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About Facelift

by Ramtin Kassir, M.D., F.A.C.S. | Learn More About Dr. Kassir

Want to look as young as you feel? Are you looking for a natural looking facial rejuvenation?

Facelift Surgery is designed to reverse the visible signs of facial aging, including the formation of jowls, which obscure the jaw line, the occurrence of a double chin and the appearance of vertical bands of the skin and muscle in the front of the neck. Dr. Kassir is a leading expert in facelifts in NJ. Patients travel from national and international destinations for Dr. Kassir's facelifts. Click here to see examples of patients who have had facelifts by Dr. Kassir and their stories.

What is a facelift?

Facelift surgery, also known as rhytidectomy, is a plastic surgery procedure performed to improve the neck laxity, jowls, and the midface. As a person ages, the midface begins to go downhill, producing the smile lines" or "laugh lines. The lower face then begins to show jowling, near the chin and the neck muscles sag, producing banding and redundancy. These three areas can be improved with the facelift procedure. The facelift does not improve the skin texture or quality.

Modern facelift techniques involve resuspending the deep connective tissues of the face and allow the face and neck skin to be elevated and produce a natural rejuvenation. These techniques avoid the "plastic" or stretched appearance so common with facelift surgeries in the past. The surgery is typically performed without the need for general anesthesia and a 1 to 3 week recovery period is usually necessary after the procedure.

What can Facelift Surgery do?

Facelifts, technically known as rhytidectomies, rejuvenate the mid- to lower face and neck. Facelifts are most effective for NJ patients who want to correct:

  • Midface sagging
  • Deep creases under the eyes
  • Deep creases between the nose and mouth
  • Jowls due to loss of muscle tone
  • Sagging areas of fat
  • Loose skin and fat under the chin and jaw

Are you a good Facelift surgery candidate?

The best candidates for facelift surgery are:

  • Wish to improve one or more of the signs of aging indicated above
  • Are men or women whose faces have begun to sag, but whose skin still has some elasticity
  • Are generally healthy
  • Are considering a facelift for personal reasons to improve their image and appearance

Recovery from Facelift Surgery

The most important thing to remember after a facelift is patience. The body takes time to heal, and your face will look worse before it looks better. Your face may feel tender and tight after the surgery, and there will be discomfort, swelling, and bruising. Dr. Kassir can prescribe painkillers to alleviate the pain, and antibiotics to fend off infection.You should be up and about in a few days, and be sure to walk around 3 to 4 times a day to increase circulation, and prevent blood clots. The bruising and swelling will subside and you should be fine in about 2 weeks. Full recovery however may take 1 to 4 months. Do not bend over or lift heavy objects until Dr. Kassir gives the all clear. Also stay away from saunas, steamrooms, alcohol, aspirin, and ibuprofen. If Incisions were made in the mouth consult Dr. Kassir on what to eat until your recovery is completed. Sleep with your head elevated for example on a pillow, and as still as possible. If you experience any extreme pain, excessive redness, or elevated temperature contact Dr. Kassir immediately.

After your rhytidectomy facelift surgery, Dr. Kassir will wrap the incisions in light bandages. On the next day your hair can be carefully washed and a week later the sutures will be removed.

At first, you may experience swelling, numbness, bruising, and a feeling of tightness or tension in the face and neck. Recovery will be noticed usually within 3-6 weeks, and sensation typically returns to normal within a few months. Scars become less red, raised, lumpy or itchy in time.

Many NJ facelift surgery patients return to work by the second week and some resume normal activities by day five.

What are the different types of Surgical Facelifts?

The SMAS (Superficial Musculoaponeurotic System) Facelift is the traditional facelift which pulls up the SMAS layer and is effective for those with jowls and skin laxity. Dr. Kassir's SMAS facelift works to lift and tighten the lower face and neck muscles as well as the skin to produce a more defined jawline and rejuvinated lower face

The Deep Plane Facelift is a modification of the traditonal facelift that works more effictively on the midface areas such as nasolabial folds. During surgery, Dr. Kassir lifts the fat pads and muscles of the cheeks to restore volume and youth in the midface region.

The Endscopic Facelift is a minimally invasive technique using small cameras to guide insturments and allows for lifting the midface and brow.  It is most effective for patients seeking to make moderate corrections of a downturned mouth, sagging cheeks, hollowing under eyes, or a drooping forehead. Incisions are only about one inch long and are typically made above the hairline and/or behind the ear, resulting in hidden sutures, a quick recovery time, and almost scarless incision sites.

The Midface Lift is a procudure to specifically targert the areas of aging in the midface; the areas between the cheekbones.Dr. Kassir's midface lift is performed endoscopically to reposition the malar fat pads in the cheek area to restore volume in the midface. 

The Mini Facelift is related to the traditional facelift but involves smaller incisions behind the ear and focuses on adjusting the skin.  The best candidates for a Mini Facelift are patients who are just starting to show signs of aging and seek to tighten their skin, reduce sagging, and reduce nasolabial through a minimally invasive procedure.

The Tissue-glue Facelift is a technique that uses fibrin, a safe biological agent, to close inscision as opposed to sutures.

More Facelift Information

One of the most common procedures in plastic surgery is the facelift. According to the American Society of Plastic Surgery 124,000 facelifts were perfomed in New Jersey in 2012, and in New York facelifts were up 42 percent from 2000 to 2011. Our skin is constantly changing, and the older we become the more our skin cells break down, and divide slower. The dermis, or lower layer of the skin, begins to grow thinner as well. The dermis is comprise of different types of tissue, including elastin and collagen. While the elastin provides elasticity for the skin, the collagen keeps the skin taut. Over time these proteins begin to break down, and results in the loss of elasticity in the skin and deeper tissue. The skin begins to sag as well as the muscle and tissue composition under the skin change, and leads to wrinkles. Although a facelift can lead to younger looking face with a better jawline, neck and midface, it cannot completely erase the signs of age, or fix all problems such as sagging eyelids, eyebrows, or skin discoloration. These problems can be fixed with other procedures for example, an eyelift, browlift, or chemical peel. The procedure of a facelift takes time for recovery, and has minimal risks.

