Choosing the Best Facelift for You

Today we are faced with an overwhelming amount of information about various non-surgical and surgical facelift procedures; many promising to make you look younger for years to come with little recovery time.  

Dr. Prashant Soni, Board Certified Cosmetic & Plastic Surgeon at Advanced Specialty Care, discusses various facial rejuvenation techniques to improve different problem areas so you can make an informed choice about which procedure would work best for you.

Before delving into the specific procedures that are effective, it helps to understand the basic physiology of the aging face, specifically the area of the face below the cheekbone down to the jawline. Facial aging in this zone leads to the drawn, tired appearance that confronts us in the mirror and often appears worse in photographs.

The conventional belief that loose skin is the culprit or that weight gain is the cause of these issues is untrue. Skin is an elastic organ that simply stretches and often contracts to accommodate the changes that are happening to the deeper structures beneath it. In this case, the aging appearance is due to changes in fat distribution.

Downward relaxation of the cheek fat (called the malar fat pad) is due to the loosening of ligaments under the skin caused by the constant pull of gravity. Descent of this fat pad results in loss of the sculpted blush line of the cheeks and leaves hollowness in its place. The weight of this fat on the laugh lines promotes deepening into prominent folds. Lastly, the falling of the bottom edge of this fat pad below the jawline is responsible for jowl formation.

With these in mind, it is clear that modern facial rejuvenation techniques must manage this troublesome fat pad and not just tighten the skin.

Liquid Facelift

The liquid facelift is the simplest technique to manage the fat pad. Technologically advanced soft tissue fillers such as Radiesse and Voluma last one to two years. They can be injected within a few minutes to restore youthful fullness to the deflated cheek area.

Thinner hyaluronic acid fillers such as Belotero and Juvederm blend the eyes and mouth areas seamlessly into the rejuvenated cheek and jawline. This technique is the perfect option for patients in their 30’s to 50’s. It is titrated to the person’s desires and can be performed in the office with no downtime. Most importantly, this procedure avoids any incisions as it is all performed with microneedle instruments.

Liquid Facelift Before and After

Liquid Facelift with Spot Liposuction to Jowls

One shortcoming of the liquid facelift is that it cannot eliminate the appearance of moderate jowling. If jowl fat is simply liposuctioned, the skin has a tremendous capacity to tighten down. Spot liposuction of the jowl fat can be performed through a tiny 3mm poke hole behind the ear to permanently remove the fat. This will smooth the jawline within a few minutes. The procedure may need to be repeated after 5-10 years to adjust for additional fat descent into the jowl area.

In many instances, spot liposuction with a liquid facelift is all that is needed, especially in people who still have a full, rounded blush line. It requires a one to two day recovery period.

Because this technique can be done fairly quickly, it can be combined with other procedures such as Botox, chemical peels, or eyelid and neck tightening procedures. This graduated approach is precise and excellent for people who are too busy to endure the recovery time involved with a mini or full facelift. Of all the minimally invasive techniques, this is also much more cost-effective than external laser and ultrasound therapies proclaimed to be non-surgical facelifts.

On scientific grounds alone, skin-tightening procedures simply cannot lift the deeper sagging tissues that cause an aged appearance. Furthermore, the ability of ultrasound treatment to reposition the fat pads has not been scientifically corroborated due to the proprietary nature of the companies that make these devices. Results on the face are anecdotally reported to take six months to be fully visible and treatments have to be repeated in one to two years. The liquid facelift with or without liposuction is currently a more cost-effective technique that yields immediate results and a similar duration of effect.


Liquid Facelift with Spot Liposuction to Jowls Before and After

Liquid Facelift with Spot Liposuction to Jowls Before and After

Liquid Facelift with Spot Liposuction to Jowls Before and After

Mini Facelift

The mini facelift has become one of the most publicized procedures in plastic surgery. Variations such as “Short Scar facelift”, ” Vertical lift”, “S lift”, “MACS lift” and “Swift lift” and “Lifestyle lift” are publicized everywhere. This category of procedures is ideal for people who have pronounced jowling and severe flattening of the cheeks. For these people, a liquid facelift with liposuction of the jowl is not very helpful. A mini facelift is often the choice of people who have only mild to moderate facial aging and simply do not want to maintain their facial volume with fillers every one to two years.

