Facelift Questions Answered By Top New York Cosmetic Surgeon Amiya Prasad, M.D.

QUESTION: What Results Can I Expect from a Face Lift?
ANSWER: A real facelift restores a natural, youthful appearance
This procedure is accomplished by lifting deeper tissue under the skin and removing excess skin to restore the balance of a youthful face. The features one can expect with a facelift includes a well defined jawline and the absence of sagging neck skin. In my practice, the lift is pulled upwards rather than outwards, as was done in the past, so that a result is a natural appearance which takes about ten years off of your face rather than the wind tunnel look that looks like you had a facelift. Lastly, we have learned how to adjust our techniques and depth of facelift surgery to the individual patient in terms of how much they need and what their desired goals may be.

QUESTION: What is the Best Alternative to a Face Lift?
ANSWER: Nonsurgical alternative to facelift is nonsensical
I see people everyday in New York who want a nonsurgical alternative. Although skin heating devices and lasers have been tried, there is no alternative which matches the benefit of properly performed face and necklifting.

In my practice, I have worked over the past 15 years on performing quick recovery face and necklifting procedures using local anesthesia with light sedation. Although no one wants to have surgery, to get the results most people want, a surgical procedure of some form is necessary. Don’t be fooled by “miracle” procedures or 1 hour factory lift procedures. Consult qualified Cosmetic Surgeons to learn about your options.

QUESTION: Why Does One Typically Have to Stay Overnight After a Face and Neck Lift?
ANSWER: No Overnight Stay after Face Lift & Neck Lift
With advancements in cosmetic surgery, an overnight stay after having a Facelift and Necklift is no longer always the case. At my cosmetic surgery practice in Manhattan, New York and Garden City Long Island, I have developed the “Quick Recovery” Facelift and Necklift designed for the modern lifestyle that gives maximum gain, minimal discomfort and little downtime. In practice, I also separate the term “facelift” from “necklift” as the necklift procedure focuses more on loose skin and muscle below the chin to the lower part of the neck. It’s not unusual in practice for me to recommend to a patient to undergo a “Face and Neck lift”.
After some time, I found that patients who sought a face lift had hesitance to having face lift surgery because they didn’t want to appear unnatural or show obvious signs of surgery. Patients also did not want the long period of recovery and did not want an ineffective “short cut” procedure. Performed under local anesthesia and light sedation, the Quick Recovery Facelift and Necklift is a 2 to 3 hour procedure. The patient will be able to return home on the same day, about 1 hour after the procedure with only a small bandage and antibiotic ointment. Recovery time is about 1 week. My patient coordinator can also arrange accommodations with nearby hotel stay if you prefer to be close to my office for a few days.

QUESTION: Is It Advisable to Consider a Facelift with an Oculoplastic Surgeon?
ANSWER: Qualified oculoplastic surgeons who perform facelift surgery
Trust. It is the basis of why patients come to us as surgeons. This trust is undermined by putting self interest and political agendas before the interest of the patient. Many of the physicians answering this question are using fear and partial information to inspire fear rather than to inform. When physicians sling mud like politicians, the profession and more importantly, the patient suffers.

The question is “is it advisable to consider a facelift with an oculoplastic surgeon?” These colleagues quickly fired back with phrases about training and board certification without knowing anything about the Oculoplastic Surgeon in question. If one were to review malpractice cases and settlements, there would be no shortage of Board Certified Plastic Surgeons listed as defendants. Board Certification in any specialty means the doctor completed a residency and passed an examination. Board certification does not measure surgical skills, artistry, judgment and ethics.

As a practicing Oculofacial Plastic Surgeon in New York City for the past 15 years and as an instructor in Cosmetic Surgery, I would answer this question posed by this individual differently. “Is it advisable to consider a facelift with an oculoplastic surgeon?“ My answer is “It Depends”.
Cosmetic Surgery is not the exclusive domain of one specialty. Cosmetic Surgery is distinctly different from Plastic Surgery. Specialization and even super specialization has led to great advances in the disciplines of Cosmetic Surgery which everyone benefits from. One can argue that a 2 year hospital based residency (standard for Board certified Plastic Surgeons) with limited experience in Cosmetic Surgery is inadequate for the complexities and art of Cosmetic Surgery. This does not mean that the general Plastic Surgeon is not qualified to perform Cosmetic Surgery but rather like any surgeon, must focus on particular areas to achieve excellence.

The exposure during residency and fellowship varies between programs and when you think about it, no matter how many years of training a doctor has, it takes many years of practice before one becomes proficient in a specialty. What does it take to excel in Cosmetic Surgery? It takes a foundation of surgical experience combined with technical skills, aesthetic sense, judgment and ethics. Does one specialty have this combination exclusively? The answer is no. Physicians are individuals.

A local Board certified Plastic Surgeon who advertises heavily and performs high volume surgery has so many poor outcomes that he has a full time attorney to handle all the malpractice suits. I personally have revised many of his facelifts and eyelifts. Some facelifts were done so poorly that there was not enough skin for me to work with. Is it fair to now say that all Board certified Plastic Surgeons are just like him? No. On the other hand, I personally have witnessed excellent liposuction performed by Ob/Gyn doctors and excellent breast surgery by Ear, Nose & Throat doctors.
Why are these doctors exceptional at what they do? The answer is training, experience, technical skills and aesthetic/artistic vision and commitment to provide the highest level of care for their patients. Personally, as a facelift surgeon, I have been impressed by and learned much from 2 colleagues who do excellent facelift surgery who are Oral & Maxillofacial Surgeons (original specialty – dentistry). The greatest contribution to the field of liposuction surgery was made by Jeffrey Klein, M.D. – a dermatologist.

