Regenerative Deep Plane: Deep Plane facelift with fat grafting and stem cells
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 Londrina, Paraná, with a 4.9/5 Google rating (153 reviews). CRM-PR 17,388 | RQE 15,688.
The deep plane facelift is the most advanced facial rejuvenation technique available today. Unlike traditional facelifts that merely pull the skin and place superficial SMAS stitches, 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 Londrina, a deep plane facelift meeting the same standards as the finest international facial rejuvenation centers. As a member of SBCP and ASPS, I remain permanently updated with specialty advances.
If you have researched facelifts, you have probably come across dozens of different techniques: SMAS, MACS, minilift, endoscopic lift. With so many options, it is natural to feel confused. Let me simplify: after two decades as a facelift specialist in Brazil, studying the most advanced techniques in the world -- including training in the United States -- I made a definitive decision. I now exclusively perform the deep plane facelift on all my patients at my clinic in Londrina, Brazil. The reason is simple: no other technique delivers such natural and long-lasting results. International patients seeking a facelift in Brazil will find here the same level of expertise available at the best centers worldwide.
The deep plane is not just an evolution of the traditional facelift. It is a completely different philosophy of how to treat facial aging. 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 scares those considering cosmetic surgery in Brazil. Whether you are wondering "how much does a facelift cost in Brazil" or researching the best facelift surgeon in Brazil, I invite you to continue reading and discover why patients from around the world travel to Londrina for this procedure.
Why I chose to only perform deep plane
After more than eight thousand surgeries over twenty years as a plastic surgeon in Londrina, Brazil, 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 centers around the world. My training at the Ivo Pitanguy Institute and subsequent Deep Plane training in the USA shaped my commitment to offering only the most advanced facial rejuvenation technique.
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 lifted as a single unit, in a vertical vector that mimics the natural direction of youth.
Compare this to traditional techniques that only pull the skin laterally and give a few stitches to the SMAS. It is like trying to raise a tent by only pulling the outer fabric, versus lifting the entire support structure. The visual result is incomparable.
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The fat graft: real cellular rejuvenation
I always perform the deep plane facelift combined with fat grafting, an association I call regenerative deep plane. While the deep plane repositions tissues that have descended with aging, the grafted fat promotes real cellular rejuvenation. The nanofat I use contains millions of adipose-derived stem cells, known as ADSCs, which stimulate collagen production and regenerate skin from the inside out. I prepare three different types of fat for specific functions: millifat to restore deep volume, microfat to smooth furrows, and pure nanofat for skin regeneration. This facial rejuvenation protocol that I developed over more than eight thousand surgeries does not exist in conventional aesthetic treatments. At my clinic in Londrina, every deep plane facelift includes this three-dimensional grafting, because I believe treating only sagging without restoring volume and skin quality delivers an incomplete result.
If the deep plane repositions the structures that have descended over time, the fat graft does something even more extraordinary: it reverses the aging of the skin itself. I'm not exaggerating. The fat I remove from your body and graft into your face contains millions of stem cells derived from adipose tissue, known in the medical literature as ADSCs.
These stem cells secrete growth factors that stimulate collagen production, improve microcirculation, and regenerate the skin from the inside out. Scientific studies demonstrate an increase of up to thirty percent in collagen production and a reduction of up to forty percent in fine wrinkles after fat grafting. It's as if you stopped aging and started rejuvenating.
The three types of fat I use
I prepare the fat in three different ways, each with a specific function:
- Miligraft (particles of two to three millimeters): I use it to restore volume in areas that have lost deep fat, such as the cheekbones and the temporal region.
- Micrograft (particles of half to one millimeter): ideal for filling more superficial grooves, such as the nasolabial fold and marionette lines.
- Nanograft (emulsion rich in stem cells): I apply it to the entire facial skin to improve its quality, texture, and luminosity. It's pure regeneration.
