At what age is a face lift appropriate?
When is a Face Lift the Best Choice?
Doctor Answers 77
Facelift Options and Choices
Surgical or even non-surgical treatment of facial aging changes must be carefully individualized to match each patient's aesthetic needs and desires. In helping a patient to make decisions about plastic surgery for facial rejuvenation, I always examine and assess how each aesthetic area or 'unit' of the face contributes to an individual's overall appearance: the brows and eyelids, the cheeks or 'midface', the lower face and chin, and the neck. An individualized plan is then developed which addresses each patient's specific concerns and needs.
A "liquid facelift" is a procedure that is performed using temporary dermal fillers like Juvederm Restylane or Perlane. There is little to no downtime with a liquid facelift. This might be an ideal treatment for some, but the results are temporary and it does not address excess skin.
Structural fat grafting, sometimes referred to as microfat grafting can provide fullness to lips, cheeks, hollowed upper or lower eyelids and can fill lines and wrinkles on the face. Unlike the liquid facelift, the results from structural fat grafting can be permanent
Laser Skin tightening is a non-invasive treatment with little to no downtime. For individuals with early signs of aging, uneven skin tone, scarring or large pores a laser skin tightening procedure can provide dramatic results.
Full Facial rejuvenation or a full facelift may be the answer for some. Some people looking for facial rejuvenation are interested in the lower face, midface and eyes, others are interested in one area only. Surgical treatment of facial aging changes must therefore be carefully individualized to match each patient's aesthetic needs and desires. No two 'facelifts', by necessity, are the same. In helping a patient to make decisions about plastic surgery for facial rejuvenation, I always examine and assess how each aesthetic area or 'unit' of the face contributes to an individual's overall appearance: the brows and eyelids, the cheeks or 'midface', the lower face and chin, and the neck. An individualized surgical plan is then developed which addresses each patient's specific concerns and needs.When choosing a plastic surgeon it is imperative to select a surgeon who is certified by the American Board of Plastic Surgery. Often, plastic surgeons who perform a great deal of aesthetic or cosmetic surgery will also be members of ASAPS. A plastic surgeon who is a member of ASAPS is an indication that a surgeon has significant interest in aesthetic plastic surgery. When evaluating a surgeons training, look for completion of a plastic surgery fellowship. A fellowship is an elite qualification that only a small percentage of surgeons performing cosmetic plastic surgery can claim. , a surgeon who has had an additional fellowship of training has completed focused and intense specialized training in a particular area of interest
Be careful about investigating board certification. Some doctors today are promoting themselves as being double board certified, triple board certified and even quadruple board certified.
Thousands of physicians with no residency training in plastic surgery and without certification from the American Board of Plastic Surgery (the only Board recognized by the American Board of Medical Specialties that certifies plastic surgeons) promote themselves as `cosmetic surgeons' and `plastic surgeons'. Some are primary care physicians, some are emergency room doctors; some have never completed a residency training program in any specialty and are not eligible to take any specialty board exam. Many take `weekend courses' on liposuction, or breast augmentation, or facelifts, then return to their practice and begin promoting that procedure and performing it on patients.
The minimum amount of training in plastic surgery that will allow a physician to be eligible for certification by the American Board of Plastic Surgery is five years, and many board-certified plastic surgeons, myself included, have several additional years of training in general surgery and plastic surgery. There are a number of reasons for such a significant training requirement. Chief among them are the following: one does not acquire sophistication in diagnosis and treatment planning, superior surgical skill, and the capacity to minimize the possibility of complications and unfavorable outcomes by taking weekend courses. It requires years of training experience under the direction of talented mentors. It requires devotion to the art and practice of plastic surgery.
Be careful in evaluating physicians whose `Board Certification' is by a `Board' which is not recognized by the American Board of Medical Specialties (ABMS), and who belong to an `Academy' that does not require residency training in plastic surgery. Some will claim that they are `double-' or even `triple-board certified', when only one (and occasionally none) of those `boards' are recognized by the ABMS. Visit the ABMS website to see which specialties have ABMS recognition.
