For decades, the standard facelift relied on a simple mechanic: separate the skin, pull it tight, and trim the excess. That tension often showed. Dr. Andrew Jacono took a different path in the early 2000s, developing a method that rebuilds the face from its deeper layers instead of stretching its surface.
The procedure is called the Minimal Access Deep-Plane Extended facelift, or MADE. Its central idea is that skin, muscle, and fat should travel together as one structure when they are repositioned. Keeping those tissues connected removes the pulled, windswept look many people associate with cosmetic surgery.
Working Beneath the Surface
Conventional techniques detach skin from the superficial musculoaponeurotic system, known as the SMAS, and then draw the skin upward and back. Deeper structures stay where they were. Results from that approach typically hold for six to eight years.
Dr. Andrew Jacono operates below the SMAS. He releases four key ligaments that tether facial tissue to bone, which frees descended fat pads in the midface, jawline, and neck so they can be lifted vertically. The logic is anatomical. Faces age because they lose volume and because tissue migrates downward, and loose skin is only part of that story.
A Smaller Footprint
The incisions are roughly one-third the length of those used in traditional facelifts. They sit behind the ear and along the hairline, which is why the surgeon calls the operation “ponytail-friendly.” Patients can pull their hair back without revealing scars.
Dr. Andrew Jacono first documented the technique in Aesthetic Surgery Journal in 2011, reporting outcomes for 153 patients. Today his Manhattan practice performs approximately 250 extended deep-plane facelifts each year, a volume that sharpens judgment about which ligaments to release and which direction of lift suits a given face.
The method has since spread well beyond one office. Through lectures, publications, and a 2021 textbook, it has shaped how many surgeons now approach structural aging in the face. Master lectures at more than 100 international conferences have helped carry it there. Refer to this page, for related information.
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