Redefining the Facelift

The term "facelift" has become widely used for all types of facial plastic surgery in San Francisco and beyond. Traditional surgical definitions describe a facelift as elevating sagging tissues from the cheek area to the neck. However, with recent aggressive marketing campaigns that describe a small incision in front of the ear with an inch of skin pulled back to patients who refer to a "full facelift" that include a brow lift, upper blepharoplasty, lower blepharoplasty and versions of volume augmentation like fat grafting, it is clear that traditional definitions are inadequate.

The Maas Clinic™ in San Francisco has developed a simple and thoughtful way of describing facelifts that accurately describes what is done rather than using vague marketing or even proprietary terms like "Lifestyle lift," "Natural lift," "Quicklift," and others. While being aggressively marketed, these terms do not clearly describe to the public what or how the procedure is performed or the risks or benefits of the procedure. In simple terms, San Francisco Plastic Surgeon Corey S. Maas, MD, a recognized leader in cosmetic surgery, has divided the facelift into three basic surgical strategies.

Maas Clinic Facelift Testimonial

Facelift (Lower)

The lower facelift is a plastic surgery procedure that is another way of describing what traditional textbooks would call a facelift. The lower facelift addresses the sagging tissues and skin from the cheekbone down to and including the neck with skin laxity and overgrown (hypertrophic) muscle (platysma) bands in the neck. In contrast to what many refer to as "the L.A. facelift," with an over-stretched appearance, the San Francisco Bay Area facelift patient typically looks for a natural restoration of the facial contours enjoyed in the 30s and early 40s. Using the SMAS in a lower facelift allows the "restoration tension" to be applied below the skin surface rather than over-tightening the skin. In the extended SMAS facelift technique, the skin can be gently re-draped naturally. In a natural facelift, particular attention is paid to several important areas by expert facelift surgeons:

They maintain the hairline above and behind the ear. Every patient is different, and while some surgeons "do every patient the same way," Dr. Maas believes that the facelift assures the hairline is maintained in the temple area and carefully aligned behind the ear. The incisions for men's and women's facelifts remain hidden behind the prominent cartilage in front of the ear – the tragus. Any hair-bearing skin that is moved into this area can have the hair ablated or removed at the time of surgery or after.

They achieve a refreshed yet natural appearance. The facelift in men and women never looks over-pulled or over-stretched. This natural-looking result is the value of the extended SMASplasty facelift technique developed by Dr. Maas at the University of California San Francisco and later refined at The Maas Clinic™. By elevating the SMAS layer, Dr. Maas can achieve effective contour restoration without creating an unnatural pulled or windswept look.

They maintain the position of the earlobe. The earlobe must rest in a natural position without looking pulled or distorted.

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Facelift Before & After

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The Neck Lift

A 2007 article in Vogue magazine rated Dr. Maas, The Maas Clinic™, San Francisco, as one of America's "top plastic surgeons" for neck lift. How one judges "the best surgeon" is probably beyond the scope of this discussion, but it is usually based on a legacy or reputation based on many patients over ten or more years with good results. The endorsement notwithstanding, neck lifting is a unique procedure that involves a sophisticated combination of liposuction, platsymaplasty (bands or cords of muscles in the neck), and subplatysmal flap SMAS elevation in the neck employing small incisions around the ear lobule (lobe) and behind the ear. This carefully sequenced series of surgical maneuvers can substantially change neck skin laxity, bringing a square or near a 90-degree angle to the neck and chin line, fat under the chin (submental fat), and deep wrinkles under the neck. The procedure, like all Maas Clinic™ facelift procedures, is an outpatient with a compression dressing that is removed after one night. Minimal swelling is expected, and quite often, bruising is minimal with this technique, which, like the mini facelift, is usually reserved for younger patients with premature neck aging and patients who have experienced neck laxity relapse after previous facelift surgery.

The Mini Facelift

The mini facelift is a term that, unfortunately, has been described by various companies with slick marketing terms and advertising campaigns that often over-promise what this procedure can do. The mismatch between outcomes and the different names applied to the mini facelift is because the procedure may differ for each surgeon or company.

