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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

What can I do about cheek asymmetry post-facelift?

Patients, after a midface lift, should generally not look to adjust the height of the cheek as it could distort the lower face as well. Cheek asymmetry, however, can be fixed by soft tissue fillers (Juvederm, Restylane, etc.) and fat transfer. Consulting with your plastic surgeon remains the best option.

Should I be concerned about nerve damage after doing multiple facelifts?

To be honest, any experienced and capable surgeon should not be afraid of doing nerve damage, etc. simply because of their knowledge in the field. However, the problem with you may be that fat grafting or augmentation is needed to plump various areas without the use of a facelift.

Can I do laser resurfacing and a rhinoplasty with my facelift?

All of these procedures can generally be performed concurrently as long as an MD anesthesiologist is available and is fully consulted with prior to surgery.

Does drinking liquid collagen help with facelifts?

Though collagen does help with addressing skin elasticity and does form an essential part of the skin’s framework, it would probably be digested by enzymes in the stomach and would not help greatly with wrinkles.

What differentiates buccal fat from cheekpad fat?

Cheekpad fat refers to malar fat which is a superficial, upside down triangle which is often elevated in a midface lift to restore fullness in the upper cheek. Buccal fat is deeper, more herniated and lower and is sometimes removed to reduce roundness in the face.

Why is there tingling in my cheeks post-facelift?

Tingling in the cheeks is quite common after a facelift and will usually last for about 2-3 years as the nerves try to reattach and supply the skin with sensory information. Usually, it is not too great of an issue and the symptoms tend to dissipate over time.

How can I treat a longer face?

If done in the hands of a qualified plastic surgeon, fat grafting on the temples, under the eyes, and the cheekbones can be used. However, the surgeon must be qualified.

What can younger patients do about droopy faces?

Generally, without pictures, it is difficult to prescribe treatment to patients. Younger patients who have “droopy” faces can probably benefit with fillers or voluminizers, but consultation with the surgeon is probably the best option.

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.

What is QuickLift?

As I have said many times before, there is no marketing substitution for a facelift for which the recovery time is approximately 10-14 days. Any facial lift surgery performed by a non-certified surgeon is risky and probably should not be done for patients serious about the outcome.

How painful will it be post-facelift?

Generally, facelifts, though associated with tightness in the skin and possible swelling and bruising of the skin, are relatively pain-free compared to many other procedures. Patients will often benefit from facelifts combined with other procedures like blepharoplasties or filler/fat injections.

When can I color my hair post-facelift?

The best option at this point would probably be to wait several weeks post-op until all the wounds have healed before coloring the hair. This point usually occurs within three to five weeks, so consult with your surgeon about your option.

What is LazerLift?

Again, laser treatments are usually brought in to tighten skin not actually adjust the skin in a great way. I would remain wary of such “gimmick” procedures.

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 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”).

How long can edemas last post-facelift?

Generally, edemas and other swelling lasts for approximately 6 months post-op, but, if it is a concern for patient, it is probably best to have a consultation with the plastic surgeon.

When can I have a facelift after doing Lifestyle Lift?

Unfortunately, many marketed procedures are ineffective, but revision surgery can usually be done 6-12 months after the failed procedure during which scars can be removed and/or repositioned.

Why do I keep hearing snapping noises post-facelift?

Patients dealing with stiffness and hearing snapping sounds within their skin may be dealing with the snapping of internal sutures. Generally, even after 2 weeks post-op, patients have a good chance of full recovery and excellent results if they see their surgeon ASAP.

Why do I look windswept a week post-facelift?

Though patients worry about having an obvious, windswept look after surgery, seven days is WAY too early to call the results of the procedure. Again, it is probably better for patients experiencing anxieties around this time to wait until results begin to improve.

Can a 45 Year Old Get a Facelift?

Again, it is the patient’s physical facial state which determines the correct time for a facial procedure. Generally, patients looking to do facelifts early (in their 40s, etc.) will definitely need to come back after 10-15 years, meaning that doctors usually do not recommend facelifts at such a young age.

What is the difference between SMAS Facelift under local sedation vs IV sedation?

For a surgeon the results of results of the surgery are not affected by the type of sedation used. IV sedation is used for the sake of the patients comfort, since some patients may be very nervous with someone operating over them. Local sedation is just as effective for blocking all the pain, and only leaves patients feeling pulling and pushing sensations.. Local sedation has the added benefit of not requiring an anesthesiologist.

