Few facial plastic surgeons can trace a technique from first idea to textbook. Dr. Andrew Jacono can. Over roughly two decades, his Minimal Access Deep-Plane Extended (MADE) facelift has moved from one surgeon’s alternative to a widely adopted approach.

Early 2000s to 2011

Jacono began with a critique of the standard facelift. Conventional surgery separates skin from the superficial musculoaponeurotic system (SMAS) and pulls it upward and backward. The tension tends to reveal that surgery took place, and results usually hold for six to eight years. His alternative works beneath the SMAS, keeping skin, muscle, and fat together and releasing four ligaments so that descended fat in the midface, jawline, and neck can be lifted vertically.

Dr. Andrew Jacono published the technique in Aesthetic Surgery Journal in 2011, documenting 153 patients. Initial figures included a 3.9% revision rate, a hematoma rate near 1.9%, and 1.3% temporary facial nerve injury, numbers below industry averages. Incisions were about one-third the length of traditional ones, hidden behind the ear and along the hairline.

2019 and 2021

A 2019 refinement introduced modifications for jawline rejuvenation and lower-face volume. Jacono backed it with quantitative evidence, including the “mandibular defining line,” a measurement that tracks jawline contour. The update focused on the lower face, where descended tissue can blur the line of the jaw.

The year 2021 brought two milestones. Marc Jacobs told Vogue his facelift with Dr. Andrew Jacono looked natural without appearing “done.” That same year, Jacono released a medical textbook drawing on more than 2,000 facelift procedures, which established technical standards now followed by other surgeons.

Today, the surgeon performs about 250 extended deep-plane facelifts a year in Manhattan and has delivered master lectures at over 100 international conferences. Results from the approach can last about twice as long as a standard SMAS facelift, with many patients keeping them beyond a decade. Lifestyle, skin quality, and care also shape how long they hold. Even Dr. Paul Nassif, a Beverly Hills plastic surgeon, traveled to New York for the procedure. Refer to this article for more information.

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