Procedures

The term facelift has become widely used for all types of facial plastic surgery in San Francisco and beyond.

Traditional surgical definitions would describe a facelift as a surgical procedure that elevates sagging tissues from the cheek area down to and including 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 browlift, 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 describe what is done rather than using vague marketing or even proprietary terms like “Lifestyle lift”, “Natural lift”, “Quicklift” and others. These terms while being aggressively marketed, do not clearly describe to the public what or how the procedure is preformed and or the risks and benefits for the procedure. In simple terms, San Francisco Plastic Surgeon Corey S. Maas MD, a recognized leader in cosmetic surgery, has divided the face lift into three basic surgical strategies:

1) Facelift (lower)

The lower facelift is a plastic surgery procedure that is another way of describing what traditional text books would simply 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 is typically looking for a natural restoration of the facial contours enjoyed in the 30’s and early 40’s. Using the SMAS in a lower facelift in allows the “restoration tension” to be applied below the skin surface rather than over-tightening the skin. In extended SMAS facelift technique, in particular, the skin can be gently re-draped in a natural configuration. In a natural facelift particular attention is paid to several important areas by expert facelift surgeons:

A lower facelift employing the SMAS (subcutaneous aponeurotic system) Call The Maas Clinic for more information about facelift surgery San Francisco.

facial surgery san francisco

  • Maintaining the hairline above and behind the ear.
    Every patient and different and, while some surgeons “do every patient the same way” it is the opinion of Dr. Maas that the facelift is one that assures the hairline is maintained in the temple area and carefully aligned behind the ear. The incisions for men’s facelift and women’s facelift remain hidden behind the prominent cartilage in front of the ear – the tragus. Any hair hair-bearing skin that is moved into this area can have the hair ablated or removed at the time of surgery or subsequent to the surgery.
  • Maintaining a refreshed yet natural appearance. The facelift in men and women never look over-pulled or over stretched. This 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 restoration of contour without creating an unnatural pulled or windswept look.
  • Maintaining the position of the earlobe. The earlobe must rest in a natural position without looking pulled or distorted. This video demonstrates the precision used in placing the lobule (ear lobe).

2) 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 reason for the mismatch between outcomes and the various names applied to the mini-facelift are that for each surgeon or company the procedure may be very different.

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. Others surgeons offer much longer lasting and more technical procedure that offer more predictable long-term results. However a mini-facelift is performed, the refinement of this centuries old early facelift procedure was driven by patient’s fast-paced lifestyle. Many patients want a facelift that minimally impacts their busy lifestyle with shorter recovery times. Mini-facelifts may not always offer shorter recovery times however.

With that caveat, there are many things a mini-facelift can provide for the right patient. The mini-facelift offered by The Maas ClinicTM in San Francisco addresses the sagging tissues between temple and the jawline, including the nasolabial fold, cheek and “marionette lines”. This procedure is usually best applied to patients that need a little tuck up some years after a previous facelift or younger patients with a still nice neck line and satisfactory neck tissues that just 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 brusing be the rate limited variable in returning to normal social activities. Recovery, in truth, is not significantly different than that of the lower facelift.

3) The Neck Lift

A 2007 article in Vogue magazine rated Dr. Maas, The Maas ClinicTM, 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 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 involved a sophisticated combination of liposuction, platsymaplasty (bands or cords of muscles in the neck) and subplastysmal 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 90 degree angle to neck and chin line, fat under the chin (submental fat) as well as deep wrinkles under neck. The procedure, like all Maas ClinicTM facelift procedures as an outpatient with a compression dressing that is removed after one night. Very little swelling is expected and quite often bruising is minimal with this technique which, like the mini-facelift, is often reserved for younger patients with premature neck aging and patients that have experienced neck laxity relapse after previous facelift surgery.

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 quite rare any surgeon having done enough facelift procedures to be an expert will have experienced at least some complication and this should be discussed.

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

  1. What is the worst complication you have experienced with facelift and how did you manage this complication?
  2. Ask to speak with patients that have had a face lift in San Francisco with the surgeon in the last month or two. They can give a first hand account of their experience and whether their expectations were met.
  3. Ask to see before and after pictures and make sure that the pictures are of patients that your consultation surgeon was the primary surgeon.
  4. Finally, corporate facelifts or trademarked procedures are considered unethical in many states and illegal in some. I discourage patients from seeking these types of procedures without carefully credentialing the surgeons.

