi.nlm.nih.gov/30268241/) Clinics in plastic surgery. 2018;45(4). DOI: 10.1016/j.cps.2018.06.007. - Marten TJ, Elyassnia D. [Fat grafting in facial rejuvenation.](https://pubmed.ncbi.nlm.nih.gov/25827566/) Clinics in Plastic Surgery. 2015;42(2):219–252. DOI: 10.1016/j.cps.2014.12.003. - American Society of Plastic Surgeons. [Facelift: candidacy, preparation, technique, risks, and recovery](https://www.plasticsurgery.org/cosmetic-procedures/facelift). Patient education material. Accessed September 22, 2026. - Mayo Clinic. [Face-lift: risks, preparation, and recovery](https://www.mayoclinic.org/tests-procedures/face-lift/about/pac-20394059); [Stroke: symptoms and causes](https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113) (warning signs). Accessed September 22, 2026.