Facelift, Necklift, Lipo? If I choose facelift - which kind should I go for? 48 yrs old in NYC.

I am wondering what type of facelift and/or neck lift is best for me? I am 48 yrs old and live in NYC. I have had two consultations - one states neck lipo only with SMAS face lift and the other states a deep place face lift with neck lift (platysmaplasty) or an in office mini lift with neck lift. I am pretty lost on which is best if I could get some help please. Thank you! PS wondering if a brow lift is in order?

Doctor Answers 17

Which way should I go - facelift, neck lift or neck liposuction?

Taking into consideration that you are a 48-year old, it is likely that the procedure of choice would be a standard cheek/neck lift, which is the proper term for a so-called facelift.

A cheek/neck lift will consist of elevation of the soft tissues in your face and neck as well as an elevation and tightening of the deep muscle structure via one of several techniques.  If you do have a substantial amount of fatty tissue in your neck, this may be removed by direct excision of the fat, or if it is localized or in smaller quantities, it may be that the best route would be liposculpture.  Typically in most patients after the age of 55, we do a substantial amount of lifting and/or surgical maneuvers which may involve resection of the fat and platysmoplasty in the neck area.  Prior to age 55, the surgery needs to be fashioned to whatever issue we find in the neck.

Bloomington Facial Plastic Surgeon
4.2 out of 5 stars 8 reviews

A full facelift takes care of all problems from the eyelids to the clavicle.

Without saying a picture it's hard to give specific advice but a properly executed facelift repositions tissues that have descended, removes unwanted fat in the neck, removes superfluous skin.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 32 reviews

What to choose for face

Do not be carried away by elaborate and big time sounding procedures as most very experienced facelift surgeons are continually simplifying their approach over time and with experience. Very few good facelift surgeons do platysmaplasties anymore as they look unnatural and can be uncomfortable over the long run. Simple cutting of the platysma bands is enough to correct this problem. Deep plane faceliftying is also way overboard as the results are no better than traditional work and its adds risk. I personally do less and less SMAS work as I get older because I see less and less benefit from it. A facelift is essentially a skin operation.....nothing more. Great results are obtained because the surgeon has a good eye, lifts the right amount, and then distributes and drapes the skin evenly and naturally. I do all my facelifts with oral sedation ( Valium, Ambien ) and local anesthesia (Xylocaine ) injections in under 3 hours. Totally safe , very easy office surgery, and amazing results. Any other approach is just making it hard on yourself for no good reason or added results.

Wht procedure for a facelift?

The reality is the best answer is going to come down to the appropriate procedures for the individual patient's findings on physical exam and the surgeon's explanations of why they chose those specific procedures.  Different surgeons will be comfortable with a variety of procedures.  As we age there are three major areas that a rejuvenating procedure should address.  That would include treating the skin, the laxity or droopiness of the tissues, and the volume loss the occurs as we age.  The is no one procedure that applies to all!

Christopher Cote, MD
Denver Facial Plastic Surgeon
4.4 out of 5 stars 17 reviews

Facelift Options

Dear avamarie, thank you for your question.Facelift surgery can dramatically improve the cheeks, temple area, jawline, and neck. Consult with a board certified facial plastic surgeon who can offer a variety of options. Good Luck!

Roy A. David, MD
San Diego Facial Plastic Surgeon
4.5 out of 5 stars 23 reviews

When faced with options, you have to decide what is best for you

and what will provide the result you seek.  They all have their benefits and risks and each delivers towards rejuvenation.  As for a brow, if your brows are encroaching on your lids/eyes, then it would be appropriate... but there are 3 ways or more to do a browlift so more choices!

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

What type of facelift do I need?

It is virtually impossible to provide you with a surgical plan without photos. I find that age is not the deciding factor in what type of facial rejuvenation procedure a patient needs.  Instead, the degree of aging and areas of concern for the patient have to be assessed.  Once a patient's "problem areas" are identified, and aesthetic goals are set, a surgical plan can then be formulated.  I would be happy to see you in my office for a complementary consultation.  Please see link below.  Good Luck!

