Lower Facelift Advice?

I saw 3 board certified surgeons, two recommended lower face lift. One does lift in front of sideburn to avoid hair loss, and the other in the scalp for the same reason. I'm concerned about scarring in front of sideburn, but I don't want to have my sideburn pulled back either. I wear my hair off my face. Neck would improve with first, second suggested lift under the chin, a scar about an inch long. Second and third both recommended fat transfer to cheek/eyes area; two recommended lower Blepharoplasty. Third doctor ruled out other reasons. I'm now confused. Any advice?

Doctor Answers (21)

Lower facelift only

+4

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.


Beverly Hills Plastic Surgeon
5.0 out of 5 stars 92 reviews

Facelift opinions differ

+2

Depending on the training of your surgeons and the facelift technques they feel comfortable with in the treatment of your face, you will get a different opinion from every facelift doctor that you meet.  The doctor who is right for you is the one who has a proven track record for giving you major improvements in the areas you want addressed.  Many times different techniques achieve the same look.  Be sure to view plenty of before and after photos, talk to former patients, and make sure your doctor is experienced.  In the end, you have to get along with your doctor, so a caring personality really matters.  Good luck!

Thomas T. Le, MD
Baltimore Facial Plastic Surgeon
5.0 out of 5 stars 32 reviews

Follow Your Inner Voice After Listening to Advice from Experienced Surgeons

+2

You bring up important questions regarding facelift surgery: Incisions, scaring, cheek/ lower eyelid region and neck. Without actually seeing you, nobody can advice you for or against any of the surgeons recommendations.

Just as a couple of philosphy points:

1. I do not like distortion and elevation of the hairline. Therefore, I virtually only use hairsparing incisions around the sideburns.

2. For a good neck improvement, an incision under the chin is mendatory in most patients.

3. About 80% of facelift patients do benefit from some volume enhancement in addition to their lift. I do like fat grafting for this.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.5 out of 5 stars 25 reviews

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Lower face lift for sagging skin

+1
The incision for a facelift starts inside the temporal tuft hairline and follows the actual hairline itself at the bottom of the sideburn. The skin that is removed after  the muscles have been tightened is the bald skin or non-hairbearing skin. This prevents raising the sideburns on a man or a woman. For many examples, please see the link below to our facelift photo Gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 55 reviews

Facelift Incision choices

+1

Great question you posed and a common one that comes up. In short here are the major pros and cons in my eyes:

Traditional incision site is in the temple hair bearing area - Pros- hidden  Cons: if you end up with a widened scar and hair loss, plus in all cases the sideburn is pulled vertically and ends up being higher than before - sometimes to the top of your ear. This is the most common method used

 

Incision at the hair line - in this case it is critical that the surgeon bevels the incision and makes it a mm or so just behind the hairline retaining follicles.

Pros - hair often grows back through the scar and no distortion of sideburn length

Cons - pink for several months to a year (easy to conceal with make up) and if hair doesn't grow back fine white line in most cases. This is a newer technique and one I personally favor in patients with high sideburns, secondary facelifts, and patients who request it. 

 

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 44 reviews

Facelift, Fat Grafts, Blepharoplasty

+1

One of the great things about seeing multiple consulting physicians is to gain insight on all the possibilities.  Sounds like you heard about all that is out there for you.

The male facelift incision approach is a very big deal....I agree with you that making the incision in the area just behind the sideburn is important here.  I have my patients grow out a light beard just before surgery to plan this out.  There are some surgeons that advocate a post tragal incision, but those patients will be dealing with a lifetime of plucking, laser hair treatments, etc.  There are some great tricks to placing this incision in the correct planes to minimize scarring.

Fat injections are great.  Volume is king these days.  This has to be done well to be anywhere near permanent.

The only push I would give with blepharoplasty is based on my appreciation for facial harmony.  Nice to have the face look like it's parts "fit together" and are natural in there appearance.

Hope that helps!

Dr. Hobgood

Todd Christopher Hobgood, MD
Phoenix Facial Plastic Surgeon
5.0 out of 5 stars 16 reviews

Lower Facelift Advice and Confusion

+1

Aftrer reading your question, I am little confused as well. Part of this confusion arises from what one means when they say "lower facelift". For some people, they are refering to the neck and tissues below the chin. Other people tend to include the jowl area as well. And some might take it to mean anything below eye level. Really, whatever term you use it is not all that important. You, and your surgeon, need to define the problem areas that you wish to address and then you can formulate a plan to address those problems. It is important to remember that different surgeons may recommend different approaches and all can potentially achieve good results.

With regard to the incision in front of the sideburn vs up into the scalp, good results can be obtained with either. If your sideburn is not high, then extending the incision up into the scalp can keep it more hidden. There is a small risk of hair loss but generally very low and very localized. On the other hand, if you have a higher sideburn, continuing the incision up into the scalp will usually pull your sideburn higher. At a certain point this looks very unnatural, so placing the incusioin around and in front of the sideburn can be a better choice. The best answer depends on your anatomy and preferences.

When referring to "lower facelift" most people are indicating that the areas under the chin and into the neck are included. There are generally three components to the changes that occur in this area and need to be addressed. They are fat excess, separation or "banding" of the platysma muscle, and skin excess or laxity. If someone is concerned about this area, they generally have components of all three. The skin laxity component is usually addressed along with the rest of the facelift, as long as the incision is continued back behind the ear and into the scalp. The issue of fat excess can be addressed with liposuction, however it is usually more effectively corrected by direct removal through about a one inch incision under the chin. Using this approach also allows for repair of the separated platysma muscle. Having a clean and nicely sculpted chin/ neck area usually requires correction of all three components.

Whether one should also have fat transfer to the eye area and/or a lower blepharoplasty is way beyond the discussion of lower facelifts and incision placement. If these are problem areas for you, then it could be reasonable to address them at the same time as your facelift.

Braden Stridde, MD
Federal Way Plastic Surgeon
5.0 out of 5 stars 22 reviews

Lower facelift confusion

+1

With such a variety of recommendations, it is difficult to decide.  Facelift scars are usually quite inconspicuous and almost universally acceptable.  Without photos or an examination it is difficult to tell you what is best.  You might see additional surgeons to see if one approach is recommended more often.  Additionally, view before and after photos of each surgeon's patients and see if you can find an example of someone like you.  Finally, ask to speak to a couple of past patients who had the procedure proposed to you.  Good luck!

Randy J. Buckspan, MD
Austin Plastic Surgeon
5.0 out of 5 stars 5 reviews

Facelift procedures

+1

Welcome to the world of plastic surgery!  Everyone does it a bit differently. I try to maintain the hair line so peopl do not get the "wind swept" look from removal of good hair.  As for the additional procedures like with the face veryonen does it a bit differently.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Fat Transfer, Facelift, Blepharoplasty - I am confused as well!

+1

What are your problems or concerns?

Write all your concerns down on a piece of paper. Then put them in order from most to least important. Then write down all the doctors names and the suggestions that they made. Then cross check their advice with your concerns. Then go to your favorite of the group and go over each suggestion slowly.

This is not rocket science, if it makes sense, then it probably is true.

Robert M. Freund, MD
New York Plastic Surgeon
4.5 out of 5 stars 18 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.