Why You Shouldn’t Fear The F Word -Where The Facelift Fits in Modern Plastic Surgery

Park Avenue Plastic Surgery Class

Episode 4

Why You Shouldn’t Fear the F Word:  Where The Facelift Fits in Modern Plastic Surgery

Everyone would like to avoid surgery if possible but deep down everyone knows at some point, you’ll need a facelift to look your best.  Preconceived notions about facelift are based on news stories, fears, and some misconceptions, starting with the history of facelifts.  The facelift started in 1901 as skin only operation removing a wedge of skin in front of the ear to reduce laxity.  Most of 20th century the operation remained skin only with minor modifications.  Facelifting was the territory of starlets and socialites, a distilled fraction of the population that brought enough attention to the facelift to make it the prototypical plastic surgery operation of all time.

Things began to change in the latter part of the 1970’s to an approach that was not skin only but involved additional modifications to the neck muscles and connective tissue layers of the face, repositioning and tightening them.  The SMAS facelift refers to this in part –SMAS being an acronym for subcutaneous musculo-aponeurotic system –the layer of muscle and connective tissue located just beneath the skin in the face and neck.

In the 1990’s techniques were developed to move tissues in a single plane deeper in the face –the deep plane facelift.  Other techniques such as extended SMAS and modifications of the extent of undermining and the direction of redraping of  skin were all attempts to create more complete correction of nasolabial fold and marionette line or to overcome some other limitation of the degree or durability of correction in one part of the face or another.   Although controversy remains about which technique is best, most facelifting in the 21st century is multiplanar.  I believe this allows correction of laxity and position of each plane in the face and neck, permitting redraping in different directions as needed to maximize correction, and restore a youthful facial shape.

Given all the improvements in knowledge and techniques why is there so much reluctance?  People would like to avoid surgery and downtime if at all possible.  Modern life has gotten even busier making it harder to fit recovery time into the schedule.  Also, we are visible to the public much more of the time with videoconferences, social media and constant cell phone selfies.  It’s much harder to hide our appearance, even for a few days.

Current trends in facial rejuvenation are focused on earlier treatment  with non-surgical techniques.   Still, there comes a time when there is no meaningful way to look your best or address some of the prominent aging changes with out a facelift.

Misconceptions about the facelift drive the fear and don’t mesh with realities of the modern facelift.

  • Fear of anesthesia –different levels are possible from general, intravenous (IV) anesthesia like for colonoscopy, local anesthesia or local with oral sedating medications. Advances in modern anesthesia have really enabled the explosive growth of ambulatory surgery over the past few decades even for procedures much more extensive than a facelift.
  • Fear of showing scars/ an unnatural look/ change who you look like.  In skillful hands you should look perfectly natural after a facelift.  The many facelift results that we walk past every day go unnoticed because of how natural they look.  The goal is to look like yourself the way you looked in past decades.  Rejuvenation surgery is all about this not changing who you look like at all, just restoring a rested look with no tell-tales of a facelift.
  • The facelift is not just about taking out loose skin. It’s about restoring the youthful shape of the face which has been lost in aging.
  • The facelift continues to evolve with better understanding of facial anatomy, for example where SMAS dissection is needed to release tissue for repositioning, where undermining does not add to the result. This means less incision, less dissection but with more precision to achieve more complete correction with less recovery -a classic win/win.
  • The facelift alone will not fix all of your aging changes. If you have aged enough to need a facelift, many other facial features have aged with you.  Adjunctive treatments help with things the facelift does not addressing.  Eyelid changes, wrinkles, and extensive volume loss are some examples of things on this list.
  • Facelift vs. necklift. The medical name of the procedure is officially cervicofacialplasty, which means the face and neck are addressed.  Minifacelift, necklift, and other partial or reduced procedures are frequently performed but the nomenclature is not important.  Each surgeon has a range of techniques that work well in their hands which they vary based on each individual patient’s facial structure and the type and degree of aging changes present.

What does the facelift do exactly?  The facelift is best at tailoring out hanging or loose skin in the neck and jowl areas sharpening the appearance of the jawline.  The shape and height of the cheek is restored along with the appearance of the emainder of the face.  The facelift does not provide correction for the eyelids or eyebrows, which can be treated with other procedures at the same time.

What does the facelift do exactly?  The facelift is best at tailoring out hanging or loose skin in the neck and jowl areas sharpening the appearance of the jawline.  The shape and height of the cheek is restored along with the appearance of the emainder of the face.  The facelift does not provide correction for the eyelids or eyebrows, which can be treated with other procedures at the same time.

What is the role of the facelift?  The facelift continues to be the big facial reset once obvious visible changes in skin laxity are present.  A facelift twill be medically indicated/appropriate/beneficial at a different age for each individual but in the population as a whole, some patterns and typical ages are shown by the statistics.  most of the time.  Each individual’s perception of and concern with their appearance,  and when he or she is psychologically ready to make a big intervention varies much more widely.

What are the ages?  Data compiled by The  Aesthetic Society shows the trends clearly.  I compared statistics looking at percentage of facelift patients in a given age bracket in 2000 and 2019 (I picked 2019 because it was before the start of the pandemic which put a big temporary dent in the rates of elective surgery).  In 2000, 31% of facelift patients were 35-50 years old and in 2019 the number was 8.5%.  I believe this is a sign of the impact of all the non-surgical treatments which developed during that time span which are particularly useful in maintaining the appearance of younger patients.  Also, improvements in lifestyle have helped our appearance to age more slowly.  In 2000 only 15% of facelift patients were 65 years old or older.  By 2019, the number had jumped to 36% .  Several factors come to mind when looking at this:  1) people are still getting facelifts but at an older age.  2) more people over 65 are still working, socializing and placing a high priority on looking their best.

People often put off scheduling a facelift consultation but facelift or not, you need to have an ongoing relationship with a plastic surgeon to work on maintaining appearance and preventing aging changes.  Smaller treatments will postpone the need for a facelift and you will have a working relationship with a plastic surgeon to have a dialog about when or if a facelift is on the upcoming agenda.

Are there non-surgical options to replace facelift?  Currently, there is no meaningful substitute for the facelift.  There are currently no techniques that produce a facelift-like result in either degree of correction or durability with non-surgical techniques.  The facelift is not about to be obsolete.  But early intervention with non-surgical techniques for facial maintenance can often postpone the need for facelift for a decade or more.

Important Takeaways:

In skillful hands you look perfectly natural and rested after a facelift.

Anesthesia is very safe and can be limited in a variety of ways.

Facelift has less recovery than ever before –typically 1-1.5 weeks for routine work and socializing is possible.





More coming soon.  Subscribe to avoid missing any episodes at Apple, Spotify, Stitcher or wherever you listen to podcasts.