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Dear Dr. Seckel,I am 53 years old and very unhappy about loose skin beneath my neck and chin and on my jaw line. I work very hard at staying fit and have tried facial exercises but see no difference after a lot of effort. I have seen a plastic surgeon in Boston who suggested a facelift and a blepharoplasty but I did not feel comfortable with him and am not sure I want surgery. I have read a lot online about the face lift, the thread lift, the mini face lift and the lifestyle lift, and must admit I am confused by all the options. You also write about the non-surgical face-lift, how good is that, does it last? I am concerned about scarring and about down time as I have to work. I know you have an office in Boston but I would like to hear your opinion before I consider another appointment. I want to do something but don’t know what. Thank you, Sherri, Boston, MA.

Dear Sherri,

Thank you for your question. Interestingly the average age of patients seeking face lift surgery in my practice is 53 years old, so there are many women who share your concerns and want a non-surgical face lift. I have written a great deal about facial aging and its prevention and correction. I believe you would find my book “Save Your Face” very helpful. In the book I discuss the various face lift options, non-surgical face lift and surgical face lift, and there is also advice on how to choose a plastic surgeon.

If you would like to see pictures of a face lift result visit my clinical website drseckel.com.

I have had a lot of experience with the non-surgical face lift and can tell you that the best results with current technology are about a 20-30% tightening of the facial skin with some improvement in skin texture and wrinkling especially around the jaw line. While these results are definitely visible when you review pre and 6 month post treatment photographs, most patients in there 50’s, who have significant facial skin laxity in the face, jaw line, and neck are disappointed with the non-surgical face lift. The skin tightening procedures are expensive, about a third of the cost of a face lift.

I repeatedly advise that the most important factor in deciding to have a face lift or non-surgical face lift is your rapport with and the skill and experience of the plastic surgeon. The various names that are marketed on the web, mini face lift, mini tuck, lifestyle lift, thread lift, face tuck and others are names used to market individual variations in the face lifting technique. The most important factor behind that name is the skill and experience of the doctor who will be performing your surgery. All of the procedures you mentioned are surgical procedures and the success of a surgical procedure is dependant on your particular anatomy, medical condition, and skin type and on the skill and experience of the doctor.

My quick answer to your question is to pick your doctor first and let him or her pick the facial rejuvenation procedure that is most likely to achieve the face lift result you want. The face lift is a very complex procedure which requires skill and experience to perform and no internet description or marketing term can compensate for that basic fact.

Having said that there are general guidelines that can be helpful to consider when you are considering any facial rejuvenation procedure such as a face lift. Almost everyone who has seen there facial skin sag on the cheek, jaw line, and neck has looked into a mirror, placed their hands on their face and pulled the skin up. I do this frequently and I always look better and younger when I pull the skin of my face up. This is what a face lift does, it pulls the facial and neck skin back to a firmer more youthful appearance.

It is crucially important however that the face lift tighten the facial skin in a natural direction and to a natural appearing degree of firmness and tightness. A non-surgical face lift simply cannot do this as well as a face lift. There is a perfect appropriate direction and degree of tightness for every individual face, I call this the face lift vector and I determine the appropriate vector for each individual face when I make my markings for a face lift just before surgery. If this is done incorrectly the result of the face-lift will be unnatural and the patient will be unhappy and look “operated on”. It is very unusual for the face to be tighetend too much during a “first facelift”, but the too tight face is common when a second facelift is done by an inexperienced or less skilled surgeon. Determining the appropriate vector and degree of pull in the various facial areas requires skill, aesthetic judgement and experience-there is no substitute. Thus again, the skill and experience of your surgeon is the most important determinant of a satisfactory outcome following a face lift.

The second important component, in my opinion, is the technical detail of the facelift operation. The skin covering the face and neck is all attached to the same musculofascial structure called the SMAS which stands for Superficial Musculo Aponeurotic System and after 30 years of research and study most, but not all, experts agree that tightening the SMAS layer as well as the facial skin during a face lift produces a better, more lasting, and safer face lift result. In my opinion the SMAS should be tightened during a face lift, and any mini facelift which only tightens the skin and ignores the SMAS will not last as long as a standard SMAS face lift. Furthermore, since the facial skin moves and sags as a unit, that is brow, cheek, jaw and neck all sag together, doing a minilift on one area such as the cheek will not produce the same harmonious facial tightening that a standard facelift will produce. Since in my experience most people who decide to have a mini or other lift instead of a standard facelift do so to save money, I think it is true that “you get what you pay for”. A standard SMAS face lift takes time and skill; taking short cuts gives sub standard results. That is why I say pick an expert surgeon you feel you can trust and follow his or her advice.