Performing facelifts for the past 15 years, I have kept up with new developments in the field and have seen facelift surgery being routinely performed by general plastic surgeons, dermatologists, oral/maxillofacial surgeons, otolaryngologists, and yes oculoplastic surgeons. Inter specialty rivalry generates endless accusations of who has more experience during training and who is more familiar with an area of the human anatomy. Once again, patients become confused and judge physicians negatively as self serving.

Based on the answers to this question in this forum, a board certified plastic surgeon who graduated 1 week ago from a 2 year residency is more qualified than an otolaryngologist specializing in facelift surgery for 20 years. The logic used here is flawed and inflammatory. In fact, by the logic used in this forum, Oculoplastic Surgeons are more qualified to perform eyelid surgery then any other specialty. I doubt if these colleagues would stop doing blepharoplasties (eyelifts) for the good of their patients and refer these surgeries to their local Oculoplastic Surgeon.

Unfortunately, it comes down to money. One specialty believing another specialty will “steal” their patients and therefore their right to revenue. It is only beneficial to the consumer to have choices and for specialists to compete in a healthy way to deliver safer and satisfying results to their patients. Inter specialty respect and sharing of knowledge ultimately benefits both patients and physicians. The American Academy of Cosmetic Surgery exemplifies this value.

The question remains, how do you as a prospective patient make a decision on who to choose for your facelift? Ask questions and judge each doctor on their own merit. Here is a simple list of questions:
1. Do you do facelifts?
2. How frequently do you do facelifts?
3. Can you show me your before and after photos?
4. Where do you perform your surgery?
5. Is your facility accredited?
6. May I speak to or meet someone who you have performed facelift on?

Although this list is not all inclusive and patients usually ask me at least 20 more questions during consultation, you should get the “vibe” from the doctor and the office staff about the quality of work being done there. Speak to the administrative and medical staff at the office. If you have any concerns or reservations, ask questions until you are satisfied.

QUESTION: While Reviewing Post Facelift Photos on Surgeons Websites I Have Noticed a Few Variations in Outcomes?
ANSWER: Face Lift Surgery Results
I wrote a book called “The Fine Art of Looking Younger” and have been teaching my patients about the elements of facial aging. Facial aging is a combination of “volume loss” and sagging soft tissue. A facelift restores the cheeks and jawline as well as the neck. A face lift does not technically restore facial volume although there is some volume being repositioned. Proper facial analysis is necessary so you understand what you can expect after face lift surgery. There are treatments to enhance facial volume such as fillers and injectables (Restylane, PRP, Vampire Facelift) that I perform at my practice in New York for patients who need enhancement in certain facial areas such as for fuller cheeks.

QUESTION: Facelift, Nose Job, Upper Blephroplast and Fat Transplant at the Same Time?
ANSWER: Combination Procedure: Speak to your surgeon
You should speak to your doctor regarding what you are experiencing after your combination procedure (facelift, nose job, upper blepharoplasty and fat transplant). This procedure can cause significant swelling and only your doctor would understand what was done and how your healing has been progressing.

QUESTION: Im Scheduled for a Facelift in June/July. What Else Would You Recommend For Facial Symmetry?
ANSWER: Facial Enhancements for June/July Facelift
Congratulations on your weight loss. It is probably in your best interest to wait until after the facelift and assess whether additional facial volume enhancement is appropriate. I would consider pre-operatively the placement of a submalar implant (cheek implant) as I noticed a fair amount of volume loss in the cheek area below your eyes so your midface looks more youthful. Best of luck.

QUESTION: I Tie my Hair Up to Give Myself a Psedo Face Lift. Would an Actual Lift Give the Same Look?
ANSWER: Pulling Hair Tightly for Facelift Effect Can Cause Hair Loss
Many women have come to my offices in New York with exactly the same strategy. Unfortunately, this practice of gathering your hair so tightly to lift the face slightly results in hair loss particularly in the hairline (referred to as “traction alopecia). My associate is Dr. Gary Hitzig, the creator of ACell and PRP (whom I coined “Hair Rescue” with) to treat male and female pattern hair loss, and we see this problem a lot with individuals who do this to that effect. As far as your concern about embarrassment, I doubt any surgeon who’s been in practice for a few years would not have come across a situation like yours. For some of my patients who want to change their eye to a more almond shape with upturned corners, I perform Almond Eyelid Surgery. Some patients, depending on their whole face, may need a brow lift and botox injections or a face lift surgery to raise or lift that facial area. Meet with qualified and experienced surgeons and learn more about your options for facial surgery.

QUESTION: Where Can I Find a Facelift Surgeon Who Will Actually Address my Entire Face?
ANSWER: Deciding on a Facelift Surgeon for Entire Face
I understand your frustration. Many people share your opinion and end up making poor choices such as going to high volume cheap surgeons or going abroad with no understanding about who is performing their surgery. Practicing in the U.S and in particular metropolitan areas like New York City is fairly expensive for doctors. Costs such as malpractice insurance and the cost of operating rooms including anesthesia, nursing etc. make it difficult to do all the things you want within your budget. I encourage you to meet with qualified surgeons with extensive experience and find the right one for you. Once you’re comfortable, you can see what the doctor can afford to offer you that’s within your budget. In my practice, we save people money by having our own facilities where I have better control over cost compared to hospitals or surgicenters. I would discourage you to make a choice for your face based on price alone. Enough misadventures occur in the best hands and the best circumstances in the U.S. Going outside in my opinion leaves you considerably more exposed and at risk. I’ve attached an informative video and link to an article “Deciding Factors for Choosing Your Cosmetic Surgeon” of any specialty.

