Facelift & Neck Lift

A facelift (often combined with a necklift) is the gold standard procedure for improving laxity in the neckline, jawline, and cheeks. Facelift candidates often feel a disconnect between how they look and how they feel. Many desire the improvement they see when they pull their face upward in the mirror. While skin tightening lasers can offer modest improvement at best, they cannot achieve the comprehensive, long-lasting results of a surgical facelift.

At Visage, our advanced lifting technique is truly superior to other types of lifts. By using an anti-gravity direction of pull and moving all the tissue (midface, lower face and neck) as one unit, we are able to give our patients the most natural appearing result. No wind-tunnel or pulled look is acceptable.

"I had always been a runner and taken good care of myself so my body was in fairly good shape but my neck and jowls had me looking older than my years. After my procedure my face matched how I felt about myself. Even now at 60, I could easily pass for a woman in her 40's. It is a great feeling. Dr Patel's skill gave me natural look with no 'pulled too tight' look. The procedure was a breeze with minimal swelling or bruising."

"I had a face lift and blepharoplasty procedures on both eyes. I would say to look no further than Dr Patel for a surgeon whom you can trust to perform the most skilled procedures on your face. Dr Patel took pictures during the consultation and then generated photos to compare to show anticipated results. Three weeks after the procedure, it is clear that the expected results will be achieved."

“Genetics caused me to appear as though I was frowning even when I was happy and people were always asking me what was the matter. Dr. Patel gave me a facelift and the results are fabulous. People often tell me I look great, rested, and younger, yet they don't suspect I had a facelift. He also lifted my drooping upper eyelids and did liposuction on my chin. I could not be happier."

Types of Facelifts

Facelift

The facelift procedure, or rhytidectomy, pulls the jowl up to better define the jawline. This elevation also carries along the skin of the neck, which improves the neckline. The procedure removes excess skin and soft tissue around the ears, which is key to lasting improvement. Non-invasive technologies work by shrinking tissue, but only to a limited extent, which is why a surgical lift is still the gold standard for lifting tissue. For some, the idea of a facelift conjures an image of a pulled or windswept appearance. This does not happen when the procedure is done correctly. A modern understanding of the progression of aging and the deep plane technique (see next tab) allows Dr. Patel to conduct a natural-appearing lift.

Ideal For: Patients interested in lifting the neckline, jawline, and cheek.

Deep Plane Lift

The deep plane lift is the most recently evolved method of face and neck lifting which involves releasing deeper tissue “ligaments” before lifting tissue. With this technique, we can move areas of the upper cheek, lower face, and neck tissues as one complete unit in an anti-gravity direction to create a more natural-looking result. The technique relies on an anatomic understanding of a tissue layer of the face called the superficial muscular aponeurotic system (SMAS) and its continuity with the neck muscle called the platysma. Laxity in the platysma muscle contributes to the sagging of soft tissues under the chin. By releasing deeper layers of tissue and directly suspending them to a higher position, we minimize tension on the skin, which is what makes incisional scars spread apart and become more visible. Tension on the deep layers allows skin incisions to heal better. The deep plane lift offers a longer-lasting rejuvenation with rapid recovery as short as a couple of weeks.

Mini Facelift

The mini lift procedure is a smaller version of the face and neck lift intended for the patient who has early jowls and neck laxity. It is not intended for the patient with heavy jowls, a double chin, or sagging neck bands. This procedure may refine both the jawline and the neckline through similar, but shorter, incisions as the face and neck lift. It also has a quicker recovery time. This procedure may be performed in the office under local anesthesia.

Ideal For: Patients with mild facial laxity.

Watch Dr. Patel's recent segment on The Morning Blend where he discusses his Modern Mini Facelift procedure below.

Video

Neck Lift

The neck lift, or platysmaplasty, is a procedure designed to tighten the neck through an incision just behind the chin. It does not remove excess skin so it works best in patients with neck laxity without jowling and can be coupled with neck liposuction. Neck lifts may be performed in the office under local anesthesia.

Ideal For: Patients who retain some elasticity in the neck skin.

Neck or Chin Liposuction

The neck or chin liposuction procedure uses a suction device placed through small incisions to remove fat from the neck. It is the procedure of choice for patients with a double chin. Good candidates have fat below the chin and in the neck without too much skin laxity. In patients with laxity, excess skin may need to be removed with a lift. The procedure may create jawline and neckline definition even in patients who have never had it previously. This may be performed in the office under local anesthesia.

Ideal For: Patients with fat below the chin and in the neck without too much skin laxity.

Common Aging Concerns

We all go through a similar aging process. Genetics, sun damage, and other environmental exposures all lead to progression of fine and deep wrinkles and loss of skin tightness. Years of facial movement wear down the underlying bone: the jawline thins, the cheekbones flatten, and the eye-sockets deepen. At the same time, our tissue loses its elasticity and various muscles and fat pads begin to sag. Cheek volume descends downward contributing to dark under-eye circles, jowls, and deepening of the folds around the mouth. Lax tissue gathers below the chin, concealing the natural neckline. We can reverse these issues with a facelift, neck lift or a combination of procedures.

Hollow Cheeks

Hollowing in the cheeks can create a gaunt, aged appearance. Flatness or indention of the cheek takes away from a youthful appearance. With the facelift, we are able to lift the cheek fat pad in a mostly upward but also slightly backward direction to restore its youthful location in the upper cheek. For most patients, this is enough. For others with more significant volume loss, we may also restore bony volume with the use of silicone implants. These implants work perfectly because they are contoured to sit flush with the facial bone – once implanted it is difficult to distinguish implant from bone. The implants are placed through incisions inside the mouth or on the inside of the lower eyelid. These pre-formed implants do not react with tissue and do not change over time. Therefore, in contrast to injectable treatments, they are more permanent, symmetric, and consistent over time.