Anthony Corrado, DO
Philadelphia Facial Plastic Surgeon
4.9 out of 5 stars 32 reviews

Without photos can't say what is "best for you"

Hi Avamarie123,

Without photos of you it is impossible to say what is best for you.

If you have a double chin and excess fat under your chin, then perhaps liposuction with a SMAS facelift may be sufficient.  Having said that, when I perform liposuction under the chin, I always perform a platysmaplasty, to control how the platysma muscle heals.  If liposuction alone can result in vertical muscle bands called platysmal bands.  This can be prevented after liposuction is performed by sewing the left and right platysma muscle bands together to make them heal together and not form the vertical bands.

If you do not have excess fat under your chin and only have sagging skin under your chin, which you can pinch between your fingers, then for those patients, I may not perform any liposuction at all and improve the profile of the neck through the platysmaplasty.  If liposuction is performed with patients who do not have excess fat, this can cause them to have a problem called a "cobra neck deformity."   Since these patients do not have excess fat under the chin, I prefer to preserve the subcutaneous fat (the fat directly under the skin which is usually already a thin 1/8"-1/4" thickness of fat on the skin and smooth it out when performing the skin removal through the lower facelift and necklift incisions around the ears.  Keeping a uniform layer of fat under the chin will help prevent crepiness of the neck skin.  Removing too much fat directly under the skin (subcutaneous far) will cause the skin to be too thin and increase the risk for crepiness.

A necklift is a superior procedure to liposuction alone.  Of the before and after photos on Realself, if you see a sharp angle created on a profile view from the chin to the neck, if you read the fine print in general you will see that a platysmaplasty was performed. 

As far as the Deep plane facelift versus a SMAS facelift or a mini-facelift, this debate has been going on since the 1990's by several prominent facelift surgeons in New York and throughout the country.  The SMAS is the layer of fatty muscle tissue directly under the cheek skin.  In a patient who has sagging of the cheeks and jawline, this layer is loose, and if the surgeon pulls on the SMAS in a upwards and backwards direction, the SMAS will easily move this way.  After the SMAS is tightened, the lower cheek and jawline is tightened and there is usually some excess skin that needs to be removed, and the remaining skin is carefully sewn together in well camouflaged incisions.

In general, a Deep plane facelift means that the SMAS is lifted up as a sheet of fatty/muscle tissue and advanced upwards and backwards along the cheek.  The full release of the SMAS tissue using the Deep plane technique releases the SMAS all the way to the Jowl and allows the sagging lower cheek to slide upwards and backwards (diagonally) without any resistance from fibers which may be resisting the SMAS movement.  Most experienced facelift surgeons will agree that a Deep plane facelift is a superior technique to a simple SMAS facelift.

A SMAS facelift has a variety of meanings.  On the low end, a SMAS plication is also considered a SMAS facelift and this type of SMAS facelift is performed by not fully releasing the SMAS and placing sutures on the surface of the SMAS and tightening the loose surface of the SMAS so that the surface is tighter.  Since the SMAS is not fully released off the layer below, the movement of the SMAS is somewhat limited.  If the patient does not have much sagging, this may be enough of a facelift for that patient.

The second type of SMAS facelift is a SMAS imbrication.  In this type of SMAS facelift, although the SMAS is not released fully as with the Deep plane facelift, a strip of SMAS is excised, and the edges of the SMAS are sewn back together.  This removal of a strip of SMAS creates more scar tissue which should help the SMAS tightening be more "sturdy" than the SMAS plication (folding) but not as "sturdy" as the Deep plane facelift.

I offer all three types as mentioned above, for different patients: Deep plane, SMAS imbrication, SMAS plication.  Of the three types of facelifts, I need the patient to have either twilight or general anesthesia for the Deep plane facelift, but for the SMAS imbrication or SMAS plication, I can offer both of those SMAS tightening as part of my mini-facelift.  In general, mini-facelifts are performed under local anesthesia with an oral sedative such as Valium.