Some surgeons or "companies" offer a one-hour office procedure with a straight vertical incision in front of the ear, a small amount of skin elevated, removed, and sutures placed. Other surgeons offer much longer-lasting and more technical procedures with more predictable long-term results. However, a mini facelift is performed, and the patient's fast-paced lifestyle refined this centuries-old early facelift procedure. Many patients want a facelift that minimally impacts their busy lifestyle with shorter recovery times. Mini facelifts may only offer shorter recovery times. With that caveat, there are many things a mini facelift can provide for the right patient.

The mini facelift offered by The Maas Clinic™ in San Francisco addresses the sagging tissues between the temple and the jawline, including the nasolabial fold, cheek, and "marionette lines." This procedure is usually best applied to patients who need a little tuck-up some years after a previous facelift or younger patients with a still lovely neckline and satisfactory neck tissues that need a lift in the areas described. The procedure employs an incision that extends from the temple hair, is hidden behind the ear cartilage in front of the ear, and ends just behind the earlobe. Dr. Maas' approach to the mini facelift is similar to the lower facelift in that it relies on extensive use of the underlying thick connective tissue SMAS (subcutaneous aponeurotic system) to provide long-lasting contour improvements with gentle and natural skin tightening. The recovery for this procedure is about one week of moderate facial swelling, with bruising being the rate-limited variable in returning to normal social activities. Healing, in truth, is not significantly different than that of the lower facelift.

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My recommendations are to ask the following questions while having a consultation with a surgeon about facelift surgery in San Francisco.

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Preparing for Your Facelift

1. How many facelifts have you performed in the last month as the surgeon in charge or primary surgeon?

2. How many facelifts have you performed in the last year as the surgeon in charge or primary surgeon?

3. Are you board-certified by the American Board of Facial Plastic and Reconstructive Surgery or the American Board of Plastic Surgery?

4. Have you ever had a complication with facelift surgery? If the surgeon responds no – be suspicious. While significant complications are rare, any surgeon who has done enough facelift procedures to be an expert will have experienced at least some difficulty, which should be discussed.

5. What is the worst complication you have experienced with a facelift, and how did you manage this complication?

6. Ask to speak with patients who have had a facelift with the surgeon in the last month or two in San Francisco. They can give a first-hand account of their experience and whether their expectations were met.

7. Ask to see before and after pictures and ensure that the photographs are of patients for whom your consultation surgeon was the primary surgeon.

8. Finally, corporate facelifts or trademarked procedures are considered unethical in many states and illegal in some. I encourage patients to seek these procedures by carefully credentialing the surgeons.

Combination Procedures for Complete Facial Transformation

After hearing about your goals during your consultation, Dr. Maas might suggest combining other procedures with your facelift when a patient's desired results cannot be achieved with a single surgery. Combining procedures can enhance the results of each one, providing a more dramatic and harmonious overall effect. Combining procedures can also shorten total recovery time and reduce the overall cost. Many factors are involved in choosing which procedures are appropriate for you. Dr. Maas will provide options and recommendations, and you will decide together. The most popular combinations for facelift patients include:

Facelift and Neck Lift

A taut and youthful-looking face can appear out of place atop an aging neck. Because the neck often shows signs of age sooner than the face, pairing a facelift with a neck lift can address the potential for discrepancies in a single procedure. A full face and neck lift is ideal for patients with prominent neck bands and severe sagging under the chin that would not be improved with a facelift alone.

Facelift and Blepharoplasty

A blepharoplasty (eyelid lift or eyelid surgery) can improve the appearance of droopy upper eyelids and puffy lower eyelids. Patients with aging or tired eyes may not see the full results they desire from a facelift alone, as a facelift focuses on the lower two-thirds of the face. When a facelift and blepharoplasty are combined, it creates balanced rejuvenation in the upper and lower face and an overall refreshed look.

