In January 2026, at IMCAS World Congress in Paris, I operated side by side with Dr. Alexandre Marchac in the live surgery session on the deep plane facelift: my “Italian touch” and his “French touch”. After the session, IMCAS recorded a conversation between the two of us for Doc Talk, its official podcast. The episode came out on October 29, 2026. It lasts 27 minutes and it is free to listen to.
Listen on Apple Podcasts or on the IMCAS Academy podcast page.
Is there a French or an Italian facelift?
The question of the episode was simple. My honest answer: I did not see any difference. During the live session we worked in parallel and followed each other on the monitors. He was drawing the same lines I was drawing. He was explaining what I had in mind.
Dr. Marchac compared us to two musicians playing the same symphony. I agree. We read the same score, but the hands are different, and so is the sensitivity. The real differences are not between Italy and France. They come from each surgeon’s style and from what patients ask for. Beauty standards in Europe, Asia, the Gulf or South America are not the same, and a surgeon has to know which result the patient really wants.
Reading the face before choosing the procedure
Many patients ask me: “What will you do to me?” That is not the first question. First I read the face. I divide it into three parts: upper third, middle third and lower third with the neck. My focus is on the jawline and on the cervicomental angle, the angle between the chin and the neck.
With age the face changes on two levels. The bone loses projection, so the soft tissues lose their support. The soft tissues slide down and form the jowls along the jawline. A facelift works on the soft tissues. When the support is missing, I give it back with a fat graft or, in selected cases, with an implant, for example on the chin. The goal is to put volume and shape back where they were, not to force a sharp V-shaped jaw.
Restore, not transform
Facelift patients are younger than in the past. Dr. Marchac sees an average age of around 50 in his practice, and even lower in the United States. Social media push some very young people to ask for a facelift. I do not follow trends such as the “fox eye”. I treat people, and I want them to look like themselves.
Dr. Marchac described two kinds of surgeons: those who transform and those who restore. We both restore. A deep plane facelift is not a small procedure. It is real surgery, and it can take several hours. The aim is a result nobody notices: friends say you look rested, as if you had slept better.
A facelift turns the clock back. It does not stop it. How long the result lasts depends on many factors: genetics, lifestyle, sun exposure, smoking and alcohol.
Why the deep plane facelift takes training
In a deep plane facelift the surgeon works beneath the SMAS, the muscular and fibrous layer under the skin, close to the branches of the facial nerve. This is why it requires solid anatomical training and many procedures. It is the technique we teach at the Milano Face Institute, and it is the basis of how I approach the facelift in Milan.
When previous treatments make surgery more difficult
Today many patients come to me after years of non-surgical treatments: fillers, threads, energy-based devices. These treatments are not wrong in themselves. But before a facelift I need to know exactly what was done, because it changes my plan.
The criterion I follow is this. If I find hyaluronic acid filler in the tissues, even years after the last injection, I dissolve it with hyaluronidase, an enzyme, before surgery. Absorbable threads and external ultrasound treatments are usually manageable if there is a resting period before surgery: Dr. Marchac suggests at least six months. The most difficult cases are deep energy-based treatments, which heat the tissues to tighten them. They can leave scarring that changes the anatomy and makes dissection harder. When the anatomy is respected, I find the structures where they should be, even in a secondary facelift.
The next appointment: MFI 2027
At the end of the episode Dr. Marchac mentioned the course I organize in Milan, where surgeons from all over the world come to learn the deep plane technique. The next edition is MFI 2027, Milan, February 4-6, 2027. The live surgery session in Paris is described on the IMCAS Surgery 2026 page.
My training and teaching activity is on my biography, together with the other congresses and courses. If you are considering a facelift and want to talk about your case, you can contact my office.