There are multitude of procedures available for facial rejuvenation. Our highly experienced and committed team is dedicated to helping you choose the right procedure for your needs. Our approach involves a thorough consultation in which we listen to your goals and concerns, thoroughly evaluate your medical history, and perform a precise assessment of your physical characteristics. We synthesize this into a treatment plan, explaining different options, including surgical procedures and nonsurgical adjuncts to optimize to your individual situation.
The term facelift (rhytidectomy) can be specifically confusing because the same term can refer to different facial procedures. Dr. Goldman and his team will help clarify these issues as part of your decision-making process. Dr. Goldman prefers the deep plane facelift, which lifts the deeper tissues underneath the skin to achieve a more dramatic rejuvenation that can look so natural that others may not suspect you had a facelift.
A facelift, or rhytidectomy, lifts and tightens the skin and deeper tissues of the face to create a more youthful and refreshed appearance. Historically, facelift techniques have focused primarily on lifting and tightening the skin alone. However, this approach often resulted in an unnatural, wind-swept look, and the lift effect had poor longevity, as the skin stretched. Modern facelift techniques have evolved significantly. Today, most contemporary methods involve a more comprehensive approach, combining skin redraping with the tightening and lifting of the SMAS layer (Superficial Musculoaponeurotic System). The SMAS is a connective tissue layer located beneath the skin and above the facial muscles. Lifting and repositioning the SMAS can produce more long-lasting, natural results by lifting and repositioning deep tissues that contribute to facial aging.
Dr. Goldman utilizes advanced two-layer or deep-plane facelift techniques, which involve both the SMAS layer and the skin to achieve a harmonious and youthful appearance. The choice of technique is personalized based on the individual patient's facial characteristics. For instance, a patient with a fuller, rounder face may require a different approach compared to someone with a thinner face. Dr. Goldman’s expertise ensures that each procedure is tailored to the unique anatomy and aesthetic goals of every patient to provide a natural but dramatic rejuvenation.
The term deep plane facelift has gained buzz on social media. Some surgeons will refer to any facelift that lifts the SMAS layer as a deep plane technique, but this is not entirely accurate. The deep plane technique refers to a specific method in which the SMAS layer is lifted towards the front of the cheeks, closer to the tissues that require elevation and repositioning. Dr. Goldman feels that this provides a more powerful yet more natural looking lift.
Multiple variations of the facelift procedure are used by different surgeons, and several different terms are commonly used when referring to these procedures. However, these terms are not used consistently, and some terminology is now outdated as techniques continue to evolve. Terms like facelift, neck lift, full facelift, mini-lift, and chin tuck are not used consistently. This is why Dr. Goldman favors more medical, specific terms, like the deep plane facelift and open neck lift.
Perhaps the most common source of confusion is the difference between a facelift and a neck lift. Facelifts lift and tighten the lower face, mid-face, and neck, so correcting the neck requires a facelift for any patients with significant aging and looseness. In order to correct looseness along the jaw-line (the jowls), under the chin (the “waddle"), and in the neck, tissues must be lifted upwards and backwards using incisions around the ear. A small incision under the chin cannot accomplish this. Facelift incisions and maneuvers are required. As a general term, ‘facelift’ would more accurately be termed ‘face-and-neck lift.’
The term ‘open neck lift’ refers to placing an incision under the chin (a submental incision) to further tighten and define the neck by removing deep fat and tightening the platysma muscles (the muscles that form vertical bands in the neck). This is often used in addition to the facelift. Generally, only younger patients with heavy necks are candidates for a submental incision alone. Patients with facial aging, with jowls and a loose neck, need a facelift to tighten these areas. An open neck lift alone will not lift the neck, although it can deepen and tighten the angle under the chin. So when patients say that they don’t need a facelift, they just need a neck lift (a common source of confusion), they actually do need a facelift to lift and correct the neck.
The terms full facelift and lower facelift are also confusing. Older facelift techniques and incisions were carried into the scalp over the temples toward the top of the head. These techniques distorted the brows and the eyelids, producing an unnatural, surgical, fake look. Some patients still think of these older techniques as a “full facelift” and understandably do not want to look fake. Dr. Goldman does not use these techniques. Instead, Dr. Goldman uses contemporary techniques to treat the upper face using separate incisions and procedures to lift the brows or smooth the eyelids. Thus, the terms upper facelift or full facelift really refer to brow lifting and eyelid surgery (blepharoplasty) done through separate incisions. Other techniques like laser resurfacing and fat injection may also be used, as part of full face rejuvenation in addition to the facelift itself.
