Facelift surgery has relied for decades on a simple mechanical idea: pull the skin tighter and hold it there. Dr. Andrew Jacono, a New York facial plastic surgeon, began questioning that premise in the early 2000s and developed an alternative that treats the face as connected tissue rather than a stretched surface. His technique, called the Minimal Access Deep-Plane Extended facelift, or MADE, moves skin, muscle, and fat together as one structural unit.
A Different Layer of Work
Conventional facelifts separate the skin from the superficial musculoaponeurotic system, known as the SMAS, then pull that skin upward and back. The lift tightens what is visible but leaves the deeper framework of the face untouched, which is part of why results from that approach often soften within six to eight years. Dr. Andrew Jacono‘s method works beneath the SMAS instead, releasing four facial ligaments that anchor tissue to bone so that descended fat in the midface, jawline, and neck can move vertically into a more youthful position.
Town & Country described the philosophy directly, noting that Jacono keeps the skin, muscle, and fat as one unit rather than separating them into layers that move independently. That structural choice is what distinguishes the deep-plane approach from surface-level tightening, and it addresses the root causes of facial aging, namely volume loss and tissue migration, rather than treating skin laxity as the whole problem.
Documented Through Peer Review
Dr. Andrew Jacono first published this technique in the Aesthetic Surgery Journal in 2011, presenting outcomes drawn from 153 patients. That publication gave the method a clinical record beyond anecdote, and the surgeon has continued to refine it since, most notably with a 2019 update focused on jawline rejuvenation. Incisions used in the procedure run roughly a third the length of those in traditional facelifts, positioned behind the ear and along the hairline so they stay concealed even when hair is worn pulled back. Visit this page for more information.
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