Complementary Procedures for Complete Facial Transformation

After hearing about your goals during your consultation, Dr. Maas might suggest combining other procedures with your facelift. Why is this sometimes a good idea?

Dr. Maas may suggest two or more procedures when a patient’s desired results cannot be achieved with a single procedure. Combining procedures can often enhance the results of each individual procedure, providing a more dramatic and more 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 the two of you together will make the final decision.

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 (a.k.a. an eyelid lift or eyelid surgery) can improve the appearance of droopy upper eyelids and/or 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 (also called 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 total transformation is desired, a full 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 referred to as a double chin. This area is notoriously hard to treat with diet and exercise but is easily addressed with liposuction. Liposuction in the neck and chin region targets submental fat to sculpt a more defined chin, neck and jawline, which nicely complements the smoother and tauter facial appearance achieved by facelift surgery.

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, a technique that takes fat from one area of the body via liposuction and moves it to another area via injections. This is becoming an increasingly popular option as fat grafting is considered a permanent and organic alternative to synthetic fillers.

Full results of a facelift may take much longer to appear, since residual swelling can persist for a number of 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.

Get a Glimpse into a Facelift Consultation With Dr. Maas

The information about facelift was reviewed by Corey S. Maas MDTM. 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 look forward to answering any questions you may have about your Facelift in San Francisco. To schedule an appointment, please call (415) 567-7000.

FAQs

Am I Too Young for a Facelift?

“No” The conditions, really, are what dictate the need for the procedure that 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 that have had a lot of sun exposure. The biggest factor, which none of us control, is really genetics. If you gave a genetic predisposition to hanging skin, and there’s even a number of medical conditions that can cause extreme skin laxity, and people who suffer from these are very good candidates for doing facelifts at the age of 40.The average age now is coming down with lifting, people are feeling youthful and energetic and very productive in their early 50′s, even late 40′s, and have a face that doesn’t match what they feel like inside. As long as the conditions of the face warrant a lift, it’s a total appropriate procedure.

How Can I Avoid Looking Overly Tight or Pulled?

There are a few reasons patients end up with the excessively taut results we often see on celebrities.

First, there are the expectations of the patient. Some patients express unusual or extreme expectations that, if met, produce unnatural results. This usually occurs 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. This ensures they understand what your concerns are (in this case, having a natural look) and are able to address them. Failure to communicate your goals and preferences can lead to an unsatisfying outcome.

A good place to start is getting referrals from friends who have had good results. Once you have a surgeon in mind, be sure to look at their before and after photographs and ask about their experience doing facelifts. These are all important parts of evaluating who does your lift.

Finally, there is the surgical technique. Many surgeons do a skin-only technique or a very 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 good 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?

I think a lot of people, like this patient who wrote in to me, would like to find a non-surgical options rather than getting a facelift and I think the question is “What do most doctors say or is the best alternative?” I will say in summary that a facelift does a specific thing. It helps to improve the contours of the face, the neck and the jawline specifically and also can help with the cheek area so there really is no non-surgical substitute that will do exactly what a facelift can do. However there are number of people who come in with fine lines and wrinkles on their face and even volume loss, that really don’t need a facelift at all. So to give the simple answer to this, I would say there’s no easy substitute for facelift. There are some alternatives than can be used, including judicious use of facial fillers and volume, particularly 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 is at the most about a 10-day to 2 week process for most patients. The first week, people are pretty swollen, and sort of, in many cases, pumpkin head swollen, so you got to be prepared and not be doing any social activities for the first week. The rate limiting thing in terms of returning back to your normal social activities is bruising, and for most people bruising is pretty much limited to just focal areas within about 10 days, which can easily be disguised with make-up since the incisions are hidden in the hairline and other areas. That’s not really a worry because there’s light red, but bruising really is where the rubber meets the road in terms of getting back into the normal social activities.

Is the Ribbon Lift a Facelift

There’s a new mattressing type of suture called the eye guide that goes underneath the neck, crisscrossing a lot like a mattress. There’s an endotine which looks like a ribbon and I suspect that the ribbon lift is probably a good marketing way of describing the endotine device, which is a device that’s made of polylactic acid, it’s basically a small flat device with several holes in it, polylactic acid is what vicryl suture is made and over time dissolves so that’s a benefit but it shaped and formed like a ribbon and at the end of it there’s a small spike catch device that is engaged into the soft tissues. This technique is used to a very commonly for elevating the mid-face region. A small incision is made in a temporal hairline and under the lip. The device is inserted underneath the skin, engages the fatty tissues of the cheek and is elevated and sutured into place. That device dissolves over time. There’s a much better way, in my opinion of doing mid-face lifting with the technique that we’ve developed called the endoscopic midface lift, or the percutaneous mid facelift, more specifically.