If the patient is already going to the surgery center for twilight or general anesthesia, our practice's cost difference between the deep plane and the SMAS facelift is currently about $1000 difference.  The main increase in cost is really the surgery center fee and the anesthesia fees.  Since the patient is already going to be asleep, then I have the opportunity to perform the Deep plane facelift which I would not be able to perform if the patient was have the procedure awake as a mini-facelift.  The results of the SMAS facelift with necklift whether awake with local and Valium versus fully asleep is the same.  The only difference is the cost.  I would estimate the Deep plane facelift is approximately 10-20% tighter than the SMAS imbrication and perhaps 20-30+% tighter than the SMAS plication.  This also results in a some additional skin removal without having the face look tight.

The main minor issue which is common after lower face and necklifts is that the patient often really loves the results, but wishes the surgeon could have just tightened it "a little more."  I translate that as I wish the surgeon tightened the SMAS 10-30% more and took a bit more skin out.  For this reason, if cost were not an issue for the patient, I would recommend the deep plane facelift with necklift (platysmaplasty with or without liposuction.)

Since my practice has a significant number of patients who are working and on a fixed income, they need to have a shorter recovery, as well as a reasonable final cost to the face and necklift.  For these patients, I offer them a Necklift plus, which is a necklift with platysmaplasty with or without liposuction depending on the patient, with a mini-facelift (SMAS imbrication or plication depending on the patient's anatomy.)  If you look through my awake face and necklift and compare it to other surgeons full anesthesia SMAS facelifts it may not look different to you.  The same work is done with local anesthesia, but the patient is awake, but sleepy with Valium.  If the patient's SMAS layer is thick, I prefer to perform the SMAS imbrication to get the SMAS tighter than the SMAS plication.  If the patient's face is already very thin, I may be reluctant to excise even a small strip of SMAS and I would want to keep all of the SMAS so the face does not get any thinner.  With the deep plane facelift, I usually do not need to remove any SMAS, so it still works for thin faced patients.

Browlifts are patient dependent, but if you have followed my posts in the past, I am not a big fan of browlifts.  If you find photos of yourself in college and in your 20's or simply flip through fashion magazines, you will see that youthful eyebrows are not elevated.  They are relatively relaxed and low, but the main common element with the lower eyebrows is that there is plenty of skin showing under the eyebrow hairs, and above the eyelid fold.

I hope this doesn't make it even more confusing for you, but in general during my consultations, I will use examples, analogies and sometimes diagrams to help the patient understand what they are really considering.  For some patients, this additional information is helpful in making a decision, while for others, they may not want too much technical information and perhaps cost is more of an issue.  For this reason, our practice offers both the Deep plane with necklift and the Necklift plus.  If cost is not an issue, then the Deep plane with necklift is superior.


Dr. Yang

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George Yang, MD
New York Facial Plastic Surgeon
4.8 out of 5 stars 30 reviews

Facelift, necklift or lipo?

Hello and thank you for your question.
Unfortunately, without at least a picture, it's really impossible to give you any advice. Standard face lifts are usually performed with some type of manipulation of the SMAS along with skin undermining and excision. To know how to best treat your face and neck could only be determined after seeing you. I would be more than happy to see you in consultation if you are unsure with the consultations you've had. Feel free to contact my office at 212-688-5882. Perhaps you need further explanation of the options and/ or differences between the options.Best of luck to you.

David Cangello, MD
New York Plastic Surgeon
5.0 out of 5 stars 8 reviews

Best face lift

  • In my experience, assuming it is needed, I see the best results are with a deep plane face lift with platysmaplasty neck lift.
  • That is reasonably likely to be best for you, at your age.
  • Liposuction only on the neck - unless your problem is fat, not skin and muscle - may be a bit disappointing.
  • I personally am not a fan of the mini-lift - assuming what is meant is a suture face lift - they can be distorting and results may not be permanent - but they are less expensive.
  • Every surgeon has his/her own techniques that work best for them.
  • When in doubt, select the Board Certified Plastic Surgeon in whom you have more confidence, return to discuss the different opinions and select  the most thorough procedure you can afford. Best wishes.

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.