Facelift

Quick Facts About Facelift

Average Treatment Cost: $4,000-$25,000
Procedure Time: 3-6 hours
In/Outpatient: Either
Anesthesia: Local with sedation or general
Recovery Time: 10-14 days
Duration of Results: Long-lasting
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What you should know

What Is A Facelift

After liposuction, breast augmentation, blepharoplasty (eyelid surgery), abdominoplasty (tummy tuck), breast reduction and rhinoplasty, facelifts (the technical name is rhytidectomy) are the sixth most requested cosmetic surgery procedure, according to the American Society of Plastic Surgeons (ASPS).

Facelifts surgically reposition sagging muscles, fat and tissue along with re-draping skin and reduction of excess skin of the face, jawline and neck to produce a more youthful appearance.

A facelift is facial rejuvenation surgery that goes beyond just tightening skin. A facelift usually extends below the skin to address the superficial musculoaponeurotic system (SMAS) by repositioning underlying facial muscles and removing any excess skin. A truly complete and comprehensive facelift with the most natural outcome will reduce, redistribute and in some cases add fat to the face.

The modern facelift has moved away from using skin tension to contour the face. As a face ages there are changes to how fat is distributed, specifically the fat in the lower part of the face. The result is that the face looks longer and squarer in shape—young faces tend to be tapered or angular. Thus, the most important aspect of a facelift is to improve facial shape while limiting signs that a surgical procedure has been performed.

Every plastic surgeon and facial plastic surgeon has their own variation on a facelift.  All facelift procedures have the same aim in common—to restore natural curvatures to the features while maintaining an appropriate amount of volume in the right places.

“When and where each technology and procedure fits best and in what combinations are still evolving but I think that the future is bright. We have ever-expanding options to customize facial rejuvenation based on a patient's specific needs, limitations, desires, anatomy and circumstances,” says Reston, VA, plastic surgeon Robert Sigel, MD, who agrees that facial rejuvenation should be tailored to each individual patient and believes, “A natural, youthful outcome is the result of a holistic approach.”

Today’s surgeons typically perform facelifts either individually or in combination with other common facial rejuvenation procedures like eyelifts, browlifts, lip or chin augmentation, necklifts and so on. 

Here, a menu of the types of facelift procedures that board-certified plastic surgeons perform:

  • Traditional or Full Facelift
  • Mini-facelift or Limited Incision Facelift
  • Lower Facelift
  • Endoscopic Facelift
  • Liquid Facelift (using Injectables and Fillers)

The latest studies show that patients get the best results with a combination of facial rejuvenation surgery that both lifts and repositions skin and underlying sagging tissue combined with the use of injectables and fillers to restore lost volume and natural fat. 

Traditional Facelift

If you are in your 50s or 60s and have a traditional (full) facelift, your face will age more slowly, from the point of where it has been reset, and you’ll look at least 10 years younger. 

The traditional facelift (a rhytidectomy) is considered the only comprehensive way to address multiple signs of aging—from the forehead to the neck, and all areas in between—thus providing the most permanent results of any of the many facelift procedure types available today.

La Jolla, CA, plastic surgeon Robert Singer, MD, who performs a variety of lifts, notes that with a full facelift, surgeons can exert the “best control of redistributing fat, repositioning muscle and accurately treating excess skin.” 

The full lift is well suited to you, if you have:

  • Excess or sagging facial skin
  • Deep facial creases
  • Redistributed facial fat pockets
  • Or if you look tired, sad and angry even when well-rested

Those with excess skin around the chin, neck and jowls benefit the most from a necklift with liposuction. In most cases, this procedure is performed with a facelift. If your skin is excessively saggy, or if there is a loss of muscle tone, “a traditional facelift (which has been modified and improved so that the skin is not just pulled and lifted) can include a cheek and necklift, and takes care of sagging and lack of volume by tightening up the muscle,” says Littleton, CO, facial plastic surgeon Brent Smith, MD. “It also gets rid of any fatty deposits and brings the underlying tissue back to a more youthful position, while getting rid of excess skin.”

How a Facelift is Performed

Full facelift incisions begin at the temples and continue along the natural curve of the ear, under and behind the ear, and then back into the nape of the neck within the hair.

To create a taut look, surgeons developed the SMAS--or submuscular aponeurotic system--technique that is still in widespread use. The surgeon peels back the skin and pulls on the deeper layers of tissue and muscle below the skin. Excess skin is removed and wrinkles smoothed out.

Expect the initial recovery from a full facelift to take two weeks. It can take a few months for all the swelling and bruising to go down, and up to six months for the scars to fade.