The collection is done through a small liposuction, usually from the inner thighs or lower abdomen. The fat is washed, centrifuged, and carefully separated. This process adds about an hour to the surgery, but the results justify every minute.
Why fat is superior to fillers
Unlike hyaluronic acid, which the body absorbs in twelve to eighteen months, the grafted fat that survives the initial process remains permanently. Furthermore, while fillers only occupy space, fat brings with it living cells that continue to work in your favor for years. It's the difference between masking a problem and truly solving it.
The deep treatment of the neck
Many patients come to my office focused only on their face, but I immediately notice that their neck needs special attention. A facelift without proper neck treatment is like renovating the facade of a house and leaving the garden abandoned. The disharmony is glaring.
In the deep plane, the dissection naturally extends to the neck, releasing the cervical ligament and allowing me to treat 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 aging. 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 problem
The submandibular salivary gland can become prominent with age, creating a bulge in the lateral neck region. In cases where this affects the aesthetic result, I only remove 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 just a good one.
The Auersvald hemostatic net: no drains, no bruises
One of my patients' biggest concerns is the postoperative period. Drains, prolonged swelling, risk of bruising. I completely understand. That's why I incorporated into my technique the hemostatic net developed by plastic surgeons André and Luiz Auersvald from Curitiba.
The technique consists of transfixing stitches with nylon thread that pass through the skin and the SMAS-platysma, creating a net that eliminates the dead space where blood and fluids could accumulate. The result is three extraordinary benefits:
- Eliminates the need for drains: you won't go home with tubes coming out of your face.
- Drastically reduces the risk of bruising: the main complication of the facelift becomes a rarity.
- Improves the contour of the neck: the net keeps the tissues in the ideal position during healing.
I remove the net in forty-eight hours, in the office, simply and painlessly. It leaves no marks. It's one of those innovations that, once you know it, you can't imagine doing it any other way.
Why this matters to you
Bruising is the most common complication of facelift surgery, occurring in up to five percent of cases in the medical literature. Besides the discomfort, it can compromise the aesthetic result and significantly prolong recovery. With the hemostatic net, this concern practically disappears from the equation.
Deep Plane vs SMAS Facelift: Technique Comparison
Patients often ask about the differences between facelift techniques. This table summarizes the key points I discuss during consultations at my clinic in Londrina:
| Criteria | Deep Plane (Dr. Zamarian) | Traditional SMAS | Mini Facelift / MACS |
|---|---|---|---|
| Dissection plane | Sub-SMAS deep, releases 4 retaining ligaments | Superficial to SMAS or plication | Limited to mid-face |
| Vector of lift | Vertical (natural direction of youth) | Lateral (may look pulled) | Oblique |
| Longevity | 10–15 years | 5–10 years | 3–5 years |
| Neck treatment | Comprehensive (platysmaplasty + subplatysmal fat) | Partial | Does not treat neck |
| Natural appearance | Highly natural result | Risk of pulled look | Natural but limited |
| Fat grafting | Yes (nano, micro and millifat with ADSCs) | Optional | Rarely combined |
| Drains | No drains (Auersvald haemostatic mesh) | Usually with drains | No drains |
| Social recovery | 2 weeks | 2–3 weeks | 1–2 weeks |
| Satisfaction rate | >95% | ~85% | ~80% |
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.
Your fears are legitimate. Let me address them.
Over two decades, I've 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 solves this problem. 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, revitalized. They don't look operated on.
Fear of general anesthesia
Any surgery under general anesthesia deserves respect. But modern anesthesiology is extraordinarily safe. I work with experienced anesthetists who monitor every vital parameter throughout the procedure. The preoperative cardiological evaluation identifies any risk before we enter the operating room. In over twenty years, I've never had a significant anesthetic complication.
Fear of swelling and recovery
There will be swelling, I won't lie. The first three days are the most intense. But the hemostatic net significantly reduces both swelling and bruising. Most of my patients are presentable for social commitments in two weeks. The result improves progressively over months as the tissues settle into their new position.
