I’m 68 years old. 5’5”. 147 pounds

Patient like you may require set of different procedures/treatments, surgical and non-surgical, to achieve good improvement. In your case, based on these photos, procedures like face/neck lift, upper and lower eyelid surgery as well as brow lift, possibly fat grafting, should be considered. Botox, soft tissue fillers, skin treatment like laser or chemical peels, radiofrequency, J plasma, would address skin part. Of course, you do not have to do all of these, but there is no one single procedure that will do all the job. As long as you are confused, before doing any of these treatments, keep asking and define your priorities. Face and neck lift may be something too start with. Hope this helps. Good luck.

All facelifts are variations on a theme. The goal is always to restore the soft tissues and skin of the face back to their natural positions. The extent of the facelift operation is tailored to each patient's needs. • A mini lift: This uses a small skin excision from in-front of the ear to just behind the ear that tightens the skin along the jaw line in young patients with minimal aging and good skin quality. • A lower face and neck lift: The most common type of lift targeted towards middle age and older patients with moderate skin excess and facial decent. The incision is extended higher in front of the ear into the sideburn and further back behind the ear into the hairline. During a lower face and neck lift, often the deeper tissues (deep plane) of the neck and face (platysma muscle and SMAS) are also tightened. Overall, this surgery typically tightens the neck and repositions the deeper soft tissues of the face to efface neck bands, lift the jowls, and add volume back to the cheeks. • An upper and lower face and neck lift: a further extension of the incision higher in-front of the sideburn to allow tightening of the upper face — addressing the crow’s feet and upper cheek skin. In some cases this can encompass a lateral eyebrow (forehead) lift to lift the brows. Your pictures demonstrate a degree of skin laxity of the face and neck, facial decent, and fullness of the neck that cannot be significantly improved with a mini-lift alone. In addition, the pictures show significant creasing of the surface of the skin – especially around mouth. For optimal treatment, a full face and neck lift with liposuction of the neck, deep plane tightening, and laser resurfacing of the skin would give you a nice improvement. Typically, we do those procedures as part of our Wide-Awake-Surgery program – surgery done under local anesthesia in the office. The same surgery is also available in the OR under anesthesia. Schedule a virtual "Instant" Consult today!

Thank you for your question. When researching facelift procedures, one can certainly be left overwhelmed by all the different terminology used by different surgeons. When deciding which type of facelift is right for your needs, it's important to remember that it is not just the name that ultimately matters, but the technique utilized. For example, a "deep-plane facelift" uses a surgical technique that involves repositioning and lifting the deeper, underlying layers of facial tissue and is usually beneficial for more advanced signs of aging. On the other hand, procedures such as a “mini lift” or “ponytail facelift” are more minimally invasive and are best suited for early signs of aging. Expressing your concerns and expectations during a consultation with the facial plastic surgeon of your choice will help you select the most suitable type of facelift to achieve the result you desire. Best of luck in your self-care journey! Dr. Konstantin

Deep plane just refers to the plane of the anatomic dissection (below a layer called the SMAS). This term has been popularized because it is quite catchy, but the technique is nothing new. I don't even know what a refresher facelift is; this sounds like a marketing tactic to just a standard facelift. I would recommend seeing a plastic surgeon with 6 years of plastic surgery residency training and a year of aesthetic fellowship training to ensure that you find an individual with adequate training in this very important area of the body.

Hello, hope you are well. This is a common question! You will see quite a lot of terminology around facelifts, but a lot of it is marketing. In reality, there are a handful of commonly performed categories and variations based on human anatomy (e.g. a skin-only facelift, a SMAS plication/imbrication, or deep plane variations). Then there are technical nuances and skills that vary from surgeon to surgeon, which accounts for the rest of the variation in results. In terms of facelifts, you would benefit most from a well-executed deep-plane facelift. But, a surgeon that specializes in the aging face would also explain there are many complementary procedures that are offed for comprehensive facial rejuvenation (to address the eyelids, skin texture, and so on). This approach makes all the difference when your goal is really to appear more youthful. Best,Dr. Tower

Hello, the names of the techniques in the literature are actually less than all you hear. The point here is the explanation from the surgeon who will make the surgery. My recommendations In your case, you have skin excess that should be removed, a saggy soft tissue under the skin that should be lifted, and a lost volume specially on the cheeks and temples that should be replaced with fat grafting. If a name of technique is asked, my suggestion is high-smas face/neck lift for your case. Regards.

