All the Details on Dr. Paul Nassif’s $50,000 “Deep Plane” Facelift Surgery

Dr. Paul Nassif has been turning heads lately and it’s not just for the surgeries he performs on Botched — this time, it’s for his own face! The Real Housewives of Beverly Hills alum went under the knife in 2018 to remove excess skin from weight loss. Dr. Nassif got a particular kind of facelift called the "deep plane" facelift, and the surgery rings in at a whopping $50,000!

Dr. Nassif chose his longtime friend, New York facial plastic surgeon Dr. Andrew Jacono, MD, FACS, who specializes in advanced deep plane facelift surgery, to perform the procedure on his face — so, of course, we just had to speak with Dr. Jacono to get all the deets.

BravoTV.com got the scoop from Dr. Jacono— who performs approximately 400 of these surgeries per year — on why his deep plane facelift was ideal for Dr. Nassif and why it’s worth the hefty price tag.

First off, where did you and Dr. Nassif meet?

Dr. Andrew Jacono: I've known Paul for 20 years! When I was a resident (physician in training) I met him at one of our Plastic Surgery Society meetings — way before his television days. He's just a good person, a good quality friend, he's always there when you need him. I've always kept in touch with him — we grew up together. We were in practice as we got older, had children. He comes to New York, I go to Los Angeles, and we always make time for each other; I'm grateful for it. I was extremely honored when he chose me to do his facelift because there are many surgeons that he could have chosen. That he preferred to use me is the biggest compliment because I know how important it is when you have a public face.

What is the deep plane facelift and how is it different from a traditional one?

A deep plane facelift is a procedure that avoids the very tight appearing look of a traditional facelift. Everybody is concerned with the idea of the facelift. A traditional facelift peels the skin away from the muscles like an onion. With a deep face facelift, you leave the skin and muscle attached. You never pull the skin away from the deep structure, so the surface looks soft and smooth — not tight. Even when the lift happens, the surface never looks pulled because you're not separating the skin from the muscle. Dr. Nassif doesn't look like he has had anything done; he looks like a younger version of himself. The best way to think of it is like restructuring the beams of a building. Instead of doing it cosmetically, you're reestablishing it. A deep plane facelift is a foundational type of procedure. 

How much does this procedure cost?

The deep plane facelift is $50,000 — it’s more expensive than the average facelift, but there is value in it because you look youthful and natural. It also lasts longer than a traditional SMAS facelift. I was trained to do a more traditional facelift, that’s what almost all surgeons perform, but it doesn't last as long. A deep plane facelift should last 12-15 years and a SMAS facelift is half as long, on average. In my experience, when I was performing SMAS facelifts, they would look droopy at a quicker pace.

What is the recovery time for surgery? 

A deep plane facelift doesn't require general anesthesia. We use twilight anesthesia (intravenous from an anesthesiologist) or local anesthesia (most people don't want to be awake). We have evolved out of general anesthesia because it’s unnecessary. The recovery following a deep plane facelift usually involves some bruising and swelling for the first few days with an initial recovery within seven to 10 days.

What are the risks for this type of facelift?

My recent Meta-Analysis Study published in the Aesthetic Surgery Journal revealed that the deep plane facelift technique has the lowest risk of facial nerve injury. Beyond that, it’s safer because the patient heals faster (not peeling the skin from the muscle) as the blood supply has been left intact, offers optimal incision healing, last longer, and looks more natural — what’s the downside? There are not a lot of doctors who perform deep plane surgery. I’m currently lecturing around the world on the topic and performing live demonstrations to share my knowledge with others doctors. 

Who is a good candidate for this type of surgery?

I perform deep plane facelifts on a wide range of patients: those in their early to mid-40s who want to keep things right where they want them. Early 50s is more common. In New York the patients I treat are closer to 47- 50, but that’s the first wave. Around 53-55 is the next wave and some people are 60s and 70 s when they start getting heavy jowls and a turkey neck.

That said, it’s not like you hit 40 and you automatically need a facelift. It depends how we are aging, if you are a smoker, how much sun you have been exposed to, and genetics. There is no hard number — it’s a very individual journey.

If a patient gets this procedure when they are younger, will they have to get it done again when they get older?

No! It doesn't require another procedure; you can age gracefully from that point forward. If a patient undergoes a deep plane facelift when they are 50-60s, most aren't going to elect a subsequent procedure. But there are some people who want to constantly keep it fresh. If you’re a public face, you may want to tweak it again, but it’s not required. It’s where you want to set the bar.

Anything to add about facelifts people should know?

I published a book called The Park Avenue Face earlier this year. In the book I have a chapter that is called ‘’Don't Fear the Facelift,” which lays out the differences between facelift techniques. The main message is, of course, that you don't have to fear the facelift! There comes a time, depending on your lifestyle, when it may make sense to undergo cosmetic surgery — and there are ways to do it, still look like yourself, and enjoy it.