Fear of scars
The incisions are strategically positioned: 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.
The real investment: facelift versus aesthetic treatments
I need to be frank about something that few professionals have the courage to say: if you have real facial sagging, non-surgical procedures will not solve your problem. They may alleviate, disguise, postpone. But they do not resolve.
Do the math with me. A person trying to maintain a youthful appearance with aesthetic treatments spends, on average, per year:
- Botulinum toxin (Botox): $350 to $700 (three sessions)
- Fillers with hyaluronic acid: $525 to $1,400
- Collagen biostimulators (Sculptra, Radiesse): $875 to $1,750
- Ultraformer or HIFU: $1,050 to $2,275 (two sessions)
- PDO lifting threads: $525 to $1,400
- Facial lasers (Fotona and similar): $1,050 to $2,800
Adding it all up, we're talking about $4,375 to $10,500 per year on procedures that need to be repeated indefinitely. In ten years, the investment easily exceeds $43,750 to $87,500. And even so, the sagging remains there, hidden under layers of filler, masked by technologies that try to stimulate collagen that cannot overcome gravity.
The deep plane facelift costs a fraction of that
A deep plane facelift with fat grafting represents a one-time investment that lasts from ten to fifteen years. When you divide the amount by the duration, you realize that the annual cost is much lower than spending on palliative procedures. And the result? Incomparably superior.
This doesn't mean you will never need anything again. Botulinum toxin, for example, is an excellent complement in the postoperative period to soften expression wrinkles on the forehead and around the eyes, areas that the facelift does not directly treat. But the structural foundation of your face will be resolved for over a decade.
Procedures I Combine with Deep Plane Lifting
The lifting addresses the middle and lower thirds of the face, as well as the neck. Other areas can benefit from complementary procedures that I perform at the same surgical time:
Blepharoplasty: Rejuvenation of the Eyes
The eyelids account for about sixty percent of the impression of facial rejuvenation. Excess skin on the upper eyelids, fat bags on the lower eyelids, and deep dark circles can be corrected during the same surgery. The combination of lifting with blepharoplasty delivers a complete result that transforms the appearance.
Brow Lift
Drooping eyebrows, especially on the lateral side, can give us an air of sadness and fatigue. A brow lift is excellent for giving a "lift" to the eyes and is a great complement to deep plane lifting.
Buccal Fat Removal: Contour Definition
The removal of the buccal fat pads can further enhance the definition of facial contours in selected patients, especially those with a naturally round 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 utilizes the miracle of stem cells and promotes deep and lasting rejuvenation, perfectly complementing facial plastic surgery.
Botulinum Toxin in the Post-Operative 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 harmoniously. The expression lines that the lifting 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 aging gracefully. In my clinic, we have a team of dermatologists who can administer Botox for you.
The Consultation: Where Everything Begins
The consultation is the most important moment of the entire process. I dedicate time to understand not only your anatomy but also your desires, expectations, and concerns. I examine each structure of your face and neck, identify the specific signs of aging you present, and explain exactly what I can improve.
What I Evaluate During the Consultation
- Skin Quality and Elasticity: very thin or sun-damaged skin requires specific care.
- Degree of Sagging: determines the extent of the necessary treatment.
- Bone Structure: jaw, cheekbone, and chin directly influence the result.
- Position of the Hyoid Bone: essential for planning neck treatment.
- Amount and Distribution of Facial Fat: some areas need volume, others need removal.
- Asymmetries: every face has natural asymmetries that need to be considered.
- Neck Musculature: platysmal bands, digastric muscles, submandibular glands.
