Understanding Facial Aging: Dr. Andrew Jacono’s Three-Dimensional Approach
Most people think faces age on the surface. Wrinkles deepen, skin sags, and the solution seems obvious: pull everything tighter. Dr. Andrew Jacono sees facial aging differently. The Manhattan-based facial plastic surgeon views aging as a three-dimensional problem where tissue descends, volume deflates, and structural support weakens beneath the surface. His extended deep-plane facelift technique addresses all three dimensions simultaneously.
The difference shows in results that last 12 to 15 years—roughly twice as long as traditional facelifts. Key factors that affect the longevity of the extended deep-plane facelift include technique, lifestyle, skin quality, and care. Dr. Andrew Jacono performs approximately 250 deep-plane facelifts annually at his Manhattan practice.
Why Traditional Facelifts Fall Short
Traditional facelift techniques separate skin from muscle, then pull the skin upward and backward to smooth wrinkles. The approach creates tension on the surface without addressing what happens underneath. Dr. Andrew Jacono explains that aging occurs when facial fat pads descend, ligaments weaken, and the superficial musculoaponeurotic system (SMAS) loses support.
Pulling skin tighter treats the symptom, not the cause. Patients might look smoother initially, but the underlying structure continues to age. Results typically last five to seven years before sagging returns. The “tight” or “done” appearance that defined older facelift techniques stems from this surface-level approach.
Dr. Andrew Jacono’s extended deep-plane facelift takes a different path. He lifts the skin, muscle, and fat together as one cohesive unit, preserving the natural connections between tissue layers. Town & Country described how “Jacono keeps the skin, muscle, and fat as one unit” to achieve results that look refreshed rather than reconstructed.
Operating Beneath the SMAS Layer
The innovation lies in where Dr. Andrew Jacono operates. He works beneath the SMAS—a layer of tissue that connects facial muscles to skin. Traditional lifts tighten this layer from above. The extended deep-plane approach releases key facial ligaments that hold tissue down, allowing Dr. Andrew Jacono to reposition the midface, jawline, and neck fat pads vertically to their youthful positions.
Dr. Andrew Jacono first published his Minimal Access Deep-Plane Extended (MADE) facelift technique in Aesthetic Surgery Journal in 2011, detailing results from 153 patients. The data showed a 3.9% revision rate, approximately 1.9% hematoma rate, and 1.3% temporary facial nerve injury. These complication rates fell well below industry averages for facelift procedures.
Studies show the deep-plane approach carries lower risk of facial nerve injury compared to superficial facelifts. When surgeons preserve anatomical relationships and blood supply by keeping tissue layers together, they protect delicate nerves that control facial expression.
Volume Restoration Without Fillers
The three-dimensional approach addresses volume loss directly. Rather than adding fillers to deflated areas, Dr. Andrew Jacono repositions the facial fat pads that descended with age. The malar fat pads in the midface, for example, sit higher on younger faces. Gravity pulls them downward over decades, creating hollows under the eyes and jowls along the jawline.
Dr. Andrew Jacono’s technique lifts these fat pads back to their original positions. A 2015 study he published in Aesthetic Surgery Journal analyzed long-term midface volume change after vertical vector deep-plane rhytidectomy. The three-dimensional analysis demonstrated sustained volume restoration without synthetic fillers.
The approach also explains why results last longer. Repositioned tissue supported by deeper structures maintains its position. Surface tightening eventually succumbs to gravity. Structural rebuilding addresses the root cause.
Natural Results and Minimal Scarring
Dr. Andrew Jacono calls his approach “ponytail-friendly” because incisions measure about one-third the length of traditional facelift incisions. He tucks them behind the ear and along the hairline where they remain virtually invisible. Patients can wear their hair up without revealing evidence of surgery.
Fashion designer Marc Jacobs went public about his choice of Dr. Andrew Jacono in 2021. Vogue covered the revelation, noting the results avoided the pitfall of overdone surgery. Even plastic surgeons seek out Dr. Andrew Jacono’s expertise. Dr. Paul Nassif traveled from Beverly Hills to New York for his own extended deep-plane facelift, later saying he wanted to look like “a younger version of himself.”
Newsweek ranked Dr. Andrew Jacono as the third-best facelift surgeon in America for 2025. He serves as Fellowship Director for the American Academy of Facial Plastic and Reconstructive Surgery, training the next generation of specialists. His 2021 medical textbook, The Art and Science of Extended Deep Plane Facelifting, synthesizes insights from over 2,000 facelift procedures.
Dr. Andrew Jacono also maintains academic appointments as Associate Clinical Professor at Albert Einstein College of Medicine and Section Head of Facial Plastic and Reconstructive Surgery at North Shore University Hospital. He has published more than 70 peer-reviewed articles in journals including JAMA Facial Plastic Surgery.
The three-dimensional philosophy extends beyond technical skill. Dr. Andrew Jacono understands that faces age in layers—skin, fat, muscle, and bone all change over time. Addressing only one layer produces temporary improvement. Rebuilding the entire structural foundation creates results that can withstand both scrutiny and the passage of time, allowing patients to look like themselves, just refreshed.
Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice. Surgical results vary by individual. Always consult with a board-certified professional regarding medical procedures.
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