In Dr. Goldman's opinion, the best way to think about and discuss facial rejuvenation is by analyzing the components that contribute to the appearance of aging in each patient (like eyelid droop, jowls, sun damage, the “waddle”) and then discussing the possible surgical and nonsurgical options to treat these characteristics. Discussing the specific procedures that address each part of the face allows a more in depth understanding of your treatment plan than just using general terms like facelift. Ask your surgeon to clarify the specifics about the procedures he or she uses: what type of facelift they use; how does that differ from other techniques; and what other procedures should be used in conjunction with the facelift to achieve the best results.
Dr. Goldman uses the deep plane facelift. This refers to a specific technique in which a connective tissue layer called the SMAS (superficial musculoaponeurotic system) is lifted to pull the neck upward and backward into a more youthful position. For this technique, the SMAS is addressed further forward in the face then with traditional facelift techniques. Most patients do like to know some of the specifics about the techniques used, especially in a situation where multiple variations exist. Patient education is a key component to the consultation process that helps you make better decisions for your care.
As noted above, the SMAS (superficial musculoaponeurotic system) is a thin layer of connective tissue underneath the skin of the face and top of the muscles of facial expression. The SMAS connects to the platysma muscle in the neck (the muscle which forms vertical bands). Most contemporary facelift techniques lift and redrape the SMAS layer, but different surgeons do this in different ways and are more or less aggressive about repositioning the SMAS. Lifting and redraping the SMAS has more long-term benefit for the face than just rearranging the skin. The SMAS can be lifted more aggressively and with different factors and redraping and lifting of the overlying skin. When combined properly, use of different skin and the SMAS vectors can produce a dramatic but natural looking facelift, unlike traditional techniques, which often produce a surgical, fake look.
Nomenclature can be confusing because of the multiple variations of the SMAS lift that can be performed. Dr. Goldman prefers the deep plane facelift, a form of the SMAS lift that he feels gives the most effective rejuvenation.
The deep plane facelift is a specific type of the SMAS lift in which the SMAS layer is lifted further forward on the cheek than with traditional SMAS techniques, allowing a more direct lift of the deep tissues and platysma muscle. This can permit more dramatic tightening of the jawline and neck while still maintaining a natural appearance in most patients. Some lifting of the midface is also generally achieved.
The term ‘deep plane facelift’ has gained recognition online and therefore many surgeons are referring to their facelift techniques as deep plane facelifts. In some cases, these techniques are more closely related to other SMAS lift techniques that have not traditionally been referred to as the deep plane facelift. Patients should always feel comfortable asking their surgeon why he or she prefers a given technique for their facelift.
As with the SMAS lifts, there are multiple variations of the mini-facelift, which can be confusing for patients. Generally, mini-facelift techniques use shorter incisions and involve less dissection and less aggressive lifting of the SMAS layer than other facelift techniques. Prospective patients who are considering a mini-facelift do have to be cautious and educate themselves because the term "mini" (whether it refers to facelift, tummy tucks, or other procedures) is often used as a marketing technique to imply a less involved procedure with less downtime and cost. However, in multiple studies and surveys mini-facelifts had lower satisfaction rates than regular facelifts. (For example, the Lifestyle Lift was a trademarked, heavily marketed form of a mini-lift that at one time comprised over 10% of facelifts done in the US, but the company ultimately went bankrupt because satisfaction rates were very low and results didn't last for this mini-lift.)
Mini-lifts may actually look more surgical, distorted, or fake than full face lifts because they tend to pull the skin in unnatural vectors with more tension than regular facelifts , which can also leave thicker scarring, even if the scars are shorter. In Dr. Goldman's experience, most patients with early aging are good candidates for nonsurgical procedures, and patients with moderate or advanced aging get a more dramatic but more natural result from full facelift techniques, like the deep plane facelift.
Dr. Goldman feels that there are specific patients who may benefit from mini-lifts. Here, one example is a patient with mild or early facial aging who wants to be aggressive. Dr. Goldman believes the communication is fundamental to the doctor–patient relationship, and that patients may consider surgical options for early facial aging when they have been properly educated about different treatment options. Another group of patients who may be candidates for a mini-lift are revision patients who have mild submental (under the chin) skin looseness after prior facelifting.
Dr. Goldman most commonly uses the MACS (minimal access cranial suspension) left as his preferred mini lift technique. This technique involves less dissection and utilizes an innovative suturing method to tighten the SMAS layer, making it an ideal option for patients seeking a more subtle enhancement. Dr. Goldman recognizes the value of mini-facelifts for suitable patients, offering a less invasive and cost-effective alternative to more extensive procedures. While the results may not be as dramatic as a full facelift, mini-facelifts, such as the MACS (minimal access cranial suspension) lift, may provide significant improvement.
Thread lifts have actually been around for over 20 years. With different companies making different sutures. Sutures used to be permanent, but all companies have now switched to dissolvable sutures, because the permanent sutures would sometimes push their way through the skin, get infected, form nodules, or cause other problems. The threads used have tiny fish hook-like projections that allow them to grasp tissue.