In a properly performed mini facelift, the existing facial fat is repositioned to its original youthful position through an incision that resides in the natural fold of the ear and often extends into the hairline. Through this incision, the jowl fat is actually grasped and sutured vertically up to its original position just under the cheekbone.

The longevity of any facelift is dependent on proper fixation of the facial fat but generally is up to 10 years when performed by a board-certified plastic surgeon. Many commercial one-hour facelifts are essentially skin tightening procedures that do not reposition the fat. The results tend to last only one to two years. Clearly, any surgical facelift procedure that cannot outlive the results of a liquid facelift should be avoided. A properly performed mini facelift is a meticulous, artful procedure that takes several hours to perform well. It is often done under light sedation in an operating room setting. There is a minimum of two to three weeks’ downtime to allow for swelling to go down enough that the person feels comfortable in public. Results continue to improve for up to a year.


Mini Facelift Before and After

Neck Lift

A neck lift, also known as cervicoplasty, is designed to correct the loss of definition and slanted angle that accompanies the aging neck. It is important to realize that the previously mentioned facelift and facial volumizing procedures have little effect on the neck. There is a dynamic interplay between neck muscle thickening, ligament laxity and fat excess that change as we age. Once again, the skin is a passive bystander to the changes happening underneath.

In the early stages, Botox and spot liposuction may address changes. Once a more sloping neckline has emerged, a neck tightening procedure called a platysmaplasty can be performed to tighten up the sagging neck muscles that are causing poor definition of the neck.

By tightening these muscles under the chin, a sling-like effect is created that reclaims the original neckline. It is performed with an incision placed behind the ears and under the chin. Light sedation while in an operating room is essential. No incisions are performed in front of the ear. An isolated neck lift can be performed in conjunction with liposuction of the jowls and a liquid facelift. Since there is no surgery performed over the face itself, the swelling and bruising are easily hidden under a scarf or turtleneck. A person can go about in public often within a few days. As with most surgical procedures, results continue to improve for up to a year.


Neck Lift Before and After

Neck Lift Before and After

Full Facelift

A full facelift is essentially a mini facelift with a combined neck lift procedure. This is the most comprehensive of the lifting techniques. Like other surgical lifts, it is performed in the operating room and takes several hours to perform. People generally require four weeks before they feel comfortable in public.


Full Facelift Before and After


Full Facelift Before and After Side View

How to Choose the Best Option

Despite the diversity of options out there, most goals can be accomplished safely and predictably with the techniques above. Nevertheless, an informed decision comes only by a thorough discussion of your expectations and a keen understanding of the recuperation required with each technique.

Make sure to review your surgeon’s actual patient photos during your consultation. Pictures provided by a marketing company on the Internet are often altered and not representative of the skill of the surgeon you may be meeting.

Furthermore, make sure your surgeon is board certified by the American Board of Plastic Surgery and has hospital privileges to perform your facelift surgery at your local hospital. Many “board-certified cosmetic surgeons” are actually certified family practitioners, radiologists or Ob/Gyns, etc. They are not trained in plastic surgery but offer these procedures in their office due to a loophole in federal laws. No hospital would give plastic surgery privileges to these physicians. With these precautions in mind, choosing the right procedure and the right surgeon becomes much more simple.

Advanced Cosmetic & Plastic Surgery offers the newest and most sophisticated cosmetic surgery procedures for men and women, including neck and facelifts, eyelid surgery, rhinoplasty (nose surgery), liposuction, abdominoplasty (tummy tuck), breast augmentation, reduction or reconstruction, as well as Botox, Juvederm and other injectable fillers. All procedures are done by ASC Surgeons, certified by the American Board of Plastic Surgery, Dr. David Goldenberg, Dr. Sohel Islam, and Dr. Prashant Soni. ASC offices are located in Fairfield & Litchfield County, CT in Danbury, New Milford, Norwalk, and Ridgefield.


Topics: Blog, Cosmetic Surgery, Dr. Prashant Soni, Plastic Surgery