Since every patient is different, the procedure will be different for everyone as well. Dr. Kassir will examine the skin, and explain the procedure to you. Smokers will be asked to stop smoking for a week or two before the surgery, and a few weeks after as well. Smoking is not advised since it inhibits blood flow to the skin, and can interfere with the healing process. Patients are also asked to avoid aspirin or other medications that increase bleeding.

The facelift surgery can be performed in Dr. Kassir's office or accredited surgical center. The patient is usually given a local anesthetic or sedative for the facelift procedure. An incision is made around the temple along the hairline, and goes down to the earlobe. An additional incision is made underneath the chin to tighten the skin of the neck. The skin is then separated from the muscle and fat, and the fat may be trimmed or sucked out via liposuction. Dr. Kassir then takes the SMAS (Superficial Musculoaponeurotic System) and repositions it at a higher, more youthful level. Tightening and reposition the SMAS in this manner gives the jawline a sleeker look, and firms the neck. The skin is then pulled back over the area of the incision and the excess skin is removed with a laser or knife. The incision is then closed with stitches, sultures, or tissue glue.The stitches are placed within the hairline so they are hidden. The surgery takes about 2 to 4 hours depending on the extent of muscle and tissue work. There are other methods to achieve a younger looking face, that require less time for recovery, such as the K-lift™ or liquid facelift with restylane, perlane, belotero, radiesse, juvederm, scultpra, artefill, or fat.

Many other types of facial lifts are favorable including the mini-lift due to its short recovery time, the S-lift and the K-lift™ which focuses on the lower part of the face (neck and chin), mid-facelift which includes small incisions in the hairline, above the ear, and inside the mouth, and the Tissue-glue facelift which uses tissue glue to seal the incisions made. Some non-surgical techniques are also available with lower costs and fewer risks. Thermage or thermacool uses radio frequency to activate the body's natural collagen, and causes the skin to tighten and contract. This technique is best used for slight wrinkles, and the results can last from six months to two years. Ultherapy uses sound waves to achieve facial and neck tightening. Another alternative is the ThreadLift or FeatherLift, which involves inserting a needle with a surgical thread (or a non-absorbable sulture) into the skin. The thread is then pulled tight, and the muscle and tissue tightens with it. This technique leaves no scars, and the thread remains in the body. Some risks of facelifts include infection, scarring, reaction to anesthesia, hematoma, damage to facial nerves, necrosis, and alopecia at the incision site. These risks are minimal, and the procedure results in a younger looking you

What Does a Facelift Cost?

The average cost of a rhytidectomy (facelift) can range from $7,000 to $25,000, depending on what's being done and the problems being addressed. The cost of revision and corrective facelifts are higher. This encompasses the anesthesia, the fee for the facility, and the remainder is the surgeon's fee. Having more than one procedure at the same time, such as a browlift or eyelid surgery, may also be cost saving since the cost for the anesthesia and facility are being paid.

Are Facelifts Safe? 

Facelift surgery or rhytidectomy is a safe procedure if performed by experienced surgeons. Dr. Kassir performs many facelift surgeries per week and also corrects “botch” jobs.  That's why it's so important to pick your surgeon carefully and be an informed consumer. Be sure to direct any questions towards Dr. Kassir. It is normal to feel anxious or nervous about your new look. Afterwards you will have some swelling and bruising, and in a few weeks you will enjoy a rejuvenated look! Be patient. If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment. The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. Be sure to follow Dr. Kassir's instructions on how to take care of yourself after surgery.

Do you Need a Facelift?

Signs of an aging face:

1. Wrinkly skin: Over time your skin's natural collagen and elastin begin to breakdown, which causes wrinkles, lines, folds, and a sagging look. A facelift can help with the sagging skin, but problems such as lines and wrinkles can be better addressed with injectable fillers, and good skin care.

2. Sunken eyes: As fat under the eyes starts to descend, your face develpoes a more sunken look. This looks like a loss of volume around the cheeks, and can be fixed most efficiently with a blepharoplasty, small amounts of fat grafts, or injectable fillers as a non-surgical option. Your blepharoplasty can be performed at the same time as your facelift.

3. A saggy jawline: When the jawbone loses density over time, there is less of a structure for the skin to hang on to, therefore the skin begins to sag. To correct this, the loose skin must be excised and the remaining skin must be tightened by a facelift.

4. Bone changes: With time then density of the bones in the face begin to reabsorb. This makes the eyes appear sunken, the jawline becomes less defned, and the cheeks appear flatter. A facelift can help with these changes.

5. Loss of volume: As your face begins to lose fat, the skin begins to droop. The more fat that is lost, the more pronounced folds and lines are. Fat can be taken from a different areas and added during your facelift to add more volume. Fillers can also be injected either before or after your surgery to gve your face more volume.

What to know before you have facelift surgery:

1. Your facelift expectations need to be realistic: A facelift is designed to make your face look refreshed, younger, and fix any laxity. A facelift can't always eliminate every wrinkle and line, and doesnt mean you will look 20 years old again. Dr. Kassir explains that the goal is to create a younger version of yourself that gives you a "rested" and "natural" look. Dr. Kassir fequently reverses and undo's the "windblown", "pulled", and "Hollywood" look.

2. You will have scars after a facelift: Although techniques have improved throughout the years, a facelift still leaves scars. Dr. Kassir makes incisions along the sidburn and ear so they are hidden by the hair, and inside the ear canal. With most patients, scars improve over time and blend in.

3. There is some downtime after a facelift: It may take 10 days to a couple of weeks until you are ready to resume daily activities, and a few months until all of the swelling goes down. With most patients bruising is slight, and pain is minimal. Most patients report that although they barely have pain, there is a bit of tightness involved that will go away the more you heal.

