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Steven J. Pearlman, MD, FACS Dual Board Certified in Facial Plastic Surgery

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Img_FaceLiftThe facelift is the quintessential procedure in facial plastic surgery. It is the ultimate in surgical rejuvenation for a more youthful face. The true facelift addresses the lower two-thirds of the face. From a medical point of view, a facelift refers to lifting the cheeks, jowls and under the neck, which is why some doctors and patients actually prefer to call this a “cheek-neck lift.” Patients and doctors sometimes expand this description of facial rejuvenation to include a browlift referring to it as a “Complete Facelift.” More than any other procedure, a facelift can restore a more youthful, refreshed face. A facelift is often combined with other procedures such as blepharoplasty and a browlift for comprehensive anti-aging facial rejuvenation as well as facial fillers to restore volume to hollow cheeks. Depending on your needs, younger patients may be candidates for the newer “short-flap” facelift. Older patients who require more facial suspension are better candidates for a deep plane or a bi-planar extended SMAS facelift.

When are you ready for a facelift?

Place your hands along the middle part of your jaw with your index fingers pointing upward and thumbs under the jaw and pull gently toward your ears. If you like the “taught” result, then you may be a candidate for a facelift.

As the facial muscles and skin weaken, facial tissue sags and jowls form along the mid-jaw. Skin may droop under the chin, creating a “turkey neck” deformity. (Believe it or not, this term is actually the commonly-used medical jargon!). The cheeks also descend causing thinning of the mid- face and deepened nasolabial folds (folds running from your outer nostril and down around to the mouth). These conditions are all best corrected by a facelift. The result will make you feel younger, like the fresher version of you, the one time forgot as years passed.

As you age, the face also loses volume and facial fat in the cheeks. To restore a youthful look, facial fillers or fat transfer will compliment a facelift by addressing not only facial sagging but by giving back youthful fullness; see section on facial aging.

What is the best age to have a facelift?

There is no “proper” age for a facelift. When performed at a younger age the results last longer because there is more elasticity in the tissue. Younger patients may also qualify for a simpler procedure such as a mini-facelift, with faster healing and a shorter incision. Timing for facelift surgery ultimately depends on when the patient is mentally and aesthetically ready for the procedure. The operation is simpler and lasts longer on patients in their early 40s due to better elasticity but can be performed as late as your 70s or even 80s. However, one should not wait too long to get a facelift. As the skin becomes less elastic and deeper lines form, it becomes harder to achieve a truly natural looking result.

Facelift Procedures

There are a number of variations of the facelift:

The “short flap” or mini-facelift is for younger patients; the lower face and jowls can be rejuvenated by an incision that begins just above the ear, goes inside the small rectangle called the “tragus,” and stops just behind and above the earlobe. This incision, once healed, is almost undetectable. The short flap facelift is best suited for younger patients with only a little excess neck skin.

The short-flap facelift describes the skin incision. What is done under the skin may vary from simple suture tightening of the underlying muscle, as is performed in a mini-facelift. A mini-facelift might be good for a young patient who needs a little tightening, but it will not last on a patient who has heavy jowls and significant facial aging.

The mid-face lift, when performed alone, may accomplish cheek elevation when the neck and jowls do not need lifting. A mid-face lift is often performed as part of a facelift when the cheeks are one component that needs lifting.

For patients who need elevation of the neck skin and heavy cheeks, two techniques are best: the deep plane facelift and a bi-plane facelift. The incision is the same as the short-flap facelift described above but it extends into the hairline behind the ear. The muscle called the SMAS is either elevated (separated from the underlying layers) and lifted with the skin, as in the deep plane facelift or elevated as a separate layer in the bi-plane facelift.

Excess fat under the chin and thick muscle bands in the neck, when present, are approached through a small incision under the chin.

After the skin is lifted, the underlying muscular/fibrous tissue called the SMAS (see below) is repositioned and tightened upward and backward. SMAS advancement is the maneuver that actually gives longevity to the facelift operation. The SMAS is pulled tightly to give a youthful face, allowing the skin to be gently “re-draped” without looking pulled.

Discoloration may remain for two to three weeks. Most patients can resume normal activities as soon as two weeks following surgery. However, minor swelling may persist for a few months, especially with the deep plane facelift.

Actual Patient of Dr Pearlman

What is the SMAS?

The SMAS (superficial musculoaponeurotic system) is a thin sheet of muscle and fibrous tissue (called fascia) that lies under the skin of the face. It continues into the neck as a muscle called the platysma. This strong layer separates the overlying skin from the delicate glands and structures of the face and neck. The SMAS can be elevated and pulled with the skin or a different direction than the skin of the face for a natural post operative appearance. The choice of deep-plane or bi-plane facelift depends on evaluation of the patient before surgery.