QUESTION: Face Lifting and Fillers to Pump Up My Face?
ANSWER: Facelifts + Fillers for the Face
As an Oculofacial Plastic & reconstructive cosmetic surgeon operating in New York, I educate my patients about the facial aging process and work with them on deciding the best time to do a facelift and the best options for facial rejuvenation that will preserve their unique characteristics. Facial aging is a combination of volume loss of bone, muscle and fat in the face as well as descent of the soft tissue (skin and underlying support). Facial volume is lost with facial aging, which is why younger individuals generally have a “plump” face. A facelift is a surgical procedure to address loose skin and deeper tissue which results in descent of the cheeks, loss of definition of the jawline and loose skin under the chin. There are many choices for volume replacement solutions for the face which require that you see a specialist who actually performs all the procedures including injectables such as Radiesse, Sculptra, and Restylane as well as surgical procedures such as fat transfer for facial volume. At my practice, a combination of a facelift and fillers may be suitable after determining what your concerns are with a proper examination. I also offer the Vampire Facelift for patients who aren’t quite ready for a facelift and want to “pump up” their face.

QUESTION: Several Asymmetries, What Can Be Done!
ANSWER: Surgical and Non-Surgical Solutions for Facial Asymmetries
Facial asymmetry is normal and everyone is asymmetrical to some degree. The faces shape is determined by the relationship between the bone and soft tissue and muscles in your face. You might benefit from an injectable filler to add volume to sunken areas and balance face. At my practice we offer the Vampire Facelift to add volume to the mid-face area and generate collagen production. In terms of lowering your left eye, please understand that eyelift surgery or brow lift surgery should be done by an qualified oculoplastic or oculofacial plastic surgeon if you a candidate. As a cosmetic oculofacial plastic & reconstructive surgeon operating in New York, I recommend you consult with a specialized doctor or cosmetic surgeon who can give you a proper examination of your face and offer treatment advice depending on your cosmetic goals.

QUESTION: Extended Recovery After Facial Surgery, Is Swelling and Distortion Normal 3 Months Post-Op
ANSWER: Facial Surgery Recovery Period
You’ve had comprehensive combination facial surgery. As well you’ve had fractional CO2 laser skin resurfacing. You are dealing with internal and external healing to your face. Although the downtime might be over, there is still swelling and healing time. I recommend waiting a few more weeks to months for swelling to go down and to see your optimal results. If you have concerns, please consult with your cosmetic surgeon.

QUESTION: Face/Cheeks Falling Apart (Only 17)?
ANSWER: Uneven Cheeks and Face
Judging by the picture, there doesn’t appear to be anything wrong with your cheeks or face and you are also very young. Everyone is asymmetrical to some degree, and slight facial asymmetry is completely normal. The structure of your bones and tissue are anatomical and a result of genetics. If it is of great concern to you, I recommend consulting with a specialized doctor who can better help you.

QUESTION: Why Do Some Doctors Say to Expect Feeling Depressed After a Full Face and Brow Lift?
ANSWER: Emotions after Facelift or Cosmetic Surgery
The emotional response to surgery is something that every surgeon is familiar with. It’s been my experience that having clear communication and well defined expectations can avoid unnecessary stress after surgery. That being said, it’s not surprising for someone to have a feeling of depression after surgery such as a facelift and brow lift. Factors which may contribute to this include anesthesia, stress, level of change in facial appearance and a person’s previous emotional condition. As far as the duration, it can last for weeks to months.

Here’s something we’ve used in our practice in New York to help people understand what they’re going through when this happens: First week- can be an emotional roller coaster (low energy, feel “zombie” like, wiped out, zonked); Second week you may be “nit picky” and “antsy” and “weird” (irritable, sad, anger, confused, questioning); third week may be “showing off”, noticing reactions about how you look, and feeling better and more comfortable with results.

QUESTION: How Long Does a Facelift Last?
ANSWER: SMAS Facelift lasts 7-10 years in general
Everything is relative and variable. All patients are of course different. On average though, I let my potential patients know that a facelift will last approximately 7-10 years. This is when the SMAS is treated. Simply doing a skin lift is most often a waste of time and money for the patient.
We can not stop aging, but a well done facelifting procedure will leave the patient always looking that much better than having never done the procedure in the first place.
As I am sure you have read, lifestyle is a large factor in healing and in the longevity of such a procedure. Returning to smoking (I insist all my facelift patients have quit smoking for 2-6 months before the procedure) will reduce its longevity. Sun exposure, as I have stated in other answers, will age you. Extreme losses or gains in weight will affect a facelift. A patient’s age is also a factor.
Lastly, I thoroughly believe that a patient’s attitude and spirit affects his or her health and longevity. I believe it speeds healing as well as how long a procedure lasts. This is impossible to measure of course and is completely subjective, but a persons spirit and well-being do make a real difference.

QUESTION: Liquid Facelift
ANSWER: Liquid Facelift is not a real Facelift
I will answer this question as to what a liquid facelift is and is not. A “liquid facelift” is a name for a series of fillers and Botox injected into several strategic areas of the face that can smooth out a few deep furrows but will not truly rejuvenate your face like a facelift will. A liquid facelift is a temporary measure to make small repairs to the canvas.
It is misguided to refer to it as a facelift because it will not restore the tone of sagging facial skin. I am a strong believer in injectibles and they can be used to maintain a youthful appearance. I use Botox, Dysport, Juvederm and Radiesse in my practice daily. However, they have been oversold by those who do not perform surgical facelifts. No matter how expertly you place fillers or Botox, you will not be able to retrieve a sharp jawline or smooth out sagging skin over the jowls or neck. If that is your true intention, you will need to update the framework with a surgical, REAL facelift.