4. Know what can and cannot be fixed with a facelift: A facelift is meant to restore a youthful shape to your face, but it will not improve the look of brown spots, fine lines, or the position or shape of your eyelids and eyebrows.

You should pick facelift surgery if:

1. You want long-term results: Unlike other age-reversing treatments like lasers and injectables (which don't address lack skin), the results of a facelift are very long-lasting.

2. There is loose skin: Loose skin  at the jawline and on the neck creates the look of a double chin or a "turkey waddle". Microliposuction can eliminate unwanted fatty areas, but loose extra skin needs to be excised.

3. There are lines and folds: Over time facial expressions cause the skin to crease and fold which causes lines. Although fillers can help eliminate these lines and folds, lax skin needs to be addressed with surgery.

4. You imagine how you would look with a facelift : If you pull your skin back and see how it would look tighter, a facelift is the only was to get long lasting, elevated results.

Are you a candidate for a facelift?

If your face is oval, you may benefit from a facelift. Hollowing in the temples and cheeks is common because of extra fat in the cheeks, which dissapates over time. Fillers and/or fat fill out hollowing; a mid-facelift helps with sagging.

If your face is round, you may benefit from a facelift. The cheeks and lower face may sag. A lower facelift, which targets the lower part of the face, is the best option. The cheeks can be resculpted by injecting fat and/or fillers.

If your face is rectangular or square, you may benefit from a facelift. loose skin and sagging jowls on the lower part of the face tend to be the biggest problems. A traditional facelift is likely the most effective solution as it addresses jowling and lax sking.

If your face is heart-shaped, you may benefit from a facelift. The forehead and upper eyes are most affected. Since the cheekbones are higer than square faces with flat cheekbones, hearts-shaped faces tend to ages slower.

Facelift: Questions & Answers

Can a Mid-face Lift help with sagging eyes?

Though the midface lift does help address sagginess in the cheeks, it can help tighten skin under the eyelid. However, for true results, removing the lower eye skin in a skin pinch procedure under local anesthesia might be more advantageous.

Can I have a facelift at 80 years old?

The only issue with age and timing for facelift is whether the patient is healthy. It is fine to have a facelift at that age, yet the surgeon must make sure to understand that the skin and deeper facial tissues may be thinner at this age compared to patients in their 50s and 60s. Patients who have pacemakers must have them demagnetized though and must make sure that their blood pressure is healthy prior to surgery.

Why aren't composite facelifts common anymore?

It is strange to think that composite facelifting has sort of gone by the wayside, as they say, but I would have to disagree with people who state that there is only one way to address certain problems in a patient. Depending on the plastic surgeon and the patient’s preferences, there are many techniques which could be used to solve the same problem. Therefore, it is important for patients to find the best plastic surgeon for them and find the right procedure for their specific needs.

What is Decadron?

Decadron is a steroid which works on the cellular level to decrease swelling and nausea in the patient. Even patients taking hydrocortisone for adrenal insufficiency are able to take this medication.

Any recommendations for facelift surgeons in South Florida?

The ASPS website has a physician locator feature that will provide a list of qualified surgeons. It is probably best to consult with several surgeons in order to find the one that best meets your needs.

How do I treat my parotid fistula post-facelift?

The best treatment for this would probably be the use of a Scopalamine patch and having a patient keep a very bland diet until saliva output decreases. Again, however, this problem is usually very temporary and the patient should remain calm.

When can I get a second opinion on my facelift?

Patients should probably wait for a minimum of six months post-op before having a second opinion on their facelift simply because the skin needs time to heal and re-establish blood supply. Unless there are major problems (e.g. infection, major pain, etc.), this is probably the ideal time frame.

Can I get a facelift at 35?

Usually, for younger patients, it is not advisable to have a facelift especially given the drastic consequences which it could have. Also, it does not seem that skin laxity in the face is a problem (photo evidence would be needed to prove this though). The best option for you would probably be less invasive technique like laser surfacing or Botox.

What can I do about my face in my 30s?

For patients in their early 30s, doctors will tend to recommend lesser, non-invasive routines than a facelift. Such solutions include implants particularly for the jaw areas (e.g. chin-jowl implant) which helps stretch the jaw and reduce jowling as well as submental liposuction to allow for a decrease in neck fat.

Can I have a facelift post-kidney transplant?

Patients looking to remove fat under the chin and the neck area should look into the option of microliposuction to the face and neck as a short-term option. Long-term, after several months or so, a minimal incision facelift can be performed, but generally, extensive surgery should not be used as a first line of treatment.

How can pain be controlled post-facelift?

Pain medications are often helpful in treating pain, but for great swelling and burning pain, other medicines like Neurontin or Lyrica may be needed. Consult with your doctor before taking any potentially harmful medications.

Should I have fat injections or multi-level fat grafting with a facelift?

In general, fat grafting is a technique used for effectively addressing volume loss and is usually best combined with a facelift for maximum results. In general, I would recommend that patients trying to choose between these two options see their surgeon and decide for themselves.

Will the MACS facelift make my cheeks bumpier?

Especially on patients with thin skin, the MACS Lift which involves pursestring sutures that elevate deeper tissues can often create noticeable lumps on a patient’s face post-op. For these patients, a limited traditional SMAS Lift may be the better option.

Can I do a facelift under an oculoplastic surgeon?

Especially for larger procedures like a SMAS or deep plane facelift, it is probably best advised that the patient exclusively sees a board certified plastic surgeon. Many oculoplastic surgeons are very skilled in procedures around the eyes, however, so they remain an option for these areas.

Why do I have a depression of the zygomatic arch post-facelift?

A depression in the zygomatic arch could be attributed to the atrophy of the temporalis muscle. In this situation, fillers, fat grafting, or even Sculptra treatment could all help.

Is there an advantage to stem cell facelifts?

The problem with the stem cell facelift is that it is not really a facelift in the true sense, but rather a modified method of fat grafting. Studies have shown that it really does not do more for the patient than simple fat transfer which can last for several years.