Facelift and Brow Lift

Like blepharoplasty, a brow lift (a forehead lift) focuses on the upper face. A brow lift complements a facelift by tightening excess skin in the upper third of the face, softening lines on the forehead, and restoring sagging brows. When a total transformation is desired, a complete facelift, brow lift, and blepharoplasty may be done together. A brow lift can also be combined with a mini facelift for patients with less aging in the lower face.

Facelift and Liposuction

Submental fat is a pocket of unwanted fullness beneath the chin, commonly called a double chin. This area is notoriously hard to treat with diet and exercise but is quickly addressed with liposuction. Liposuction in the neck and chin region targets submental fat to sculpt a more defined chin, neck, and jawline, which complements facelift surgery's smoother and tauter facial appearance.

Facelift and Fat Transfer

While a facelift excels at elevating and tightening sagging tissues, it is not designed to restore lost volume. Volume restoration can be achieved with fat transfer or fat grafting. This technique takes fat from one area of the body via liposuction and moves it to another via injections. Fat transfer is becoming increasingly popular as fat grafting is considered a permanent and organic alternative to synthetic fillers.

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Facelift Post-Operative Care

After facelift surgery, patients will experience significant swelling and some bruising. Lying with the head elevated can keep swelling to a minimum and help the patient feel more comfortable during the healing process. Special headbands may also be used to minimize swelling and keep the surgical areas clean. Discomfort is common after a facelift and can be managed with oral pain medication for the first few days. Sutures placed during the surgery are usually completely out within the first week as the incisions begin to heal. Most patients are ready to return to activities within 10-14 days.

By that time, makeup should be sufficient to hide the patient's cosmetic surgery on the face. Strenuous exercise will be restricted for several weeks to ensure the surgical area can heal completely. Full facelift results may take much longer since residual swelling can persist for several months. Most patients will see complete results within 6-12 months after surgery. Those results should last for many years before the effects of aging take their toll once again. At that time, the patient may opt for a non-surgical rejuvenation to touch up results or a second surgical procedure to produce long-lasting, dramatic results comparable to the original procedure.

Schedule a Facelift Consultation With Dr. Maas

Corey S. Maas, MD, reviewed the information about the facelift. If you have any questions, please don't hesitate to contact us using our contact form on the sidebar. Corey S. Maas, MD, and the staff at The Maas Clinic™ in San Francisco look forward to answering any questions you may have about your facelift. To schedule an appointment, please contact us today.

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Facelift FAQ

Am I Too Young for a Facelift?

How Can I Avoid Looking Overly Tight or Pulled?

Are There Alternatives to a Facelift?

How Long Does it Take To Recover from a Facelift?

Is the Ribbon Lift a Facelift?

Non-Surgical Facelift: Does it Exist?

Are 'Weekend Facelifts' Worth It?

What Is the Difference Between a Mini Facelift and a Regular Facelift?

What Is the Deep Plane Facelift?

What Is the Difference Between a SMAS Facelift and a Deep Plane Facelift?

What Type of Facelift Is Right for Me?

Is Scarring Significant With a Facelift?

How Can I Ensure My Face Looks Rejuvenated and Not Puffy or Overdone?

Should I Use Implants, Fat Transfer, or Fillers to Restore Facial Volume?

What Is the Difference Between a Mini Facelift and a Regular Facelift?

Am I Too Young for a Facelift?

No. The conditions dictate the need for the procedure we are doing. We typically see patients in their 50s and 60s. However, many young patients have premature aging, particularly those who are smokers or have been smokers or patients who have had a lot of sun exposure. The most significant factor, which none of us control, is genetics. Suppose you have a genetic predisposition to hanging skin or one of several medical conditions that can cause extreme skin laxity. People who suffer from these are excellent candidates for doing facelifts at the age of 40. The average age now is coming down with lifting; people are feeling youthful, energetic, and very productive in their early 50s, even late 40s, and have faces that don't match what they feel like inside. As long as the face conditions warrant a lift, it's appropriate.

How Can I Avoid Looking Overly Tight or Pulled?