Despite being around for over 2 decades, thread lifts have remained a niche procedure. Thread lifts generally only last for a few months, they can cause significant bruising, since the threads have to be tunneled underneath the skin, they do not effectively lift the SMAS layer, but just pull on the skin, which will pull back down around the threads over time. Threads are therefore generally used as a temporary measure to enhance other nonsurgical procedures.
Presents are more commonly used not as a temporary lift of the face but more so to act as filler. But fillers can generally be injected with less downtime than with the subcutaneous tunneling required of the threads. Threads also tend to be used more by medical spas when surgical options are not available.
It is quite common to perform a facelift concurrently with other surgical procedures, especially blepharoplasty, open neck lifts, facial fat injection, brow lifts, and CO2 laser skin resurfacing--all of which are either discussed here or in other sections of our website.
Combining multiple surgical procedures into a single session has the obvious benefit of limiting postoperative downtime and requiring fewer sessions of anesthesia. Safety is always paramount in our practice, so concerns like total operating room time and the amount of postoperative care are always considered when determining whether procedures can be combined.
All facial rejuvenation patients should also be educated about nonsurgical options, to use sometimes instead of surgery and often in combination with surgery. Nonsurgical treatments almost always holistically benefit and complement a facelift, optimizing longevity of the facelift result but also enhancing the overall rejuvenation. Most facelift patients benefit from medical grade skin care, including retinoids, to improve the texture, tone, and elasticity of their skin. The facelift repositions, lifts, and tightens the tissues. Retinoids and skin care improve skin quality and thickness, further rejuvenating the face.
Most facial rejuvenation patient's will also benefit from injectables. For instance, there is no ideal surgical option to reduce crow's feet, which are formed by the orbicularis oculi muscle. However, crow’s feet are effectively treated by botulinum toxin injections, which relax the muscle, smoothing the folds. This can also improve brow aesthetics. Similarly, adding volume to the face with fillers (or fat injection) can enhance the facelift result by adding volume to areas like the cheeks or nasolabial folds (the so-called parenthesis lines by the mouth). When a facelift alone is used to flatten the nasolabial folds, the mouth can be pulled too widely, causing a wind tunnel effect. Balancing surgery with addition of volume can produce a more dramatic and natural result.
As discussed above, the term neck lift can be confusing for patients because the name implies that an incision under the chin can correct aging in the neck, but almost all patients with significant aging in the neck actually require a facelift–which is why the facelift could more accurately be called the face and neck lift. As noted above, pulling loose tissues from under the chin and the front of the neck back into a more youthful position requires lifting the SMAS layer and platysma muscles (the muscles that contribute to the vertical bands in the neck) into a higher position; since these tissues originate in the face, they must be lifted in the face. Furthermore, excess skin of the neck cannot simply be cut out using incisions on the neck, since these would leave obvious scars. The excess skin has to be trimmed using hidden incisions around the ears and hairline. Thus, a neck lift is really a face and neck lift when used to treat facial aging.
The term open neck lift is used when an incision was placed under the chin to remove deep fat in the neck and to tighten the front of the platysma muscles. The open neck lift is used in conjunction with the facelift primarily in patients who either have heavy necks (and therefore require deep fat removal) or have prominent vertical muscle bands in the neck (and therefore require suturing and release of the platysma muscles in the midline).
There are some young patients who have heavy necks, who may in fact be able to have an isolated incision under the chin to remove fat and tighten the front of the platysma muscles. These patients do not require a facelift. The goal here is not rejuvenation, but increasing the depth and definition of the neck and jawline. Many of these younger patients are candidates for liposuction to the jawline and submental area (under the chin) alone, without an incision and open removal of fat. For such patients, consultation with a qualified facial plastic surgeon can help clarify whether liposuction alone or with an open neck lift is best.
This combination helps achieve a comprehensive result by not only tightening the neck tissues but also addressing the tissues of the neck at the sides, creating a "hammock effect" that smooths and lifts the entire neck area effectively.
An isolated open neck lift generally involves short incision underneath the chin, which is well hidden. Approximately 1/4 inch incisions may be used around the earlobes if liposuction is used as part of the procedure, which is Dr. Goldman's preference. If the neck lift is really a facelift (which you can call face and neck lift), these incisions are generally very well-tolerated. Patients can wear their hair up in the vast majority of cases after surgery, or if they keep their hair short, they are able to continue to do so, including men or women.
Good candidates for an isolated open neck lift are generally younger, with tight, elastic skin, but heavy necks that would benefit from deepening, contouring, and defining, which often gives the appearance of weight loss.
Patients with signs of aging, including jowling and the so-called "waddle" under the chin are good candidates for the deep plane facelift to rejuvenate the lower face, midface, jawline, and neck. The open neck lift is added for rejuvenation patients who have a heavy neck and require deep fat removal and for patients who have thick vertical muscle bands requiring suturing and release.
