Facelift-Surgical or Non-Surgical, Mini or Maxi?
Facial aging changes begin in everyone during their 30’s and many people consider a facelift or other anti-aging or facial rejuvenation treatment such as a non-surgical facelift during their late 30’s or early 40’s. As we age, facial laxity and skin sagging become evident and people notice nasal labial folds running from the nose to the corner of the mouth, jowls along the jaw line, marionette lines running from the corner of the mouth down to the chin, and loose skin on the neck below the chin, often referred to as the “turkey wattle”, technically called platysmal banding.
Traditionally a facelift is done to correct these facial aging changes, however in the past few years the concept of a non-surgical facelift has evolved prompting many who would never consider facelift surgery to inquire about the possibility of non-surgical facial rejuvenation and skin tightening.
While many people undergo plastic surgery to correct eyelid aging with a procedure called a blepharoplasty,
the third most common plastic surgery procedure in the United states, most are reluctant to consider a facelift to correct facial aging changes. Nearly every person I see who is concerned about facial aging tells me they want to look younger but “do not want a facelift”. Many people are willing to have surgery but only if the procedure is called something else, such as a mini lift, tuck, week end lift, or anything other than a facelift.
Recently with the many technological advances in non-surgical facial rejuvenation and skin tightening, the concept of a non-surgical facelift has emerged, and more and more people are asking me about the possibility of a non-surgical facelift as opposed to a traditional facelift. There are many procedures which are advertised as a non-surgical facelift, but the most widely mentioned are the various skin tightening procedures using infrared and radiofrequency energy to heat the deep layers of the skin causing the collagen in the skin to shorten and thus tighten th skin. The more popular of these technologies are LuxIR, Aluma, Refirme, Titan and Thermage.
These new skin tightening procedures, which are called the non-surgical facelift, are expensive, averaging about $4000.00, they are new, and while subtle skin tightening is possible with the non-surgical facelift, results are not comparable to those achieved with traditional facelift surgery. Thus it is very important for prospective patients to understand their goals and expectations and have a realistic understanding of what the non-surgical facelift can and cannot achieve.
I have had a lot of experience with the non-surgical facelift 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 their 50’s, who have significant skin laxity in the face, jaw line, and neck are disappointed. The cost of the non-surgical facelift or skin tightening procedure is about a third of the cost of a facelift.
I repeatedly advise that the most important factor in deciding to have a facelift or non-surgical facelift or any other facial rejuvenation procedure is your rapport with and the skill and experience of your plastic surgeon. The various names that are marketed on the web, mini facelift, min-tuck, lifestyle lift, 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 or non-surgical procedure. A facelift is a 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 the question “should I have a facelift or a non-surgical facelift?” is to pick your doctor first and let him/her pick the procedure that is most likely to achieve the result you want. The facelift 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 facelift or non-surgical facelift. Almost everyone who has seen their 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 facelift does, it pulls the facial and neck skin back to a firmer more youthful appearance. Skin tightening, the non-surgical facelift simply cannot tighten the skin to the same degree, at least at this stage of development.
It is crucially important however that the facelift tighten the facial skin in a natural direction and to a natural appearing degree of firmness and tightness. There is a perfect appropriate direction and degree of tightness for every individual face, I call this the vector and I determine the appropriate vector for each individual face when I make my markings for a facelift 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 tightend too much during a “first facelift”, but the too tight face look is common when a second facelift is done, especially 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 facelift.
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 facelift produces a better, more lasting, and safer facelift result. In my opinion the SMAS should be tightened during a facelift, and any mini facelift which only tightens the skin and ignores the SMAS will not last as long as a standard SMAS facelift. Furthermore, since the facial skin moves and sags as a unit, that is brow, cheek, jaw and neck all sag together, doing a mini lift 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 facelift 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 facelift 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 contemplating a facelift is your general state of health. A facelift 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 facelift. 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 facelift. Although many people can have a facelift 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 facelift 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 facelift 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 usually not a problem with a properly executed facelift. Only 20 % of the scar is visible, as 80% 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 facelift 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 facelift is a good option.
If you decide to have a facelift 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 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 and are happier after a facelift done by an experienced skilled plastic surgeon. To learn more or ask a question, contact me.
Boston, Massachusetts