Facial plastic surgery has long grappled with a central tension: patients want to look younger but not obviously operated on. Dr. Andrew Jacono, a dual board-certified facial plastic surgeon based in New York, developed a technique that addresses both concerns through deeper anatomical intervention and shorter incisions than conventional facelifts allow.
The Minimal Access Deep-Plane Extended (MADE) facelift moves skin, muscle, and fat as a single cohesive unit rather than pulling surface layers independently. This approach departs from the standard SMAS technique, which separates skin from the musculoaponeurotic system before repositioning. By keeping those layers together, Dr. Andrew Jacono avoids the stretched, windswept appearance that often identifies older facelift methods.
Anatomical Roots of the Approach
Faces age primarily through volume loss and the downward drift of fat pads, not through skin laxity alone. Standard facelifts address only surface tension, leaving deeper structural changes untouched. The MADE technique corrects this by releasing four key facial ligaments that tether tissue to underlying bone. Once freed, descended fat pads in the midface, jawline, and neck can be repositioned vertically, restoring the contours that gravity has eroded.
Dr. Andrew Jacono first published this technique in the Aesthetic Surgery Journal in 2011, documenting outcomes across 153 patients. His initial data reported a 3.9% revision rate, approximately 1.9% hematoma rate, and 1.3% temporary facial nerve injury. All three figures fall below industry averages for facelift procedures. He performs roughly 250 of these procedures each year at his Manhattan practice, a volume that refines both judgment and execution over time.
Longevity and Patient Experience
The extended deep-plane technique is widely regarded as delivering results that last roughly twice as long as conventional SMAS facelifts. Many patients maintain outcomes for over a decade, with some surpassing 12 years before any meaningful change. Incisions measure approximately one-third the length of traditional approaches and sit behind the ear and along the hairline, making them virtually undetectable. Dr. Andrew Jacono has described the procedure as ponytail-friendly, reflecting how well the scars are concealed. Fashion designer Marc Jacobs publicly credited Jacono for results that appeared natural and undone in a 2021 interview with Vogue. Visit this page, for related information.
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