It takes just a few mouse clicks to verify a surgeon's credentials online. Make sure that the surgeon or surgeons that you are considering are certified by the American Board of Plastic Surgery and are active members of the American Society of Plastic Surgeons (ASPS). ASPS members are also eligible for membership in the exclusive American Society of Aesthetic Plastic Surgeons (ASAPS), the premier professional association of board-certified plastic surgeons with a specialty practice in cosmetic surgery
Selecting a plastic surgeon should always start with board certification by the American Board of Plastic Surgery, but it doesn't end there.
Choosing Your Surgeon
There is endless information about plastic surgery available online, some of it helpful, some of it hogwash. Many patients learn about treatment options and narrow their search for a plastic surgeon with the help of their computer. And then they make one or two or more appointments, and on the basis of these encounters decide on a surgeon. Some patients already have a particular plastic surgeon in mind, based on the recommendation of satisfied patients or the surgeon's reputation.
Regardless of how you decide who you see, ask yourself the following questions after your consultation appointment(s):
Is this surgeon qualified to perform the surgery I am considering?
Do I like this person? Will I enjoy seeing them over the course of my surgery and recovery?
Was my complete medical history taken and examined in detail?
Did this physician truly listen to me as I explained my thoughts about the improvement I am seeking?
Does this physician share my aesthetic sensibility? Do they understand me and are they able to provide exactly what I am looking for?
Was I provided with a thorough understanding of all options available (both surgical and non-surgical)?
Was I shown photographic examples of surgical outcomes that give me confidence?
Was the office staff professional, friendly and accommodating?
Was I pressured in any way to proceed with surgery?
Does this surgeon perform aesthetic surgery exclusively or is aesthetic surgery a small percentage of the pratice?
Listen to what your heart and your gut tell you when you are evaluating your consultation experience. Only move forward if you can do so with confidence about the experience you expect to have in a given plastic surgery practice, and about your ultimate outcome as a surgical patient.
Your experience with the consultation process is a good indication of what you are likely to receive as a surgical patient in any practice. If the process is well-organized and enjoyable, the staff is respectful and efficient, and the physician takes adequate time to understand your individual needs and communicates effectively, then you have a very high likelihood of being treated in a similar fashion if you become a surgical patient of that practice. If the process is disorganized or rushed, if the staff is discourteous or unprofessional, or if the physician does not give you confidence that your needs will be met, then don't expect things to get any better once you are a surgical patient.
You must be absolutely certain that your plastic surgeon's aesthetic sensibility matches your aesthetic goals. I have a very particular aesthetic vision, and I do not pretend to be the plastic surgeon for everybody. I strive to produce surgical results that are natural-appearing, results that do not advertise a trip to the operating room. For example, I do not perform breast augmentation for patients that are seeking an overly large and distinctly `done' breast appearance. And I have a particular distaste for cheek implants, as I think they rarely produce natural-appearing cheek contours, and instead prefer to enhance facial volume by means of structural fat grafting. Make sure that your plastic surgeon's philosophy and preferred approaches are consistent with the goals that you have in mind.
Adequate communication is obviously invaluable, and you should be able to communicate clearly and easily not only with your doctor, but also with your doctor's staff. Over the course of preparing for and recovering from aesthetic surgery, your doctor's staff will have an important and active role. Make sure that your interaction with the staff gives you confidence that you will receive the care and attention that you expect, and deserve, postoperatively.
Verify that major surgical procedures are performed in an accredited surgery center and that anesthesia care is provided by board-certified M.D. anesthesiologists. If you are most comfortable with overnight observation after surgery with the bedside care of an R.N., verify that this is available to you. Look up your surgeon on your state's Medical Board website to verify that they are in good standing and have no public record of sanction or limitation of their license to practice.
Be confident enough to ask some `difficult' questions. Feel empowered to ask any physician questions like: What are your complication and reoperation rates for this procedure? Has a cosmetic surgery that you performed ever resulted in a lawsuit? Have you had any serious complications and unplanned hospitalizations after cosmetic surgery? Have you ever been disciplined by a state medical board? I am never offended by these kinds of questions, and no competent and qualified surgeon should be. In my opinion it is actually the savvy prospective cosmetic surgery patient who does this kind of `due diligence'.
Facelift surgery involves restoration and tightening of...
Facelift surgery involves restoration and tightening of the underlying facial fascial system (often referred to as SMAS) with excision of excess skin and redraping of the skin/SMAS in an upward vector (i.e. - reverse the natural pull of gravity and aging).