Will steroid injections cause weight gain or flare-ups for rosacea patients?

Dilute steroid solutions should not cause either.

Is getting a facelift early detrimental?

Though patients should not get facelifts until they are truly ready, there is no harm in having one early under the hands of an experienced and capable surgeon. Especially if early signs of aging are present, treating them earlier may help create more long-lasting results. But consult with your plastic surgeon about this.

How can I correct deep nasolabial folding?

Patients who have very little success with fillers and fat grafting generally experience better results with a lower and mid-face or cheek lift in a way that would help the tissue falling over the corners of the mouth to be elevated. Botox in the mouth could also help with the “frown” look.

Can I have a rhinoplasty post-facelift?

If the patient is particularly ambitious, rhinoplasties can technically be done after 30 days of healing. However, to ensure the best results, it is probably best to wait for any residual swelling to go down which could take as long as 6-9 months.

How did my balding happen suddenly after my facelift?

When associated with surgery or stress, hair loss is usually caused by a condition known as alopecia areata which is completely reversible. Waiting a couple of months post-op is the best option for patients.

Can I get another midface lift right after my first facelift?

I would be careful of having an aggressive subperiosteal midface lift so soon after a facelift and would instead look to substitute it with fillers or fat injections which fulfill the same task and are less invasive.

How much does anesthesia and facility fees cost during a facelift?

Depending on the surgeon, geography, overhead costs, etc., the price for facility and anesthesia fees will vary. Patients should spend significant time researching their surgeons in order to provide a rough estimate of the costs. Generally, urban areas will have higher facility costs and more extensive anesthesia (general) will be more expensive than local or IV sedation.

I'm dissatisfied with my facelift. What can I do?

After the operation, it is important for patients to give themselves times to heal. Swelling and bruising will be rampant for the first couple of weeks and the patient should expect to look worse before things begin improving. If any concerns are present, consulting with their plastic surgeon could help, but is usually unnecessary.

How can I address my concerns about general anesthesia?

It is perfectly normal for patients to have concerns about general anesthesia and, if this is the case, they should consult with their plastic surgeon about it prior to surgery. However, anesthesia is very safe and patients should not be concerned unless health problems present an issue.

What is the cause of hard swelling post-MACS lift?

Patients experiencing this symptom could be experiencing a laundry list of symptoms from a deep hematoma to a hardening of surrounding tissue caused by tightening due to a MACS Lift Suture.

What are procedures for sagging at age 24?

At age 24, except in special cases, facelifts are usually out of the question and are far too invasive. Some options for addressing these problems could be through the use of filler and fat injections to add volume to the face and laser treatment for facial resurfacing.

How is tumescent fluid used during a facelift?

Tumescent fluid is a combination of local numbing medicine (lidocaine,etc.) coupled with adrenaline (epinephrine) used in order to constrict blood vessels and reduce bleeding. Generally, it is not used as the sole source of anesthesia but is used in conjunction with sedation or other forms of local anesthesia.

Is nerve damage post-facelift permanent?

Again, after having a facelift, it is very uncommon for patients to sustain nerve damage. Generally, nerve damage recovers over a long period of time, but may be contributed to synkinesis which can be treated through Botox injections.

What is this hot lump on my face post-facelift?

Generally, patients dealing with major lumps post-surgery are dealing with hematomas where cells break up, releasing salts and drawing fluid to create more swelling. Needle aspiration of the area is usually required to test for infection.

Can I get a facelift at 45?

Often, it is not the age of the patient but the symptoms which the surgeon considers when deciding on a facelift. At this age, is not unreasonable for you to believe that you need a facelift. Such a procedure could be beneficial, but fillers and fat augmentation could also give you similar results with less invasiveness. You must decide with your plastic surgeon which route you want to take, as I believe both will improve your overall facial structure.

What are these ridges on my cheeks several months post-facelift?

Several months post-op, it is unusual to have swelling around the incision site. Such symptoms could be the mark of an edema or possible fluid, but may be an underpulled skin flap. Again, a more face-to-face exam is probably necessary.

Is the facelift procedure different for a patient with sleep apnea?

Patients who have severe sleep apnea and require a CPAP machine should be monitored 24 hours in a hospital following the facelift to avoid a severe apnea episode.

Is swelling post-endotine face lift normal?

For patients several weeks post-op, it is perfectly normal to experience swelling. Consultation with the surgeon and looking out for infections are probably the best routes for these patients.

How can I tell if my facelift was well done?

Examining the results of a facelift consists of carefully inspecting the before and after photos taken with the same facial expression to check for any differences. Take care to look for aging features in both photos and examine them from different angles. Ultimately, the surgeon’s job is to create a younger looking more natural version of the patient.

What is the relationship between weight loss and a facelift?

Patients, when having a facelift procedure done, should attempt to keep their weight stable, meaning that any substantial weight loss/dieting should be done prior to surgery. However, patients who lose weight after a facelift will generally have the same benefits, as do patients who use standard fillers like Juvederm or Restylane.

How is aging affected post-facelift?

The extent to which aging increases/decreases post-facelift depends on the way the surgery was performed. Generally, if performed adequately, the surgery should not cause any changes in skin texture or blood supply to the skin, meaning that aging should not be affected generally. The point of a facelift is not to alter the aging clock, but simply to reverse it temporarily. A facelift, if done correctly, should be followed by normal aging without any facial distortion.

What is a deep plane facelift?

A Deep Plane Facelift is a more intensive version of the classic SMAS Facelift. The Deep Plane Facelift involves cutting and repositioning skin and removing parts of the SMAS layer. The way in which the SMAS layer is manipulated leads to more significant changes in the midface than a SMAS Facelift. The Deep Plane Facelift also last longer, and tends to require less revision surgeries years down the road.

Any good tips for patients undergoing facelifts?

The best way to avoid complications during and post-surgery is by making sure that all questions are answered. Be frank and open with your surgeon and ask anything which could be troubling. Also, quitting smoking and following other orders by your surgeon is also important.