QUESTION: What Are the Pros and Cons of a Face Lift?
ANSWER: Pros & Cons to Facelift Surgery
As a Cosmetic Oculofacial (Specializing in Eyelid and Facelift Surgery) Plastic Surgeon practicing for 15 years, this question requires time and detailed understanding. In th right candidate, a facelift procedure is the ideal procedure to lift sagging skin, loose neck and improve the appearance of jowls. I will provide a video response to help you understand the answer to your question.

QUESTION: Facelift While Botox or Fillers Still Active?
ANSWER: Botox Cosmetic and Facelift in combination
I’m a Cosmetic Oculofacial (Specializing in Eyelid and Facelift Surgery) Plastic Surgeon practicing for 15 years with offices in Manhattan’s Upper Eastside. assuming the Botox is in the usual areas (forehead, frown and Crow’s feet lines) , a facelift (which addresses the midface to the upper neck) should not be affected by the presence of Botox.

QUESTION: When is a Face Lift the Best Choice?
ANSWER: Facelift Surgery is Best When
This is an excellent question and in many ways reflects the confusion there is about this misunderstood procedure. In a time when we hear about “non surgical facelift” or “liquid facelift”, the definition of a facelift becomes unclear. The definition of a facelift for most cosmetic surgeons is a surgical procedure to address loose skin and deeper tissue which results in descent of the cheeks, loss of definition of the jawline and loose skin under the chin. In practice, I also separate the term “facelift” from “necklift” as the necklift procedure focuses more on loose skin and muscle below the chin to the lower part of the neck. It’s not unusual in practice for me to recommend to a patient to undergo a “Face and Neck lift”. A facelift does not include eyelid surgery or an eyebrow or forehead lift.

Facial aging is a combination of volume loss of bone, muscle and fat in the face as well as descent of the soft tissue (skin and underlying support). Too many people who would benefit from a facelift are afraid because of misinformation about the level of risk. These same people go continuously to a physician who is “saving them from a facelift” and receive thousands upon thousands of dollars worth of injectables which help some of the volume loss but does nothing for the descent.
In my practice, I educate my patients about the facial aging process and work with them on deciding the best time to do a facelift. The threshold depends on each individual’s anatomy, health and personal desires.

QUESTION: Will I Need a Facelift to Fix my Neck?
ANSWER: Facelift surgery for extra skin on face and neck
Based on your photos, it appears you’ll need a face and necklift to help the appearance of your neck. A proper consultation may better determine the appropriate surgery to achieve the results you ultimately seek. At my cosmetic surgery practice in Manhattan, New York and Garden City Long Island, I have developed the “Quick Recovery” Facelift designed for the modern lifestyle that gives maximum gain, minimal discomfort and little downtime.

QUESTION: Differences Between Traditional Facelifts Depending on the Surgeon
ANSWER: Facelift Surgery Recovery Factors
Depending on your facelift surgeon’s technique, certain factors will affect your recovery downtime after having facial cosmetic surgery. The goal of a facelift is to lift the cheeks, improve the jawline and neck. A lot of surgeons who are more traditionally trained use general anesthesia, and the surgery often has trauma to the area resulting to swelling requiring drains and bandages, as you’ve described.. A quicker recovery facelift method, such as the one used at my practice in New York, has been developed to alleviate the recovery process and at the same time produce the same goals with great, natural-looking results. At our practice, we use local anesthesia with light IV sedation (“twilight”) with no drains and some facial bandages placed. Local anesthesia for facelift surgery is also safer than general anesthesia.

QUESTION: Do I Need a Facelift? What Happened to Me? I Look 20 Years Older
ANSWER: Lifestyle adjustments or facial cosmetic surgery to look younger
You’ve described a lot of elements of what a youthful face is, and many people on television illustrate that: bright beautiful eyes and a sharp jawline makes one look young or even energetic. When you are younger and overweight, not just on the body but also in the face – due to genetics and the way the fat is distributed- can make you look older. You have choices for procedure. However, if you are 20 pounds overweight, adjustments to your lifestyle and diet will build a strong foundation for your appearance. Being in peak physical fitness and looking young goes together – basically, being healthier helps! To better define the jawline, you can opt to have facial liposuction or other procedures determined by a board certified cosmetic surgeon. If you do consider improving the appearance of the eyelids, eyelid surgery is an option.

QUESTION: Face Lift to Reshape the Face
ANSWER: Reshaping the Aging Face
Someone who is 30 years old or younger may not be ready for a facelift surgery, but may be showing signs of aging. This question identifies elements of the face that define a youthful face and elements of the face that change due to aging that make one appear older that he or she is. Instead of lifting, there are options to add volume. In my book “The Fine Art of Looking Younger”, I address facial aging as 2 processes: dissent and volume loss. Dissent is when part of the face or body begin to droop downward, such as the skin, cheeks, and eyes. Volume loss is when the features lose their fullness, such as hollowing in the cheek area. This question asks to add volume to the cheek area and make the eyes appear more almond shape and upturned- both of those are the elements of a youthful face. Facial aging has been described by many of our colleagues,that when we are younger, our face is like an upside down triangle (in which the top part of the face is wider); as we get older, it is more like a triangle in the proper orientation (in which the lower part of the face is wider). There are choices to help you improve your appearance. My advice: find a qualified cosmetic surgeon, (who doesn’t necessarily have to perform surgery) that is familiar and comfortable with facial work and can provide the results you seek.

