How to Improve Your Facelift Results

A facelift is one of the biggest investments you can make to enhance your appearance. Facelifts are often performed in operating rooms by a team of professionals, in addition to the surgeon over the course of several hours by specialty-trained specialists. With so much time, effort, and money invested in a facelift, why are some people dissatisfied with their appearance following the procedure? I’ll discuss what kind of results should be expected from a facelift, as well as the facial aging issues that a facelift alone does not address.

I routinely perform all types of facelifts, from short scar mini lifts, to more extensive deep plane, and sub SMAS facelifts. For those with advanced facial aging, I frequently perform a combination of face and neck lifting. Since facial aging also affects the appearance of our eyes, I often perform eye rejuvenation such as upper and lower eyelid surgery.

Facelift Before and After

Mini Facelift Results

In many of my facelift surgeries, I make it a point to address the volume loss seen with age in the lips and facial support by strategically placing selected hyaluronic acid fillers to augment the lips, treat vertical lines, as well as restore volume to the cheekbones, chin, and jaw angles.

One of my main concepts in my work is to first characterize the problem before establishing the best solution plan. As a result, it’s critical to first determine which precise issues can be treated by a facelift.

How a Facelift Works

A facelift is a surgical procedure that restores the cheeks and jawline soft tissue that has become loose and dropped downward owing to facial aging. These anatomic traits are made up of layers that comprise skin, soft tissue, and connections to the deep facial muscles.

The connection to the deep facial muscles is commonly referred to as “the muscle” and is known in our profession as the SMAS, or superficial musculoaponeurotic system. The SMAS provides a necessary foundation for the skin to be supported by. Skin-only lifts and treatments like threadlifts lack the level of support provided by a properly performed facelift and, so results are not optimal, and don’t last very long.

How Aging Changes the Face

As previously said, aging changes not only affect the cheeks and jawline, but also the eyes. As the skin above the eyes stretches and becomes redundant with age, the upper eyelids may seem hooded or sagging. Lower eyelids might also appear puffy, which is often referred to as eye bags. Puffy eye bags are caused by fat around the eyes prolapsing forward. I recommend combining eyelid surgery with facelift surgery to help you appear your best. The recovery time overlaps the facelift recovery, and you get the most value out of the cost of the operating room facility and staff.

The descent of skin and soft tissue, which are addressed by facelift surgery, are two major contributors in facial aging. The other major aspect of facial aging is volume loss at the bone and soft tissue levels. The fullness and projection of the cheeks, the jawline definition, and overall facial harmony found in younger persons all contribute to youthful facial volume. Many facelift patients claim that they are pleased with their results in the first few months after surgery, but that their facelift no longer looks as nice after a year. This is a common misperception because transient swelling during the early healing stage can give the appearance of youthful volume. This temporary fullness fades as the healing process advances.

How to Improve Facelift Results by Addressing Facial Volume Loss

As a surgeon I have used 2 strategies in the past to help my patients. One was to place facial implants made of silicone such as cheek and chin implants at the bone level. The other was to harvest fat and perform fat grafting. Patients often resisted having facial implants in fear of looking overdone. They were generally willing to have a small chin implant, but objected to having cheek implants.

Cheek and Chin Implants

I found myself concerned about 2 things with the placement of cheek implants. One is whether the patient would be satisfied with the outcome, or would they feel the shape wasn’t what they wanted or if the implant was too big or too small.

The other concern for me was whether the patient’s thin skin would reveal an outline of part of the implant, particularly as aging continued so bone loss and skin thinning could make the implant appear more visible. Furthermore, if the patient wants the implants removed, they will have to undergo another surgery.

Fat Grafting

I also tried to enhance the facial soft tissue loss with fat grafting. This involved my performing liposuction to harvest fatty tissue, and placing the fatty tissue into areas of facial volume deficiency. Unfortunately, the fat survival rate was too unpredictable, and patients required further surgery to try to recover the volume lost during the first surgery. Furthermore, older skin is thinner and weaker than younger skin, so the skin, whether with fat or filler, has a limited weight-bearing capacity.

Several years ago, I experienced a significant paradigm shift in my approach to facial volume insufficiency. This was the consequence of a synergy created by integrating face implant surgery principles with the technological breakthroughs of recently developed thicker and longer lasting hyaluronic acid fillers like Juvederm Ultra Plus, and Juvederm Voluma. I use blunt cannulas to insert these fillers without surgery at the bone level of the cheeks, jawline, and chin. I cannot emphasize how important technique is.

Many doctors and “injectors” assume that if their needle meets bone, they have reached the bone level. The needle may be touching the bone, but the filler is often not going where they want it to go. While facial fillers have a reputation for appearing doughy and unnatural, as a facelift and facial implant surgeon, I use my knowledge and experience to carefully insert filler at the bone level underneath the facial muscle layer, resulting in a more defined and sculpted appearance.

Structural Volumizing

I call this technique Structural Volumizing because it adds structure and definition to the face. As I mentioned earlier about technique, I use very few entry points to place the hyaluronic acid filler so bruising is rarely an issue. Many of the so-called “master injectors” do demonstrations on social media platforms with needles piercing the skin multiple times in just one small area, only to be repeated several times more for the other areas to be addressed. That’s a lot of poking, which means more swelling and more bruising.

I can be considerably more accurate with volume and shape by performing Structural Volumizing or Y-Lift, allowing me to make micro adjustments for asymmetric features. Unlike a face implant which requires extra surgery, if I need to reverse the filler placement I can use the enzyme hyaluronidase in my exam room to dissolve the filler completely.

I commonly use Structural Volumizing for clients who wish to look better after having a facelift performed by another surgeon. These patients often feel relieved to find that they do not require another facelift and are astounded by how beautiful they look in less than 30 minutes in my exam room.

Conclusion

If you’re considering getting a facelift, you obviously care about your appearance and want to look better afterward. While facelift surgery is excellent for elevating drooping cheeks and jowls, I advise my patients on facial volume loss as well as the appearance of their eyes and lips when developing a holistic treatment plan for them. My patients enjoy that I, as their beauty doctor, take an integrated approach rather than having to see various people for different services. Whether I treat volume during or after a facelift, restoring structure improves the balance and definition of your face, completing the intended effect of a skillfully done facelift.

Facelift Surgery Manhattan NYC and Long Island, New York

Dr Amiya Prasad is a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic & reconstructive surgeon. He’s been in practice in New York City and Long Island for over 25 years. To schedule a consultation, fill out the contact form below, or you may call any of our offices at (212) 265-8877 for Manhattan, New York City; (516) 742-4636 for Garden City, Long Island; or (703) 356-1336 for Vienna, Virginia.

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