Facial Plastic Surgery in 2026: Notes From an Austin Surgeon
I just got back from the 2026 American Academy of Facial Plastic and Reconstructive Surgery meeting in Las Vegas. For anyone who does a lot of deep plane facelifts, it’s one of the most useful weeks of the year.
Some of the best learning happens in the lecture hall. A lot of it happens at dinner, in the hallway, and in the side conversations between sessions. This year, the same five topics kept coming up in both places.
I want to walk you through each one, what it means in plain language, and how it’s likely to show up in the care you get over the next few years. Some of these I’ve already added to my own practice here in Austin. Others are still being debated, and I’ll tell you where I land.
1. The “Deeper Plane” in Deep Plane Facelifts
A deep plane facelift works beneath the SMAS, the superficial musculoaponeurotic system. That’s the layer of connective tissue and muscle under the skin and fat. We release the ligaments that hold the face down, and we carry that release into the neck below the platysma muscle.
The “deeper plane” goes one layer further. There’s a layer of fascia called the parotidomasseteric fascia. It wraps around the buccal fat, the parotid gland, and the masseter muscle, and it turns out to be an important support layer for keeping the soft tissues of the cheek lifted.
Dr. Dominic Bray, a surgeon in Europe, gave a strong lecture on adding a deeper suture in this fascial layer. That stitch helps lift the nasolabial fold and jowl area, repositions the cheek fat pad, and can even tighten the zygomaticus major muscle.
I started using this technique about six months ago after hearing Dr. Mike Nayak teach it at a course earlier in the year. It has taken my midface results up a level. At this meeting, it was clear that more surgeons are hearing about it and building it into their own deep plane technique.
If you want a refresher on how the deep plane differs from older approaches, my post on deep plane vs SMAS facelifts covers the anatomy. The classic anatomy paper on how these facial fascias relate to each other is Stuzin and colleagues’ 1992 study in Plastic and Reconstructive Surgery, and much of what we’re refining today builds on that work.
2. The Endoscopic Facelift
The second big topic was the endoscopic facelift. Dr. Mark Mani, a plastic surgeon in California, spoke at length about his technique, who he thinks is a good candidate, and who isn’t. He has also published on it, including a 2026 review titled Millennial Facelifts: The Endoscopic Approach Makes Them a Reality, where he describes growing demand from younger patients who want to avoid a visible scar.
In my hands, the best candidates for an endoscopic facelift are on the younger side. They don’t have much extra skin that needs to be removed. That matters because the endoscopic approach is more of a vertical lift through an incision in the temple.
When you lift skin vertically and there’s too much of it, it bunches. Some surgeons adjust the position around the ear to accommodate it. But in a more mature patient with real skin excess, that skin has to go somewhere, and usually it has to be removed.
I expect we’ll see a lot more about endoscopic facelifts in the next few years, including new techniques and how they pair with a structural neck lift. For now, I think of it as a good option for a specific patient rather than a replacement for the deep plane facelift.
3. GLP-1 Medications and How Patients Heal
GLP-1 medications came up constantly. My friend and colleague Dr. Lindsey Pennington gave a lecture on it, and it was a frequent topic at every dinner I went to.
Most people know these medications can cause volume loss in the face. What we’re paying more attention to now is how they may affect the structure of the skin itself, and how patients heal. A 2026 literature review in Aesthetic Plastic Surgery looked at the published evidence on GLP-1 receptor agonists and skin quality, including changes in the dermis, fat compartments, and elasticity. The research is still early, and much of it is case reports and small studies.
One study cited in the lecture even suggested that facial fat in patients on GLP-1s may have a different stem cell content than in patients who haven’t taken them. That work is a 2026 controlled study by Firsowicz, Kamrani and colleagues in Dermatologic Surgery, which compared stem cell populations in the skin of people taking GLP-1 receptor agonists with those who weren’t.
Nutrition is the practical piece. If someone is nutritionally depleted, I need to bring them back to a point where they can heal well after surgery. Some of what I’m using now:
- Vitamin supplementation
- Adequate protein before and after surgery
- Hyperbaric treatments
- Good skincare before and after the procedure
If you’re on one of these medications and planning surgery, read my post on when to stop tirzepatide before surgery and bring your medication history to your consult.
4. Whether to Remove the Submandibular Glands
The submandibular glands are salivary glands that sit just below the jawline. They help produce saliva when you eat. They aren’t your only salivary glands, though. You also have the parotid glands in front of the ears, the sublingual glands tucked under the chin, and many minor salivary glands.
A growing number of surgeons now feel comfortable trimming the submandibular gland when it hangs low or has enlarged over time. Techniques for doing this safely have improved. Some surgeons use a vessel-sealing device to seal the gland at its base, which helps prevent salivary leak and bleeding. Some use a LigaSure and others use CoolSeal. Both essentially accomplish the same thing with different designs.
