Wading Through Confusing Doctors' Opinions on Facelift

I am ready to make a decision on which surgeon to choose in Sacramento for Facelift. I'm not an extreme case. I'm 52. I've been examined by 5 drs to make the best choice.

I've narrowed it down. One says that if the muscle is plicated (folded) that it can leave a bump that could show through later. The other Dr. says this could benefit by adding some fullness to side of my face.

Also, one said the incision is only necessary in the sideburn (horizontal), while the other says that is must also extend over the ear. I'm very confused. Thank you.

Doctor Answers 20

Facelift options

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There are several ways of performing facelift operation, all of which can give excellent results. Review some photos from the surgeons that you are leaning towards choosing. Seeing acutal results should give you confidence in that particular surgeon's technique. The options that have been offered to you are all accepted methods of performing facelift surgery.

New York Facial Plastic Surgeon

Which Facelift Procedure?

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You should not be put in the position of having to decide which facelift technique is best for you. All you're interested in is the results. First, you must be comfortable with the surgeon. You want to know what will be done, what will change, what is your post-operative course, what are potential complications and what it will cost. See before and after pictures of patients similar to you. Hopefully this will eliminate the confusion.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Sorting out facelift options

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Having seen 5 doctors you have hopefully discovered that there is no one facelift operation - but this can become very confusing. My best advice is to look at lots of photos from each of the doctors and decide who's look best and most like what you want. Then be sure you "click" with that doctor and his/her staff and then go ahead with surgery.

Don't fret over small details like incisions and plication vs SMAS flaps. This is an artform and no 2 surgeons are the same and neither are their results. Pick the best and let them do what they do.

See facelift before and after photos

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With respect to the facelift incisions, the incisions are not placed in a vertical fashion in front of the ear. The incision is usually placed behind the tragus and half the hairline in the sideburn area. The excess skin that is removed is bald skin, not hair-bearing skin so as not to raise the hairline. This holds true for the postauricular area as well. The muscles are usually folded over in the neck when the neck muscles are tightened, and this does not show through. On the side of the face, muscles are actually sewn together side by side, not folded over. Ask to see some of the placement of incisions from the surgeons that you have narrowed a decision down to, and talk to past patients regarding their care. It is also important to look at the surgeon’s before-and-after photos to get a good idea of the facelift that he or she performs.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Establish A Level of Trust With ONE Plastic Surgeon

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I think it is very important to establish a level of trust with the surgeon you choose. It is important to do your homework and seek out well trained experienced board certified plastic surgeons who does facelifts on a weekly basis. Do this and you will probably get a good result with whomever you choose.

While facelift nuances you mentioned are important to understand, they are not critical for you to receive an excellent result. There are many more nuances and decisions that a plastic surgeon makes during any facelift that you never know about. We make these decisions based on each patients individual factors such as severity of laxity, sun damage, volume loss, pigmentation, hair density, hairline location and on and on.
What I am getting at is you need to find a plastic surgeon you can trust to do the right thing for you, and to certain extent, let him do it. Yes, there are choices to be made! Let one surgeon you feel comfortable with help you make them.

Word of mouth

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As other surgeons have noted on this topic, there are different approaches that can yield excellent results. The key is finding a surgeon who uses an acceptable technique, while obtaining stellar results. Most accomplished Facelift surgeons agree that the best results are obtained with some form of SMAS mobilization technique (elevation, repositioning, and suturing of the SMAS).

My observations are as follows:

1) Listen to what people say about a surgeon's staff, his manner, his results, and his status in the community. What percentage of the surgeon's practice is devoted to facial rejuvenation? Physicians can be a reasonable gauge, as can hairdressers and former patients.

2) Analyze the photographs your are shown. Do the patients you see have similar aging characteristics to what you see in your own face? This is not always possible, but something to look for.

3) Is computer imaging useful for Facelift surgery? In my opinion, absolutely not! Indeed, this may present an implied result; the results you actually obtain may not be close to computer imagery. The best approximation is looking at the surgeon's actual work.

4) Choose a surgeon you are comfortable with.

5) The general rule of thumb is that the cheapest and the most expensive surgeons are generally not the best.

Good luck in your search.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 104 reviews

Ask to see facelift before/after photos

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You are confused, but this can be alleviated by seeing multiple before and after photos of each surgeon's patients. It is most important to see patients with your type of facial morphology and deformity and approximate age range in my opinion. Don't rely just on computer imaging for this procedure. I would advise narrowing the decision down to no more than 2 or 3 surgeons, and then make a choice. Talking to former patients can be helpful, if they are willing and open to discussion.

Harrison C. Putman III, MD
Peoria Facial Plastic Surgeon
4.7 out of 5 stars 13 reviews

Talk to former Patients

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As always you have received excellent advice from the Doctors here.

I would add one more thing:

Ask the Surgeons to speak with former Patients of theirs who have undergone the procedure they are proposing to you and also have (had) similar anatomy to yours. They should be at least 6 months to one year or more from having had their procedure.

While this does not serve as any guarantee of what you can expect it will give you an idea of the Surgeon's experience, results and what the whole process was like from beginning to end for previous Patients of theirs.

Good luck to you - seems like you are doing an excellent job of researching your options!

Dr. Kamran Jafri

Kamran Jafri, MD
New York Facial Plastic Surgeon

Confusing facelift

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You are confused by the myth that there is a "RIGHT" in Plastic Surgery. Many studies have shown that skilled Plastic Surgeons can get excellent results from substantially different techniques.

Read the book "Blink" by Malcom Gladwell, do your homework on your possible surgeons and go with your instincts. Stop worrying about where he makes his cut.

No Easy Answer

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Unfortunately there is no easy answer to your question. As pointed out by Dr. Chaboki, a facelift is not just one procedure but a range of procedures. Each surgeon will have a slightly different way of performing the procedure. The results that they discuss in consultation will be a combination of their experience and the procedure they perform. In the end you can get excellent results with several options. Choose a surgeon with whom you feel comfortable. Sometimes more important than initial results are if the surgeon can handle complications should they occur.

D.J. Verret, MD
Dallas Facial Plastic Surgeon

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.