QUESTION: 26 is Too Young for Mid Face Lift?
ANSWER: Face Lift vs. Facial Fillers
With “non surgical face lift” or “liquid face lift” using fillers, the definition of when to have a face lift becomes unclear. For most cosmetic surgeons, a facelift is a surgical procedure to address loose skin and deeper tissue which results in descent of the cheeks, loss of definition of the jawline and loose skin under the chin. Facial aging is a combination of volume loss of bone, muscle and fat in the face as well as descent of the soft tissue (skin and underlying support). Too many people who would benefit from facelift surgery are hesitant because of misinformation about the level of risk involved with face lift surgery. These same people go continuously to a physician who is “saving them from a facelift” using expensive fillers which help some of the volume loss but does nothing for the descent. As an Oculofacial Plastic & reconstructive cosmetic surgeon operating in New York, I educate my patients about the facial aging process and work with them on deciding the best time to do a facelift and the best options for facial rejuvenation that will preserve their unique characteristics. While you are still very young, a consultation with a specialized doctor helps to address your individual anatomy, health and personal desires. Attached is a video I answered on “When to have a facelift?” Check out my YouTube channel for other videos on facelift.

QUESTION: Do I Need a Facelift at 35?
ANSWER: Facial Aging: Volume Loss and Saggy Skin
If you’ve noticed a significant change in a short amount of time, you may want to see a physician in case there are other health factors that could be causing this besides aging. While at 35 you may not be ready for face lift surgery, you may be showing signs of aging: dissent and volume loss. Dissent is when part of the face or body begin to droop downward, such as the skin, cheeks, and eyes. Volume loss is when the features lose their fullness, such as hollowing in the cheek area. Elements of a youthful face change due to aging and can make one appear older that he or she is. A healthy lifestyle with appropriate diet, exercise and sleep also plays an important role in looking your best. Instead of a face lift, there are options to add volume, such as injectables fillers. At my practice in New York, the Vampire Facelift® is a great option for patients who aren’t quite ready for surgery to restore volume in the face. I recommend finding a qualified cosmetic surgeon who can properly address your situation.

QUESTION: Male, 40: Ready for a Facelift?
ANSWER: Advice on Facial Cosmetic Surgery for Men
Change due to facial aging that make one appear older and in most cases can give a tired appearance. As an Oculofacial plastic and reconstructive surgeon super-specializing in the eyes and face, I’d suggest instead of lifting, there are options to add volume or non-surgically tighten the skin. I can understand, being a male, your hesitance to having eyelid surgery. At my practice in New York, people are surprised to learn that 50% of our clients for eye lift surgery are men. Maintaining a masculine quality during the eyelid surgery procedure is an art in itself that requires judgement. For this reason, many of our male clients do extensive research before electing to have their procedure with us. We routinely show before and after photos of our patients to give prospective clients a feel for our unique approach.

In my book “The Fine Art of Looking Younger”, I address facial aging as 2 processes: dissent and volume loss. Dissent is when part of the face or body begin to droop downward, such as the skin, cheeks, and eyes. Volume loss is when the features lose their fullness, such as hollowing in the cheek area. There are choices to help you improve your appearance. My advice: find a qualified cosmetic surgeon for a proper consultation that is familiar and comfortable with facial work and can provide the results you seek.

QUESTION: What is the Minimum Age for a Facelift? Do You Need to Be a Certain Age?
ANSWER: Age for a Face Lift
If you are showing signs of aging and are interested in rejuvenating, I recommend seeing a certified cosmetic surgeon. A facelift for most cosmetic surgeons is a surgical procedure to address loose skin and deeper tissue which results in descent of the cheeks, loss of definition of the jawline and loose skin under the chin. A facelift does not include eyelid surgery or an eyebrow or forehead lift.

In my cosmetic surgery guide “The Fine Art of Looking Younger”, I address facial aging as 2 processes: dissent and volume loss. Dissent is when part of the face or body begin to droop downward, such as the skin, cheeks, and eyes. Volume loss is when the features lose their fullness, such as hollowing in the cheek area.

After a proper consultation at my practice in Manhattan and Garden City, NY, I educate my patients about the facial aging process and work with them on deciding the ideal time to do a facelift.

QUESTION: Why Are So Many Plastic Surgeons Opposed to Facelifts at a Young Age?
ANSWER: Facelifts on Younger People
As a facelift specialist, I see some younger people come in looking to have their face lifted. By younger, I mean people under the age of 40. The key is to understand what a facelift is and the objectives of this procedure. A facelift procedure improves the appearance of sagging cheeks, jawline, and neck skin. This typically becomes an issue in your mid-forties and older. Prior to this time, aging changes are more about volume loss, particularly in the area below the eyes called the “submalar” area or the “apple” area. Understanding this, it’s usually more practical to have a filler procedure rather than a surgical facelift.

QUESTION: Would Getting a Facelift in Your 40′s Guarantee That You Would Need One in Your 50′s?
ANSWER: Facelifts Now, Facelift Later?
I’ve ben performing facelift surgery for about 20 years at my practice in New York and have many patients who have been with me throughout this time. This statement is not clearly accurate. Having a facelift at any time is for a specific reason to improve the sagging of cheeks, jowls and neck skin. Since facial aging is a combination of factors such as genetics, stress and health, you can’t make such an assumption. There is also no laser or ultrasound procedure that prevents the skin from getting older. 40s and 50s covers a range of 20 years. If you have this laser procedure at 42, does that mean you won’t need a facelift at 58? I doubt that.

QUESTION: Can One Safely Take Fish Oil and EFA Pre and Post Op Facelift?
ANSWER: No Fish Oil Before Facelift Surgery
In my cosmetic surgery practice in New York, I ask my patients to stop taking fish oils before surgery. Your doctor can provide you with a list of medications and supplements to avoid before having a facelift.

QUESTION: It is Safe to Take Amoxicillin 875 Mg Week Before Facelift Surgery?
ANSWER: Antibiotics Before Facelift Surgery?
It is recommended to consult with your facelift surgeon who is performing your facelift surgery if taking any antibiotics, such as Amoxicillin, or supplements prior to your surgery. Every patient is unique, and so is every surgeon.

