Is a Deep Plane Facelift Worth It? When I Recommend Against One
By Dr. Rushapol Sdawat, MD — Thai Board-certified Plastic and Reconstructive Surgeon, Medical Licence No. 17689
Last reviewed: Aug 28, 2026
You have done the maths already. You know roughly what it costs, you have worked out how many days of leave you would need, and you have probably had the conversation with your partner where you both agreed it was a lot of money and then neither of you said no. What you want to know is whether it is worth it — and you have noticed that every page you have read so far says yes.
That should worry you. I perform deep plane facelifts and I charge money for them, and the honest answer to "is it worth it" is: for some people, clearly; for a significant minority of those who ask me, no, and I tell them so.
This article is a list of the patients I decline. I publish it because it is the most useful thing I can give you before a consultation — you can read it and work out, before you spend anything, whether you are on it.
Who I decline to operate on
In rough order of how often it comes up:
Anyone smoking or vaping who is unwilling or unable to stop for a defined period before and after surgery.
Anyone whose blood pressure is uncontrolled, or who cannot safely stop anticoagulants and antiplatelet medication.
Patients whose face has deflated rather than descended, and who need volume, not tension.
Patients whose complaint is skin texture, pigmentation or fine lines rather than laxity.
Patients in their thirties and early forties with minimal descent who want a facelift because they have been told to have one early.
Patients whose expectations cannot be met by any operation I can perform.
Patients who cannot give the recovery the time it needs, including those whose travel plans do not allow them to stay near the hospital through the first 48 hours.
Patients with an untreated eating disorder, active body dysmorphic disorder, or unstable major psychiatric illness.
Patients with significant uncontrolled systemic disease, where anaesthetic risk outweighs a cosmetic benefit.
Some of those are absolute. Most mean "not now" rather than "not ever". I will go through the ones that generate the most argument.
Smoking: the refusal I do not negotiate
A facelift lifts a flap of skin off its bed and relies on the remaining circulation to keep the edges alive while they heal. Nicotine constricts exactly those vessels.
The numbers are not marginal. Sinclair and colleagues report that active smokers are approximately 12.5 times more likely than non-smokers to develop skin slough (Aesthetic Surgery Journal Open Forum 2021;3(1):ojab007), with histological evidence of increased vascular occlusive disease in the dermis. Smoking is also a recognised risk factor for post-operative haematoma.
Skin necrosis in front of or behind the ear is not a temporary setback. It is a wound that takes weeks to close by secondary intention, often leaves a scar requiring revision, and for a patient who has flown to another country means an extended stay or wound care managed at a distance.
I ask patients to stop completely — cigarettes, vaping, nicotine replacement — for a defined interval before and after surgery, which I set at consultation. Cutting down is not a plan I can operate around.
Blood pressure, blood thinners, and the haematoma window
Haematoma is the most common serious complication of facelift surgery. In an analysis of 11,300 facelifts by Gupta and colleagues (Aesthetic Surgery Journal 2016;36(1):1–13), the overall major complication rate was 1.8%, with haematoma the most frequent at 1.1% and male sex an independent predictor at a relative risk of 3.9. The most controllable driver is blood pressure: Sinclair and colleagues report a systolic pressure above 150 mmHg carrying a relative risk of 3.6, with male sex at 2.8, aspirin or NSAID use at 2.0 and smoking at 2.0.
So I will not operate on a patient whose hypertension is unmanaged. Not because the surgery cannot be done, but because a patient who arrives in Bangkok with a systolic of 165, has an operation, then has a coughing fit or an argument on the phone in the first twelve hours has a genuinely elevated chance of returning to theatre that night. If you are on antihypertensive medication, I want it optimised by your own GP before you book flights — not adjusted by me in a hotel room.
The same applies to anticoagulants, antiplatelet agents, fish oil, high-dose vitamin E and several herbal supplements. If your cardiologist says you cannot stop your medication, then you cannot have elective cosmetic surgery, and that is the correct outcome.
Deflation and skin failure: two problems a lift cannot solve
This is the group I most often disappoint, because they have come a long way and are not obviously unsuitable.
A facelift repositions tissue; it does not create tissue. If your mid-face has lost volume — the cheek flattened, the area under the eye hollowed, the temples scooped in — then lifting what remains will make an empty face look tauter and emptier. It is a recognisable result and it looks operated-on. What that face needs is volume: fat grafting, or in some cases a skeletal solution.