Pre-Operative Exams
I request the following exams before surgery:
- Complete Blood Count
- PAT with INR + APTT
- Creatinine and Urea
- Fasting Blood Sugar
- Total Proteins and Fractions
- Urinalysis
- Electrocardiogram
- Cardiological Evaluation with Surgical Risk
Medications to Be Discontinued
Fifteen days before and fifteen days after surgery, you should discontinue:
- Acetylsalicylic Acid (Aspirin, AAS, Bufferin)
- Non-Steroidal Anti-Inflammatory Drugs
- High-Dose Vitamin E
- Ginkgo Biloba and Other Herbal Remedies
- High-Dose Omega 3
- Arnica
Smoking should be stopped for the same period. Nicotine compromises blood circulation in the skin and significantly increases the risk of complications.
The Surgery Step by Step
The surgery lasts between five and six hours, depending on the associated procedures. It is performed under general anesthesia in a properly equipped surgical center.
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 anesthetic, centrifuged to separate the oil and concentrate 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 favors the performance of blepharoplasty 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 folds, marionette lines, and jawline. The nanofat is distributed superficially across the entire face to stimulate skin regeneration.
Treatment of the Neck
Through the submental incision, I access the deep structures of the neck. I remove subplatysmal fat, treat the digastric muscles when necessary, and bring the platysma bands closer together at 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 mobilize 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 Hemostatic Mesh
The skin is redraped over the new structure without excessive tension. I only remove the excess, without pulling. I suture with fine threads in multiple layers. Finally, I apply the Auersvald hemostatic mesh, which will be removed in forty-eight hours.
Post-Operative: What to Expect
Recovery from the deep plane facelift is smoother than most patients imagine. I use the Auersvald hemostatic mesh, which eliminates the need for drains and drastically reduces the risk of hematomas. Within forty-eight hours, I remove the mesh at the office simply and painlessly. In the first week swelling peaks and begins to subside, and most patients are presentable for social activities within two weeks. The definitive facial rejuvenation result emerges between six months and one year, lasting ten to fifteen years. In my experience with over eight thousand surgeries across more than twenty years of practice, the satisfaction rate with the deep plane facelift exceeds ninety-five percent. I see patients from all over Brazil and abroad at my clinic in Londrina, where I offer complete facilities and postoperative follow-up personally conducted by me.
The recovery from deep plane lifting is more peaceful than most people imagine. Some important points:
First 48 Hours
You will remain with a compressive dressing and the hemostatic mesh. There will be swelling and some discomfort, controlled with medication. Keep your head elevated and apply cold compresses as directed.
Removal of the Mesh and First Follow-Up
In forty-eight hours, you return to the office. I remove the hemostatic mesh simply and painlessly, change the dressing, and assess the initial progress. Most patients are surprised by their appearance at this moment.
First Week
The swelling peaks around the second to third day and begins to decrease. Some patients may have bruises (purple spots) that can extend to the neck and chest due to gravity. This is normal and resolves spontaneously in ten to fourteen days.
Second Week
Most stitches are removed or have already been absorbed. You will be presentable for social activities, although still with some residual swelling. Makeup can be used with care.
First Month
Gradual return to normal activities. Avoid intense exercise, direct sun exposure, and any trauma to the face. Sleep on your back. Soft foods in the first few days, gradually progressing.
Two to Six Months
The result continues to refine. The residual swelling continues to subside, the tissues settle, and the scars mature. This is the period when the final result emerges.
Final Result
Between six months and a year, you will see the complete result. And this result will last from ten to fifteen years, aging naturally with you, but always looking younger than if you had not had the surgery.
My Education and Experience
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 learned 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) and the American Society of Plastic Surgeons (ASPS). I regularly participate in national and international congresses, keeping myself updated with the advances in the specialty.
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 centers, 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 lifting, 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.
Frequently Asked Questions
What is the ideal age for a facelift?
There is no fixed ideal age. What determines the indication is the degree of facial aging, not the number on the ID. I have patients who are forty-five years old with a clear indication and patients who are sixty-five with little sagging. An individual consultation is the only way for this assessment.
Does the result look natural?
