“My technique is comprehensive by design. I address the neck, the lower face, and the midface in the same operation, moving the skin, the SMAS, and the malar fat as one composite unit — and I undermine as little skin as possible to do it. Every retaining ligament is released, the vector is chosen for the patient in front of me, and the fixation is permanent. That is what makes the result both natural and durable. It is the foundation of every Masterpiece.”
What the Truesdale Facelift Technique is
In one sentence: the Truesdale Facelift Technique is an extended deep plane, composite-flap face and neck lift that treats the neck, lower face, and midface as a single surgical composition — combining a small submental approach to the deep neck, a high and lateral entry into the SMAS, complete release of the facial retaining ligaments, the Deep Mastoid Crevasse Technique for platysma anchoring, and a vertical midface vector secured with permanent sutures, all under a preservation philosophy that undermines as little skin as possible.
It is a composite-flap operation: the skin, SMAS, and malar fat pad move together as one thick, well-vascularized unit rather than being separated and pulled in different directions. And it is extended: the deep plane release is carried farther forward, and connected farther down into the neck, than a standard deep plane facelift.
Layered onto this is a preservation principle. Skin is undermined only as far as it must be. In the neck, whenever anatomy allows, a bridge of undissected skin is intentionally left between the lateral neck and the submentum — preserving blood supply and reducing swelling and recovery time.
How the operation is performed
The sequence below is the order Dr. Truesdale actually operates in — neck first, then the face — because the neck correction sets the foundation the facelift is built on.
A small incision, a complete correction
The operation begins in the neck through a submental incision hidden beneath the chin — typically only 2 to 2.5 centimeters. Through this small opening, the deep structures of the neck are addressed directly, rather than simply tightened over:
The goal is the crispest cervicomental angle the patient’s anatomy will allow — achieved by correcting the structures that actually cause a heavy neck.
Incisions designed to disappear
Facelift incisions are hidden in the temporal tuft of hair and along the inside edge of the tragal cartilage. Two details matter here:
A high, lateral entry and a thick composite flap
Skin is undermined only lightly, just to the level of the SMAS. The SMAS is then entered at a very high point — high enough that the flap is lifted directly off the orbicularis oculi and the zygomaticus major and minor muscles. This is what allows the midface, not just the jawline, to be repositioned.
This dissection is performed with cautery rather than a scalpel. That choice keeps the flap thick and intact, preserves its blood supply, and measurably reduces bruising and swelling afterward.
The SMAS is also entered farther laterally than a traditional deep plane entry point, over the fixed SMAS that overlies the parotid gland, and high on the zygoma. This leaves a long undissected skin flap and a hearty, robust SMAS on the lateral face — a strong, stable anchor that the lift is later secured to.
Every retaining ligament, fully released
The deep plane dissection is carried forward all the way to the nasolabial fold and past the buccal fat pad. This fully releases the malar fat pad while keeping it firmly attached to the overlying skin and SMAS — the essence of a composite flap — and creates a zone of skin that will carry no tension at closure.
Inferiorly, the dissection continues down to the platysma, and every facial retaining ligament is released:
With the ligaments released, the SMAS moves freely and without tension. The sub-SMAS dissection of the face is then connected to the sub-SMAS dissection of the neck, creating one continuous plane. The facial artery and vein are identified during this release, and the branches of the facial nerve are protected throughout.
The Deep Mastoid Crevasse Technique
A release is made along the sternocleidomastoid muscle, and the attachment between the sternocleidomastoid and the SMAS is fully released — a step most techniques leave intact. This permits Dr. Truesdale’s Deep Mastoid Crevasse Technique, a platysma-anchoring maneuver he developed: the platysma is mobilized and anchored superiorly, medially, and deeply using two distinct suture techniques.
The effect is a sharply defined angle of the mandible and a clear separation between the plane of the face and the plane of the neck. A second suture — a modification of the Deep Mastoid Crevasse Technique — recruits additional platysma to flatten the cervicomental angle and define the submental triangle.
A vertical vector, fixed permanently, reinforced along its length
The midface is lifted along a strongly vertical vector — the direction the tissue originally descended — and fixed with permanent sutures. This is what produces maximal effacement of the nasolabial fold and jowl.
The SMAS is then reinforced with a running suture along its length. This distributes the lifting force across the entire flap rather than concentrating it at a few points, recruits slightly more SMAS laterally, and reinforces the closure of the SMAS in both the face and the neck — tightening the circumference of the face and the circumference of the neck. The result is more anatomic and more durable. The dissection pocket is meticulously sealed.
