Anti-Aging Skin Care Plastic Surgery

Facelift surgery- do you need it and are results good?

By Kim Crawford, M.D. Last updated: September 6, 2018

Do you actually need a facelift?

Oh oh do you think you need a facelift? For those of you who have been following my blog you know I’m a fan of great anti aging skincare including the use of all sorts of great products which exfoliate, increase skin appeal by minimizing pores, and have amazing anti-aging effects like the famous Lifeline Proplus products. You know that I tell you to start learning how to tighten skin in your 40’s because you cannot fight gravity once it happens. Ways to tighten topically include ethocyn and kelzyme. 

Now other ways to tighten things up is by using galvanic current devices, dermarollers, microneedling and so I would tell you to start it up with all of this by 40 if you want to avoid a facelift. And then there are laser skin tightening (noninvasive) methods which work. Titan works and Ultherapy works even better. This can all stave things off and so far so good here. But if you let “things droop” like your jawline most noteably, there is just no getting around the need for a surgical procedure if you want to look younger than you are. Another thing to make sure of is that you take care of menopausal “unexplained weight gain”  and keep your bodyfat and lean body mass not just appropriate but stable since weight swings make sags.

Are you a candidate for a facelift?

As we age, facial tissues lose volume and skin begins to lose elasticity. Unattended to with what I discussed above this will  ultimately cause “jowls” on the lower face, deep wrinkles, and loose skin on the neck. When that happens, if you want to to reverse it, nothing but surgery will work. Here is what Plastic Surgeons use as criteria for facelift “candidacy”, assuming you are in good health and are not a “plastic surgery addict”:

how's this for serious skin careSagging and loss of muscle tone in the lower face, resulting in jowls, sagging skin in your midface and/or jawline, facial fat (volume) that has fallen or is displaced, a double chin, resulting from loose skin and excess fatty deposits under the chin and jaw.

Other criteria include:

Creased and sagging skin in your neck, deep creases extending from your nose to the corners of your mouth, and/or lines extending from each corner of your mouth down your chin. These changes in the face and neck  can be due to a variety of factors, including heredity, gravity, environmental conditions, and stress.

What exactly is a facelift?

A facelift is the most comprehensive approach to treating sagging, wrinkled aging skin. The surgery varies in range from minimally invasive ‘lunchtime lifts’ to more extensive, sophisticated surgery. A “full” facelift removes excess skin, tightens underlying tissues and muscles and then redrapes skin on the face and neck. It can correct midface sagging, jowls and a double chin, as well as above-mentioned lines.

What a facelift won’t do:

this is sure how to tighten skin isn't it? A well-done facelift does not change your fundamental appearance. Gone are the days with the “stretched canvas look” and the frozen face.

However one caveat to that-if you have sun damaged, paper thin skin a good Plastic Surgeon will have you do invasive skin laser rejuvenation first to try to get some collagen and elastin back for proper healing.

Most cases require a CO2 laser but many times the surgeon will do this treatment during the surgical process once the facelift is done.

And needless to say, a facelift won’t stop you from aging. So if you have to get one, as soon as you’re healed, get started on what I’ve talked about at the beginning of this article. If you happen to be on human growth hormone you’ll heal that much faster, too-as an aside.

How is a facelift procedure performed?

Most facelift techniques focus on the lower facial areas, such as the jowls, jawline, and cheeks. A facelift can also focus on the midface. With some techniques, deeper facial tissues may be repositioned or tightened. With yet other techniques, removal or addition of fat or other soft-tissue fillers might be needed to restore what appears to be youthful volume. Your incisions will depend on the area of the face that is targeted and the amount of change you want.

kelzyme is applied to help with healingOnce the incisions are made, the surgeon does a certain amount of separation of the facial and neck skin from the muscles and other deeper tissues. This frees up the facial and neck skin so it can be redraped at the end of the procedure. This is needed so that the result is nice, smooth skin.

Then, after the initial skin layer separation, the surgeon will reposition the underlying connective tissue and remove excess fat and skin. If this procedure is performed with a neck lift, the surgeon will draw the neck muscles together, stitching them together at the midline to form a strong sling of muscles to support the whole neck and jaw. Your surgeon may also include liposuction under the chin.

Finally, your surgeon redrapes the skin over the new underlying structure. Incisions are closed with sutures or small metal clips. When needed, drainage tubes may be inserted. A padded, supportive dressing is then applied.

What are the options?

Your plastic surgeon will recommend an approach based on your goals and facial characteristics. The placement and length of incisions vary, depending on the facelift technique that he/she decide will work best with your face. Facelift fads such as the ‘LifeStyle Lift’ or ‘Quick Lift’ or “String Lift” are a form of facelift. However none of these have the “staying power” of a full facelift.


Traditional facelift: 

magselect aids scar healingIncisions are hidden in your hairline at the temples. They blend in right in front of your ears and then are hidden in the natural creases behind your ears.

Limited-incision facelift: 

Your surgeon will make short incisions in your hairline, starting at your temples and continuing down and around the front of your ears, hidden in the natural creases. There may also be incisions in the lower eyelids, temporal area, or under the upper lip.