QUESTION: Is It the Nicotine Itself That Constricts Blood Vessels?
ANSWER: Nicotine Affects Facelift Surgery
Nicotine constricts blood vessel walls to raise blood pressure and also decreases the amount of blood that can pass through the vessels. Less circulation means less oxygenated blood can reach every part of the body, which can lead to complications for a facelift especially during surgery and healing. If my patient has a healthy lifestyle, follows a good diet, exercises regularly and refrains from cigarette smoking and excessive alcohol, the results of a facelift can last for more than 10 years.

QUESTION: Is It Unwise to Chew Gum After Facelift Surgery?
ANSWER: Don’t Chew Gum After Facelift
As gum chewing causes the excess movement of your facial muscles, I advise against chewing gum for a few weeks. Chewing one’s food is natural and one must eat so chewing food is fine; gum chewing isn’t a necessity and if one can avoid, they should so that the facelift heals optimally and with the results one has

QUESTION: What Types of Medication Are Routinely Given for Swelling and Pain After a Brow Lift and Full Eye,face and Neck Lift?
ANSWER: Medication Types for Swelling and Pain After Facial Surgery
In my practice in New York, I don’t routinely give my patients anti-inflammatory medications after browlift, eyelid surgery or facelifts. Occasionally I do give a medication like Decadron during surgery. As far as your question about HRT and bioidentical hormones is concerned, I don’t ask my patients to stop these medications. Your surgeon may have specific preferences based on the surgical technique and the type of anesthesia you will be having.

QUESTION: What Can I Do About my Very Uneven Face?
ANSWER: Uneven Face Cosmetic Procedures
It is very common to have a difference between the two sides of the face based on bone structure as the foundation. In my practice, I’ve compensated for this asymmetry with volume enhancement as well as by compensating for this difference in surgery. Meet with a qualified and experienced Cosmetic Surgeon to learn about your options.

QUESTION: Do You Have to Lose Weight Before Getting a Facelift?
ANSWER: Weight Loss Before Face Lift Surgery
This is a common question in my practice in New York. If your face is very round and there is a lot of fat in the cheeks, there is some benefit to weight loss (slow and steady, not starvation) before having facelift surgery . If your face is more thin, then weight loss of 20 pounds or less makes little difference previous to having a face lift. The other factors to consider are your age and skin elasticity. It’s best you meet with a specialist who performs facelift as a specialty and you should be able o get your questions answered.

QUESTION: Facelift Vs. Fat Injections to Look 5 Years Younger?
ANSWER: Facelifts and Facial Volume Loss
Your perception of facial volume loss is great. It is true that facial volume loss is best treated by restoring volume. Volume is lost with facial aging, which is why younger individuals generally have a “plump” face. The choices of volume replacement solutions for the face are many and require that you see a specialist who actually performs all the procedures including injectables such as Radiesse, Sculptra, and Restylane as well as surgical procedures such as fat transfer for facial volume. A qualified and experienced Cosmetic Surgeon will guide you with the options that will be right for you. In my book “The Fine Art of Looking Younger” I address these topics in more depth.

QUESTION: How Long Does Tightness Last After Facelift?
ANSWER: Face Lift Tightness
Since facelift surgery involves tightening of the deeper tissue (referred to as the “SMAS”) which is the foundation and the repositioning and removal of excess skin, you can experience a “tight” feeling. In my practice, I avoid creating a “tight” appearance when performing a face lift, since younger people don’t look “tight”. If the question is about the longevity of a facelift in terms of when the skin becomes less tight, this depends on skin elasticity. Typically, a facelift can appear looking good for between 5 to 10 years.

QUESTION: What is Best Procedure for Mild Sagging in Lower Face and Below Eyes?
ANSWER: Limited Facelift For Lower Facial Sagging
You may be a candidate for a limited facelift without a neck lift. People with fair skin often come to our office in New York with this concern (particularly when they are thin). Since facial aging is a combination of volume loss (bone, muscle, and fat) as well as sagging of skin and deeper tissue, it is important to determine the right procedure for you. It sounds like performing a face lift (addressing the sagging skin) would create the right structure so if you need volume enhancement with fillers, the skin will be more resilient and you will probably require less volume correction. A proper consultation with a qualified doctor is recommended.

QUESTION: Can a Face-lift Help Wih Malar Bags and Sagging Skin at 40?
ANSWER: Submalar Cheek Implants Recommended
As an oculofacial cosmetic plastic and reconstructive surgeon, practicing in New York for over 15 years, I would be more inclined to suggest the placement of submalar implants as the area below your eyes are relatively lacking in volume. Looking at your photos,You may also consider a filler such as Radiesse or Sculptra to correct this relative volume loss. I wouldn’t recommend a facelift as the benefits would be limited and the incisions as well as the change in your hair bearing skin on the side would be less than desirable. Consult with a qualified facial cosmetic surgeon.

QUESTION: Do Microcurrent Face Lifts Work?
ANSWER: No Evidence that Microcurrent Facelifts are Effective
There is no clear evidence in the medical literature (not manufacturer studies) that support that these devices provide any significant benefit. That being said, I find that people who do these routines also take good care of their skin with moisturizers which help soften the appearance of lines caused by dehydration of the skin.

QUESTION: What is the Best Procedure to Lift the Midface?
ANSWER: Restoring Volume to the Midface
The midface in youth has volume and the cheeks are sometimes referred to as “apples”. As time goes by or after childbirth and weight loss, the midface area loses volume and becomes more flat. In the late 90′s, some surgeons interpreted this loss as a drooping of the midface and believed the area need to be lifted.The Midface or area of the cheek has been a controversial area in the field of cosmetic surgery. There are some surgeons who believe in lifting the mid face with an endoscopic midfacelift. As an Oculofacial cosmetic surgeon with over 15 years of experience, I routinely see patients who these surgeons have done this endoscopic mid-facelift procedure for, and they look overpulled and “cat like”. I believe in restoring volume to the midface with techniques such as fat transfer and placement of submalar implants or the Vampire Facelift using PRP (Platlet Rich Plasma) or PRFM (Platelet Rich Plasma Matrix). Restoring the midface volume at the time of facelifting makes a significant difference in how young you can look.