Are raised sideburns a concern post-facelift?

Generally, most facelift operations are made to have scars that look as inconspicuous as possible. Scars, in an effort to avoid raised sideburns, may be placed horizontally along the top of the ear.

Why are there jowls and double chins post-facelift?

For patients who have jowls remaining after a facelift, it is probably best to realize that the deeper layers of the face and neck (SMAS, etc.) were left relatively unaffected causing the development and the remaining of saggy jowls. Microliposuction or fractional resurfacing could be used to treat these symptoms.

What distinguishes a deep-plane facelift from other procedures?

The procedure for a deep plane facelift is very much like the procedure for a SMAS Lift, yet carries the steps of the SMAS Lift much further. In this surgical operation, small incisions are made along the hairline in an effort to reposition facial muscles and upper fatty tissue layers. These incisions are then extended downward along natural creases along the face and proceed along the edges of the ears ending behind the earlobes. After this is done, the skin is separated, leaving the SMAS layer behind. Going further, the surgeon then ventures underneath the SMAS layer (into the “deep plane” layer), cutting attachments and repositioning certain areas in order to create a more tension-free, vibrant look in the face. Finally, after the necessary SMAS portions are appropriately repositioned, excess skin is removed and the edges are sutured. Again, this procedure is a much more invasive version of the SMAS Facelift and is known to be more effective in correcting nasolabial folds (“laugh lines”).

Will more facial work mean more swelling?

Patients who have major facial work done, meaning several major procedures done concurrently, should expect a great deal of downtime AND a longer period of swelling and bruising as they are dealing with internal and external healing. Optimal results may be in store if the patient is willing to wait up to several months.

Can an S-Lift help with jowling?

Generally speaking, the S-Lift is not a fully adequate procedure to use when patients want to address jowling. The S-Lift is more of a procedure which lifts the skin and does not frequently touch the deeper SMAS layers of muscle and fascia which control jowling. Perhaps a more invasive facelift is needed to address jowling.

What is your opinion on SMAS vs MACS vs Short Scar Lifts?

All three of these procedures are considered true facelifts. The only variance between them, however, is the scale on which they are performed and the areas they specifically address. A mini-face lift, more frequently used for younger patients, consists of a small incision made behind the ear and only adjusts the skin, leaving the underlying muscular structures intact. This procedure is more frequently used for younger patients and is generally less invasive. In an attempt to avoid the windswept look (AKA the windtunnel face) which is a potential side effect of normal facelift, the MACS lift relies on the vertical lifting of the skin, creating a more natural, less apparent look. Surgeons often describe it as a variation of a normal “short-scar” or “S” Lift because of this. The operation of the MACS lift involves the creation of a small incision within the hairline in front of the ear. The traditional facelift, however, is more extensive and involves an incision near the hairline which extends behind the ear. During this procedure, excess skin is cut and the remaining skin is pulled and sutured. This surgery is more frequently used for those with excessive neck fat and it corrects skin laxity in the lower face.

What is the miracle facelift?

There are many so-called “miracle” products on the market right now which claim to be able to substitute for facelifts and other surgical procedures. However, again, I would remain wary of these devices and would stick with traditional methods that have been proven to work.

Are revision facelifts common?

Generally, in the hands of an experienced facial surgeon, the need for revision is relatively low (about 1 to 6 percent), but the risk for revision increases if the patient is overweight, has a generally heavy neck, smokes, etc. Talk with your surgeon to best understand the options which you have.

Does losing weight help before having a Facelift?

On the contrary, losing weight may make things worse. People desire a facelift because of increase skin laxity and loss of facial volume. Losing weight means volume loss in the face, that may need to be replaced during a Facelift with Fat Transfers. However, if you are at an unhealthy weight losing weight may be a priority.

What can I do about sagging skin in my 40s?

Certainly, patients in their late 40s should not be considering a facelift as a first line of treatment. Generally, a good start would be to have a “mini” necklift done and avoid a facelift due to the possibility of making the jaw too feminine (not to mention the scars which develop). Facial skin resurfacing and Botox could also be good, non-invasive options as well.

Why do I have beads under my skin post-facelift?

Patients experiencing the sensations of beads under the skin are probably dealing with minor blood clots or sutures. The former problem can be dealt with by massage, but the latter should be taken care of by the surgeon.

How can I fix my droopy cheeks?

Without photographic evidence, it is difficult to actually prescribe a line of treatment for patients. However, for droopy cheeks, I would say that the best method of treatment would be a cheek lift. Consult with a plastic surgeon about this and patients who have had this done.

Any inexpensive, but good, surgeons you would recommend?

In the world of plastic surgery, it is important to remember that price is relative. You can probably find a surgeon that will do a great job that fits your budget. It all depends on what you think is inexpensive. However, the patient should remember that often, you get what you paid for, so it is important NOT to let price be a guiding factor.

Can fillers be done in conjunction with a facelift?

Volume augmentation with fat grafts can definitely be performed at the same time as a facelift to restore the volume that the face has lost.

Facelift Costs

The total cost of a Facelift is made up of several components, including: surgeon’s fees anesthesia fees, facility fees, and other variable costs. Some of the average costs for these components are listed below:
· Upfront surgery cost – $6,000 to $25,000
· Anesthesia – $1,300 to $3,600
· Facility/hospital fees – $1200 to $5,000
· Surgeon’s fee – $7,000 to $25,000
The other variable costs include blood tests, X-rays, a physical exam, prescription medications, bandages/elastics, and many more costs.
In addition, the previously outlined costs range depending on several variables. One major variable is geographic location. For example, Urban areas like New York City or Los Angeles, have highly capable, experienced, and reputable plastic surgeons, and tend to have high overhead costs (money spent on maintenance, rent, wages, etc.). This often translates into higher surgery costs for patients. Another important variable is the type of facelift, since by their very nature some facelifts such as the SMAS facelift or the deep plane facelift are more expensive in comparison to their lesser counterparts like the K-lift® (nonsurgical face-lift).