Separately, some patients dislike what surgery cannot touch. Crepey texture, fine lines around the mouth, sun damage and pigmentation are problems of the dermis. A facelift moves the dermis; it does not improve it. Resurfacing, disciplined sun protection and long-term medical skincare will get you closer to the photograph of yourself at 40 than my scalpel will.
The test I apply with patients is simple. Lie back on the couch. If most of what you dislike improves when gravity is removed, you have a descent problem and a lift will help. If it barely changes, you have a volume or a skin problem, and a lift is the wrong operation.
Patients who are too young for the operation they are asking for
I decline a small number of patients each year on age — usually people in their thirties persuaded that having a facelift early is somehow preventive.
There is no evidence that operating on a face before it has descended prevents it from descending. Ageing is driven by bone resorption, fat compartment change and dermal ageing, none of which are altered by releasing a retaining ligament. What an early facelift reliably produces is a permanent scar, a first operation that will need revising sooner, and an altered surgical plane that makes every subsequent operation harder.
Expectations that cannot be met with a scalpel
Some patients want a result I cannot deliver. Some want a result nobody can deliver.
I am careful with the patient who brings a photograph of a celebrity, or of themselves fifteen years ago, and wants that face; who has had several procedures elsewhere and been dissatisfied with all of them; who cannot name what they dislike but is certain something is wrong; or for whom the operation is carrying the weight of something else — a marriage, a job, a bereavement.
The complication nobody lists is the one where the surgery is technically excellent and the patient is unhappy anyway. It is more common than nerve injury and no operation fixes it. When I think that is the likely outcome, I say so and I decline.
Patients who cannot give the recovery its time
This is the one that trips up overseas patients specifically.
Around 90% of facelift haematomas occur within the first 24 hours after surgery. That is the clinical reason I will not operate on a patient whose itinerary has them in a hotel across the city on night one, flying to an island on day three, or catching a flight home at the end of the first week. ASAPS advises patients in Australia and New Zealand not to fly for six to eight weeks after surgery — more conservative than most overseas practice, and it exists because flying adds immobility, dehydration and pressure changes to a healing period.
If you can realistically take only ten days away from work, a deep plane facelift is not the operation for that ten days. Say so at the consultation and we will discuss a different timeline.
The case for a simpler SMAS operation in the right face
Here is the part that costs me money. For a substantial group of patients — early to moderate jowling, good skin, a genuinely uncomplicated neck, no strong mid-face descent — a SMAS technique is the better decision. Not the compromise. The better decision.
The best available synthesis, a 2025 systematic review and meta-analysis by Khoury, Almubarak, Khan, Boldt, Villemure-Poliquin and Nichols in Aesthetic Plastic Surgery (2025;49:5895–5903, doi:10.1007/s00266-025-05118-x) pooling 21 studies and 2,896 patients, concluded that deep plane and SMAS facelifts "both provide robust and long-term outcomes with high patient satisfaction" and could not declare either superior on longevity. It also found a pooled complication rate of 17.2% for deep plane against 10.3% for SMAS (95% CI 6.20–14.4).
Deep planeSMAS techniquePooled complication rate (Khoury et al. 2025)17.2%10.3% (95% CI 6.20–14.4)Pooled patient satisfaction94.4% (95% CI 84.8–99.7)87.8% (95% CI 84.3–91.3)Longevity advantageNot establishedNot establishedRetaining ligaments releasedZygomatic and masseteric cutaneous, under visionNone to minimalProximity of dissection to facial nerve branchesCloser, sustainedMore limitedBest suited toGenuine ligamentous descent, heavy mid-face and jowlEarly to moderate jowling, good skin, uncomplicated neckSkin necrosis riskLower (under 1%)Higher with subcutaneous technique (around 3.6%)
Neither column wins outright. The deep plane operation buys a more complete release and a more vertical repositioning, at the cost of a longer operation, a dissection closer to the facial nerve, and a higher pooled rate of complications. If your anatomy does not need that release, you are buying the risk without the benefit.
Our published prices are organised by how much of the face and neck is treated rather than by plane — Mid/Lower Face Lift A$7,000 / ฿159,000, Mid/Lower Face and Neck Lift A$7,400 / ฿170,000, Lower Face and Neck Lift with neck muscle tightening A$9,200 / ฿210,000, adding under-chin correction A$11,400 / ฿260,000, adding VASER A$14,400 / ฿330,000, Endoscopic Forehead Lift A$7,400 / ฿170,000. All indicative in Australian dollars and confirmed at booking.