Signs of fallen tissue may manifest as:
- increasing or deepening of the nasolabial folds
- marionette lines (corners of the mouth to chin region)
- excess neck skin with less than ideal neck line, etc.
This is not to be confused with improving the actual quality of the skin itself, in terms of pigmentation (rosacea, brown spots, etc), fine wrinkles, texture, etc. It does not address the actual skin quality. This can be addressed via proper skin care and resurfacing (in the likes of laser or chemical). Furthermore, although an improvement may be seen, a complete reduction in nasolabial folds is not expected. Often times, during the initial phase of healing, fine wrinkles are significantly reduced, but often to the dissapointment of many patients, once the swelling settles, fine wrinkles resurface (as fine wrinkles are more inherent to the skin itself).
It is important to distinguish and understand the aforementioned limitations of facelift surgery. Facelift often implies necklift as well; however, it often does not include the brow/forehead lift. There are several variations of facelift surgery, all with various utilities, depending on the elements involved in the surgery. Classically, facelift mostly involved only the excision and tightening of the skin; however, many surgeons currently perform some degree of manipulation of the deeper structures (SMAS, etc). Ask your surgeon which technique is used.
There is also some minor variations for the incision patterns as well, which determines the the placement of the final scar. Some degree of lipocontouring may be performed as needed. In discussing facial rejuvenation surgery, be familiar with - i.e. ask about:
- Forehead lift/ Brow lift (Open, Endoscopic, Limited)
- Blepharoplasty (Eyelid surgery - Upper and Lower)
- Midface lift
- Facial implants (chin, cheek)
- Resurfacing (mechanical, chemical, laser - invasive/noninvasive)
- Role of fillers/botox/proper skin care
From the list above, one, multiple, or none may be applicable to your specific needs/desires. After a proper consultation, you should be clear as to why a certain recommendation was made and for what purpose. If you do not fully understand, then you are not ready and fully informed. Cosmetic surgery is an emotional topic, as we are addressing our appearance, often times reflecting our feelings for ourselves. Do not make an emotional decision, but be methodical and cautious in your approach. There have been many advancements in cosmetic surgery, but be sure to find out if it's right for you.
We recognize aging to be a combination of volume loss of the face, loss of elasticity of the skin and structural changes of the face. A true rejuvenation needs to address all of these issues. The process is a continuum which begins in the late 30's.
Where you fall in this continuum will dictate the best intervention for you.
Botox fillers and lasers are wonderful devices to address volume loss and changes of the skin. Some structural changes can be addressed with fillers as well such as restoring volume to the jawline adjacent to the chin which we call the prejowl.
However, once the jowl is present and laxity of the skin is seen in the neck a facelift is the only recourse to reposition the tissue and address the excess skin.
This is a quick over view and I would encourage you to seek out a board certified plastic surgeon to help you understand the best correctove action for you.
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Facelift: When is it the Best Choice?
This question is frequently asked in my practice.
If performed properly and for a patient with the right indications, Facelift is a wonderful procedure. Surgical indications for Facelift are: jowls, plasma banding ("ropes" that fall down under the chin and extend toward the chest), facial and neck skin laxity, obliquity of the angle the neck makes with the chin. When a patient has these indications, and a desire to address them, there is no replacement for a Facelift. There is no filler, no peel, no laser, and no amount of Botox that, in good hands or bad, will effectively address these issues.
Ask your surgeon to show you pictures of work that he/ she has performed, find out about his/ her Anesthesia provider (I currently use a Board Certified Anesthesiologist). In addition, make sure that the facility in which you are having your procedure performed is accredited by AAAASF, AAAHC, ACHA, or JCAHO to ensure the consistency and safety of the environment in which you will have your surgery.
What is the best age for a facelift?
Thank you for the great question! The answer, in my opinion, is "it depends." Each of us age differently -- some people have noticeable changes in their 20's, while others sail into the 40's and 50's. A facelift is right for you when these three things are true: 1) you are mentally prepared -- and even excited -- to refresh your look, including going through the healing required; 2) you have the time to dedicate to proper healing and aren't trying to squeeze this into a weekend; and 3) it makes sense for you financially. In terms of the specific procedure(s) needed, this will depend on your anatomy. Basically, a facelift is most successful at tightening the jawline, elevating or eliminating the bands in the neck, and reducing the fullness under the chin and in the jowl region. Please see a few consults before deciding to move forward. A good relationship with your surgeon is essential!