Non-surgical facelifts:

Here is the scoop on non-surgical facelifts: there is no such thing! Faces can be made to look younger and refreshed with non-surgical techniques but nothing really lifts sagging faces without surgery. Another term for a non-surgical facelift is a liquid facelift. I am a big fan of this assemblage of procedures-because they work. The face ages in 5 ways: drooping tissue from loss of elasticity, effects of gravity, changes in the skin such as wrinkles and pigment changes, volume loss and dynamic lines from overactive muscles. The first two of these 5 causes can only be addressed by surgery. Nothing, including lasers, can predictably lift sagging facial tissue. However, filling out lines and wrinkles with fillers (Re: “liquids”), smoothing overactive muscles with Botox and treating the skin with lasers and peels, patients can be made to look much younger. So these non-surgical techniques work well for most of the causes for facial aging, but none can unequivocally lift the face.

About the “suture” or “thread” lift

There was a procedure introduced around 2005 that used tiny sutures with barbs to lift the sagging skin of the face and neck. These procedures have been embraced by non-surgeons as a technique to perform almost surgical facial rejuvenation without making surgical incisions. However, if the sutures are placed too superficially, the barbs may become visible. If they are placed too deep, there can be effects on the nerves of the face. As a matter of fact, the most popular version of thread lift threads were removed from the market by the FDA due to technique and device problems. This goes back to the old concept that if something appears too good to be true, it is likely because it is.

Since there are a number of present day options for facelift techniques, results are more natural than ever before. The pulled or windblown look can be gracefully avoided by choosing the appropriate facelift approach for each individual patient.

Liposuction of the Neck

Liposuction of the neck is for patients with excess fat under the chin to produce a more sculpted, angular and youthful neck and jaw line. The best patients for this procedure have good skin tone. Neck liposuction does not tighten the skin, however in younger patients the skin adheres to the underlying neck following the procedure, which can improve loose skin.

In most patients over 50 with loose skin – a facelift to tighten skin and underlying muscle may be a more appropriate procedure. Other procedures to enhance neck liposuction may include sub-mentoplasty to tighten the muscles. Better neck contour may also be obtained by chin augmentation to improve the profile.

Liposuction, however, is not a substitute for a facelift. Removing fat from under the neck is ideal for truly fat necks, but a thin layer of fat is necessary to cushion the underlying muscle so it does not show through the skin as you age.

Liposuction is performed under local tumescent anesthesia with sedation. One tiny incision is made under the chin and behind each earlobe. Fat is removed with small suction cannulas. A soft chin supporting garment is worn for 5 days following the procedure.

Questions? Contact Dr. Pearlman about Facelift surgery



Answers to frequently asked questions about the procedure

Q: Can Plastic Surgery Help my Eyes Look Less Tired?

Eyelids can look "tired" from a number of reasons. The more common ones are bags under the lower eyelids, excess skin of the upper and/or lower eyelids and drooping of the eyebrows. You don't have any of these.

Your eyelids slant downward towards the sides; the corner where the upper and lower eyelids meet (called the canthus) is lower towards your ears than near your nose. There are a number of surgical techniques that can be used to raise the lateral canthus. Sometimes, there may be some hollowness of the bone of the eye socket as well. This is also treatable. Seek out a surgeon who is versed in this procedure for a more definitive discussion.

Q: How long does a rhinoplasty last and at what point will you need to do additional maintenance?

A: A rhinoplasty will last for the rest of your life. However, even a nose that has undergone a rhinoplasty ages like the rest of your face and body. As we age, the nose begins to droop. After a rhinoplasty they will age from where they were after the procedure. The procedures we do for an aging nose is often more subtler than a formal rhinoplasty.

Q: What is a "mini lift"?

A mini-facelift of today was the maxi-facelift of 2 decades ago. Mini or maxi, best to discuss with your doctor.  There are many definitions of what a mini-facelift is. For some it's a shorter incision, for other doctors its less work on the muscle called the SMAS. The technique depends more on the doctor's skill and your anatomy. For a patient in their early 40's, you often don't need the same deep plane facelift that someone in their 50's or above might need. Most of these procedures address your jowls.

Q: If I were to have a rhinoplasty and septoplasty, would I go to a facial plastic surgeon, ENT or Plastic surgeon?

A: Performing both a quality septoplasty and rhinoplasty is dependent on the individual's training and experience. Generally, facial plastic surgeons start with ENT training before they move on to facial plastic surgery. Although they are not formally trained, many plastic surgeons can also be experience and qualified to perform septoplasty procedures. The main focal point should be how much training they have received and how much experience do they have performing the procedures together and separately. There are subtle signs that could indicate if the proposed surgeon is right for you:

  • Did the surgeon look inside my nose? (As surprising as it sounds, in a number of my revision consults, patients often say that their original surgeon never looked inside their nose.)
  • Do they have specialized instruments to tackle the procedure? (A special headlight, nasal instruments, etc.)
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You will receive a confidential, in-depth personal consultation with Dr. Pearlman on your selected procedure.

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New York, NY, 10065
Phone 888-387-5811

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Confidential consultations are available
by appointment only. Please call
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You will receive a confidential, in-depth personal consultation with Dr. Pearlman on your selected procedure.

Our Location

521 Park Avenue
New York, NY, 10065
Phone 888-823-1890

Get Started

Confidential consultations are available
by appointment only. Please call
888-823-1890 or fill out the form below.

Office Tour

Earning your trust through quality, our office is
accredited by the Accreditation Association for Ambulatory Health Care (AAAHC).