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.

What can I do about lip asymmetry post-facelift?

Asymmetry in the lips due to a neurological issue can be easily corrected with Botox, fillers, and additional revision surgery.

Is red scarring normal post-facelift?

It is normal to have raised scars in and around the tragus area, but it is probably best to consult with the surgeon in order to avoid any possible infection especially since red scars are more common around the earlobe and behind the ear. Cortisone shots can be used in addition to treat scarring.

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.

What are good post-op procedures following facial fat grafting?

Patients who have underwent facial fat grafting should keep their head elevated for 2-3 weeks post-op and should generally avoid movement and pressure around the area affected.

Do facelifts lead to unhealthier skin?

Unlike facelifts of the past, facelifts today generally rely more on addressing lost volume than actually pulling the skin. Furthermore, patients who have had facelifts generally have better skin due to the use of skin care systems, microdermabrasions, weight control, exercise, etc. Again, however, it depends on the surgeon and the type of facelift performed.

How can I address nasolabial folding, jowling and festoons?

Though photos are usually a better tool for determining the nature of a recommended procedure, patients who are dealing with these symptoms will often require a neck and midface SMAS elevation in order to address muscle laxity in the lower jaw area and also have fat transfer to treat the nasolabial folds.

Which facelifts have the least scarring?

Some of the least invasive facelifts include short scar or mini facelifts which, though providing less long term results than SMAS lifts, etc., have less scarring and downtime.

Why are my ears protruding so much post-facelift?

During a facelift, incisions are made behind and often in front of the ears. Patients are encouraged not to worry about swelling which may occur and are encouraged to remain calm in the face of “Dumbo-like” ears.

Is the neck area cut during a facelift?

Generally, it is the neck lift procedure which relies on the incision around the neck to tighten and remove excess skin in the area. Doctors may cut there during a facelift as well if they deem it necessary.

Why do I still have pulsing in my ears post-facelift?

Patients dealing with pain the ear after a long period of time may have injured the greater auricular nerve, causing it to form a neuroma (overgrowth of nerve endings). The best thing to do for patients is to consult with a neurologist.

What should I do if my cheek implant shifted post-facelift?

Generally, it is important for doctors after a cheek implant to fix it in place with a screw which may require surgical incision. A simpler method of treatment could be to inject fat into the area to hold up the implant in place.

What are some fixation techniques in a facelift?

Two different types of fixation during a facelift are imbrication and plication. Imbrication consists of dissection underneath the SMAS and the suturing of the SMAS flap to the fascial layers (under tension) to achieve a lift. Plication involves folding over the SMAS.

What is the thread facelift?

A technique which caused quite a buzz in the plastic surgery world several years ago, the thread or feather lift is a minimally invasive technique used to replace open surgery in the lifting of sagging facial skin. A relatively simple procedure, it consists of using tiny suture barbs to act as a hook to gather skin layers upwards, thereby causing the skin to tighten. These barbs are connected to a thread which remains in place after the procedure and solely cooperate with the fibrous tissue to provide a lifting effect to the skin. Though not used quite frequently as a technique by itself, this procedure is often used in combination with other facelifts as a method of support, especially with younger people having facelift surgeries earlier and more frequently.

Can buccal fat pad suspension help with jowling?

The buccal fat pad is located in an area superior to the fat around the jowls and thus will have very little impact on jowling if suspended. The true method to treating jowls consists of an SMAS Lift possibly combined with fat resection.

Can patients prone to keloid scarring undergo a facelift?

Patients prone to keloid scarring should have no problem undergoing a facelift as what most patients see as keloids are simply hypertrophic scars (thick, itchy raised scars) which can easily treated by the surgeon. However, the surgeon which whom you are working may want to consider alternative incisions methods to combat the possibility of major scarring.

Will my midface lift affect my eye size?

Patients undergoing a subperiosteal midface lift combined with orbital rim implants may have a problem in that the eyes, if small in the beginning, may look even smaller. In this case, the incision for the facelift is made through the eyelid which changes the angle of the corner of the eye and the apparent height and width of the eye.

What is the cost of a lower facelift?

A lower facelift can cost anywhere between $7,500 and $15,000, depending on on the location, surgeon and other fees such as anesthesia. You should focus on finding a good surgeon with proven results and ignore any minor differences in prices.

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 pixie ears be corrected post-facelift?

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

What are some irregularities of the Endotine device?