The lip lift has gotten increasing attention on the Internet lately. There are two main patient demographics interested in this procedure: The lip lift is most commonly performed for facial rejuvenation patients (usually in conjunction with the facelift) but is increasingly common in younger patients who have been using lip fillers and want a more dramatic, lasting result.
Goals of the lip lift include: shortening the height of the skin of the upper lip (above the red part of the lip); elevating and everting the red portion of the lip (the vermilion); and improving the shape of the lip, emphasizing a natural cupid's-bow shape.
With age, the skin above the upper lip tends to elongate, while the red part of the lip tends to thin and become deflated. The lip itself may also flatten, losing curvature and shape. The lip lift can rejuvenate by reversing these changes.
By itself, the lip lift can be performed under local anesthesia. An incision is used at the base of the nose. Some younger patients may feel that the scar can be noticeable to others, since younger patients tend to have thicker scarring, so patient education and selection are critical (as is always the case in surgery).
An important consideration is that the upper front teeth (the incisors) do not normally show in the mouth at rest, but do show during smiling. Ideally, the lip lift mimics this normal function. Overcorrection can cause the “bunny rabbit” deformity in which the incisors are exposed even at rest, which can be obvious and unesthetic. This is something that has been reported online in many cases unfortunately.
Good candidates for a lip lift are those who have excessive height of the skin between the red part of the lip (vermillion) and the base of the nose, are looking to improve lip proportions, and are in good overall health with realistic expectations about the outcomes.
Several types of patients are typically not a good candidate for lip lift because of potentially poor aesthetic results or other considerations:
Recovery is usually straightforward, especially when the procedure was performed under local anesthesia. Most patients take only Tylenol, but may take narcotics for 2 to 3 days occasionally. Patients can shower the next day. Non-dissolvable sutures are usually used for this procedure. These are removed in a week in the office. Patients are allowed to exercise vigorously in 2 weeks. Bruising and swelling is generally noticeable to others for about 2 weeks, but bruising is always highly variable between patients. Most patients are back to work in 2 to 3 days, as long as they are comfortable showing bruising and swelling or can work from home.
Fat transfer, also known as fat injection, autologous fat injection, or fat grafting, involves removing fat from one part of the body and re-injecting it into another area to enhance its volume and contour. The term autologous refers to using your own tissue. This procedure is versatile and can be used to improve facial volume, smooth out deep wrinkles, and augment various areas of the body.
During a fat transfer, fat is gently harvested using liposuction from a donor site—most commonly the abdomen, thighs, or flanks. The extracted fat is then purified through processes like rinsing with saline, balloting, or centrifugation to remove ruptured fat cells and concentrate the fat. Once purified, the fat is carefully injected into the desired area, such as the nasolabial folds (the lines between the mouth and cheeks), lips, cheeks, or temples to provide volume and enhance contours.
Fillers are used more commonly than fat injections because there is less downtime, less initial cost, and more predictable results with filler because fat survival or take is highly variable. Generally, about half of the fat is absorbed. Fat transfer is used more commonly when a larger amount of volume is needed for contouring or augmentation or when a procedure like a face lift is being performed concurrently, so that downtime overlaps with recovery from the face lift.
For facial rejuvenation, patients who have thin faces, sallow cheeks, especially with a bony appearance, are most likely to benefit from the addition of volume with fat. Fat injection is generally combined with a deep plane facelift. Thin faced patients often benefit from CO2 laser resurfacing as well, because they are more likely to have thin, sun damaged skin.
Although fat injection can be performed as an isolated procedure, given its downtime and unpredictability and given the high satisfaction rates and predictable effects of injectable fillers, most patients who only need volume will use fillers. And even though fat can be permanent in some patients, aging progresses inevitably, and most patients will continue to use fillers over time, even after facial fat injection. It generally takes 4 to 6 months to see the final result from fat injection. The result from filler injection usually takes 2 to 3 weeks to settle.
The main disadvantages of fat injection are more downtime than filler injection (because of bruising and swelling), less predictability than fillers (because of variable fat survival), greater cost, and the need for anesthesia in most patients.
As you can see from the discussion above, facial rejuvenation is a complex topic. At Beachwood Plastic Surgery and Westlake Plastic Surgery, we feel that the best patient is a well-informed, well educated patient. Choosing the ideal treatment plan, both surgical and nonsurgical, for you requires a thorough consultation, in-depth communication, an exacting physical exam, artistic surgical planning, precise surgical technique, and close follow-up. Dr. Goldman is triple board-certified facial plastic surgery, plastic surgery, and ear nose throat surgery. He has extensive experience with facial rejuvenation. He brings on paralleled skill and personalized care to every procedure.
