Dr. Andrew Jacono Rethinks the Facelift From the Inside Out

For decades, facelifts meant one thing pulling skin tighter until wrinkles smoothed out and hoping the results held. Dr. Andrew Jacono built a different method around a simple observation. Skin alone was never the problem.

Traditional procedures separate skin from the muscle layer beneath it, then stretch the skin backward and upward. The tension needed to hold that lift is often visible, giving away that surgery took place. Dr. Andrew Jacono’s Minimal Access Deep-Plane Extended facelift, known as MADE, takes a different path by lifting skin, muscle and fat together as one connected unit.

Working Beneath the Surface

Because the layers move as a single structure, there is no separation to create surface tension. The face can be repositioned without the pulled, wind-tunnel look associated with older techniques. Dr. Andrew Jacono developed the approach in the early 2000s and has continued to refine it since.

The surgeon operates beneath the superficial musculoaponeurotic system, the connective tissue layer that gives the face its structural support. By working under this layer rather than only tightening above it, he can reposition fat pads that have descended in the cheeks, jawline and neck over time.

A Smaller Footprint

One practical advantage patients notice immediately is scarring. The incisions used in this approach run about one-third the length of those in conventional facelift surgery, a detail that matters to patients who want results without visible evidence of the procedure.

Dr. Andrew Jacono has built a Manhattan practice around this technique, performing roughly 250 of these extended deep-plane procedures each year. His original findings appeared in the Aesthetic Surgery Journal in 2011, based on outcomes from 153 patients, giving the field a documented foundation rather than anecdotal claims.

The core idea remains consistent across his published work: aging is a structural shift, not simply loose skin, and treating it that way produces results that last.

Surgeons who study facial anatomy closely tend to agree that skin tension alone has limits. Once gravity and volume loss have reshaped the underlying framework of a face, tightening the surface can only go so far before results look artificial. Addressing the deeper layers first gives any later skin adjustment a more stable foundation.

Patients evaluating this option are typically advised to review before-and-after documentation and ask how long a surgeon has practiced the exact technique being offered, since deep-plane methods vary between practitioners. Visit this page, for related information.

 

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