When you are tired of looking at yourself in the mirror
If you can look at yourself in the mirror every day and not pull and push on the wrinkles, the jowels or the "granny bands" in the neck then you are pretty well adjusted to growing old. Very few of my facelift patients report that they don't mind lookiing in the mirror before surgery but afterwards it is so easy to llok at what they see in the mirror or the wondows or in their rear viwe mirrors...putting on makeup is a lot more fun again.
Mostly, you are ready for a facelift when it bothers you enough and the surgeon shows you how much change you will get from surgery that it just seems right. There is no specific age to get a facelift. As long as you are healthy enough for surgery and don't consume nicotine, the best time is when it bugs you.
When patients are done healing and come back a few weeks after the surgery the one thing they all say to me is "I love the way I look now." They don't say, "I wish I had waited." or "I don't notice any difference." That is because they were ready to take that step finally and it didn't depend on someone else telling them to do it. They just made the decsion to jump in finally.
Facelift to improve sagging in a patient, fillers and fat
Facelifting is used to remove excess skin that produces sagging. It is extremely valuable when it is necessary and performed by a qualified caring surgeon.
Aging changes can be broken up into 3 classes:
1.) Sagging skin- treated best in all cases with facelift. There are only a couple of types of lifts that are used. Your surgeon can explain what type is best for you. The gold standard lift is a SMAS Imbrication Lift.
2.) Volume loss- Beginning as early as 30, we start to show signs of atrophy or loss of the underlying fat, muscle and bone of the face. Remember that fillers such as fat or hyaluronic acid can replace this. We always want to strive for the youthful heart-shaped face. That avoids a pulled or "operated" look.
3.) Texture- Sundamage produces fine wrinkles and irregular pigmentation. Always use sunblock to prevent this as much as possible. Chemical peels, abrasions, and lasers treat this issue nicely.
You may have issues with one or all of the above. In all areas of medicine, making an accurate diagnosis is the key to developing a plan. You should find success.
Dr. Todd Hobgood
Am I a good candidate for face lift surgery?
Great question. depending on your age, severity of wrinkles or loose skin on face and neck area. If you're in your early 40's non-surgical lifts such as Botox or fillers are best choices. However people in their late 40's and older might be good candidates for mini face lift. People with sagging neck tissue and presence of neck bands may also require neck firming procedure in addition to their mini face lift.
It depends which area concerns you most and if it is the jowl and jaw line some facelift maybe appropriate treatment for you.
Facelifts essentially reverse the gravitational changes to the face which occurs with time.
They tighten the skin and elevate the tissue to its original position.
Traditional facelifts however, do not access other aspects of facial aging such as loss of volume in the lower part of the face, active lines caused by muscle contraction and the appearance of the skin.
Overall, it depends which area concerns you most and if it is the jowl and jaw line some facelift maybe appropriate treatment for you.
A Facelift is "worth it" when the benefits outweigh the risks
And that's a very personal assessment. Technically, a facelift sharpens the jawline by elevating / smoothing the jowl, softening the nasolabial fold, smoothing the cheek skin, and defines the neck by removing fat and tightening skin and underlying muscles. The direct risks of the procedure are related to the necessary incisions and resultant scars, the possible loss of facial skin (which is a greater risk with a history of smoking), and possible damage to the facial nerves. It is the only procedure that addresses global aging of the lower face (cheek bones down to the collarbones). All other less invasive types of procedures (neuromuscular agents, fillers, resurfacing) are temporizing measures that camouflage aging rather than reversing the changes. It is wise to use some of these measures while their benefits outweigh their risks, but don't use them forever. Eventually the side effects of the temporizing measures will cause some alterations in anatomy that will not be easily correctable by a facelift. (For instance, performing multiple or deep facial peels will smooth the skin, but if there is underlying contour irregularities [such as jowls], these will be "starched" into the skin with the new collagen, and will be harder to re-drape naturally with a facelift.) Consult with a plastic surgeon who performs all types of facial rejuvenation, and create a global plan for maintaining your youthful facial characteristics.