How do you avoid that sharp unnatural angular look after face lift with neck lift?

If you look at two classic beauties from the ages, certain
things become clearer:



Athena, one of the three beauties in Greek mythology
(Aphrodite and Hera being the other “fairest of them all”) is often shown as a
classically beautiful face. She has a fullness to the face with gentle angles
along the jawline and a blending in of the face into the neck: not the “puppet
on a stick” you note.



Nefertiti from more than 3000 years ago, one of the two
famous queens of ancient Egypt (Cleopatra, of course, being the other), is
regarded in cosmetic surgery as being “well-good” as the saying goes. She is
put up as an example, not only of perfect proportions (of the face), but also
desirable angles and sharpness of the neck (cervico-mental angle). I am afraid,
she may, rather, unfortunately, to you, look like a puppet on the proverbial
string!



If you were going to gather all the cosmetic surgeons you
know who do facelifts and neck lifts, you will find that most will find both
these faces pleasing and desirable.



Depending upon the wishes of the patient and the aims of the
surgeon, by using techniques and modifications, one can endeavor to achieve an
Athena-like or a Nefertiti-like result. Preoperative discussions and
expressions of likes-and-dislikes are vital.



I have put these two beautiful ladies in a brief video for
you to digest. At the end of the video is an example of the Duchenne smile,
which is where we smile with our eyes but people call them crow’s feet.
However, preserving them gives one a much more approachable and genial facial
appearance. Another example of how variable tastes and perceptions can be.



In other words, horses for courses, each unto him or
herself, or there is no accounting for taste! Take your pick.



A very useful and astute observation on your part: gives
many of us in the teaching and operating profession an opportunity to discuss
and learn. Thanks.



Best wishes,



Prof. Bhupendra C. K. Patel MD, FRCS

Of course it is possible to avoid the facelift results you described above! First and foremost, when deciding to have a facelift and neck lift, it is vital you find a board certified facial plastic surgeon with extensive experience in these procedures to help avoid undesirable results. When you are consulting with a facial plastic surgeon, ask for the surgeon's credentials, review before and after pictures of his/her patients, and spend time talking about your goals and make sure that the surgeon is listening to and understanding what your expectations are so you can achieve the results you want. On the surgical side, it should be your surgeon's goal to give you naturally beautiful results so that you simply look like a younger version of yourself. Today, we know that volume in the face is an important component of a youthful face. When surgeons just remove excess skin and tighten the face, you see that unnatural angular look you mentioned. But when fat grafting is used to add volume to the face, we see much more natural looking results. When I perform facelifts and neck lifts, I create a heart-shaped face that looks balanced and youthful. The jawline, neck and chin areas create the bottom portion of the heart-shaped appearance and high-arched cheeks and a full mid face and temples are the top portion. A facelift and neck lift should make you look and feel like the best version of yourself, so make sure you do your homework to find a surgeon that can deliver these results to you; you deserve to look great!

There are many details and fine points that can be reviewed
with your surgeon at the time of consultation. I would recommend that you write
down these points as each reasonable question can be addressed at the time of
your surgery by an experienced facial specialist. The most important factors
responsible for your future success are directly related to your surgeon’s
training, board certification, surgical specialization, and observed outcomes.
Your initial consultation provides you with the opportunity to review each of
these elements and to make the right decision for you. I would also recommend
bringing photos of faces you like and older photos of yourself to such
consultations.

Be healthy and be well,

James M. Ridgway, MD, FACS

Thank you for the great question. The overly angular or "puppet" look you are describing can be related to aggressive removal of fat from the under-chin area. This maneuver, preferred by some patients, can lead to the "surgical" look that you fear. The way to avoid this is to leave some fat on the skin flap in the neck, and to lift the face and neck superiorly, rather than pull back.

Contour following a facelift should be improved along the neck and jawline, but you're correct that an overly angulated neck and jawline loses the smooth softness of youth.  One important factor in creating this smooth contour is to avoid over-aggressive fat removal in the submental and neck area.  A common mistake is to remove this fat too aggressively in a well-intentioned but misguided attempt at creating a more defined jawline.  This fat is important to maintaining a smooth and soft appearing neck and jawline.  An individual consultation with a facelift specialist should help to clarify and distill these issues for you personally.  A link with more information and pictures is included.  Good luck!

Some surgeons pull as much as they can during a facelift.  That's never a good idea because it distorts the face and results in widened scars.  But in particular it is bad to pull too much behind the ears because it gives that sharp unnatural angular look across the neck which I think you are referring to.  That problem is made worse because during a facelift the patients shoulders drift upwards, so that what seems ok on the table causes a tension band across the neck as the shoulders relax.I promise this is avoidable by finding a surgeon who can describe to you the things that he/she find troublesome in facelifts and how they avoid those looks.  Don't just tell them what you don't want; listen to them describe their aesthetics and you are sure to interview a plastic surgeon who has your taste.

The best way to avoid an un-natural appearance is to avoid over-tightening and to utilize fat transfer to help restore a more youthful appearance. Discuss this concern wtih your plastic surgeon at your consultation. Good luck!

Your question addresses many important nuances in facelifting. The most important consideration in avoiding the  "sharp, unnatural, angular look" you eschew is to perform a facelift in which the tension of the lifting vectors is placed on the SMAS layers of the face rather than the skin.  The SMAS is the layer covering of the muscles of facial expression in the face, and using it to lift the soft tissues of the face allows much less tension to be placed than when pulling on the skin itself, thus yielding a much softer and more natural final result.  Another trick to avoid the unnatural look you decry is to avoid skeletonizing the neck too aggressively in a facelift.  It is important to leave a layer of fat of adequate thickness beneath the skin of the neck, submental region and jawline to create a soft and youthful appearance of these areas.Finally, performing fat transfer to the face at the end of the facelift allows volume and fullness to be restored to areas of the face that still remain somewhat hollow after the soft tissues have been elevated.  While this list is not exhaustive, it does illustrate the fact that a well-performed facelift is actually the summation of a series of subtle adjustments and surgical nuances that in concert can deliver a soft and natural final result.

When you interview your plastic surgeon asked to see many pre-and postop photographs. If you don't like what you see and it appears a natural to you and you should get another opinion.

In order to have less angularity after a neck and face lift , first the underlying bone needs to be less angular,less prominent,rounder,smoother. Next, their has to be some type of camofhlage ie. fat to cover the bone. Finally the skin cannot be pulled too tight. This technique is available and essentially customizeable for you but its results don't last as long as a standard lift.