The Art and Science of Extended Deep Plane Facelifting and Complementary Facial Rejuvenation Procedures

To a “senior” generation of surgeons (progressively getting more senior and less productive) it is amazing to see how the remit of the otorhinolaryngologist head and neck surgeon has expanded over the last three decades. Our speciality title is long enough as it is and cannot really be further expanded. However, we now take it for granted that, with proper training, our next generation can tackle endocrine surgery of the head and neck, the most radical tumour resections through the nose and also facioplastic surgery, as reflected in this year’s book reviews in the Journal of Laryngology and Otology.

I am very grateful to my former colleague (for some reason he favoured a spell in Istanbul over the joys of a winter in Middlesbrough) for taking on a review which would have been way beyond my comfort zone. David is currently a Visiting Fellow at the Face Istanbul Clinic, under the supervision of Prof. Dr. Özcan Çakmak and I am grateful that he produced a prompt review. Publishing has been relatively quiet of late, but the pandemic will just be bad memory when this is printed. Surely.

Book Review Editor

Review by D E J Whitehead
Istanbul, Turkey

This comprehensive, satisfying and beautifully illustrated reference book is the culmination of one surgeon’s experiences and reflections on how he challenged and developed his own thoughts on facelift techniques over two decades. For the last 20 years Andrew has worked towards becoming one of the preeminent facial plastic surgeons of our time. He is a highly regarded Ear, Nose and Throat surgeon and Facial Plastic Surgeon.

He provides the reader with a masterclass in surgical education applicable to facial rejuvenation, with an emphasis on the extended deep plane facelift. The book is drawn from peer reviewed publications and his experiences as a single author surgeon, providing a methodical overview of the development of one man’s technical journey and craftsmanship. Guiding the reader through techniques acquired through the substantial number of facelifts he has undertaken, he discusses the methodology by which he has arrived at any given technique. He thus reminds the reader that, no matter how much of an expert they may have become, technical knowledge is never-ending.

This lengthy book is divided into two parts: the first leading the reader through an historical introduction to facelift techniques and the fundamental anatomical components of modern face and neck lift techniques, and the second concerning the ancillary procedures that will provide a more comprehensive, balanced, and harmonious rejuvenation to the face.

The first half commences with a look at the anatomical changes that develop with aging, finishing with an in-depth description of the extended deep plane technique, with an emphasis on the midface, jawline definition and neck rejuvenation. The chapter skilfully demonstrates the technique with carefully drawn illustrations and relevant photos to help the reader comprehend what is required and why.

The second half begins with a significant contribution to the often neglected but challenging subject of neck rejuvenation. This includes the topic of deep neck work, to further overhaul and enhance aesthetics. The author continues with coverage of brow lift techniques and peri-orbital rejuvenation, including blepharoplasty. Jacono then covers the overlooked areas of perioral rejuvenation, which logically leads on to the two topics and techniques of facial fat grafting and skin resurfacing.

The final chapter concludes with a fascinating look at revision face lift surgery. This is an important subject for those who experience progressive functional decline in their skin, as it fatigues despite previous surgery. Additionally, a subset of patients seeks to correct the distortions related to their previous facelifts, many of which are related to the technical limitations and traction deformities of traditional superficial muscular aponeurotic system (SMAS) techniques.

The book is skilfully illustrated with over 800 drawings and carefully matched colour photographs. Each chapter is summarised with “Key Clinical Insights” and a significant number of references for further reading and comprehension. Included with the book is access to over six hours of operative technique, contained in two operative videos.

This book is for any ear, nose and throat surgeon, facial plastic surgeon, plastic surgeon, maxillofacial and oculoplastic surgeon, at all stages in their career, who wishes to make room for further education in place of the status quo.

This is a highly thought-provoking book for either the established or less experienced facelift surgeon. It is a rare text on this subject and a significant achievement by a single author. Nothing similar, or even as comprehensive, has been published for decades and it is a testament to his passion.

Andrew Jacono’s textbook is likely to remain an authoritative reference on this subject and an inspiration for others in years to come.