What certifications should you look for in a facelift surgeon?

When doing a plastic surgery, it is probably for the best that the surgeon be certified by the American Board of Plastic Surgery. Even for mini-lifts, which are not considered as invasive as facelifts, a great deal of experience and training is needed for good patient satisfaction.

Why are my facelift results so tight?

Patients are expected to feel a great deal of tightness post-op and swelling combined with blood clots are perfectly normal (they also exacerbate the tightness as well). It is probably best, if patients are worried about tightness, to wait for time to improve these conditions.

What is a short-scar lift?

Short scar lift/mini facelifts, like many facelifts, are done under local anesthesia and are performed by creating an incision in the back of the ear towards the earlobe. They, however, merely address the skin, rather than the underlying muscle tissue (SMAS layer of the skin), meaning that the results typically last for a maximum of about a year (the usual recovery time is about 2 weeks).

Why do I still have jowling post-MACS lift?

Unfortunately, patients who are unsatisfied with their jowling post-MACS Lift have fallen victim to a common problem in facelift surgery. The MACS Lift, while being effective for some, is totally ineffective for those who want penetration into the deeper tissues, for which there is no cure but the SMAS Facelift.

Why do young people not need facelifts?

Generally, facelifts are reserved for patients who have problems with skin laxity, not with volume loss. Rarely does a young person have premature signs of aging such as jowling and neck laxity in which it would be appropriate to offer the patient a face and neck lift.

Can microcurrents address facial drooping?

Again, like many other methods of so-called “treatment”, I remain rather dubious of microcurrents. Granted, they give you some improvement, but major facial drooping can only be corrected with facelift surgery.

How can I address rippling post-facelift?

It is unusual for patients to demonstrate ripples, especially months after a facelift. This may be caused by residual swelling, but more importantly, may be the result of underlying scar tissue. If the problem continues for about half a year, it is probably best to consult with the surgeon. Until then, patients are encouraged to massage the area.

Can I get a facelift after cheek implants?

Patients who already have cheek implants in place generally do not require a subperiosteal midface lift. Either the cheek implants should go or the surgery should be avoided.

How long will my face feel tight after a Facelift?

The amount and duration of tightness you feel will depend on the type of facelift procedure and the surgeon’s style. More invasive Facelifts that suture muscle layers will feel more tight than others. The first 2 weeks are the tightest, and by 2 to 3 months the feeling of tightness will be virtually gone.

What is your opinion on endotine periorbital lifts?

Endotine, for me, does not have a useful role in facial rejuvenation. It is a foreign body and creates unnecessary scarring and inflammation. The best option would be to consult with a plastic surgeon trained in problems of facial aesthetic surgery.

Can Sculptra be done post-facelift?

For patients willing to plump their cheeks and rid themselves of tear troughs, a Sculptra procedure can be done post-surgery once the swelling has disappeared (6 months or so post-procedure). This is in order for the patient to have more symmetry in the face prior to Sculptra procedure.

Can spacer grafts be performed during a midface lift?

For facelift patients who happen to have severe lower eyelid retraction, it is often necessary to perform a spacer graft procedure in concurrence with the facelift surgery.

What should I consider when choosing to undergo a facelift?

Generally, the best way to determine where to undergo a facelift is to evaluate the surgeon’s experience, training, and their before and after photos. Patients should choose the doctor who they are most comfortable with.

What kind of sunscreen should I use post-facelift?

Patients who wish to use sunscreen post-op should probably go with a simple zinc oxide or titanium oxide formula or even non-oily coppertone SPF 30 or 50.

Can I a have True Facelift after having a Thread Facelift?

The fact is that Thread Facelifts only yield temporary results, and tend to be overpriced for the results they give. Clinically there shouldn’t be any reason why a patient can’t have Traditional Facelift (SMAS, deep plane, etc) after a Thread Facelift.

I think my doctor made a mistake during my facelift. What can I do?

Generally, patients following facelifts will have certain areas of concern like scars and nerve weakness. These issues tend to resolve themselves over time, but patients must remain calm and remember that the healing process is gradual.

What can be done about my post-facelift parotid gland swelling?

Patients may, after having a facelift surgery, experience swelling of the parotid gland which must be reduced. Generally, the use of Botox or the scopolamine patch can be used to improve the area, but must be done in the hands of an experienced surgeon to negate the possibility of infection.

Can peroxide be used as an antibacterial agent during and after a facelift?

Patients using peroxide should probably stop using it as an anti-microbial agent as it is known to slow wound healing and cause a drying of the skin edges. Skin sloughing at this point could also be a problem due to excess tension on the skin.

What is the MTHFR gene mutation?

This gene mutation which is noted for creating an increased risk of blood clots and other vascular complications may present problems during surgery. It is important for patients with this condition to be cleared by the hematologist prior to undergoing surgery in order to avoid hematomas.

When will I look "normal" after a facelift?

Generally, patients should be looking at a healing time of 2 months or so following a facelift for results to begin to normalize.

Can dermal fillers be put in before the surgery?

If patients wish to have fillers added prior to surgery, the best initial option would be to first consult with their surgeon. However, inserting fillers prior to surgery will distort the anatomy of the face and will probably not address areas which could be hollowed-out post-op. Generally, it makes more sense to have fat/filler injections done during or after surgery.

What are some non-invasive alternatives to facelifts for younger patients?

At your age, it is probably inadvisable to look at surgery as the first line of treatment especially because skin laxity is usually not a great problem in the late 30s and early 40s. Other non-invasive options exist such as neuromodulators, fillers, laser-based procedures, and soft tissue tighteners.

Is residual distortion normal post-MACS Lift?

Unfortunately, as I have stated before, the MACS Lift is a surgery which works well for some patients and not so well for others. Patients in the latter category, because of the rather limited nature of the MACS Lift, may need to undergo secondary facelift or mini-lift surgery to achieve optimum results.