Non-Surgical Facelift – Does it Actually Exist?

First of all, everybody should be aware that there’s no magic cream that does a facelift because facelifts by definition, by our surgical and medical definitions, are actually improving the contour of the lower face and or the neck and that’s really, by definition, what facelifts do. Facelifts, by definition, should be improving contouring. Well, then we get into some of these procedures or technologies where people are claiming facelifts and I’m not sure that that’s really what you’re getting. The first of them were really lasers. When lasers skin resurfacing first came out, a lot of people were claiming that it lifted the face. Well, in fact, what resurfacing does is tighten the skin a little bit. It makes the surface texture smoother, it makes wrinkles much less perceptible, in fact, in many cases it can make them go away, but it is not physically or substantially changing the contour to the skin.

Are ‘Weekend Facelifts’ Worth It?

Increasingly, we are seeing 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 these procedures can provide 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 was 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 behind 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.

What Is the Deep Plane Facelift?

As its name suggests, the deep plane facelift works within a deep layer of tissue to address the underlying structures of the face. For the right patient, this technique may provide more substantial improvements (particularly in the nasolabial folds) and longer-lasting results. A deep plane facelift procedure can last for 10 to 15 years.

Proponents of the deep plane facelift suggest that it can provide more natural results because it focuses on adjusting the muscles, fat and ligaments rather than on skin pull and removal. This allows for significant rejuvenation without giving the skin an excessively tight appearance.

Whether the deep plane facelift is actually 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 about 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 originally adopted as an improvement on skin-only facelifting techniques, 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 the release of the ligaments attached to the deep plane layer to further reduce the over-tightness that can be created by an unskillful facelift procedure.

While some surgeons tout the deep plane facelift as the “latest and greatest” technique, we caution against seeing it this way. Patients present with unique conditions, and various factors affect the final outcomes. Any facelift can produce a beautiful result when it is appropriately matched with the patient.

What Type of Facelift Is Right for Me?

Decades of advancements in plastic surgery mean today’s patients have a wealth of options to choose from. 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 differently and ages differently; therefore, each facelift procedure must be tailored to the needs of the individual patient.

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 right procedure for you depends on your goals and the recommendation of Dr. Maas. Dr. Maas will explain each facelift option in detail and help you make an informed decision about your treatment.

Is Scarring Significant With a Facelift?

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

How can I make sure 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 a little 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. This is why it is important to bring pictures of your younger self during your consultation, so Dr. Maas can accurately identify the exact areas 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 depends entirely from patient to patient, but rest assured Dr. Maas will lay out all your options clearly so you can make an educated decision. Each option has their own set of risks and benefits, so it is important 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 the exact size and shape of your face, and can be reversed if necessary.

Autologus 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 later 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 induce an increased production of collagen over time, and are indicated for use in the mid-face cheek area, as well as the temporal area below the hairline to correct the loss of fatty tissue in the face. Dr. Maas personally prefers to use Radiesse, which provides not just an immediate result, but also 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, designed to restore mid-face volume. Hyaluronic Acid fillers like Juvederm Volume and Restylane Lift can be administered as a quick and comfortable in-office procedures, and there are very few reactions to the formulations, which largely 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 was 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 behind 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.

Should I use implants, fat transfer, or fillers to restore facial volume?

This depends entirely from patient to patient, but rest assured Dr. Maas will lay out all your options clearly so you can make an educated decision. Each option has their own set of risks and benefits, so it is important 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 the exact size and shape of your face, and can be reversed if necessary.

Autologus 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 later 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 induce an increased production of collagen over time, and are indicated for use in the mid-face cheek area, as well as the temporal area below the hairline to correct the loss of fatty tissue in the face. Dr. Maas personally prefers to use Radiesse, which provides not just an immediate result, but also 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, designed to restore mid-face volume. Hyaluronic Acid fillers like Juvederm Volume and Restylane Lift can be administered as a quick and comfortable in-office procedures, and there are very few reactions to the formulations, which largely use a naturally occurring enzyme in our body. These FDA approved options are adjustable and can last for up to two years.

How can I make sure 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 a little 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. This is why it is important to bring pictures of your younger self during your consultation, so Dr. Maas can accurately identify the exact areas where volume loss has occurred, and how much restoration is needed to help you turn back the clock.

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