Undergoing a facelift is a major decision, not to mention a significant financial and time commitment. The procedure can also feel like it should be a be-all, end-all fix—going under the knife is always going to yield more significant results than anything less invasive, right? Theoretically, yes… but here’s a caveat. Pairing a surgical procedure with a complementary nonsurgical treatment may ultimately yield the best results. “People worry that if they have multiple things done, everyone will be able to tell that they’ve had plastic surgery, but that’s not the case,” says Dr. David Gilpin, a board-certified facial plastic surgeon in Nashville, Tennessee. “You’ll likely end up looking more naturally rejuvenated than if you had surgery alone, because there are so many things that can be complementary to a facelift,” he explains. (For context, he says he performs stand-alone facelifts only about 10% of the time.)
The truth of the matter is that, while it’s extremely effective, a facelift is somewhat a one-trick pony. “It’s important to understand the limitations of a facelift. While it can improve the contour of the jawline and neck, it’s not going to improve the texture of the skin. Surgery doesn’t do that. The benefit of doing other procedures at the same time is that you’re tackling different problem points that one treatment alone can’t,” explains Dr. Catherine Chang, a board-certified plastic surgeon in Beverly Hills, California. And by the time someone is ready for a facelift, chances are good that there are other issues that need to be addressed, she adds. Dr. Lucas Bryant, a double board-certified facial plastic surgeon in Mt. Juliet, Tennessee, agrees: “Think of a facelift as the cake. You want the cake to be good, but these other things are like sprinkles and frosting that just make the cake even better.”
Improved results aside, there’s also a huge convenience factor. You’re combining the downtime you’d have from two procedures into one, making this a good option for people who are busy and don’t want to repeatedly take time away from their social calendar, notes Dr. Chang. And of course, there’s the matter of pure comfort. Many of the treatments commonly added on to a facelift (more on those in a moment) can be significantly uncomfortable if not downright painful, often requiring local anesthesia or IV sedation. Getting everything done while you’re under general anesthesia makes for a much easier and more pleasant experience.
So which procedures work best with a facelift? According to the experts we spoke with, these are three of the most common.
Fat grafting
“A facelift doesn’t add volume. Fat grafting does,” says Dr. Chang, who adds that she tacks it on to about 90% of the facelifts she performs. It’s an appropriate choice for the majority of patients; most people older than 30 are noticing some type of volume loss, so adding that back in at the time of the lift makes for a more rejuvenated end result, she explains. Along with addressing volume deficiency, there’s another benefit to fat transfer. You’re transferring not only fat but also growth factors and native stem cells, all of which help improve the texture of the overlying skin, points out Dr. Gilpin, noting that he sees a marked difference in patients who have both procedures performed simultaneously.
While harvesting fat from a site on the body—the abdomen, the medial thigh—is common, Dr. Bryant adds that during a facelift is the ideal time to harvest excess buccal fat (assuming that the patient has enough to give). Though not scientifically proven, he finds using facial fat rather than body fat in the face to be more effective, both in terms of the amount of fat that survives the transfer and the way it behaves over time. (He typically adds it into the lips or under the eyes.)
CO2 laser
“Visually, the recovery from a CO2 laser can almost be worse than with a facelift, so keeping them within the same time frame is great,” says Dr. Bryant. Dr. Chang agrees, noting that the CO2 laser can come with 7 to 12 days of downtime in and of itself, which can easily fall within the two weeks people typically need post-facelift. A CO2 laser is also the gold standard workhorse for targeting irregular skin texture and wrinkles, particularly in trouble spots like around the mouth and eyes, notes Dr. Gilpin. That being said, that efficacy comes not only with that dramatic downtime but also major discomfort, which is why doing it while someone is under general anesthesia makes perfect sense. Similarly, this also affords the option to be even more aggressive—ultimately yielding a more dramatic result—than a provider could if the patient were awake, says Dr. Bryant. (However, there is some surgical nuance involved. Depending on the type of facelift being performed, you may not be able to be as forceful in certain parts of the face, notes Dr. Chang.)
RF microneedling
Options such as Morpheus8 and VirtueRF may not require as much downtime as some of the big-gun lasers, though they still can be very unpleasant, notes Dr. Bryant. While the tightening effects may not necessarily be needed for the areas of the lower face that the facelift addresses, they can be beneficial for other areas, such as around the eyes. Similarly, Dr. Gilpin notes that he also adds radiofrequency microneedling treatments on to other surgical procedures, such as blepharoplasties, to address areas like the jawline. Plus the microneedling portion is great for helping to address textural changes in the skin.
The bottom line
While all the experts we spoke with agree that there are definite advantages to adding on to a facelift, they also all underscore the fact that it’s definitely not necessary and you shouldn’t feel pushed or pressured into doing so. “At the end of the day, a facelift is purely elective. It should be about addressing what bothers you and performing treatments that you’re ready to have done,” says Dr. Chang. “If you weren’t thinking about or concerned with other issues beforehand, then don’t do anything else,” adds Dr. Gilpin. Dr. Bryant also echoes their sentiments, noting that the best thing to do is have a thorough consultation with your doctor in order to convey and communicate what bothers you and better understand exactly what your options are in terms of treatment(s) and what each of them can and can’t address.
