One of the most common questions that I get from patients is what can we do to avoid bad facelift results and to ensure the best possible facelift outcome.
The answer is quite a lot.
Here are my top 10 most important things to improve the odds of a great facelift results.
Table of Contents
1. Lift the muscle layer
Make sure your surgeon is lifting the muscle layer, not just the skin.
When the facelift was first performed more than 100 years ago, surgeons only lifted the skin. Unfortunately the results would often fail to last even one year, because the skin has significant distensibility and is unable to hold things in suspension for long.
Placing tension on the skin also means more tension on the incisions, which predisposes to poor scarring and skin injury.
So instead make sure that your surgeon is lifting the muscle tissue layer known as the SMAS, which stands for superficial musculo aponeurotic system.
This SMAS is a thick and fibrous layer that is better suited for suspension. Not only do SMAS lifts last longer, they also look more natural because the skin isn’t being pulled.
2. Lift the cheek
Most of us know that facelifts are designed to lift the jowl. However, you also need to make sure that your surgeon is not ignoring your midface or cheeks.
In many patients, especially those in their 60s and 70s, there is often already a lot of descent of the soft tissues of the cheek. In these instances the surgeon should ensure that the cheek is also being lifted. Ideally in a vertical vector.
Failure to lift the mid face vertically can result in an unnatural distortion of the face, known as a lateral sweep, which can make the face look done.
Facelift techniques that suspend the cheek include the high-SMAS and the deep plane techniques and if they’re needed be sure to inquire with your surgeon about them.
3. Lift the neck
Add a platysmal plication for maximal neck contouring.
If you’ve got plenty of loose neck skin or a short or round neck that you don’t love, please make sure to discuss with your surgeon about possibly having an anterior platysmal plication at the same time as your face lift.
The platysmal plication is meant to remove the loose excess tissue of the central neck and re-tighten the superficial neck muscle layer called the platysma.
This procedure is imperative for any patient with moderate severe aging of the neck. Although it can make the procedure more lengthy and invasive, it most often delivers dramatic neck results.
Remember the platysmal plication is something you should do ideally at the same time as a facelift, so don’t put it off if it’s something you feel you need done.
4. Peel the skin
Resurface the skin if there is significant sun damaged or aged skin.
Consider adding a skin resurfacing or peeling with the facelift if you have sun damaged skin. Remember the facelift does not actually do much for the skin itself. It merely gets rid of the slack, so if the skin remains damaged and replete with age spots, the amount of visible rejuvenation will be limited.
To improve the skin and reverse some of the chronic damage of aging, resurfacing is necessary and it can help get rid of the age spots, pre-cancerous lesions and fine wrinkles.
Because most of my face patients often have moderate severe skin damage, I often recommend a laser skin peel at the time of surgery.
5. Fill the cheeks
Restore cheek volume if necessary.
Not only do cheeks descend with aging, but they also lose significant volume due to fat atrophy.
In some patients with severe mid facial cheek volume loss, it is important for the surgeon to consider restoring volume with fat transplantation. Fat transfer can be done at the same time as the facelift or be done after a few months.
Failure to identify and correct severe mid facial volume loss in facelift patients, especially in those with long faces, can result in a joker deformity, also known as a cross cheek depression.
6. Lift the eyebrows
Pay attention to the eyebrows and lift them if they are droopy.
Like the cheeks, the brows start to drop later in life than the jowls, usually beginning by the age of 60.
If you’re doing a facelift to improve the lower face and neck and ignore a droopy brow, the result just won’t be as great.
This is because the eyes are the aesthetic center of the face and if they remain aged, the overall rejuvenation will be limited.
Although a brow lift is a separate procedure from a facelift, they are usually best done together.
Remember there are many different ways to lift the brows. But if it’s too early for a brow lift then consider having an upper eyelid lift done instead, also known as an upper blepharoplasty.
Often times in younger facelift patients that’s all that’s necessary to rejuvenate the eyes.
7. Plan ahead
Choosing to have a facelift is a big decision and you should be prepared for all that it takes to successfully heal from it. This means you should plan to have approximately two weeks of social downtime where you will likely want to avoid being seen because of swelling, bruising and just plain looking surgical.
Furthermore, if possible, you should also avoid traveling, strenuous activity, outdoor activities and responsibilities for the first two weeks following surgery to minimize stress and facilitate the healing process.
Have someone with you for at least the first one to two days, especially if anesthesia is employed. You will likely only begin to look your best somewhere between one and three months postoperatively.
So if you’re planning for a big event, you will need to start preparing well in advance.
Remember your face is important so plan to be patient. A great result does take time.
8. Get healthy
Having a facelift is never a small deal and you need to make sure you are healthy prior to proceeding with this type of surgery.
This means that if you’re a smoker you should plan to quit all nicotine use while in advance of surgery and you should know that most surgeons won’t even consider you for surgery until you quit at least temporarily.
If you’re obese, have poorly controlled diabetes or other medical problems, plan to work on those before ever contemplating surgery.
Any realistic weight loss goals that you have should be met prior to a facelift because significant weight loss after a facelift can speed the rate of aging of the face by unmasking sagging that was hidden due to the supporting role of fat.
Being healthy is going to allow you to heal faster and to also help you avoid potential complications relating to surgery and anesthesia.
9. Mini facelift
Although the facelift surgery is a very popular procedure, most patients still don’t know a whole lot about the different types of facelift varieties that exist and as a result there’s plenty of confusion.
This is made worse by the extensive marketing that many clinics employ to advertise their lift as being different. To make matters worse, there’s actually no consensus on even what a mini facelift is, even though the term has existed for more than 50 years.
So if your surgeon is selling you a super amazing lift and is not taking the time to explain which technique they are using and why they recommend it, then you may want to consider walking away.
Please do your research and always be prepared to ask questions of your surgeon. Inquire on why the surgeon feels that their chosen technique is best for your face and always get a second opinion from an expert surgeon.
10. Pick a board certified expert
This brings us to our last and most important point: pick a board-certified plastic surgeon with facelift experience and expertise.
Board certification is a long process that requires that surgeons meet several criteria in knowledge, experience and code of conduct, such that it provides a basic assurance that you’re not just getting anyone off the street to operate on your face.
Find a surgeon who has expertise and experience in face lifting. Ask to see before and after photos of their work and meet with them to see if you have good rapport.
Good communication with your surgeon is extremely important should anything go wrong.