The Modern-Day Facelift

A full facelift not only offers the longest-lasting results but can address a wide array of aging concerns over other facial rejuvenation procedures like limited incision lifts, mid-facelifts or lower facelifts to name a few.  “There is only one-way to correct sagging skin, it has to be lifted,” says Reston, VA, plastic surgeon, Dr. George Weston. 

In the past, facial plastic surgeons would try to eliminate nasolabial folds with a facelift by pulling back the skin, which gave a tight, almost gaunt appearance. Although a facelift can improve nasolabial folds to some degree, Pasadena, CA, plastic surgeon John Gross, MD says that surgery alone will not completely erase them. “The folds develop as a result of lost volume. While they can be diminished with a facelift, they really need to be filled at the same time, preferably with fat,” he says.

If the skin is pulled too tight, warping can produce a somewhat unnatural-looking outcome, which was more common with facelifts performed just a few decades ago. A well-trained surgeon with an artistic eye will aim for natural-looking results, including a smooth, firm face with uplifted and rounded features.

“The only people who should know that you had a facelift are those you choose to tell,” says Boca Raton, FL, plastic surgeon, Dr. Albert Dabbah.

A facelift plus injectables or lasers

Laser skin resurfacing and facelifts both have their strengths, but when used together, the two provide an even more rejuvenated look. Montclair, NJ, plastic surgeon Barry DiBernardo, MD explains, “A facelift can tighten, but only light- or energy-based devices can improve the quality and function of the skin.”

But lasers alone can’t accomplish what a facelift can. Laser resurfacing is great for addressing skin surface problems like wrinkles and hyperpigmentation, but only a facelift can address gravity and age-related changes such as sagging skin and repositioned fat deposits, and removing excess skin.

When combined, a laser treatment with a facelift is a dynamic duo, which is why many plastic surgeons use both when designing a facial rejuvenation plan.

However, many surgeons will only use laser resurfacing in limited areas if it is done at the time of a facelift, since the combination may increase complications. You should always consult with your doctor to solve your individual concerns.

Restoring volume with injectables or by fat transfer are complementary facelift procedures widely used by plastic surgeons today.


Mini-Facelift

If your aging concerns are confined to the mid-face area, a limited incision facelift procedure may provide the results you’re looking for with minimal scarring.  

As the name implies, the mini facelift is suited to those who have a limited amount of excess or sagging skin, and fewer concerns with a droopy brow, lower eyelid and in general, sagging in the mid-face, jawline and neck.

Limited incision facelifts using short-scar and endoscopic facelift techniques reposition the underlying facial tissues to a more youthful contour.

In your 40s, if you have a mini facelift, the rate at which the lower part of the face ages may be lessened.

It’s becoming more common for women in their 40s to have small facelift procedures—known as a mini-lift or short-scar lifts—to correct the initial signs of aging and give better definition. “These procedures are different than a traditional facelift. They’re less invasive and small incisions can be hidden more easily, “says Englewood, NJ, facial plastic surgeon, Dr. Geoffrey Tobias. 

Like a traditional facelift, during a mini-facelift, the underlying muscles are tightened, which provides a youthful boost to the brows and cheeks. The face has not yet maximally aged in the 40s; a mini-lift keeps you looking younger longer.

Some Considerations about Mini-facelifts

  • Limited lifts target signs of aging in a particular area of the face. These procedures are called limited lifts because they use abbreviated facelift incisions that give your surgeon access to limited areas of muscle, fat and excess skin.
  • This procedure is appropriate for younger people who are starting to exhibit signs of droopy jowls, or people who have already had a lift, but once again are showing some signs of sagging.
  • Limited facelift incisions are generally placed at the temples and in the hairline to give the surgeon access to the underlying tissues.
  • Limited lifts are generally performed in one to four hours, usually with local anesthesia and/or sedation.
  • The results of a limited lift can make you look 10 years younger, but overall the face will continue to age naturally.
  • As with any surgical procedure, limited lifts carry the risk of nerve damage, infection, irregular scarring and complications related to anesthesia.
  • Some doctors are even trademarking specific techniques. It’s important to ask about surgical details such as incision placement of the targeted area and whether or not an endoscope is used in conjunction with the lift. 

Mid-facelift

Mid-facelift is a term used to describe a limited-incision facelift that targets the middle portion of the face.

Salt Lake City plastic surgeon Renato Saltz, MD, an innovator of the mid-facelift, believes the mid-facelift and endoscopic browlifts fit well with contemporary theories of how best to fix facial aging.