QUESTION: Are my Slanty Eyes After Midface Lift Permanent?
ANSWER: Improper Mid Face Lift Can Cause Cat-Like Appearance
The Midface or cheek area has been a controversial area in the field of face lift cosmetic surgery. Some surgeons believe passionately in procedures such as endoscopic mid facelift, however it’s been my experience and observation that when I see the patients who have gone to these surgeons and have had this type of mid facelift procedure, they look overpulled and “cat like” as you describe. You may have to consult with your former surgeon or another surgeon who can evaluate possible solutions for revisional surgery or treatments.

At my practice in New York, I prefer to restore volume to the midface with techniques such as fat transfer and placement of submalar implants, or the Vampire Facelift using Platelet Rich Plasma from your own blood to restore volume and generate new collagen and a healthy glow. Restoring the midface volume at the time of facelifting makes a significant difference in how young you can look.

QUESTION: Why Such Conflict of Opinions on Deeplane Facelifts Being “Natural” or “Windswept Look”?
ANSWER: “Natural” Facelift vs. “Windswept” Look
The reason is actually straightforward. Regardless of what facelift technique is employed, the surgeon’s artistic sense and technical skills are what makes the difference between natural and “windswept”. There are some surgeons who claim expertise at “deep plane” which makes them appear more technically capable than their colleagues. The reality is that a surgeon who has experience performing facelift surgery can perform all types of facelift surgery variations such as “short scar”, “SMAS plication or flap” as well as “deep plane”. In my practice in New York, I make decisions about the type of facelift I perform based on several factors, including age, gender, skin type, degree of volume loss, skin elasticity, as well as what I see is the condition of the “SMAS” (often referred to as “the muscle”) during face lift surgery. When choosing a facelift surgeon, consider how the surgeon communicates with you as well as the feedback the surgeon’s staff gives about how happy their facelift clients are. Don’t get caught up in the hype and jargon. Good luck!

QUESTION: Can You Have a Mid-face (Check) Lift After a Traditional Face Lift or Are There Conflicting Issues?
ANSWER: Mid-Face Lift After Face Lift Surgery
The “mid-face lift” has a few variations in definition. If you are speaking of a vertical lift of the cheeks through an incision in the temple, this option is viable after a traditional facelift. In my practice, i prefer to add volume to the mid face after a facelift (or during the facelift with submalar implants or fat). From my experience with facelift patients, mid face descent in the cheek area (as a facial aging process) is more the result of mid facial atrophy (loss of volume). I routinely perform volume enhancement in the mid face in addition to the repositioning of skin and soft tissue during a facelift. This combination makes my patients in general very happy (especially when they see their “before” photos).

QUESTION: Asymmetrical Face – Makes Me Appear Angry, Please Help Me to Pinpoint the Problem Areas?
ANSWER: Asymmetrical Face Concerns
Thank you for your photos. I don’t see your situation as your face being “wrong” but there is some asymmetry. While facial asymmetry is natural and normal, I recommend you meet with a specialist who can meet you and evaluate your concerns in a three dimensional way. If the orbital appearance has changed from the way you appeared in the past, you should meet with an orbital specialist.

QUESTION: Who Has the Most Risk of Scarring After Surgery? (Age-wise)
ANSWER: Age and Facelift Scars
Although it may be somewhat intuitive to feel the way you do about older people being at higher risk for scarring from facelift surgery, it is NOT true. There are several factors including skin elasticity, skin type and basic cellular aspects of older skin which makes it more “forgiving”. In my practice in New York, I have developed the Quick Recovery facelift (for candidates), which produces a shorter scar as the incision is a lot smaller and does not go to the temple. Because of the way the incision is made, hair loss is minimal (if any) and the sideburn is preserved.

QUESTION: What is the Minimum Number of Face and Brow Lifts a Doctor Should Have Performed?
ANSWER: Experienced Face Lift and Brow Lift Surgeon
Asking the what the minimum number of brow lifts is more complicated than you may realize. There are several types of brow lifts which means a specific minimum number is difficult to determine since the understanding and performance of these procedures require overlapping skills. A skilled and experienced surgeon has a level of mastery which is comparable to a highly experienced pilot. If you are feeling suspicious, there is already some doubt in your mind about the surgeon you met with and it’s key you feel comfortable. Browlifts are one of the core areas of expertise in Oculoplastic Surgery however you will find some variability in Oculoplastic Surgeons’ experience based on individual aesthetic judgment and preference of technique. If you really need a brow lift, you actually have several options for the type of surgery you may undergo and you should meet with more than doctors who’ve performed a certain “minimum”. The brows have a significant impact on your facial character and aggressive lifting mary be viewed as successful by the surgeon but may make you look too different. Artistry and balance are critically important in creating the ideal brow shape and height.