The next important factor in determining the outcome of a face lift is your facial skin type. Patients with very fair, thin skin that never tan and always burn and who have blue eyes and blonde or red hair can have an excellent facelift result, but generally the facial tightening does not last as long as other skin types. Patients with this skin type, which we call Fitzpatrick Type 1 skin, age earlier and more severely than people with darker skin. In addition thinner skin has less elastic tissue and is less resistant to sagging. Consequently aging will continue after the facelift and the result will not last as long. Tightening of the skin and wrinkle removal can be enhanced in these patients by laser procedures which increase the collagen in the skin after a facelift has been done, and improve the results of the facial rejuvenation achieved by the facelift.

Conversely, patients with darker thicker skin age less rapidly and have more skin elasticity, thus a facelift in a darker skinned person who always tans will last longer, often a satisfactory appearance of 10 to 15 years.

Another important consideration when considering a face lift is your general state of health. A face lift is a surgical operation, and surgery is safest in people who are in good general health. High blood pressure can cause bleeding and should always be under very good control before considering a face lift. Severe diabetes or anything that impairs wound healing poses a serious risk during and after a facelift. Patients who smoke cannot have a facelift unless they have been free of nicotine in any form for at least 8 weeks. I have seen patients who have not smoked in 20 years still have slow wound healing after a facelift.

You will need help and support after a face lift. Although many people can have a face lift as day surgery someone must drive you home and stay with you at least the first night. You will need help negotiating stairs, getting to the bathroom etc. Don’t believe what you read about returning to work the next day. Even after having a face lift with local anesthesia you are not going to be able to work the next day. I tell my patients to plan to take at least 2 weeks off of work after a face lift. You will be up and around with make up after 4 to 5 days, but you are not going to feel like a full day’s work and you are not going to want your fellow employees to see you. Generally I take some stitches out at day 5 or 6 and the remainder, those in the hair out at day 12-14.

Surprisingly most of my patients who have had a face lift do not complain of pain. They tell me the face feels tight but not painful. I believe this is because when the facial skin is lifted it is removed from the underlying nerves, and in fact the cheek is often numb for several months after a facelift.

You see a youthful face right away after surgery! I always ask my patients to look into a mirror when I see them the morning after a face lift. You can always see the results immediately, the nice tight neck and jaw line and full cheek. There is swelling and slight bruising but bruising usually does not show up for a day or two and then mostly in the neck. I also have my patients shower and wash out their hair the next morning so they can put on a scarf and dark glasses and draw less attention as they go home. Most patients have a small drain placed under the skin which I remove the next morning. Men, because they have more blood vessels in the face because of their heavy beard, are more likely to bleed, thus I leave their drains in longer.

Scarring is not a problem with a properly executed facelift. Only 25 % of the scar is visible, as 75% is hidden behind the ear and in the hair. The visible portion is placed in a crease immediately in front of the ear and is not visible to most people. A person would have to look closely at your ear to see it.

The decision to have a face lift is a very personal one. If you are healthy and having a youthful looking face is important to you, and a qualified, experienced, skilled board certified plastic surgeon thinks you are a good candidate, and you can afford a two week recovery time then a face lift is a good option.

I am not sure why the doctor also suggested a blepharoplasty. It is my custom to never suggest any procedure to a patient unless the patient specifically asks about the correction of a condition. If you are also troubled by loose eyelid skin, hooding of the eyelids, bags and dark circles under the eyes there are many links to informative articles on these subjects at the Saveyourface.com website.

If you decide to have a face lift by all means the most important factor is to find an experienced skilled plastic surgeon. Ask friends or relatives who have had a good experience for a recommendation. Ask the surgeon to show you pictures of patients who have had a facelift with the doctor. Ask to speak to prior patients who have had a facelift.

Although non-surgical facial rejuvenation and skin tightening or non-surgical face lift techniques have improved and are getting better I believe they are more appropriate for younger patients in their 30’s and 40’s who have minimal facial laxity and have younger skin which responds better to skin tightening techniques. In my experience most patients in their late 40”s and older get a better result by choosing plastic surgery and are happier after a face lift done by an experienced skilled plastic surgeon.

Please feel free to email me your photo which will be kept confidential. There are many other facial rejuvenation options including the 6-step non-surgical facial rejuvenation program which may interest you.

For more information on face lifts, plastic surgery and non-surgical facial rejuvenation read Save Your Face or contact me.

Thank you,

Dr Seckel

Boston, Massachusetts