I've also answered this question on this video in YouTube:The Fundamentals of a Facelift, Why Shortcut Procedures Don't Work, and Cautions for Medical TourismAs a cosmetic oculofacial plastic surgeon practicing for 20 years, facial rejuvenation happens to be an area I specialize in. I wrote a book called “The Fine Art of Looking Younger” and I can help people like yourself who are confused about fillers as well as other optimal procedures. Facial aging is a combination of volume loss and laxity. Volume loss means loss of bone, muscle fat, collagen and soft tissue. As we get older, the face gets a little bit older, the baby fat diminishes and everything gets smaller. That’s why fillers have such a vital role especially in the earlier decades of facial aging such as 30s and 40s. On the other hand, laxity or loss of elasticity where tissues such as the skin and the tissue under the skin called the superficial muscloaponeurotic system or SMAS gets lose, becomes thinner and sags. Over my 20 years of practice, I have seen so many procedures come and go that are supposed to be shortcuts. These include thread lifts, mini weekend lifts, various heating devices and lasers that are supposed to take over facelifts. However, there are no shortcuts. There are ways that procedures can be done to optimize the results but certainly shortcuts never really work. When you have to make a decision and money is an issue, from my perspective, that is where people make a lot of mistakes. As a specialist and as someone who has become well-known, I have patients who come to me from all over the world and all over the country who have had some unfortunate results by going for less expensive options. Unfortunately, in the field of cosmetic surgery, there appears to be two types of doctors: those who do high volume and low prices, and low volume and higher prices. There are also people in the middle. Unfortunately, quality does cost: anesthesia, operating facilities and the art of doing the surgery cannot be rushed so you do get what you pay for is true. People have come back after going to different countries for surgeries where they needed additional aftercare. Surgery is a single procedure but there are certain percentage of people that need more care whether it’s the incision, swelling or other areas that need treatment with steroids. The aftercare process is so important and they missed that by going to another country. They come to someone like me or a colleague and they are surprised that they have to deal with all of these issues. Being in the United States or going to a doctor who has the qualifications, experience and who is accessible has tremendous value. I always teach my patients that your procedure is an investment that will pay long term dividends in terms of the benefit after many years. Being in practice for many years, my patients and I have gotten old together and at one point, I’ll do their eyes and they’ll come back and I’ll do their face. I’m always available to my patients and the accessibility and the ease makes it a very good journey for the majority of my patients. My advice is to meet with several experienced cosmetic surgeons and come up with plan. If it’s about the budget, you choose the things that you are most concerned about and you address them in a particular time. In our practice, we do everything under local anesthesia with LITE™ IV sedation. If someone cannot afford everything, they don’t feel bad that they are not going under general anesthesia and having to go back to it. When our patients do the sedation, they recover very quickly and when the time is right they’ll come back and they’ll do another procedure. Anesthesia is certainly a factor in my experience that has helped a lot of our patients budget their priorities. Unfortunately, when you go under general anesthesia, there’s pressure to do more procedures just because it’s not the best experience in terms of the risks involved. Have a plan and an idea of what you need to do. You may need to do a limited procedure as long as you and the doctor are clear on what the ultimate benefit is. In my experience, shortcut procedures are not the best way to do things. Most of our procedures like facelifts or face and neck lifts, we do aggressively enough so that they feel that their jawline is tight, their neck angle is well defined, cheeks are up and it looks very good. When you do shortcut procedures, sometimes you get a better jawline but then there’s a little neck sagging and laxity. I would discourage you from going abroad. There are many highly qualified experienced cosmetic surgeons here and I think it’s the matter of you clicking with the right one and figuring how to budget intelligently. I hope that was helpful, I wish you the best of luck, and thank you for your question.