Smile Lines & Thin Lips

Deepening smile lines and thinning of the lips is a common feature of facial aging. The lift helps with smile lines to a limited degree by elevating cheek fat directly away from them. Some patients benefit from augmentation of these areas with tissue grafts that act like longer lasting dermal fillers. These tissue grafts are harvested from the areas around the ears that we have exposed for the lift procedure. The tissue grafts are placed into small tunnels created in the body of the lip or under the smile lines. Soft silicone implants are a more permanent option.

Planning Your Procedure

Pre-Operation

The Consultation

During the consultation, we want to get to know you and understand what makes you tick. We will review with you the changes you would like to make and their potential impact on your life. We will also discuss your medical history and your current concerns. We will examine your face/neck and determine the optimal direction of pull. We will look at other factors such as your earlobes, lip/cheek volume, and nasolabial folds to decide whether you would benefit from complementary procedures for a more balanced rejuvenation.

After the consultation, there is a second visit before surgery called a "pre-op". At this visit, we will go into much greater detail about how to best prepare for the coming surgery. We offer a wealth of information about optimizing your recovery, ensuring proper healing, resuming normal activities, and avoiding complications.

The Surgery

How It's Done

Any lift that relies on skin tension is doomed to fail because skin stretches. In contrast, the deeper tissue that holds the lift stretches very little over time. Once we have freed the deeper tissues, we place strong sutures between the loose tissue in the lower cheek and the firm tissue around the ear. This has the effect of pulling everything up. The direction of pull is mostly up and somewhat backward. The tissue is then lifted and suspended in a direction opposite to the pull of gravity, and excess skin is removed around the ears. A proper lift will elevate the jowls, redefine the jawline, and restore a sharp neckline. This procedure is tailored to the patient and may include liposuction in the neck, earlobe reduction, and tissue grafts to the deep smile lines and/or lips.
Duration

A traditional facelift takes about 4 hours.

The mini facelift, neck lift, and neck liposuction range from 1 to 3 hours.
Anesthesia Options

A traditional facelift is performed using general anesthesia.

A mini facelift, neck lift and neck liposuction may be performed with local anesthesia, or with general anesthesia if preferred.
Incisions

Why do we need incisions at all? Years of age-related sagging has created a lot of excess skin. If you have ever pulled your face upward (to simulate a facelift), you will notice that extra skin bunches up above your fingers. This excess skin must be removed, and this may only be achieved at the site of incisions placed around the ears and sideburn. For those tempted to pursue nonsurgical options for lifting tissue, remember that without removing excess skin, one will have to settle for a lesser result. Another reason for incisions: we need to access the deeper tissues because they take on the force of the lift (see How It's Done).

The incision starts either along the sideburn hairline or within the sideburn depending on the patient’s anatomy. When a significant amount of skin requires removal and/or the patient has a high sideburn, we make the incision along the hairline to not displace the sideburn upward. In this case, we make the incision at an angle so that the sideburn hair may grow through and help conceal the incision. When less skin requires removal and/or the patient has a low sideburn, we generally carry the incision up into the sideburn hair. In this case, we bevel the incision at an angle that minimizes hair damage, and we maintain the sideburn at a normal position. The incision then continues around the natural curve of the ear before traveling along the edge of the tragus (this is the cartilage above the earlobe that extends back toward the ear canal).

We have found the most natural result comes from an incision placed at the edge of the tragus. Placing the incision deeper into the ear canal will bring unnaturally thick skin over the tragus and placing the incision in front of the tragus risks a visible scar. After traveling down the tragus, the incision wraps around the earlobe at its attachment point to the face. It then travels upward in the crease behind the ear. This portion of the incision is completely concealed. After the incision nearly reaches the top of the ear, it is either carried back into the hair, or it follows the hairline downward for a short distance. Similar to the sideburn region, the choice depends upon the amount of skin that will need to be removed, and all hairline continuity is maintained. In patients with heavy or more advanced aged necks, we also use a small incision placed in a crease just behind the chin. This incision allows more direct access to neck regions that require liposuction or treatment of prominent neck bands. Poorly placed incisions or displacement of hair will make the best lift look terrible. Our intention is for patients to be able to wear their hair up and not worry about visible incision lines or irregular hairlines. We have many methods to achieve this goal.

Post-Operation

Recovery

For a traditional facelift, typical at-home recovery time is 10-14 days. For the mini facelift, neck lift, and neck liposuction, standard at-home recovery time is 7 days. Immediately after surgery, the patient wears a compressive dressing for a couple of days. For the following one to two weeks, a chin strap is worn at all times. The sling gives a sense of security by protecting the incision sites and resisting the ever-present pull of gravity until the neck tissues heal and become stronger. Sutures in particular locations are removed at specific times to ensure proper healing. By 7-14 days, all sutures are out, and bruising has generally disappeared. Makeup may be applied. Most patients feel comfortable being out in public at this point.
Pain

The first night after surgery, you will feel a dull ache around your ears and tightness around the jaw and neck. Every day thereafter, any discomfort will reduce significantly. It is normal to take opiate medication as needed up to a week after surgery, but most transition to regular Tylenol within the first week. The feeling of tightness will decrease over the course of weeks.
Swelling & Bruising

Swelling and bruising are normal and expected. Most of it subsides in the two weeks. Most bruising may be concealed with cover-up as it gradually fades. On average, 90% of the swelling subsides by 6 weeks after surgery, and the remaining 10% slowly diminishes over the following months. Eventually all swelling and bruising will go away.