QUESTION: Facelift Scheduled in March. Is It Normal to Have Alot of Anxiety?I Have a Great Doctor….but the General Anesthesia Scares Me!
ANSWER: Facelift Surgery Anxiety: Local Anesthesia vs. General Anesthesia
Anxiety is normal before having a cosmetic surgery procedure. It seems like you like and trust the doctor who will perform you facelift surgery (which is GOOD), but are nervous about general anesthesia after doing research and understanding the risks of general anesthesia. At my practice in New York, I prefer to perform facelift surgery under local anesthesia with light IV sedation. Leading anesthesiologists like Barry Friedberg, M.D. share our professional opinion that most, if not all cosmetic surgery procedures, can be performed safely under local anesthesia with IV or intravenous sedation. Despite this fact, a large percentage of people undergoing cosmetic surgery are subjected to the risks of general anesthesia. General anesthesia requires less prep time and more procedures can be performed in a day. However, the longer someone is under general anesthesia, the more stress it puts on the heart and lungs. With local anesthesia, the preparation time is longer and fewer patients can be accommodated in a day. But, the bottom line is that a patient’s safety should always come first – far more important than the financial bottom line. Not only do I find local anesthesia to be safer, it also eases puts the body under less stress thus eases recovery. Discuss with your surgeon the possibility of local anesthesia.

QUESTION: Why Do Surgeons Choose One Incision Technique Over Another?
ANSWER: Technique for Facelift Incision
Each patient is unique and requires a customized approach to achieve their cosmetic goals. After some time, I found that patients who sought a face lift had hesitance because they didn’t want to appear unnatural or show obvious signs of surgery. Patients also did not want the long period of recovery and did not want an ineffective “short cut” procedure. So, I have developed the Quick Recovery Facelift at my practice in New York, based on years of experience with facelift patients. Performed under local anesthesia and light sedation, the Quick Recovery Facelift is a 2 to 3 hour procedure. An incision is made typically in crease between ear and face and slightly around the earlobe through which the surgery is performed. The Quick Recovery Facelift produces a shorter scar as the incision is a lot smaller and does not go to the temple. Because of the way the incision is made, hair loss is minimal (if any) and the sideburn is preserved.

QUESTION: Could my Facelieft 8 Years Ago Be Causing my Headaches?
ANSWER: Facelift cause headaches 8 years later unlikely.
It is very unlikely that your facelift surgery done 8 years ago is the cause of your headache. You should consider seeing a doctor in that area, such as your primary physician or a neurologist, who can help you better determine the cause of your headache.

QUESTION: Will Insurance Help with Facelift?
ANSWER: Facelift and Insurance Coverage
The only situation I’ve come across where insurance covers a facelift procedure has been related to facial palsy where the rehabilitation involves surgery which requires a facelift approach and listing of sagging tissue. In this situation, insurance may cover “half” a facelift.

QUESTION: My Mother is 80 Years Old and Wants to Have a Facelift. Is She Too Elderly for Plastic Surgery?
ANSWER: Elderly Facelift at Age 80
In my practice in New York, I’ve performed facelift on patients as old as 87. This is based more on their physical age rather than their chronological age. I also make it a point to avoid performing surgery for longer than 2 hours and do the procedure under local anesthesia with ‘twilight’ anesthesia with the Quick Recovery Facelift procedure I developed. She should be cleared by her medical doctor as well as be able to be off any blood thinners (in my experience, many patients with pacemakers also are on aspirin daily). Based on her medical situation, you should also be clear with the surgeon about desired results and see if the face lift procedure can be adjusted to her situation with minimal stress to the body.

QUESTION: Aftercare For Facelift and Upper Eyelid Surgery for a Patient With Severe Sleep Apnea?
ANSWER: Facial or Eyelid Surgery for Patient with Sleep Apnea
This question is best answered by your medical doctor or pulmonary doctor. In my practice in New York, I place a dressing typically without drains after a facelift so the central area of the face is open. It may be better to consider doing the eyes and face on separate occasions just for ease of the aftercare.

QUESTION: On a Deep Plane Facelift…is Facial Nerve Injury Risk Very High?
ANSWER: Deep Plane Facelift and Facial Nerve Injury Risk
The facial nerve, particularly the “buccal branches” are more exposed therefore at higher risk. Nonetheless the incidence of long term loss of function of the facial nerves after any facelift is fairly low. It’s more important to understand the benefit of a “deep plane” face lift in your case in comparison to a SMAS/Platysmal flap. You will find that facelift surgeons have differing opinions about the longevity and benefits of a deep plane lift compared to others. There is an implication that “deep plane’ is a better technique however many surgeons would suggest it best to customize the type of procedure to the patient.

QUESTION: How Long Does the Quicklift Last
ANSWER: Quicklift: Results & Longevity
The Quicklift as I understand it is a variation of the “S Lift” which is essentially a “short scar” facelift. I think most of my colleagues would agree that these types of lifts are more appropriate for patients with minimal facial sagging although a lot can be done with a smaller incision. Most facelifts can last about 5-10 years, however, there is a wide variation because of the differences in people’s anatomy and aging processes. Many surgeons including myself feel that a limited lift has a limited long term benefit. Performing a purely local anesthesia procedure within 1 hour leaves little time for detailed artistry which I focus on when I perform a facelift.

QUESTION: How Long After Having a Bad Cold is It Safe to Have a Facelfit?
ANSWER: Facelift after Colds
Your physical health is important when considering facelift surgery as you are technically putting your body under some stress. Given the severity of your cold, it would be better to have your facelift surgery when your respiratory system (lungs, nasal) is clear and breathing isn’t affected; if you don’t have fever, and your body temperature is stabilized; and are not taking medications that could counteract sedation or thin your blood and cause more bleeding.

QUESTION: What Can I Do About My Long Face?
ANSWER: Facial Implants for a Long Face
It is difficult to give clear advice as your photo appears darkened. I recommend consulting with a qualified doctor for facial cosmetic surgery who might be able to help you achieve your cosmetic goals. It’s possible the issues you have are genetic, and dependent on your facial bone structure, and there may be solutions, such as adding volume to your cheek with filler or fat transfer or enhancing the mid-face with facial implants to add more definition. Facial implants bring balance and better proportion to the structural appearance of your face. They define your face by increasing projection and creating more distinct features. This all depends upon a proper consolation with an appropriate doctor.