Patients end up with the excessively taut results we often see in celebrities for a few reasons. First, there are the expectations of the patient. Some patients express the desire for unusual or extreme results that, if met, appear unnatural. These unnatural results usually occur in combination with a surgeon who is promising something unusual or extreme. Set your expectations appropriately. Second, there is the choice of surgeon. You should feel comfortable maintaining an open line of communication with your surgeon. Doing so ensures they understand your concerns (in this case, having a natural look) and can address them. Please communicate your goals and preferences to ensure a satisfactory outcome. An excellent place to start is getting referrals from friends who have had good results. Once you have a surgeon in mind, look at their before and after photographs and ask about their facelift experience. These are all essential parts of evaluating who does your lift. Finally, there is the surgical technique. Many surgeons do a skin-only or nominal technique involving the SMAS or deep connective tissue layer underneath the skin. These approaches are more likely to create a windswept or stretched look because they typically require a lot of skin tension to get a sculpted contour. A more comprehensive technique like Dr. Maas' Deep Plane SMAASplasty Facelift™ is designed to provide lasting, natural results.

Are There Alternatives to a Facelift?

Many people would prefer non-surgical options to a surgical facelift. What's the best alternative? Well, a facelift addresses a specific concern. It improves the contours of the face, the neck, and the jawline and can help the cheeks, too. There is no non-surgical substitute that achieves the results a facelift can. However, many people come in with fine lines and wrinkles on their face and even volume loss that don't need a facelift. While no easy substitute for a facelift exists, some alternatives can be used, including judicious use of facial fillers and volume, mainly through the cheek area, around the lips and marionette lines, and the jawline, which can disguise things and make it look like a facelift.

How Long Does it Take To Recover from a Facelift?

Facelift recovery typically spans from 10 days to 2 weeks for most patients. During the first week, significant swelling occurs, often resembling a pumpkin head in many cases. Preparing to avoid social activities during this initial period is essential. The main factor determining the return to normal social activities is bruising. Fortunately, bruising is generally confined to specific areas for about ten days, and makeup can effectively conceal it. The incisions, hidden in the hairline and other discrete areas, make bruising less of a concern. While there may be some light redness, bruising is the primary factor to consider when planning a return to regular social activities after a facelift.

Is the Ribbon Lift a Facelift?

The ribbon lift involves a unique type of suture, the eye guide positioned beneath the neck, creating a crisscross pattern resembling a mattress. It incorporates an Endotine, resembling a ribbon. Made of polylactic acid, this flat device with multiple holes dissolves over time. Shaped like a ribbon, it features a small spiked catch device at the end, engaging with soft tissues. Commonly used for midface elevation, the procedure entails making a small incision in the temporal hairline and under the lip. The device is inserted beneath the skin, engaging the cheek's fatty tissues, which are then elevated and sutured into place. While the device dissolves gradually, an alternative technique, such as the endoscopic mid-face lift or percutaneous mid-facelift, may offer a more favorable approach to midface lifting, according to our developed techniques.

Non-Surgical Facelift: Does it Exist?

First of all, everybody should be aware that no magic cream does a facelift because facelifts, by our surgical and medical definitions, improve the contour of the lower face and or the neck, and that's, by definition, what facelifts do. Facelifts should improve contouring. When laser skin resurfacing first came out, many claimed it lifted the face. What resurfacing does is tighten the skin. It makes the surface texture smoother and wrinkles much less perceptible; in many cases, it can make them go away, but it does not physically or substantially change the skin's contour the way a facelift does.

Are 'Weekend Facelifts' Worth It?

Medical practices advertise so-called 'weekend facelifts' that promise to have patients back to work and social activities in just a few days. While it's easy to see the superficial appeal of a shortened procedure and recovery time, the benefits of these procedures are limited. Only deeper techniques, like Dr. Maas' Deep Plane SMAASplasty Facelift™, can create results that last 10 to 15 years or more.

What Is the Difference Between a Mini Facelift and a Regular Facelift?

