According to the American Society of Plastic Surgery, minimally invasive facial rejuvenation procedures such as Botox and dermal fillers continue to be among the most requested procedures in the country -- greatly outnumbering the number of requested surgical procedures like facelifts.
However, this year's ASPS statistics point to popularity resurgence in facelifts' popularity. More than 125,000 facelifts were performed last year, an increase of six percent over 2011 figures.
Facelifts remain popular for good reason. The results can be powerful and last far longer -- years vs. months -- than those achieved with minimally invasive procedures. If you are contemplating a facelift procedure, here are answers to some of the questions I hear most often about the surgery.
1. Who is a good candidate for a facelift?
There is no set age or profile for those who should consider a facelift. Facelifts can and should be individualized, taking into account factors including age, body type and size.
2. What kind of facelift is best?
The vast array of facelift techniques can be bewildering: deep plane, high SMAS, short scar, skin only, MACS lift, SMASectomy and the list goes on. But how different are they, really? At this year's Cutting Edge Aesthetic Surgery Symposium 2013 in New York City, expert surgeons will explore the question "Are most facelifting techniques just a variation on one basic theme? Is it the technique or the surgeon?"
In my professional opinion, it is more important to find the right surgeon than decide for yourself the right surgical technique. If you like the results of facelifts done by a certain surgeon, regardless of his or her technique, then you are on the road to obtaining the results you want.
My goal with facelifts is to make patients look younger and more refreshed by shifting more of the facial tissue than just superficial layers, which can create the "pulled" or obviously "lifted" look.
3. How long does the surgery take, and what is the recovery time?
Time will depend upon the extent of the procedure. For some patients, mini-facelifts can be done in under two hours. Standard facelifts usually take three to four hours and may take up to six when combined with eyelid or brow surgery. Since a facelift is by definition a relatively superficial operation (no bones are broken), a longer surgery has little detriment to the patient.
Patients' recovery times differ, but in general, noticeable swelling will go down within 10 to 14 days. My patients often return to work in two weeks. To be sure you'll be at your best for special occasions, schedule surgery a month before the event.
4. How will I look different?
Most patients report looking refreshed. A good facelift make patients look younger rather than "different" or "operated on." The best facelifts look natural -- as if nothing has been done beyond rest and relaxation.
The best way to make sure you will still look like yourself is to choose your surgeon carefully. Those who are afraid of not looking like themselves will want to choose a plastic surgeon carefully. Which brings me to the next question...
5. What should I look for in a plastic surgeon?
Many of us have seen facelifts gone wrong -- the results might cause the patients to look perpetually surprised (eyebrows raised too high on the face) or their eyes are round and hollow following excess skin and neck fat removal. Other bad results include uneven or overdone necks, pixie ears or lower eyelids that merge unnaturally with overly flat and windswept cheeks.
How can you avoid these outcomes? Look carefully at a variety of patient examples from the surgeon you are considering. Look at their websites but also ask for additional photos of patients who have received facelifts so that you can be confident that you and your surgeon have the same understanding of how much will really change.
As with any procedure, ensure that a surgeon is certified by accredited medical boards such as the American Board of Plastic Surgery. These surgeons will go through lengthy and specific training, examinations and requirements for recertification to avoid complications and make cosmetic surgery safe. All members of both the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery must be certified by the American Board of Plastic Surgery to be considered for membership.
6. What are the risks?
Facelifts are safe if performed by a well-trained physician competent in evaluation, judgment and surgical technique. Like any surgery, facelift procedures carry some risks. Infection is possible but rarely occurs because of the face's abundant blood supply. Bleeding in the postoperative period may result in hematomas, which can require returns to the operating room to evacuate.
Healing is usually uneventful unless a patient is a smoker, and nerve damage is usually temporary. The incidence of these risks relate closely to the surgeon's skills. However, these remain small but real risks even in the best surgeon's operating room.
7. I want to lose a few pounds. Should I wait to have my facelift?
Ideally, a patient should be in the best health and shape possible before any surgery. Patients should not smoke or abuse drugs or alcohol.
It's normal to want to be at your best when considering this type of procedure, but if it is just a few pounds, it will not make that much of a difference in results.
For more than a few pounds, I advise waiting until you feel comfortable and healthy with your weight before seeing a plastic surgeon. He or she will be able to review your health and consult you on what will be the safest and most effective option for your body type and build.
8. How long will the effects of a facelift last vs. fillers?
Fillers are temporary solutions for adding volume to deflated tissues. So-called "liquid facelifts," whereby large amounts of fillers were injected to eliminate soft tissue redundancies, were in vogue until it became clear that the result was too often a swollen, bloated appearance. Patients did not look younger -- just different.
Real facelift results will last for years, though the longevity depends on several factors including skin quality, significant weight changes and environmental factors such as excessive sun exposure.
Note that while fillers are not interchangeable with facelifts, they certainly can be complementary. The aging face can usually benefit from both treatment modalities to maintain a youthful, full look without reinventing fundamental facial appearance.
9. I've been considering another procedure (rhinoplasty, fillers, etc.). Should I do the procedure in conjunction with my facelift? If not, how should I prioritize?
It will depend upon the patient, but the most common procedure done with facelifts is eyelid surgery (blepharoplasty). In fact, these procedures are performed together more often than not.
When adding more procedures such as rhinoplasty (nose reshaping), the patient should understand that the additional procedure will add a bit more discomfort and perhaps lengthen recovery time. The well-trained plastic surgeon will arrive at a surgical menu that is safe and appropriate for each patient, and the best course of action is to consult with your surgeon to see what he or she recommends.
10. What is the difference between facelifts, upper and lower facelifts, mini-lifts, and neck lifts?
When plastic surgeons discuss facelifts among ourselves, we're referring to a procedure that has an impact on the cheeks, jowl and neck. It requires incisions placed in front of and behind the ear.
A neck lift addresses neck skin redundancy or deformity, and involves an incision behind the ear and usually beneath the chin.
Mini-lifts are usually done for patients who have relatively minor concerns about their cheeks and jowl. They are often done to refresh a face that has had a facelift before.
Upper and lower facelifts are usually scheduled together and are another way of saying "facelift."