Deep plane facelift and upper & lower eye lid surgery - which should be first?

Question

Female 55yo planning to have deep plane, noise and eye lids done within next three years

Lucian Ion, FRCS · Answer

Thank you for your inquiry. 
There is no hard and fast rule applicable to this decision. My impression would be that it would help to do the rhinoplasty first, since your plan for deep plane facelift and upper eyelid surgery may involve consideration of deep plane facelift and brow lift surgery. There is synergy of treatment between the deep plane facelift and brow lift intervention, and the brow lift sometimes makes the upper eyelid surgery unnecessary or delays it, depending on the anatomical characteristics.

Safa Manav, MD, FEBOPRAS · Answer

Deep plane facelift, eyelid surgery and rhinoplasty can be combined or staged, depending on your health, total operative time and how much recovery you can manage at once. If staged, I usually prefer the facelift before or together with lower eyelid surgery, because repositioning the midface changes the lid–cheek junction and can alter how much lower lid work is needed. Upper blepharoplasty is often done with the facelift or afterward, and brow position should be assessed first, since a low brow can mimic excess eyelid skin. Rhinoplasty is fairly independent of the lifting procedures and can be done separately. Combining everything means one recovery but longer anesthesia and more swelling, so the sequence should be individualized.

Lexie Wang, MD · Answer

genuine question -- why not both at the same time?

But if that's not possible, then it really depends on what bothers you more. that answer is different for different people, but facial surgeries are not small undertakings, so you really want to address something that you are really bothered by and that you are very confident will improve afterward, even if you have to "suffer" for a little bit. that could end up being the eyes vs. the face/neck. if they bother you equally and you don't think you can do both at the same tiem, then generally I counsel patients to consider the eyes first since usually that is where strangers will first see a face, so it offers the maximum benefit.

Muhsin Yilmaz, MD, FEBOPRAS · Answer

A deep plane facelift and upper and lower eyelid surgery can sometimes be performed during the same operation by an experienced facial plastic surgeon, provided you are a suitable candidate and your overall health allows for combined procedures. This can offer the advantage of one recovery period.
The order does not necessarily have to be staged, as the facelift addresses sagging in the mid and lower face, while eyelid surgery focuses on excess skin and other concerns around the eyes. The best plan depends on your anatomy, the extent of correction needed, and your surgeon’s assessment. If rhinoplasty is also planned, this should be discussed as part of the overall surgical plan to ensure the combination is appropriate and safe.

Yurdakul İlker Manavbasi, MD · Answer

There is no universal rule that a deep plane facelift must come before or after eyelid surgery. These procedures address different concerns, and the sequence should be based on your anatomy, priorities, health, and recovery plans.
Facelift and eyelid surgery can sometimes be performed together in appropriately selected patients. In other circumstances, staging them is preferable. The total operating time and the extent of each procedure are important considerations.
Since you are also considering rhinoplasty over the next few years, it would be helpful to discuss all of your goals at the initial consultation. Brow position and the relationship between the lower eyelids and cheeks should be assessed as part of that plan.
If the procedures are staged, the next operation should be planned after adequate recovery and reassessment rather than according to a fixed sequence based only on procedure names.

Sinyoung Song, MD · Answer

Hello, this is Dr. Sinyoung Son. First, combining a Deep Plane Facelift with upper and lower blepharoplasty in a single operative session yields the most harmonious results. Because the deep plane technique elevates the midface and cheeks along the same anatomical plane as the lower eyelids, addressing the eyes and face together allows for a seamless, continuous repositioning of the soft tissues from the lower lid down to the jawline and neck. Performing these procedures simultaneously also optimizes your total recovery period and spares you from multiple anesthesia sessions.
For rhinoplasty, waiting approximately three months after your facelift and eyelid surgery is ideal. A deep plane facelift temporarily alters the soft tissue dynamics and causes edema around the midface and perinasal areas. Allowing these tissues to fully heal and settle for three months ensures that the facial proportions, cheek volume, and nasolabial angle are completely stabilized. Once your new facial contours are established, your surgeon can precisely tailor the projection and shape of your nose to complement your refined features with optimal aesthetic balance and minimal risk to tissue healing.

William Portuese, MD · Answer

It is certainly possible to perform a deep plane facelift and upper and lower eyelid surgery all simultaneously under one anesthesia with one recovery period. It's very important to study your prospective surgeon's before and after facelift photo gallery and eyelid photo gallery to ensure that you're going get a natural result.

Suheda Cildir, MD · Answer

My philosophy is to approach facial rejuvenation as a comprehensive, three-dimensional procedure. I advocate combining forehead lift, temporal lift, upper and lower blepharoplasty, deep plane facelift, and neck lift in a single surgical session when medically appropriate. This integrated approach addresses the face as a whole, creating balanced lifting vectors and harmonious, natural-looking results rather than rejuvenating individual areas in isolation.
Rhinoplasty can be performed in a separate session, either before or after facial rejuvenation, depending on the patient's needs and surgical planning. Each treatment plan is individualized following a thorough assessment of anatomy, health, and safety considerations.

Randall O. Craft, MD · Answer

If you are going to do all three within a few years, the usual order is the facelift first or the facelift and eyelids together, and the rhinoplasty separately. The reason is anatomical. A deep plane facelift with fat grafting changes the cheek and the lower eyelid-cheek junction; if lower eyelid surgery is done first, the lift can change what the eyelid surgery looks like, and some of it may need revisiting. Upper eyelids are more independent and can be done at any point, including with the lift. Rhinoplasty does not interact with either and benefits from being its own anesthetic and its own recovery, because the swelling timeline is different and longer. In my practice the common combination at 55 is deep plane facelift with neck, fat grafting, and upper and lower blepharoplasty in one operation under IV sedation, then rhinoplasty later if still wanted. Your surgeon should give you a sequence based on your examination, not a general rule.

Bryan Friedman, DO · Answer

May I suggest you generate a rank list. What is my number one priority. What do I want to address first and foremost, than go down the line. Your body, especially your face requires time to heal. So staging the above procedures and allowing the healing of each procedure, sufficient time is a great option. It also allows for a more subtle transition in this facial rejuvenation, transformation journey you are set to embark on.
If I were to make a suggestion with regards to the order of such. Start off small. Address your upper eyelids with an upper lid blepharoplasty. This procedure yields wonderful results when performed correctly, minimal downtime and can even be performed awake with just some local anesthetic, perhaps a relaxation pill like Xanax if desired. This will give you an idea of the healing process, as well as give you a small “taste” if you will as it pertains to facial plastic surgery. Thereafter, consider doing the lower lids and face in a second stage. A longer healing process, yet having done the upper eyelids already, you are more prepared. Now you have achieved facial rejuvenation!If you than wish to address your nose, go for it! A rhinoplasty when performed correctly still maintains your facial identity yet makes for subtle adjustments in the central identity to your face.I hope this was helpful
Warm RegardsDr Bryan Friedman

Deep plane facelift and upper & lower eye lid surgery - which should be first?

Answers (10)

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