What can be done about my chin dimple and bulbous nose?

Dimpling of the chin can generally be improved greatly with Botox and the nose can easily be fixed with a bulbous tip reduction. Furthermore mentalis bunching can be corrected with the use of a chin implant.

What is the difference between Men and Women having Facelift?

Facelifts for men are typically more challenging than for women. Men tend to have more vascular and more supported skin, as well as larger faces than women. This means Facelifts for men take more time, and that men bleed more than women.

Should I have a facelift or a hemi-facial spasm surgery first?

The best route, in my opinion, would be to do the latter surgery before the facelift.

When can facelift sutures be removed?

Generally, sutures are removed very gradually, with some removed after one week in front of and behind the ears and others located behind and above the ears removed after two weeks.

Will healing after a midface lift be impacted by excessive facial movements (smiling, laughing, etc.)?

Patients worried about affecting the results of the facelift with excessive movement of the face (smiling, talking, etc.) should not be so concerned. Again, the elevated tissues modified in the facelift are fixed in place with sutures and/or Endotine devices and will be released in time.

What should I be looking for in Before & After photos?

In before and after Photo’s you should focus on whether the person still has the same facial structure that defines them. Then look to see if the person looks like a more refreshed and youthful version of themselves.

What can I do about a previous “ugly” MACS surgery?

The difficulty with MACS procedures is that since it is performed with vertical suspension, the surgeon must be very experienced for the results to be correct. You should come into the office for a consultation to see what type of revision surgery would work best for you.

Can nerve damage occur from a facelift?

With an experienced surgeon, it is very unlikely that injury to the facial nerve will occur during surgery. Again, many surgeons are certified by the American Board of Plastic Surgery and are often trained to avoid such complications. Therefore, the risk is relatively low (around 1% or so), even if a small cyst is removed. However, if doctors are removing large objects like a tumor, the chance for nerve injury increases, so take care to select a surgeon with great medical skill.

When can I get another facelift?

Patients must remember that a facelift is only a temporary measure which, rather than stopping the time clock entirely, sets it back about 10 years. Because of this, aging often initiates the necessity for a second facelift particularly when volume loss and skin laxity continue to be a problem.

Can I have fish oil post-facelift?

Fish oil and other medications should probably be avoided weeks before and after surgery. The surgeon will provide an indication as to which medicines should be avoided.

How can loose skin around the mouth be dealt with?

Loose skin around the mouth area, especially for younger patients, is usually best addressed with the use of fillers or fat grafting.

Are Stem Cell Facelifts the new Trend or just another Fad?

Stem Cell Facelift take fat stem cells from the thigh, buttocks, and other lower body areas and transplant them into the face. The idea is that these stem cells will grow and fill in what has been lost with age. Some patients have noticed significant improvements, however so far research has not shown it to be better than other fat augmentation procedures This technique is new and it is probably best to proceed with caution.

What are less expensive options than a facelift?

Facelifts come in a variety of forms depending on the desire for invasiveness and results on the part of the patient. Generally, however, younger patients are not recommended to get a facelift and should instead rely on other, non-surgical methods like fractional laser resurfacing, fillers, and Botox to aid in the youthful rejuvenation of their face.

What are side effects of a facelift?

Side effects, though rare, include
• Infection
• Bleeding
• Scarring
• Numbness
• Hair loss along incision lines
• Facial nerve damage (very rare)

What is the procedure for a secondary facelift?

To be honest, there is no set procedure for a secondary facelift. It all depends on the surgeon’s skill, knowledge of facial anatomy, experience, the patient’s facial structure, and several other factors. Generally, if you find an experienced surgeon, he/she will be able to yield the desired results.

How can I determine if a clinic is up to standard for a facelift?

Patients should check if offices have some sort of safety standards, preferably AAAHC or JCAHC (or even Medicare facilities) which hold surgeons, RNs, etc. responsible. Patients can also avoid general anesthesia if they are especially anxious.

Why is my facial surface so uneven post-MACS facelift?

Uneven surface features following a MACS Lift can be attributed to an attached pursestring suture, tethered tissue underneath the skin, etc. Yet, many of these issues can be corrected with revision surgery and the same scars can be reopened.

What can be done about chin scarring post-facelift?

Chin scarring is generally the hardest and most irritating scar and usually takes up to three months to heal. Usually, in order to speed up this process of healing, pressure is put on the incision using a foam pad secured with a bandage which is worn for 6 hours a day.

Is 76 too old for an Acculift?

To be honest, if a patient is serious about a facelift procedure especially at the age of 76, it is probably best to go for the more long-lasting, more invasive procedures. The Acculift procedure does very little actually tightening the skin and has been shown to reduce volume and fat, making it almost useless for MANY patients.

What are the basics of facelift surgery?

An incision is made along the hairline, that extends around and behind the earlobe. Skin and muscle are pulled towards the incision, trimmed appropriately, and are sutured/clipped/glued closed. The various /procedures can take from 2 to 5 hours, with a minimum recovery of 2-3 weeks.

Can sagging be addressed via a lower facelift?

Especially for patients who have had jaw reduction surgery, poorly attached skin can be a problem especially as the plastyma muscle and the submental fat pad under the chin are moved down. To correct this, a procedure will be needed to reduce submental fat pads near the platysma (liposuction, etc.) and tighten the platysma muscle.

I have ear canal issues post-facelift. What can I do?

Any issues with the ear canal are probably be resolved with an appointment with the plastic surgeon. Swelling and bruising around the ear is perfectly normal in these situations and should not be a major issue for the patients.

What can I do about ptosis and lacrimal gland swelling?

It is probably best for patients dealing with these conditions to first see an ophthalmologist or even an oculoplastic surgeon to examine the lacrimal gland swelling. If ptosis surgery is needed afterwards, it can also be done.

What are the pros and cons of Acculift?

Generally speaking, the Acculift procedure, in the grand scheme of things, does very little for patients who are serious about facelift surgery, particularly those in their later years. Residual neck bands and poor facial definition are just some of the post-op complications which can occur.

