What You Need to Know About Facelifts

By: Allan E. Wulc, MD June 29, 2018 Category: Face

The word, facelift, is one of the most confusing terms in all of cosmetic surgery, but it describes the reversal of what brings almost everyone into the office: the sagging, flaccid changes that happen as time and elements work on flesh, muscle and bone—making that person we see in the mirror look like a stranger.

As it was originally envisioned in the early 20th century, a facelift was an operation involving the removal of a bit of skin in front of the ear. It evolved to include treatment of other aging areas—the forehead, brows, neck, and eyes. Today, many think that a facelift is a large procedure with long, visible incisions and a prolonged healing period. A common belief is that the results will make you look like someone else, someone that “had something done,” or even someone from another planet!

What’s most interesting about facelifts is that nobody wants one. We look for facelift replacements, shortcuts or other ways to avoid the dreaded procedure. These include facelifts in a bottle, laser facelifts, liquid facelifts, thread lifts, stem cell facelifts and shortened scar face lifts, among other procedures.

What works? What should you avoid? Let’s take a look.

Four ways you can actually avoid facelift surgery.
First, let’s talk about the real ways to avoid a facelift, or at least extend the time before you need one.

  1. Live healthy. It’s the advice of your doctor, life coach, trainer and your own common sense. And you know what? They’re onto something. A healthy lifestyle will do a lot to help you retain a youthful appearance. That means eating well from a variety of healthy choices, drinking a lot (mostly water), exercising regularly, and getting plenty of sleep.
  2. Protect your skin from the sun. Avoid the sun or wear lots of sunscreen. The former is better than the latter. Avoiding a sunburn does not necessarily mean that your elastin and collagen are safe from the sun’s rays.
  3. Consider aggressive skin care. Facelifts in a bottle or jar—Retin A, alpha hydroxy acids, pentapeptides, and other products usually available in a physician’s office or by prescription—have been documented in scientific studies to improve the quality of the skin. Daily moisturizing will also help. Almost anything you buy over the counter can work, and the products you buy at a department store or through multi-level marketing organizations are not necessarily any better—or even as good. They may be a lot more expensive. For example, in our practice, a two-month supply of Quattro-Luma (Retin A, hydroquinone, hydrocortisone and kojic acid) costs much less than well-known brand names such as La Mer or Rodan and Fields, and they have been documented to work in multiple studies. Drugstore products with hyaluronic acid, retinol, and alpha hydroxy acid may not have the strength formulated in a pharmacy or in a physician’s office, but they are often better than the stuff that comes in the expensive jars.
  4. Consider other treatments. Dermabrasion, microneedling, intense pulsed light, radiofrequency skin treatments, fillers and Botox are all great treatments that help postpone or put off a facelift.

How do you know when it’s time to consider a facelift?
There are times when a facelift surgery is your best option. How will you know?

  1.  When the techniques mentioned above don’t work.When you’ve tried everything, it’s time to try something else.
  2. When you catch a reflection of your father or mother in a store window and it’s you.
  3. When you start noticing your jowls and neck in a selfie. Or if you see a photo someone else takes of you from the side, and you can’t believe that the photo wasn’t retouched to make you look worse.
  4. If you’ve gone on a massive and successful campaign to lose weight and you notice that in place of your neck you have jiggly skin excess.

What kind of facelift is right for you?
When you’ve decided to look into a facelift, there are many options out there. This brief overview will help you start the process of evaluating, but it’s by no means a comprehensive list. We’d be happy to discuss the best treatments for you. Just request a consultation

Liquid facelift, spacelift, Y lift
All of these so-called lifts are attempts to increase the fullness of the face. They achieve their rejuvenative benefit by pumping a variety of materials into the face in strategic locations. Most fillers that are put in the face are temporary, but they do produce a plumping effect. There is absolutely no lifting that occurs in the vertical axis with these procedures. However, there is no doubt that volume loss occurs with aging, and these procedures, which are all office-based, can make you look younger. They can effectively postpone the need for a true facelift.


Liposculpture, lipostructure, liposuction
As discussed above, volume loss occurs with aging. One of the elements that we lose over time is fat, which redistributes (and also sags) in the face.
With time, fat accumulates in the neck and along the jawline (jowls). The puffs around the eyes become more apparent because of volume loss in the cheek.

Liposculpture, also termed LipoStructure® by Dr. Sydney Coleman, involves the addition of “micronized” fat to the face. This fat is harvested from the abdomen. It’s centrifuged and liquified and made into tiny droplets, then grafted strategically in the face to increase fullness in locations from which it has been lost. Harvested fat can also be specially diluted, treated and injected into wrinkles. This procedure is called nanofat injection. Currently, there is little proof that nanofat actually gives a long term correction, but early studies are promising.