Neck lift: 

Incisions starting in front of your earlobes and continuing around behind your ears in your lower scalp. There will also be a small incision underneath your chin. usually means shorter incisions around the ear. Facelift scars can be pretty invisible nowadays unless you have a “keloid” issue in which case you need to discuss this with your surgeon ahead of time.

How do I prepare for a facelift procedure?

Your surgeon will usually have a team which provides thorough pre-operative instructions, answers questions, and makes sure you have the proper items needed to prepare for and recuperate from your surgery.  You may also be required to obtain medical clearance from your family physician, meaning labs, an EKG and an exam.

Before your procedure, you need to:

  • Stop smoking six weeks before your surgery to promote good wound healing. Now is the time to stop for good and smoking is awful for your skin in case you didn’t know it already.
  • Avoid taking aspirin, nonsteroidal anti-inflammatory medications (NSAIDs: Advil, Motrin, Aleve) as they can increase post-op bleeding.
  • Also avoid fish oils, Vitamin E and other nutraceuticals which cause bleeding (ginko biloba is another example).


Your facelift will be performed an outpatient surgical facility or in a hospital. If it is done in an outpatient facility, you’ll be instructed to arrange for someone to drive you home after surgery and stay with you for the  forty-eight hours.

More prep tips:

Plan your recovery. If you have a recliner chair, it’s great for elevating the feet, knees and head. If you do not have a recliner, make sure you have several good pillows available you can use to prop up your head and knees. If you color your hair, you should get it done right before surgery or you will need to wait at least a month post-op. After surgery, get plenty of rest and plan on not doing any heavy lifting, housework, or exercise. You’ll also be told to avoid hot showers, hot tubs and saunas for two to three weeks post-operatively.

What happens on the day of facelift surgery?

Facelift surgery requires at least several hours to complete. Local anesthesia combined with sedation is commonly used during facelift surgery. Sometimes general anesthesia is used instead. An anesthesiologist or nurse anesthetist will administer sedatives (or a general anesthetic) and monitor your vital signs during surgery. After surgery, you will be taken into a recovery area where you will continue to be closely monitored. Your incisions will be covered with thick bandages which provide gentle pressure to minimize swelling and bruising. A small tube might be placed under the skin behind one or both of your ears to drain any excess blood or fluid. Remember- under no circumstances will you be permitted to go home alone.

Right after your facelift surgery:

this is how to stop a runny noseYour face will be surrounded by a compression wrap which goes over your bandages. Wear this exactly as directed. Remove it only as directed for cleansing incisions or showering as this is vital for optimal results from your surgery.

To minimize swelling, recline rather than lie down flat.  Always keep your head elevated. You will have a mild to moderate amount of pain and discomfort which is easily controlled with oral medication.

The discomfort should begin to decrease within forty-eight hours after surgery. If you have a significant increase in pain after this period, call your plastic surgeon. Severe pain is rare- if you experience this, call your doctor immediately. Definitely expect swelling and bruising.

These symptoms will peak within the first thirty-six to forty-eight hours after surgery and will gradually subside over the next ten to fourteen days. It is not unusual to have a little drainage for the first forty-eight hours. A bulky cotton compression dressing with drains will cover your scalp and face for one to two days to help prevent blood from collecting under your skin.

Recovery time after a facelift:

Follow all post-op instructions, including information about bandages, drains, taking an antibiotic (if prescribed), and how much activity is safe. Your doctor will let you know the signs of problems to watch for, such as signs of infection. Recovery time will vary but you will be “presentable” in about 2-3 weeks but not back to “normal” for about 3 months.

Risks and potential complications:

Scarring, adverse reaction to anesthesia, allergic reactions, unsatisfactory results that may necessitate additional procedures, changes in sensation are rare but possible. Loss of hair (around the incision site), skin necrosis (loss of skin from tissue death), widened or thickened scar, asymmetry (unevenness between two sides) are rare but possible.

Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal), damage to underlying structures, infection, neurological dysfunction (loss of muscle function or sensation), which is usually temporary round out the list. Death during any surgical procedure is a very remote possibility.  All of these are uncommon but you’ll be “given the list” you see here.

Cost of a facelift:

A facelift can cost anywhere from $3,000 to $20,000 based on the extent of treatment, the geographic location of the practice, and whether or not the facility services, anesthesia and more is included. And there are other factors which can come into play which you should take seriously in terms of results-you get what you pay for.

Factors That Affect the Cost of a Facelift:

Surgeon’s skill and reputation: 

Highly respected plastic surgeons with advanced training often charge more than less experienced colleagues. Advanced methods, such as endoscopic facelifts, may have a higher cost than traditional procedures. My two cents here is that from what I have seen, the surgeon is the whole story so if you’re spending the money, don’t skrimp. My patient, Dr. Ross Clevens, is one of the best in the country.

The type of facelift:

A traditional full facelift will cost more than a mini or mid facelift, as these latter procedures are faster and involve smaller incisions.

The type of anesthesia: 

Patients can choose between local and general anesthesia, and full sedation will cost more than local anesthesia.

Additional treatments: 

Many patients combine facelifts with other surgical procedures. These additional costs will not be included in the initial treatment estimate of course.


Just as cost of living changes depending on where a person lives, so, too, does the cost of cosmetic surgery.



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