Because the deep plane has been fully extended, the final vector is not a formula — it is chosen to match each patient’s individual anatomy. Vector selection and the extent of the release are artistic decisions as much as technical ones: they are chosen for the facial shape, balance, and contour that will read as most natural on that particular face.
Tension-free closure with 6-0 microsutures
Before closure, the lateral face is sculpted further as needed, including conservative reduction of the parotid gland and of fat along the angle of the mandible and the subgonial region. This is artistic sculpting, not just reduction: the neck and its fat structures are shaped for the most balanced facial shape and contour. Excess skin is then excised along the trichophytic incision, matched precisely to the skin edge so that closure is completely tension-free.
The skin is closed with 6-0 microsutures — finer than most surgeons use — for the least visible scar and the most natural contour achievable.
Meticulous hemostasis is maintained throughout the entire case. Together with the thick composite flap and minimal undermining, it is a major reason recovery is faster than most patients expect.
Volume, and everything the lift alone cannot do
A lift alone does not restore a youthful face. As part of The Masterpiece Surgery™, volume loss is addressed with facial fat transfer, and complementary procedures — brow lift, blepharoplasty, skin resurfacing — are incorporated in the same session so that every region of the face is designed to work with every other.
What makes the Truesdale Facelift Technique different
Thirteen specific choices that separate this operation from a standard deep plane facelift.
Dr. Truesdale teaches this technique. He is faculty and a live surgeon at the NYC Facelift & Rhinoplasty Master Course™, where he has performed live deep plane face and neck lift surgery to demonstrate the approach to other practicing surgeons, and a repeat podium presenter on facelift and neck lift technique at AAFPRS national conferences — including “Facelift and Revision Rejuvenation Strategies” (AAFPRS, 2025), “Deep Necklifting” (Vegas Cosmetic Surgery, 2025), and “Facelifting Scar Management & Keloid Prophylaxis” (AAFPRS, 2023). See his full speaking and teaching history →
The Truesdale Facelift Technique FAQ
An extended deep plane, composite-flap face and neck lift developed by Dr. Carl Truesdale that treats the neck, lower face, and midface together in one operation. It combines a 2–2.5 cm submental deep-neck approach, a high and lateral SMAS entry over the fixed SMAS, complete release of the facial retaining ligaments, the Deep Mastoid Crevasse Technique for platysma anchoring, and a vertical midface vector secured with permanent sutures. It is the surgical foundation of The Masterpiece Surgery™.
A standard deep plane facelift releases the retaining ligaments of the face. The Truesdale technique extends that release forward to the nasolabial fold and past the buccal fat pad, keeps the malar fat pad attached to the skin and SMAS as a composite unit, fully releases the sternocleidomastoid–SMAS attachment, connects the sub-SMAS planes of the face and neck, and corrects the deep neck — fat, digastric muscles, submandibular gland, platysma, and hyoid position — through a 2–2.5 cm incision under the chin, all in the same operation.
Minimal skin undermining preserves the blood supply to the skin, keeps the flap thick and intact, and reduces bruising, swelling, and recovery time. Where anatomy allows, Dr. Truesdale leaves a bridge of undissected skin in the neck between the lateral neck and the submentum for the same reason. The SMAS flap itself is raised with cautery rather than a scalpel to keep it thick and well vascularized, and meticulous hemostasis is maintained throughout the case.
A platysma-anchoring maneuver developed by Dr. Truesdale. After the attachment between the sternocleidomastoid muscle and the SMAS is fully released, the platysma is mobilized and anchored superiorly, medially, and deeply over the mastoid using two distinct suture techniques. A second, modified suture recruits additional platysma. The result is a sharply defined angle of the mandible, a flattened cervicomental angle, and a clear separation between the plane of the face and the plane of the neck.
Because the retaining ligaments are released rather than tightened over, the SMAS is fixed with permanent sutures along a vertical vector, and the repair is reinforced with a running suture that distributes the lifting force across the entire flap, results typically hold 10–15 years.
Discuss the Truesdale Facelift Technique with Dr. Truesdale
A private, unhurried conversation with Dr. Truesdale personally — never a coordinator. Share your goals, review the plan, and learn whether this technique, or the full Masterpiece Surgery™, is right for you. We respond same-day, Monday–Friday.
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