It is common for people with thin skin to feel the endotine device under their skin, but the device does dissolve over a period of one year. Dimpling may occur during this point, but the endotine device should not be visible.

Is there an issue with bald patients having a facelift?

Again, there is no real issue with bald patients having facelift surgeries. The problem lies in placing the incisions where it is least conspicuous. In many cases, the incisions are placed normally (behind the ear and around the structure of the ear) and will usually be noticeable for about 3-4 months as they turn from red to a natural fleshy color. Patients can help the process along by using makeup 1 week post-op.

Can I use Fat Augmentation to rejuvenate my face?

Fat Augmentation or Fat Transfer, cannot replace a Facelift in the appropriately aged face, however it can be used as supplement. Fat Augmentation is used to add volume to the face in areas that are naturally fatty in the young.

How can permanent nerve damage be repaired post-facelift?

Unfortunately, little can be done surgically, other than static or dynamic slings/muscle grafts, to repair long-term nerve damage. Patients can attempt to strengthen weak muscles through nerve stimulation and therapy, and asymmetry could be disguised with the use of fillers or Botox.

When can I go out in public post-facelift?

Generally, people should wait a minimum of two weeks before resuming daily activities.

Should I get an ABPS or ABFPRS surgeon?

Both ABPS (requires the longest training) and ABFPRS are solid credentials for a plastic surgeon to have. However, the best results are often the ones in the hands of experience. Find a surgeon who has the capability and technical skill to adequately perform facelift procedures.

Why am I panicking about my looks post-facelift?

The key saying with post-facelift patients is that “You look worse before you look better”. Patients will often find themselves questioning when the swelling and bruising will end and will usually look for immediate gratification post-surgery. The important part post-procedure is simply patience.

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.

What are the pros and cons of a facelift?

Pros: Removal of excess skin, lifting of drooping skin along face, jawline, and neck
Cons: Cost, undergoing surgery, recovery time, scars, swelling/bruising, and risks of surgery

Can I lose weight after a facelift?

Patients who are looking to keep the results of a facelift intact are generally not advised to lose a significant amount of weight as loss of fat in the face can reduce facial structure and may cause the return of skin laxity post-facelift. If weight loss is desired, patients should go about it slowly, evaluating themselves after every 10 lbs or so lost.

Can protein-S deficient patients still have facelifts?

Patients, even if they have protein S deficiency (involved with thrombosis), should not worry about undergoing surgery if they have been cleared by their hematologists.

How can I address early jowling?

Patients who are in their early forties should not look for a particularly invasive procedure. Personal recommendations for correcting early signs of jowling would be procedures like the S-Lift or mini jowl lift which address the SMAS layer but not drastically.

Can I look natural after a facelift and fillers?

In my opinion, anything is possible in the hands of an experienced plastic surgeon, especially concerning fillers and facelifts. A physician who is experienced and has a good reputation in his/her field and whose before and after patient photos are stellar is probably the best way for patients to achieve a “natural” result without the look of plastic surgery.

Are lumps common post-facelift?

For most procedures, it is extremely common to have lumps several weeks after surgeries which are mainly composed of blood collections under the skin. However, if they remain for a long time after surgery, they may develop into hematomas (blood clots) and will require frequent massage for healing.

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.

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.

When do people usually start having facelifts?

For most people, the first facelift usually occurs between the ages of forty and fifty because of the loss of facial volume from age-related fat loss and by the development of lax skin again due to age. Again, however, it is the physical state of the patient, as opposed to his/her age which actually determine the need for surgery, so consulting with surgeons is probably the best first step in deciding.

Can paralysis occur one week post-facelift?

Though damage to the facial nerve can occur post-op, it is extremely rare and patients should wait and allow existing nerves to heal before diagnosing themselves.

What's the closest thing to a full facelift?

The next best thing to a facelift would probably be a mini facelift which offers small-scale improvement to jowling and other “facelift”-related symptoms. However, non-surgical options like fillers or fat grafting do exist which, depending on the patient, can provide better results.

What are staples used for in a facelift?

Generally, surgeons reserve staples for anything in the scalp area especially for incisions along the hairline because they provide excellent eversion and do not compromise blood supply (thereby reducing hair loss).

Can a facelift be done at age 24?

Again, young patients are not recommended to use a facelift as a first line of treatment. Often, patients who demonstrate pre-mature aging have genetic deficiencies in facial structure and are probably in more need of good fillers/fat grafting techniques. Surgery is definitely not a good option.