Should tissue damage be a concern in a facelift?

Like any procedure which separates the skin from underlying tissues, a facelift does come with its share of risk, namely of damage to the skin. However, because the face is so vascular, such risk is relatively minimal.

I got parotid swelling months after facelift. Why?

Generally, if deficiencies are not present immediately after the surgery and appear a while post-op, they are usually not related to the results of the surgery. It is more likely the result of a parotid gland problem which can be resolved by seeing an ENT.

What is the cost of a ribbon lift?

Again, over the years, the ribbon facelift has gone down in popularity simply based on the overwhelmingly high cost to benefit ratio. I personally would not recommend this procedure, but, if dead set on this particular technique, average costs hover $3500 to $5,000.

My doctor is giving me a half-priced facelift. Should I do it?

As with most surgeries, it is probably best to remain wary of “discount” facelifts. Unless the doctor is a Board Certified Plastic Surgeon, it is not a good idea to undergo surgery.

How can pixie ears be corrected post-facelift?

Generally, pixie ears can be easily corrected by elevating the remaining lobe and closing off the scar area.

Can a lower facelift address sagging chins?

What is generally found with a lower facelift is that it addresses the lower two thirds of the face, causing the jawline to become sharper and the angle of the jaw to become more acute. Sagging chins, on the other hand, are more caused by a lack of projection (AKA loose skin and fat), or, in other words, the absence of structure. The best method of treatment, in this case, is to do a chin implant since the problem is not skin laxity.

Why is my forehead bulging post-facelift?

A bulging forehead muscle post-op may be the result of an internal fixation device which slipped, but also could be an endotine device placed during an upper blepharoplasty which will eventually dissolve over time.

How can I handle suture contraction post-MACs Lift?

Massaging the area of contraction could help in getting rid of the dimples, but so can a procedure known as needle subcision in which a scar is created that can then be broken up with further application of the needle.

What distinguishes a mini facelift vs a modified facelift?

With all the names out there for various facelifts, it is difficult to understand what is what at some points. A minifacelift generally will remove excessive skin and pull the remaining skin to the side for a more youthful look, whereas a modified facelift may orient itself towards the neck more for greater and more long-lasting results.

Will sensation be impacted differently depending on if glue or sutures are used?

Generally speaking, using glue versus using sutures should not affect the overall regeneration of sensation which should return fully after about 2 years.

How can I best deal with post-facelift acoustic neuroma?

Post-surgery acoustic neuroma is best dealt with by a specialized facial nerve center comfortable with the procedures of static slings, dynamic slings, nerve grafts including cross facial nerve grafts, and free innervated muscle grafts.

How can I address a leaking parotid gland post-facelift?

The conservative approach to dealing with a leaking parotid gland would be pressure dressing, the avoidance of spicy and sour foods (which promote excessive salivation), and anti-cholinergic medications.

Is a revision necessary if my earlobes are elongated and scarred?

A revision facelift is not often necessary in these conditions as less invasive procedures like skin redraping or local tissue rearrangement can be done far more easily.

Can a facelift be done at age 43?

Good candidates for facelifts are those with sagging cheeks, jowl formation, and severe skin laxity. Volume loss, which is the problem that many people in their forties have as opposed to skin laxity, is best addressed by injectable fillers or fat grafting. Consult with your surgeon about the best option for you.

How should I prepare for a Facelift?

To prepare for a Facelift, 2 weeks before surgery you should avoid taking prescription and OTC medications that increase bleeding risks such as aspirin, and advil. To decrease the amount of swelling after surgery, you should avoid salty foods which can increase water retention.

When are the final results from a facelift apparent?

Facelifts should improve quite subtly over a course of 6-12 months.

Is it normal for jowling to return post-SMAS facelift?

Generally, for such invasive procedures, it may be too early to make a truly accurate call as to the effectiveness of the surgery. For now, try looking at before and after photos, trying to maintain clear, rational expectations for yourself. However, SMAS lifts specifically target the jowls, meaning that you may need revision surgery.

If I'm dealing with skin laxity post-facelift, is a revision necessary?

Patients who are still dealing with skin laxity post-op especially after a period of many weeks are usually in need of a revision facelift surgery. Excess fluid present in the neck could also be a problem and could be easily drained and the skin could be redraped behind the ears.

Why do I still have jowling post neck and chin lift?

Generally, after a face and neck lift, one would expect any jowling before surgery to be gone. However, it all depends on the extensiveness of the facelift and whether the deeper SMAS tissues responsible for jowling were addressed at all. Again, though, patients must remain patient even months after the procedure before they start making judgment calls.

What are some basic improvements I can hope to see post-facelift?

Though changes after a facelift vary from patient to patient, some basic results of a standard lift include a better defined jawline, tightening of the skin under the chin, and elimination of muscle banding in front of the neck. As healing progresses, fluid collection and swelling should decrease dramatically and tissue should begin to soften.

Does swelling require drainage?

Swelling for up to a month after surgery is extremely common and is probably the worst stage of swelling post-op. Patients at this stage should definitely be patient about swelling and should follow-up with their surgeon if there are any potential concerns.

Why is my face still tight a year after my facelift?

After a long period of time (e.g. a year), it is unusual for patients to deal with tightness in the face and numbness. Possible nerve damage could be a factor if these symptoms persist and it is best that patients see a neurologist as soon as possible.

Do I need to wait to do a facelift following thermage and filler treatments?

Generally speaking, thermage and filler treatments work very well with facelift and skin resurfacing procedures. As long as the patient waits for the Sculptra injection site to be become soft, a facelift will simply enhance the look which fillers, etc. gave the patient.

What is the general format of a facelift?

A traditional facelift is an extensive procedure which involves an incision near the hairline that extends behind the ear. During this procedure, excess skin is cut and the remaining skin is pulled and sutured. This surgery is more frequently used for those with excessive neck fat and it corrects skin laxity in the lower face.

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