A mid-facelift can be achieved through incisions of 1 to 2 cm in length with the use of endoscopic technology. Endoscopes are cameras that allow surgeons to view and reach distant anatomies through very small incisions. Using an endoscope in surgery requires very specific surgical training. 

For a mid-facelift, Dr. Renato Saltz favors endoscopic methods. “The results can be much better, as the endoscope allows us to reach deeper or more contained pockets of fat we otherwise could not.” Because you will lose some elevation with the first year, many surgeons tend to overcorrect a bit, and Dr. Renato Saltz explains, “This is why you may look a little tight in the first few weeks after a mid-facelift.”

Endoscopic Facelift

Endoscopic lifts include the assistance of a surgical periscope inserted through limited incisions to address lifting underlying facial tissues. Only limited amounts and areas of excess skin can be improved using an endoscope.

Limited endoscopic facelifts generally erase three to eight years from your face.  After an endoscopic lift you will continue to age naturally and the procedure can be repeated in the future. You may also opt for a full lift in the future.

“The limited-incision facelift helps to elevate the cheeks and smooth nasolabial folds, as well as gives the jaw line a better look,” says Ellicott City, MD, plastic surgeon Daniel Markmann, MD.

The endoscopic lift is named so because of the special instrument called an endoscope that is used to extend the surgeon’s reach and field of vision beneath the skin’s surface.

Liquid Facelift

At some point in time lines and wrinkles trouble us all, which is where the liquid lift can help. A quick fix that literally plumps up lines and erases wrinkles, the liquid lift or injectable facelift has become a mainstay facial rejuvenator. The liquid facelift is a nonsurgical way to take years off your appearance.

“Strategically placing a variety of fillers can help to turn back the clock,” says San Francisco facial plastic surgeon David Mabrie, MD, who performs liquid facelifts.

To restore volume or to provide definition, your plastic surgeon or dermatologist can inject fillers along the cheekbone. While there are a variety of injectables available, different ones produce varying effects. Not all of them last the same amount of time.

In a liquid facelift, many of the injectables used are used off-label, “but there are several options that are considered safe and effective,” explains Plano, TX, facial plastic surgeon D.J. Verret, MD. For temporary correction, Dr. D.J. Verret suggests hyaluronic acid fillers like Restylane and Juvéderm, as well as collagen stimulators such as Radiesse and Sculptra Aesthetic.

A liquid lift can fill lines and wrinkles, increase facial volume and contour or add definition to facial features.  Liquid lifts are not used for eliminating excess skin or tightening skin. Boca Raton, FL, plastic surgeon Jason Pozner, MD, says that while a liquid lift offers a substantial change, “it doesn’t offer the same results as surgery.”

And, results are measured in months, not years.

A liquid facelift may delay a facelift

Injectables can’t prevent you from possibly needing a facelift down the road, but they can potentially delay it.

Botox, in particular, can prevent dynamic wrinkles—those associated with muscle movement—from forming. Even though injectable fillers are often used in conjunction with a facelift, they are not a replacement or substitute for surgery.

If you have severe signs of aging, like extreme skin laxity, then a traditional facelift is most likely a better alternative.

“Although a liquid facelift may produce temporary results, keep in mind that they aren’t long-term. You will need to repeat the procedure for the best outcome,” says La Jolla, CA, plastic surgeon Robert Singer, MD.

Who It Is For

Not everyone is suited to having a facelift.  If you are considering a facelift, many factors come into play that will help you determine whether a facelift is right for you.

Age

If you are under age 40, you probably don’t have enough age-related signs to warrant a full facelift or even a mini facelift. Facelifts are typically performed on people between the ages of 40 and 60.  You might be a good candidate in your 50s, 60s, 70s, and 80s, if you are in good overall health and cleared for the procedure by your physician.

Sun Damage or Wrinkles

Facelifts are not usually indicated to treat fine lines or wrinkles of the face. 

Facelifts address fixing deeper wrinkling and other age-related damage to the face from too much sun exposure, like deep lines around the mouth and a loss of definition around the jaw line stet. Loose neck skin can also be treated with a necklift or combined with a facelift.

Ask your doctor about your concerns to see if you are a good candidate for a facelift.

Be Realistic

The best candidates for facelift procedures have realistic expectations. You need to be fully aware of what surgery can and cannot do for you, as it is not a magic pill.

Look at before and after pictures with your surgeon and fully discuss your goals with your doctor before you opt for surgery.

Your individual issues and concerns are factors in determining which lift is right for you, and a consultation with a plastic surgeon is the best way to decide whether you are a candidate for a facial rejuvenation option. A facelift may not solve all the problems of aging—age spots and surface texture changes—but a variety of techniques can make you look as young as you feel. 