Thread lifts
Silhouette Lift™, feather lift and NovaThread Lift™, among others,  are terms you might hear. These lifts use small, barbed or knotted sutures placed under the skin to elevate it. Many of these sutures are placed per side.  They have minimal downtime, and the procedure is done in the office.

Unfortunately, the results of this procedure do not last for long, so you should know this before going through with a thread lift. Look at the results of the doctor you are considering, and make sure that you are happy with the way patients look after a year and not just a week after surgery (when they usually look great).

Tread Lifts

Midface lift
This is a procedure that addresses the cheeks and makes the face regain the heart shape it had in youth. Based on the surgeon performing it, it can be done with an incision hidden in the temples or inside the mouth, or it can be done with visible incision near the ear or the eyelids. This is a great procedure, but not for amateur surgeons or uninformed patients.

Midface Lift

Neck lift
This procedure, also called a corset platysmaplasty, or submentoplasty, addresses only a loose, drooping neck. It does not lift the face, but markedly diminishes the jowls and sagging in the neck. It can be done under local anesthesia with a bit of sedation or general anesthesia, and and it can be performed as an outpatient procedure, depending on the surgeon. At W Cosmetic Surgery, we do neck lifts with IV sedation.

SMAS lift, SMASectomy, ESP lift, Deep plane facelift, short scar facelift, minilift
A minilift is a great procedure for the right patient. But what exactly is a minilift? It’s probably one of the procedures mentioned above. These terms are all variants of a basic operation, as described by Millard, Rees, Skoog, Hamra, Trepsat, and many, many others.

The purpose of the procedure is to put things back in as natural a place as possible. Based on the surgeon and his or her surgical technique, that can be a realistic aim. The results that you see are generally not about the procedure name, but about the artistic abilities of the surgeon.

The details of these different approaches vary in where the incisions are placed, whether the midface or sideburns are changed and in what they do with the deeper tissues. Sometimes the deep tissues are cut and removed. Sometimes they are lifted or even left alone. Most surgeons have a favorite technique, and they won’t hesitate to tell you why their procedure is better (that includes me).

The branded lift  
Many surgeons have a favorite (and trademarked) procedure that involves one or more of the techniques described above. Examples you may have heard of are the PonyTail Lift™, or the MACS lift, or the Quicklift®󠀩.

At W Cosmetic Surgery, we offer the Micro Midface Lift, a minimally invasive midface lift procedure that addresses common signs of aging by elevating volumes in the cheeks back into a more youthful position. This procedure provides a natural-looking result with minimal scarring and downtime and improves the jawline as a secondary benefit.

A lot can be achieved with these procedures, which are usually idiosyncratic variance of the lifts described above. You should look at the results.

The Micromidface

Full Facelift
This procedure, as it was originally described, involved an incision in the hair of the temple that tapers down along the front and back of the ear and into the posterior hairline,with an incision in the neck. Many surgeons will also perform an upper and lower eyelid blepharoplasty (eye lift) at the same time. The procedure is done under general anesthesia and often involves a stay in the hospital. Lots of these procedures are still done, but various issues are presented by the limitations of the procedures themselves, such as displacement of the hairline, scars, hair loss, and a general funny pulled  look. The procedure that we perform, outlined in TEAL, shows how many surgeons avoid this swept look by making the incision below the sideburn, so no little to no hair is lost and the sideburn is not displaced with the lift.  It is also a smaller incision, and really isn’t a  full facelift.  Some surgeons call this a minifacelift.

You actually don’t want a full facelift.  A variety of smaller, less invasive  procedures available today, such as the minifacelift,  can make you look much more natural with a result that holds up better over time.

Traditional Full Facelift–and our smaller incision approach

*The dotted lines shown here illustrate the incisions that W Cosmetic Surgery makes when performing a facelift. With a mini facelift procedure, we lift the cheek up with a small incision.

The solid line illustrates how much longer the incision will be for a full facelift that lifts the midface. The bigger incision mean possible hair loss and a hairline shift.

We can recommend a number of treatments based on the changes you’d like to see. Talk to us about what you’re looking for.

Allan E. Wulc, MD

About the Author

Allan E. Wulc, MD is the lead surgeon at W Cosmetic Surgery and is Quadruple Board Certified with over 25 years experience in cosmetic and plastic surgery. Dr. Wulc is a leader in his field and pioneer of new surgical techniques. His work has been featured in lectures, presentations, and publications worldwide. Find out more about Dr. Wulc.