Dr. Min-Hee Ryu's deep plane facelift: the five concepts on one page
Dr. Min-Hee Ryu's deep plane facelift at RNWOOD Plastic Surgery in Seoul is described through five concepts: releasing the retaining ligaments, a High SMAS approach, preserving the composite flap, an extended deep plane, and repositioning the buccal fat. They are used together, and the release of the retaining ligaments is the one Dr. Ryu describes as the most important. This page sets out all five side by side.
The five concepts at a glance
| Concept | What it is meant to do |
|---|---|
| 1. Release of the retaining ligaments | Sufficient release of the zygomatic and masseteric retaining ligaments in the sub-SMAS plane. Dr. Ryu considers this one of the fundamental principles of the deep plane facelift, as these ligaments tether the superficial tissues and must be adequately released to effectively improve sagging of the anterior face. |
| 2. High SMAS concept | The High SMAS concept is incorporated to provide more controlled lifting vectors and improve the midface and lower face. In particular, it allows an independent vertical lifting vector, which can provide more effective midface elevation while allowing the surgical design to be adapted to the patient's individual facial anatomy. |
| 3. Extended deep plane facelift | When necessary, the deep plane dissection is extended to include the release of the cervical retaining ligaments, allowing more comprehensive correction of the lower face and neck. |
| 4. Preservation of the composite (skin-SMAS) flap | The natural attachment between the skin and SMAS is preserved as much as possible while minimizing unnecessary skin dissection. The actual lifting and fixation are performed through the SMAS flap rather than by placing excessive tension on the skin. This helps preserve circulation, minimize surgical trauma, and support a natural result and favorable recovery. |
| 5. Buccal fat repositioning | Rather than routinely removing buccal fat, Dr. Ryu focuses on repositioning the buccal fat when indicated, helping improve the descended tissues while avoiding unnecessary loss of facial volume and potential hollowing of the cheeks. |
Is every concept used for every patient?
Though facial aging is predictable and present in all individuals, each recommended procedure is crafted and tailored personally to suit the patient's aesthetic goals and concerns.
Are results guaranteed?
Please note that any surgery comes with risks. Anatomical structures and inherent asymmetry cannot be fully corrected.
Furthermore, a deep plane facelift does not guarantee a halt in aging. Sagging is bound to return as the body undergoes its natural aging process. However, there are many ways to manage sagging using dermatological methods.
When is the operation not recommended?
Facial rejuvenation surgery is not recommended for patients who have health risks.
Where does the volume that is still missing come from?
Whereas sagging is corrected by lifting, areas of volume loss are improved using fat grafts. The fat is harvested from the patient's own body (thighs or lower abdomen), centrifuged and mechanically emulsified before being reinserted into depressed areas of the face.
Frequently asked questions
Q1) What are the five concepts of Dr. Ryu's deep plane facelift?
A1) Releasing the retaining ligaments, High SMAS, preservation of the composite flap, extended deep plane, and buccal fat repositioning.
Q2) Which concept matters most?
A2) Dr. Ryu describes the release of the retaining ligaments as the most important.
Q3) Is buccal fat always repositioned?
A3) No. This is highly dependent on the patient's facial anatomy.
Q4) Does the preservation concept mean a faster recovery?
A4) It can contribute to a smoother recovery, but that is not guaranteed.
Q5) Is the operation suitable for everyone?
A5) No. It is not recommended for patients who have health risks.
About the Author
Dr. Min-Hee Ryu is the Medical Director and Founder of RNWOOD Plastic Surgery in Seoul and a plastic surgery specialist certified in Korea (2008). He has been Faculty of the Mendelson Advanced Facial Anatomy Course (MAFAC) since 2016, an Editorial Board Member of the Aesthetic Plastic Surgery Journal since 2019, and an Educational Council Member of the International Society of Aesthetic Plastic Surgery (ISAPS) since 2024.
Deep Plane Facelift — Deep plane facelift involves extensive dissection beneath facial tissues. Risks include anesthesia reactions, bleeding, hematoma, infection, seroma, delayed healing, wound separation, persistent pain, and visible scars. Swelling, bruising, tightness, and numbness can last for months, and hair loss or distortion of the hairline or ear position can occur. Poor blood supply can cause skin loss or tissue death. Nerve injury can cause temporary or permanent weakness, an altered smile, or numbness, and injury to the parotid gland or salivary duct can cause salivary leakage. A postoperative hematoma can require urgent drainage or another operation. General risks include thrombosis or embolism, and a complication can require emergency treatment or additional surgery. No result, symmetry, scar quality, or duration can be guaranteed, and sagging can recur. Fat Graft — Fat harvesting can cause donor-site pain, scarring, numbness, contour irregularity, bleeding, hematoma, or infection. Fat grafting can cause prolonged swelling, asymmetry, lumps, oil cysts, calcification, overcorrection, undercorrection, migration, infection, or fat necrosis. Rarely, injected fat can enter a blood vessel and cause skin necrosis, permanent blindness, stroke, or severe neurological injury. Not all transferred fat survives, results vary substantially, and no preparation or injection method guarantees better fat survival. A complication can require emergency treatment or additional surgery.