How do I minimize bruising after a facelift? Should I be worried that I’m swollen and it’s been only 3 days?

Bruising after a facelift can be an unsettling problem for some patients. There a ways to significantly preemptively reduce bruising and swelling which include proper surgical technique and the use of fibrin sealants or fibrin glue or tissue glue. It can be expected that the worst of the bruising will be seen around 3 days post-operation and will gradually disappear over a six week period. Therefore, patients should not be alarmed if they have still have some bruising apparent after the three week mark. If you have a hematoma (small pocket of slowly resorbed blood in the tissues) then it may contribute to your bruising and may extended the normal healing process.

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.

Why do I have indentations in my face post-facelift?

Indentation following a facelift may be the result of fluid or residual laxity but it is difficult to truly pinpoint without the benefit of a full surgical exam. If the issue remains unresolved for months, fat grafting may be the best option to correct any deficiencies.

Does platysmal banding post-facelift require a revision?

Patients dealing with platysmal banding after surgery, usually the results of aging, shortening, and fibrosing of the neck muscles, can usually only be treated with revision platysmaplasty. This procedure consists of a small incision made under the chin through which the platysmal muscle is tightened.

Are drains needed post-facelift?

Generally, surgeons will need to include drains after performing a major facelift as a way of speeding up healing by preventing fluid accumulation. Drains are usually left in for a day post-op and are carefully removed by the surgeon.

Does a Serdev Suture Lift work for younger patients?

For younger patients, regardless of the marketing technique used, I would not recommend getting a facelift. Patients who are young are probably better off with injectables or even smaller scale techniques like threadlifting.

Why do I have bruising 6 months post-op?

Bruising in the face 6 months post-op is somewhat unusual and is something which should be consulted with your doctor ASAP. Time may be needed for healing, but problems could lie with pigmentation issues.

Does muscle tightening always occur in a facelift?

Most facelifts frequently used today, whether they be SMAS, deep-plane, or even mini facelift, have at least some interaction with the SMAS layer beneath the skin. Tightening of the muscle layers underneath the skin usually always happens with any of these procedures.

Can I get a facelift at 59?

Most patients even at this age do not require a full facelift, but are often more eligible for procedures like a mini facelift or laser and chemical peel simply to treat skin laxity around the jawline. These procedures all performed under local anesthesia can give long-term results.

Can a facelift address asymmetrical faces?

Again, I would not recommend opting for a facelift surgery at your age even with the symptoms you are describe (marionette lines, etc.). For people with disproportionate faces, the problem often lies in the underlying fat structure of the face for which a facelift and a liposuction can do greater damage. I would consult with your plastic surgeon about your individual options.

Why don't I see any difference a year after my facelift?

It is important for patients to realize that a facelift will not induce dramatically facial contours/facial structures and that a totally rejuvenated look is wishful thinking. However, looking at before and after photos, patients should notice at least some difference if the facelift was suited for them. Again, some procedures like the Lifestyle Lift, etc. do very little, so expect few things from them, but generally, you should notice SOMETHING.

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 have uneven cheeks after my facelift?

Uneven checks may be the result of the procedure itself or from the effectiveness of the fat grafting. Please consult your surgeon. If your uneven cheeks become apparent shortly after surgery it is likely due to postoperative swelling or scarring. If the uneven cheeks begin later down the road it is likely due to failed fat grafting, which would require additional fat transfers.

How does bandaging work post-facelift?

Bandages are generally not used in a facelift. Rather, garments are wrapped around the head for up to a day before being removed.

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

Dilute steroid solutions should not cause either.

Should I be thinking about a Facelift at age 32?

At age 32 you are more likely dealing with a loss of volume in the face as opposed to those over 40 who are dealing with increased skin laxity. To correct purely volume loss, and to give a more youthful appearance you should consider using injectable fillers or fat grafts; for example to the cheeks.

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 can I do about asymmetrical post-facelift sagging?

Post-op, many patients will find that sagging can be asymmetrical. However, this is not due to the skin laxity which required the facelift, but more so because of fat/volume loss in the cheeks. This can easily be corrected with fat grafting or fillers.

Can a facelift correct droopy eyes?

Droopy eyes are caused by sagging eyelids, not by facial skin laxity. Skin laxity is treated using facelift that tighten the skin and muscles underneath; sagging eyes are treated with eyelid surgery or browlift to adjust the anatomy.

How long can I expect a Facelift to last?