Facelifts traditionally describe procedures where the lower 2/3 of the face are addressed, lifting and tightening the underlying muscles of the face or even transferring fat deposits. Mini facelifts, which were first performed in 1908, are a slightly less extensive procedure. While other surgeons may only perform some skin elevation, Dr. Maas' mini facelifts involve addressing the underlying connective tissue of the subcutaneous musculoaponeurotic system, or SMAS layer, along with an extensive elevation of the skin from the jawline to the cheek, and even the temporal region for certain patients. The specific areas addressed in Dr. Maas' mini facelift are the jawline, the marionette line, and the lower part of the nasolabial fold. The incisions will be hidden behind the tragus cartilage of the ear and the hairline, compared to the traditional method of placing incisions in front of the ear, and care will be taken to ensure results look natural, not windswept. Depending on the extent of correction, a mini facelift with Dr. Maas may involve local anesthesia with sedation or deep sleep anesthesia. To see what a mini facelift might look like for you, apply gentle upward tension along the sides of the lower half of the face.

What Is the Deep Plane Facelift?

As its name suggests, the deep plane facelift works within a deep layer of tissue to address the face's underlying structures. This technique may provide more substantial improvements (particularly in the nasolabial folds) and longer-lasting results for the right patient. A deep plane facelift procedure can last for 10 to 15 years. Proponents of the deep plane facelift suggest it can provide more natural results because it focuses on adjusting the muscles, fat, and ligaments rather than skin pull and removal. The deeper method allows for significant rejuvenation without giving the skin an excessively tight appearance. Whether the deep plane facelift is a better technique is the subject of much discussion and debate among surgeons. We encourage you to speak with Dr. Maas about your options so you can select the best approach for your needs. One of the benefits of working with an experienced facial plastic surgeon like Dr. Maas is his extensive knowledge of all techniques in the specialty.

What Is the Difference Between a SMAS Facelift and a Deep Plane Facelift?

A SMAS facelift focuses its corrections on the SMAS (superficial muscular aponeurotic system) layer, a thin fibrous layer of fascia that sits between the skin and facial muscles. This system divides the deep and superficial layers of the face. This technique was initially adopted to improve skin-only facelift methods, which are more likely to give patients an overly pulled or 'windswept' look. The deep plane facelift procedure goes further than the SMAS layer for corrections. It addresses the area between the SMAS and the muscles below it. Some deep plane techniques also incorporate releasing the ligaments attached to the deep plane layer to reduce the over-tightness further that an unskillful facelift procedure can create. While some surgeons tout the deep plane facelift as the 'latest and greatest' technique, we caution against seeing it this way. Every patient has unique conditions, and various factors affect the outcomes. Any facelift can produce a beautiful result when appropriately matched with the patient.

What Type of Facelift Is Right for Me?

Decades of advancements in plastic surgery mean today's patients have many options. If you are considering surgical facial rejuvenation, it's important to remember that there is no single best type of facelift. Every face is structured and ages differently; therefore, each facelift procedure must be tailored to the patient's needs. A younger patient who does not need drastic improvement but is bothered by early jowling may be an excellent candidate for a mini facelift. An older patient with sagging skin, drooping fat pads, deep folds, and a 'turkey neck' may be an ideal candidate for a deep plane facelift and a neck lift. These are simply examples. Ultimately, the proper procedure for you depends on your goals and the recommendation of Dr. Maas. Dr. Maas will explain each facelift option and help you choose your treatment.

Is Scarring Significant With a Facelift?

Any surgery can leave a scar behind, but with good surgical technique and appropriate aftercare, the scar heals into a thin line that is nearly indistinguishable in most cases. Facelift incisions are placed in the hairline so the scars are hidden, even in men and other patients wearing short hair. Most patients report their scars no longer visible three months into facelift recovery.

How Can I Ensure My Face Looks Rejuvenated and Not Puffy or Overdone?

You've seen the unnaturally voluminous cheeks of movie stars and television personalities, and much of this has to do with inappropriate placements or overuse of facial volume restorers. Of course, depending on which method of facial volume restoration you use, there will be a transitional period where you will look slightly overfilled due to natural swelling in the area, but this will subside. Dr. Maas believes strongly in a natural-looking restoration of facial volume that enhances his patient's features. The goal is not to make you look different but to restore a more youthful version of yourself. For this purpose, we ask you to bring pictures of your younger self to your consultation so Dr. Maas can accurately identify where volume loss has occurred and how much restoration is needed to help you turn back the clock.