The financial picture does not end there. Medicare does not cover overseas medical treatment and Australia has no reciprocal health agreement with Thailand. Australian private health insurance generally does not cover procedures performed overseas and may not cover follow-up at home. Standard travel insurance generally excludes medical tourism, and Smartraveller warns that medical evacuation can cost hundreds of thousands of dollars. ASAPS estimates revision is needed in up to 7% of overseas cosmetic surgery cases — an upper bound, not a point estimate, but budget as though it might apply to you. And in October 2025 the ATO and Ahpra jointly warned that some practitioners are "inappropriately supporting individuals to access their superannuation on compassionate grounds, particularly for cosmetic procedures that aren't aligned to compassionate release requirements." If someone has suggested you fund this from your super, take independent advice.
What saying all this costs me
I lose bookings over this page and over the consultations that follow its logic. A patient who has flown to Bangkok, taken leave, and been told the operation they researched for eight months is the wrong one for their face does not usually book something else that afternoon. Some are relieved, some are angry, and a number have the operation elsewhere, which is their right.
I publish it anyway, because the Australasian Society of Aesthetic Plastic Surgeons was correct in August 2026 when it criticised the industry's "heavily curated patient stories, before-and-after content and positive recovery experiences" that "can create an impression of safety that may not show complications, recovery difficulties or longer-term outcomes." The only way I know to be a credible alternative is to publish the refusals as prominently as the offers.
When to seek care
If you go ahead — with me or anyone — these are the thresholds.
Emergency, present to an emergency department immediately, wherever you are: rapidly increasing swelling of one side of the face or neck, particularly in the first 24 to 48 hours; escalating pain with tightness or pressure; any difficulty breathing or swallowing; a colour change in skin over a swollen area. This is how an expanding haematoma presents and it requires urgent surgical evacuation.
Same-day review: fever above 38°C; redness spreading from an incision; discharge, particularly if it smells; new inability to raise one eyebrow, close an eye fully, or move a corner of the mouth; darkening, blistering or a dusky, cold appearance of skin in front of or behind the ear, which can be early flap compromise and is the presentation smoking makes far more likely; calf pain or swelling, chest pain or breathlessness at any time in the first six weeks, which needs assessment for venous thromboembolism.
Routine review: numbness of the cheek and earlobe, tingling as nerves regenerate, firm ridges under the incisions, asymmetric swelling, itching. Expected, and slow.
And one more: if weeks after surgery you are checking your face many times a day, unable to stop, distressed by something other people cannot see — that is a symptom too, and worth telling someone about. It is more common after cosmetic surgery than the brochures admit.
So when is a deep plane facelift worth it?
When the thing you dislike is genuinely descended tissue, tethered by ligaments that need releasing; when your skin has enough quality to re-drape well; when your medical risk is controlled; when your expectations are of an improved version of your own face rather than a different one; and when you can give the recovery six to eight weeks of your life rather than ten days.
For that patient, in my experience and in the pooled satisfaction data, it is one of the most rewarding operations in plastic surgery. For everyone else on the list at the top of this page, it is an expensive way to acquire a scar.
I am a Thai Board-certified plastic and reconstructive surgeon at Intrarat Hospital in Bangkok, Medical Licence No. 17689, board-certified in plastic surgery by the Medical Council of Thailand since 2000 and an ISAPS member since 2008. Intrarat Hospital is ISO 9001:2015 certified. None of that removes surgical risk from any operation described here, and I would be suspicious of anyone implying that credentials could.
I am a Thai Board-certified plastic and reconstructive surgeon practising at Intrarat Hospital, Bangkok — Medical Licence No. 17689, verifiable on the Medical Council of Thailand register at checkmd.tmc.or.th. Diploma of the Medical Council of Thailand certifying proficiency in Plastic Surgery (13 July 2000); full member of The Society of Plastic and Reconstructive Surgeons of Thailand since 2001; ISAPS member since 2008. International training includes the AO Foundation course in advances in rhinoplasty and facial osteotomy, the International Plastic Surgery Training Center (malarplasty and angle reduction) and the safe use of laser-assisted lipolysis at Goldman Butterwick & Associates, San Diego. I hold Thai specialist certification and am not registered with Ahpra or the Medical Council of New Zealand.
This article is provided for general information and education. It is not medical advice and cannot substitute for individual assessment by a qualified practitioner who knows your history. Surgery carries risk, including risk of serious complications and of outcomes that do not meet expectations. Results vary between patients.