Patients can expect that a Traditional Facelift will typically hold good results for up to 10 years. Exactly how long a Facelift lasts depends partially on the patient in terms of health, smoking status and genetics.

Why can't younger patients get facelifts?

Younger patients who are serious about having a facelift should probably have a consultation with a qualified surgeon to see if that is the only option for them. Facelifts are most commonly used for facial aging due to the drooping of midfacial tissues or for patient who have very little volume in the face. However, younger patients are more encouraged to maintain proper nutrition and have less invasive procedures like cheek implants, etc.

How do I discuss options with my surgeon?

Often, when discussing surgeries, different surgeons will recommend different procedures for the same problems. The best way for patients to find the best options for them would be to look at many before and after photos for each procedure to find what they want.

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.

Should I protect my neck post-facelift?

It is important for patients post-op to take it easy on the face and neck area especially in an effort to avoid platysmal banding and the stretching or straining of delicate post-op facial structures.

Can I have a facelift at age 45?

At age 45 it is not an unusual for someone to have a facelift. Whether an individual is needs to have one 45 depends on their particular face. At age 45 volume loss, and particularly skin laxity may have begun to set in. At age 45 you may still be a candidate for less invasive procedures using fillers. Please consult with an experienced surgeon.

How long does swelling last post-facelift?

Patients must remain patient when it comes to swelling. Though the worst of the swelling generally subsides after 2 weeks, patients should expect moderate swelling for 4 to 12 weeks and even later post-op. The best thing to do is to avoid strenuous activity and bending excessively.

How can I treat heavy brows and nasolabial folding post-facelift?

Low brows can generally be treated with neuromodulators like Botox and nasolabial folds with fillers like Juvederm. Yet, partial MACS Lift surgery could also be an option. Consult with your plastic surgeon about your options.

Can I have a chin implant after already having a lower facelift?

Yes. The lower Facelift scar under your chin can be used as an entry point to place the chin implant.

What defines an experienced facelift surgeon?

Often, it is better to not get bogged down with numbers when it comes to surgeries. Examining before and after photos and deciding whether you are completely satisfied (COMPLETE is emphasized here) is probably the best option when it comes to opting for surgery.

How do I combat excess fat after a maxillofacial surgery?

Patients who have excess fat above and below the platysma post-maxillofacial surgery could have many of their problems with a neck lift combined with a platysmaplasty designed to remove this fat and sew the platysmal muscle next to the hyoid bone.

How long is recovery post deep-plane facelift?

For an invasive surgery like a deep-plane procedure, the swelling will usually last for several weeks to several months. Patients should expect to out of work for at least 2 weeks and should plan on having someone take care of strenuous activities and tasks where bending is needed.

Is it okay to have a full body massage post-facelift?

Contrary to popular belief, having a full body massage is not only OK after surgery, but is probably encouraged. A full body massage can be easily done 4-6 weeks post-op to help dealing with swelling and other lingering problems.

Is Beverly Hills the only place to get quality plastic surgeons?

Though it may seem like all the best plastic surgeons are in the Beverly Hills area, there are plenty of other surgeons throughout the country who can probably do the same work for a cheaper price. Most board-certified plastic surgeons are perfectly capable, but patients must make sure to check credentials and certifications beforehand.

When should I have a facelift?

Again, as I have told my patients several times, it is the physical state of the patient’s face, rather than the age of the patient, which determines the timing of a facelift. If the patient has problems with jowling, marionette lines, deepening nasolabial folds, and excess neck skin (all issues related to skin laxity), a facelift may be the best option.

What should I do about the muscle spasms post-facelift?

Patients who are experiencing muscle spasms, but still retain feeling in the area around which the spasm is occurring, should likely not worry as this is usually indicative of minor nerve irritation. Again, consultation with the plastic surgeon may be necessary, but usually this is not a serious problem.

I have major swelling 2-3 weeks post-op. Is this normal?

Patients experiencing unusual swelling may be at risk for developing hematomas post-op. These growths need to be aspirated as soon as possible unless the body can naturally resolve on its own. IF these symptoms persist, it is important to consult your surgeon.

How can I address my red suture lines post-facelift?

Usualy, if the scars are thin and flat, but have a red, rather fleshy color, they are still maturing and will continue to mature for up to 90 days. People in the short-term recovery phase of the surgery should be patient and allow the scars to heal naturally. However, if the red lines become raised or thick, they could be hypertrophic scars and one should see their surgeon if this occurs.