Hi there, and thanks for the question. Based on your photos you would be a great candidate for a facelift. As you have observed, many surgeons have advertised (and some have trademarked) certain names for their facelifts. And deep plane facelift techniques are a recently recognized term in the patients' vernacular. The specific differences between techniques are mostly helpful when surgeons discuss these at conferences. In order for you to pick the right surgeon, the best choice should depend most on their specialty experience, before/after results, and their ability to be approachable and answer all your questions. The specific technique matters, but the result photos are the best gauge to tell whether your surgeon has perfected whichever technique they choose. That said, for your specific anatomy the technique I would use would be elevating the SMAS and platysma in the deep plane and elevating them to their youthful positions while trimming the excess skin. I would also consider laser resurfacing as that will greatly help with the fine lines and skin texture/pigmentation and can be combined with a face and necklift surgery for a single recovery

There are significant differences in facelift technique and many of those differences absolutely matter. Buzz word descriptions like "Refresher Face Lift" or "Enigma Lift" mean nothing. They are marketing ploys to sell surgery. A deep plane facelift describes an operation that works in the sub-SMAS layer. There are several variations of this operation and different variants are chosen based on the patients specific needs. Looking at your photos, I would suggest strongly considering facial skin resurfacing (deep chemical peel or fractionated CO2 laser) prior to a facelift/neck lift. Facial skin (not neck skin) resurfacing can significantly improve the texture, tone, and quality of your skin. A well executed deep chemical peel can reduce the number and severity of superficial and deep wrinkles. This is critically important because performing a facelift with skin like yours puts you at risk of creating unnatural appearing wrinkles that will compromise the quality of your results.

Don't be swayed by clever names for facelifts. The key is to think of a facelift in 3-dimensions, involving lifting and re-shaping the layers under the skin and restoring volume where it is deficient. This is accomplished by lifting the SMAS layer and sometimes fat grafting in addition to skin. There is some debate about "traditional" SMAS technique vs. deep plane, which is the same thing only going deeper. IMO, deep plane has a longer recovery time and I'm not convinced the results are better or longer lasting.

This is a wonderful question and one that deserves a clear explanation. Terminology used in the the aesthetics world is very confusing. Every surgeon wants to market their own facelift. "Pony tail facelift" Mini Facelift" "weekend facelift" "Vertical vector facelift" "Refresher FAcelift". What does it all mean?!!. Amongst plastic surgeons we can tell the difference based on the techniques that are used. As with most surgeries, the techniques and surgeries have evolved over time. In earlier times, surgeons would make incisions around the ears and hair and pull on the skin to achieve a tightening effect on the lower face. This method often left the skin very tight, distorted and pulled particularly around the eyes and mouth. It was very obvious and un-natural. Because the skin is relatively elastic, over time the pull would weaken and the results did not last long. The facelift further evolved into pulling on the SMAS (Superficial Muscular Aponeurotic System) A sheet of fibrous tissue and muscular connections which runs through the middle layer of the face and neck. Surgeons found that by pulling on this structure we could achieve longer lasting results without the stigma of the "skin only" method. These were done in two main types, - imbrication (Cutting) and plication (folding). These techniques have been the mainstay of facelifts over the past 20-30 years. There is also a MACS lift which is a minimal access cranial suspension lift that uses sutures to pull on the ptotic structures. The idea of anything "mini" or "minimal access" is usually a facelift through smaller incisions and less dissection and pulling. It is important to remember that these will often not give you long lasting or powerful results. Many physicians use this as a marketing tactic - minimal facelift shorter recovery, less down time..... Deep plane facelifting has been around for about 40 years but has undergone a huge overhaul in the past 15 years by pioneers like Dr. Andrew Jacono. Surgeons have found that by entering deep to the SMAS and releasing the SMAS layer allows you to reposition the tissue, midface volume in a more natural and powerful way. This is now combined with transection of several fibrous ligaments in the face to allow even more of a durable pull on the deep structures. The vertical vector just refers to the way we are repositioning the tissue after we release it. These newer techniques are novel and are only taught at very specific fellowships/training programs. There is a newer generation of surgeons (The first wave) that are still in their 30-40's who are all using this. Most older surgeons are still using Imbrication or Plication techniques. The older surgeons who are doing Deep Plan facelifting are likely the ones who have pioneered this technique, but their surgeries come at a steep price. Soon the Extended Deep plane facelift will be the standard of care. Judging by your photos you would benefit most from an extended deep plane facelift. I would not do anything mini. Hope this helps!