Should I Use Implants, Fat Transfer, or Fillers to Restore Facial Volume?

This decision depends on your unique situation, but rest assured, Dr. Maas will lay out all your options so you can make an educated decision. Each option has its risks and benefits, so it is essential to be clear about your concerns and expectations so he can recommend the best course of action for your needs. For patients looking for a long-term option that involves a single surgical treatment or patients looking to correct facial flatness they have been born with, a good and very long-lasting solution would be cheek, chin, and even temporal implants. These fully customizable implants will be ordered according to your face's exact size and shape and can be reversed if necessary. Autologous fat transfer involves removing fat from somewhere you don't need it and washing it down so only purified fat cells and the stromal vascular or stem cells remain. The volumizing effects of the adipocytes (small fat cells) are augmented by cellular messengers stimulating cytokines in your face where they are injected, sending out signals to build up tissue for long-term rejuvenation. Long-lasting stimulatory fillers like Sculptra and Radiesse use micro-particulates to increase collagen production. They are indicated for use in the mid-face cheek area and the temporal area below the hairline to correct the loss of fatty tissue in the face. Dr. Maas prefers to use Radiesse, which provides an immediate result and a limited inflammatory response for most patients, with a lasting duration of effect. The least invasive option with minimal downtime would be specially formulated fillers to restore mid-face volume. Hyaluronic acid fillers like Juvederm Voluma and Restylane Lift can be administered as a quick and comfortable in-office procedure, and there are very few reactions to the formulations, which primarily use a naturally occurring enzyme in our body. These FDA-approved options are adjustable and can last for up to two years.

What Is the Difference Between a Mini Facelift and a Regular Facelift?

Facelifts traditionally describe procedures where the lower 2/3 of the face are addressed, lifting and tightening the underlying muscles of the face or even transferring fat deposits. Mini facelifts, which were first performed in 1908, are a slightly less extensive procedure. While other surgeons may only perform some skin elevation, Dr. Maas' mini facelifts involve addressing the underlying connective tissue of the subcutaneous musculoaponeurotic system, or SMAS layer, along with an extensive elevation of the skin from the jawline to the cheek, and even the temporal region for certain patients. The specific areas addressed in Dr. Maas' mini facelift are the jawline, the marionette line, and the lower part of the nasolabial fold. The incisions will be hidden behind the tragus cartilage of the ear and the hairline, compared to the traditional method of placing incisions in front of the ear, and care will be taken to ensure results look natural, not windswept. Depending on how extensive the correction is, a mini facelift with Dr. Maas may involve local anesthesia with sedation or deep sleep anesthesia. To see what a mini facelift might look like for you, apply gentle upward tension along the sides of the lower half of the face.

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Facelift

Facelift

Rediscover a more youthful you with our advanced facelift procedure, expertly tailored to rejuvenate and lift sagging facial tissues.

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Mini Facelift

Mini Facelift

Experience the transformative effects of a mini facelift, a minimally invasive approach to achieving a refreshed and revitalized facial appearance.

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Mid Facelift

Mid Facelift

Elevate your mid-face contours and restore youthful volume with our specialized mid-facelift technique, designed for natural and harmonious results.

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Silhouette Lift

Silhouette Lift

Explore the innovation of Silhouette Lift, a non-surgical thread lift solution that provides a subtle yet noticeable lift to sagging facial skin.

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Revision Facelift

Revision Facelift

Entrust your facial rejuvenation to our revision facelift expertise, ensuring personalized solutions for refining and enhancing previous facelift results.

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Neck Lift

Neck Lift

Sculpt and redefine your neck and jawline with our precision neck lift procedure, addressing signs of aging and restoring a more defined profile.

Dr. Maas examining patient
Facelift Combinations

Facelift Combinations

Customize your facelift journey by combining other procedures for comprehensive facial enhancement, ensuring you achieve your desired results.

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