What is an "experienced" surgeon?

Surgeons who are experienced are not qualified simply by numbers, but by their before and after photos, their technique, etc. Research is the key for patients.

What is a weekend facelift?

These are a group of less invasive procedures that have much shorter recovery time, which allows most people to recover over 1 weekend. One example is the mini lift where incisions are made behind ear and only skin is pulled to adjust the contours of the face. These quick procedures are categorically less effective than the more traditional facelifts, such as the SMAS which adjusts muscle layers, and are thus not appropriate for every face.

Can I get flattened cheeks from a facelift?

Typically, an SMAS facelift will reposition the cheek muscles in a more youthful position and will usually elevate the cheek fat to augment the area. Therefore, it is advisable not to be worried about “cheek damage” in this case.

Do I need a facelift to address just the eyes?

Patients who have under eye surgery are generally not expected to have a facelift done to simply “even” out the face. Of course, it can be done with fantastic results, yet it is not always necessary.

Are there any cheek issues associated with endoscopic lifts?

Patients with an endoscopic lift may have issues with elevated cheekbones, issues which usually resolve themselves over time.

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.

Why do I have ropey fullness on my neck post-facelift?

Ropey fullness on the neck tends to be the mark of fluid collection which can easily be aspirated by a surgeon. Even untreated, the symptoms will eventually begin to heal on their own. Consult your surgeon to check it out.

Why do I still have swelling/sagging weeks post-facelift?

It is unusual for swelling to be present after six weeks and it may be caused by a slight clotting of the blood, usually associated with bruising. Jowling may also be caused by swelling that could subside.

Will swelling stretch the skin appreciably?

Generally, swelling within the first few weeks of surgery, though seeming like a lot, will not stretch the skin to any appreciable degree. The results of the facelift will largely remain intact.

How can I deal with lateral sweeps post-facelift?

Patients dealing with lateral sweeps across their face should definitely wait for time to hopefully heal things. It is probably not the best option to select fillers and patients should instead look for other methods like massage which do not interfere with lift.

Can suturing be done along the hairline behind the head?

It is common for sutures to be placed in this location because it allows for trimming of neck tissue to be easily hidden within the hairline.

Will my sore ears and leaky salivary gland go away?

For patients having issues in these areas, time is probably the best factor for healing and for determining if additional treatment is necessary. Especially for the sagging submandibular glands, I would wait about 9 months or so before making any major decisions.

How can I address post-op hyperpigmentation and residual fat?

Patients dealing with post-op fat under the chin may be dealing with excess fat (easily reduced with lipocontouring techniques) or residual scar tissue (could be treated with cortisone or other steroid injections). Hyperpigmentation can be addressed with laser resurfacing techniques.

Is nerve damage a risk during a facelift?

Board-certified plastic surgeons must undergo rigorous training and must be extremely familiar with the anatomy of the face to earn this high level of certification. Therefore, if you selected a capable surgeon, you are probably in good hands and need not worry about nerve damage.

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.

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.

What can be done about my droopy smile?

Fillers can be used on patients who are having droopy corners on their mouths when they smile.

What are the best facelift options for a woman in her 50s?

The most important part of a facelift procedure is planning on what the patient wants. Choosing the best surgeon is often the best idea for not only finding the best option, but also of understand what to expect from surgery. Doing your research is the only way to become truly happy with your results.

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.

When will my facelift scars heal?

When it comes to facelift scars, the initial redness of these wounds will begin to heal after about 3 months or so, and wound appearance continues to improve for 6-12 months. Again, it is usually the surgeon’s duty to assure that the scars are as inconspicuous as possible and the patient can also apply makeup after 1 week to help with the camouflage.

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)

Is tightness associated with nerve damage?

Generally, tightness around the ears several months post-op should not worry patients as it is not associated with permanent nerve damage but rather with inflammation associated with healing. Here, nerves are just beginning to recuperate after the trauma of surgery but may take a while to adjust themselves.

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.

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.

What is the Ribbon Lift?

The ribbon lift is a procedure similar to a thread lift but uses a different device, a collar with spikes of one side. The device is inserted into the platysma muscle and used to pull it back, a procedure which helps with neck lifts, but does nothing for jowls and cheeks. It is a good temporary procedure if done correctly.

Are there non-surgical ways for facial rejuvenation?

Patients who are not comfortable with facelift surgery may consider fillers as a way to simply restore volume without actually lifting the face. This may be best discussed with your plastic surgeon.

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