It is in my opinion the rare patient that would look their best with only a lower facelift, and the additional incisions between a neck-only facelift and a facelift are minimal. In many cases, there is more gathering and artifact (unnatural appearance) from a neck-only procedure.
Why would there be a more pulled appearance from less surgery?
When only a lower facelift is done, there is little restructuring of the deep tissues of the cheeks, and little chance to elevate and preserve the volume of the face.
The hairline is critical to preserve, in my opinion. Surgeons differ on this philosophy. Many surgeons raise the temporal sideburn hair to well above the ear during surgery, in order to reduce wrinkles maximally. We believe this creates a prematurely old appearance and therefore preserve the sideburn. If the sideburn has been diminished or lost in previous facelift surgery, it is usually possible to reconstruct it either with a flap of hair bearing skin or with revision facelift techniques that restore hairlines.
When you are looking at before-after pictures of facelift patients, if these factors are important to you, you will look specifically for the earlobe and hairline appearance before and after. If you see a lot of large earrings on the postoperative patients, hair combed down to conceal incisions, or if you don't see normal appearing hair patterns, beware. Also look closely at the ears before and after. Another clud to natural surgery is to take a step back and look at the overall patient before and after. Do they look natural or excessively pulled?
Ironically, it is often the most pulled appearing patients who had the least invasive lifts, just that their lifts were closed under great tension.
With modern deep layer restructuring techniques, it is not necessary to pull as hard as it was in the past. There are articles in our top surgical journals of how to pull maximally in order to defeat the nasolabial folds. Nowadays, most patients in our practice prefer not to look pulled, regarding that look as artificial. Rather, patients with to appear younger through volume redistribution and replacement, with techniques that pull more as an after thought, yielding a more natural, less pulled appearance.
When you reach the right office, you will likely feel at home with the doctor, their surgical philosophy, and their staff.