The deep plane is precisely the technique that produces the most natural results. By working in the deeper layers and using a vertical traction vector, it completely avoids that stretched appearance of older techniques. You will look like yourself, just younger and more rested.
How long does the result last?
Between ten and fifteen years. You will continue to age, naturally, but you will always look younger than you would have if you hadn't had the surgery. Some patients opt for a second facelift after this period.
Can I have a facelift if I have had aesthetic procedures before?
In most cases, yes. Previous fillers do not prevent a facelift. In fact, the deep plane is especially indicated for patients who have tried everything and realized that non-surgical procedures do not resolve real sagging.
What are the risks?
Like any surgery, there are risks: hematoma (greatly reduced with the hemostatic network), infection (rare with adequate antibiotic prophylaxis), nerve injury (minimized by meticulous technique), unsightly scars (rare with proper closure). I discuss all risks in detail during the consultation.
When can I return to work?
It depends on your activity. For remote work or light activities, one week to ten days. For activities that require public presentation, two to three weeks. For intense physical effort, one month.
Does the facelift leave visible scars?
The scars are strategically positioned in hidden areas: within the hair, in the natural folds of the ear, behind the ear. When healed, they are practically imperceptible.
How long does the deep plane facelift surgery take?
The surgery lasts between five and six hours, depending on associated procedures such as blepharoplasty, fat grafting, and neck treatment. It is performed under general anesthesia in a properly equipped surgical center, with a dedicated anesthesia team monitoring every vital parameter.
How do I know if I am a candidate for the deep plane facelift?
The indication depends on the degree of facial sagging, skin quality, bone structure, and patient expectations. The deep plane is especially indicated for those with moderate to severe sagging in the middle and lower third of the face and neck. The in-person consultation is the only way for this assessment, where I examine each structure of your face and explain exactly what I can improve.
What is the difference between deep plane facelift and traditional SMAS?
The traditional SMAS facelift works at a more superficial level and pulls laterally. The deep plane releases the four facial retention ligaments (zygomatic, masseteric, mandibular, and cervical) and elevates the entire structure vertically, producing a more natural and long-lasting result: 10-15 years versus 5-10 years for SMAS.
What is the Auersvald hemostatic network?
It is a Brazilian technique developed by Drs. André and Luiz Auersvald that consists of transfixing stitches with nylon thread creating a network that eliminates dead space. The benefits are: elimination of drains, drastic reduction of hematoma risk, and better neck contour. The network is removed in 48 hours in the office.
Is fat grafting mandatory in the facelift?
It is not mandatory, but highly recommended. Fat contains adipose stem cells (ADSCs) that promote skin regeneration, stimulate collagen, and improve skin quality. Additionally, it replenishes volume lost with aging. The combination of facelift with fat grafting offers the most complete result.
Can fat grafting make the face swollen or artificial?
No, when performed with the proper technique. I use fat in three different sizes — millifat for deep volume, microfat for grooves, and nanofat for skin regeneration — applying conservative and precise amounts in each area. The goal is to restore the volume lost with aging, not to create volume that never existed. The result is natural and harmonious.
Schedule Your Deep Plane Facelift in Brazil via WhatsApp
If you have made it this far, it is because you are seriously considering a facelift in Brazil. The next step is simple: schedule a consultation with me. My team is ready to assist you, answer your questions, and find the best time for your evaluation. International patients considering medical tourism in Brazil for plastic surgery will receive complete assistance with travel planning and accommodation in Londrina.
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, blepharoplasty, rhinoplasty, brow lift, lip lift, and botulinum toxin. See information about investment, pre-surgical preparation, and post-operative recovery.
Are you ready for this new change? Schedule now!
Dr. Walter Zamarian Jr.
Plastic Surgeon in Londrina - Brazil
Rua Engenheiro Omar Rupp, 186
Londrina - Brazil
ZIP 86015-360
Brazil
YouTube Channel: Dr. Walter Zamarian Jr.
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