Who It Is Not For

Some patients have existing medical conditions that pose some medical risk to having a facelift procedure performed.

For instance, those with uncontrolled high blood pressure should not have this treatment. People who have blood-clotting conditions also should avoid having a facelift. Medical risks associated with these two conditions should outweigh the benefit of facelift surgery, which is an elective procedure.

If you have a tendency to form excessive scars, this may not be the right plastic surgery for your needs.

Find a skilled surgeon who will take the time to answer your questions. If you and your surgeon both feel like you are a good candidate for the procedure, then move forward.

What to Expect

The type of facelift you and your doctor choose will depend on the severity of skin laxity and other signs of aging you need to address. Recuperation time for facial plastic surgery will vary depending on your individual procedure combined with your individual medical profile. 

Traditional Facelift - If you have a full or traditional facelift, expect at least 10 to 14 days recovery time before returning to work. Swelling, bruising or stiffness can last up to four weeks. A facelift offers a permanent advantage in that you’ll always look seven to 10 years younger than if you hadn’t had it done. Results depend upon your general health, genetics, skin elasticity, quality of the skin and environment.

Plastic surgeon Albert Dabbah, MD, of Boca Raton, Florida, advises that sun exposure, smoking and significant weight gain and loss also can affect your facelift’s longevity. In many cases, a facelift is a one-time procedure, although that can vary depending on your age at the time of your first lift and your individual signs of aging.

Mini or Limited Incision Facelift – Recovery takes one to three weeks. You can expect results to last about eight to 12 years. The more elastic your skin is, the longer the results will last.

Mid-facelift – You will probably be swollen and bruised for four to 10 days. Results can last upward of 10 years.

Lower Facelift – A lower facelift usually necessitates a recovery period of about one week. You can expect the results to last five to 10 years.

Endoscopic Facelift – Offering the shortest recovery period of all the facelift procedures, an endoscopic facelift takes just a few days to recover from.

Liquid Lift – Depending on what types of fillers are used and where they are injected, a liquid lift can show immediate improvement or improvement over time. You may be bruised or slightly swollen for the first few days. Results can last a year to a few years.

Post-Treatment Care

The recommended length of stay varies by procedure.  For instance, eyelid surgery warrants an overnight stay while tummy tucks, facelifts and breast surgery stays average about three days.

Some ideas to help your post-facelift recovery:

Skin Adhesives: Also known as Dermabond, skin adhesives are like superglue for the skin. Adhesives offer a continuous and consistent application to join the skin, unlike sutures that provide interrupted tension. The use of adhesives can help in healing incisions after a facelift, and some plastic surgeons feel that they allow wounds to heal more quickly and evenly. In combination with sutures or steri-strips, the result is very fine, even hairline scars.

Adhesives are not right for all skins. Patients with skin that tends to produce raised scars or cannot fully break down absorbable sutures may find skin adhesives a detriment rather than an advantage.

Arnica: Also called leopard's bane, this herbal supplement reportedly helps reduce post-surgical swelling and bruising. There is no hard data proving it works, but some patients and doctors swear by it. In controlled doses, arnica is not harmful, but when taken inappropriately, it can cause serious intestinal distress.

Vitamin K: Primarily an essential blood-clotting agent, vitamin K is recommended as a topical by some plastic surgeons to reduce redness, swelling and broken capillaries following facelift surgery. It is also considered a calming agent for serious burns and has been suggested to improve scar formation. Whether or not vitamin K makes a difference has yet to be scientifically proven.

Lymphatic drainage: Some plastic surgeons believe in the benefits of gentle rhythmic massage to stimulate the body's lymphatic system. The system is responsible for regulating the immune system and defending against infectious diseases and conditions such as cancer. It also transports nutrients to cells and eliminates metabolic waste and excess fluids from the body. There is no clinical data that shows the effect of lymphatic massage as essential to healing.

Compression: Some plastic surgeons use drains, while others use a compression garment on the head and neck for a few days after facelift surgery. Clearly in the case of a necklift where deeply sagging jowls have been corrected, compression following surgery is helpful to control swelling and to support the newly sculpted skin and tissue. 

Inside Tips

  • Do not put ice or cold on your face unless specifically instructed by your doctor. After a facelift, for example, putting anything too cold or too hot on the skin can cause serious injury.
  • If you’ve ever wondered what you’d look like after facial surgery, New York City plastic surgeon Tracy Pfeifer, MD, suggests lying flat on a bed and holding a mirror over your face, which will mimic the results of a facelift.

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