I use the device called CoolSeal. It’s longer and narrower, the jaws open in a way that lets me seal the gland without producing as much heat, and its smaller design helps me see in the tight space where the gland sits.
This is still a real debate. Some surgeons trim the gland in a large share of their cases, and others think it’s too risky to do routinely. A 2026 series of 240 patients in Plastic and Reconstructive Surgery reported on partial gland resection as part of deep neck contouring, including complications like hematoma, seroma, and sialocele. It’s one surgeon group’s experience in a specific population, so it doesn’t settle the question, but it adds useful data.
What struck me most was a generational split. Some of the senior surgeons said their patients simply don’t complain when the gland is left alone. Younger surgeons said their patients do. I think expectations have changed. Over the last five years or so, I’ve seen more and more patients who want a sharp jawline with a smooth contour underneath, and fullness under the chin isn’t as accepted as it was even a decade ago.
My structural neck lift page explains when I address deeper neck structures and when I don’t.
5. Beautification vs Rejuvenation
This was the theme running through the whole meeting, and it’s my favorite.
Rejuvenation means restoring the face to where it was at an earlier point in life. Many surgeons ask patients to bring photos from each decade and talk about which period they’d like to get back to. It’s a helpful way to set expectations and to see which parts of the face have aged and which haven’t.
Beautification goes a step further. It aims for a more elevated version of you than you’ve ever had, even in your twenties. Some of the tools for that:
- Careful fat grafting in the neck, the orbital hollows, and around the face, partly for its regenerative effects
- Hairline lowering
- Orbital rim contouring
- Rhinoplasty
- Jaw contouring
These add something to the face that may never have been there. People are living longer, they’re successful, and they want to enjoy their results for decades. What they’re asking for is natural, but rested and more elegant.
Where I Think This Is Heading
Attendance this year was higher than I’ve ever seen, the speaker panel was more multidisciplinary, and surgeons came from all over the world. That kind of exchange is how a specialty gets better.
For patients, the practical message is that technique details matter more than labels. Two surgeons can both say “deep plane” and do different operations. Ask your surgeon how they handle the midface, the neck, and the deeper structures, and how they’d prepare you if you’ve lost weight on a GLP-1.
Frequently Asked Questions
Is the deeper plane stitch a different procedure from a deep plane facelift?
No. It’s a refinement within a deep plane facelift. It adds support in the fascia around the buccal fat and parotid region to improve midface lift and longevity.
Am I a candidate for an endoscopic facelift?
It depends mostly on how much skin needs to be removed. Younger patients with good skin elasticity tend to do best. If you have significant skin laxity, a deep plane facelift is usually the better fit.
Will GLP-1 medications affect my facelift healing?
They can, mainly through nutrition and changes in fat and skin. I’ll review your medication timing, protein intake, and labs as part of your planning. I routinely order labs for patients on GLP-1 medications before surgery.
Is removing the submandibular gland dangerous?
Any deep neck work carries risks, including bleeding and nerve injury. In experienced hands with the right tools, partial gland reduction can be done carefully in selected patients. Not everyone needs it.
What I Brought Home From the Meeting
I left excited about where our field is going. What stayed with me most was how much attention surgeons are paying to the small details that keep a result looking great years later. If you’re wondering which of these approaches fits your face, let’s talk. I see patients in southwest Austin, toward Dripping Springs, and I do virtual consults too.
You May Also Like:
- Deep Plane vs SMAS Facelift: What’s the Difference?
- How Long Does a Deep Plane Facelift Last?
- Understanding Ozempic Face
- When to Stop Tirzepatide Before Surgery
- Ponytail Facelift vs Deep Plane Facelift
- Facelift Before and After Gallery
References
- Stuzin JM, et al. The relationship of the superficial and deep facial fascias: relevance to rhytidectomy and aging. Plast Reconstr Surg. 1992;89(3):441-449.
- Mani M. Millennial Facelifts: The Endoscopic Approach Makes Them a Reality. Facial Plast Surg Clin North Am. 2026;34(4):549-562.
- Barone M, et al. Effects of GLP-1 Receptor Agonists on Skin Quality: A Comprehensive Literature Review. Aesthetic Plast Surg. 2026;50(13):5403-5407.
- Firsowicz M, Kamrani P, Zubair R, Boen M, et al. Cutaneous Variations in Stem-Cell Population in Those on GLP1-Receptor Agonists: A Comparative Controlled Study. Dermatol Surg. 2026;52(6S):S39-S44. doi:10.1097/DSS.0000000000005175
- Lee I, et al. Submandibular Gland Resection in East Asian Patients: An Anatomical and Clinical Series of 240 Cases. Plast Reconstr Surg. 2026. Online ahead of print.
