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Facelift SurgeryTable of Contents

Redefining the Facelift

The term "facelift" has evolved to encompass a wide range of facial plastic surgeries, often blurring traditional definitions. Originally, a facelift referred to lifting sagging tissues from the cheeks to the neck. Modern approaches now integrate various procedures, such as brow lifts, eyelid surgeries, and volume augmentation, making the traditional definition insufficient.

One of the most important distinctions for patients researching facelift surgery is depth: whether a technique addresses the SMAS layer alone or goes deeper to release the underlying facial ligaments, an approach known as a deep plane facelift.

A few factors actually determine how a facelift should be classified, beyond marketing names:

  • The tissue layer the surgeon addresses (skin only, SMAS, or the deeper plane beneath it)
  • Whether supportive tissue is repositioned or the skin is simply pulled tighter
  • The surgeon's specific technique, rather than a generic or trademarked marketing term
  • How long results are expected to last based on that technique

The Maas Clinic™, led by Dr. Corey S. Maas, has developed a clear and straightforward way to classify facelifts in San Francisco. Instead of using vague or proprietary terms like "Lifestyle Lift" or "Quicklift," which often lack transparency about the techniques, risks, and benefits involved, Dr. Maas focuses on accurately describing the depth and technique used. He performs a modified deep-plane technique known as the Deep Plane SMASplasty Facelift™, which will be discussed in detail below.

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Who is a Candidate for a Facelift?

A candidate for a facelift typically desires to address signs of aging, such as sagging skin, deep creases, and jowls. They're often in good health, non-smokers, with realistic expectations. Age-wise, they're typically in their 40s to 70s. Contact Dr. Maas for a personalized assessment and guidance on which procedure may be right for you.

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Preparing for Your Facelift in San Francisco

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.

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.

Facelift Recovery Tips: A Guide to Healing Gracefully

  • Follow Post-Op Instructions: Your surgeon will provide detailed instructions for post-operative care. Adhere to them strictly to ensure optimal healing.
  • Rest and Relax: Allow your body ample time to recover by getting plenty of rest and avoiding strenuous activities.
  • Stay Hydrated: Drink plenty of water to keep your body hydrated, which aids in the healing process and promotes skin elasticity.
  • Manage Discomfort: Expect some discomfort and swelling post-surgery. Use prescribed pain medication as directed and apply cold compresses to reduce swelling.
  • Avoid Sun Exposure: Protect your delicate skin from harmful UV rays by staying out of the sun and wearing sunscreen outdoors.
  • Gentle Skincare: Follow a gentle skincare routine recommended by your surgeon to promote healing and maintain results.
  • Patience is Key: Understand that full results may take several weeks to manifest. Be patient and allow your body time to adjust.

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 (Lower)

A lower facelift, traditionally the standard facelift, lifts sagging tissue and skin from the cheekbone to the neck to correct loose skin and prominent neck muscle bands (platysma).

Dr. Maas performs this procedure as his Deep Plane SMASplasty Facelift™, releasing and repositioning the deeper facial ligaments and surrounding tissue as a connected unit rather than pulling the skin alone. Placing tension on that supportive tissue, instead of the skin, produces contour restoration that avoids an unnatural pulled or windswept appearance.

The incision is hidden behind the tragus, the hairline stays in its natural position, and the earlobe retains its natural placement throughout healing. Dr. Maas developed this technique at UCSF and has refined it over more than two decades at The Maas Clinic™.

Deep Plane vs. SMAS Facelift: What Patients Should Know

Deep plane and SMAS describe two different depths of facelift surgery, and patients comparing them want to know how each affects the results. Both target tissue beneath the skin, but the difference in depth changes how natural and long-lasting the outcome tends to be.

A SMAS facelift tightens the Superficial Musculoaponeurotic System (SMAS), the muscular layer beneath the skin, to avoid the pulled look that comes from lifting skin alone. This technique has been a facelift standard for decades and produces reliable results for the right candidate.

A deep plane facelift goes a step further. Rather than tightening the SMAS from above, it releases the underlying ligaments, freeing the deeper tissue and repositioning it as a single unit with the skin and SMAS.

Because the lift comes from below instead of pulling the skin, results tend to look more natural and last longer, often 10-15 years, compared to shorter durability with skin-only or SMAS-only approaches.

Dr. Maas' Deep Plane SMASplasty Facelift™ combines both techniques: releasing the deep ligaments the way a deep plane facelift does, then repositioning the SMAS along with the surrounding tissue.

Patients weighing either option should ask a prospective surgeon:

  • Which specific tissue layer the surgery will address
  • Whether the technique repositions supportive tissue or primarily tightens skin
  • What results the surgeon has achieved with that exact technique
  • How long results typically last with that approach

Not every patient needs the deeper technique. Early jowling with minimal sagging may respond well to a SMAS-only lift, while more advanced aging often benefits from the added support of a deep plane release. Dr. Maas evaluates each patient's anatomy and goals during consultation to determine the appropriate depth of correction.

Facelift Downtime: Social Recovery vs. Clinical Recovery — What's the Difference?

Facelift Downtime: Social Recovery vs. Clinical Recovery — What's the Difference?

The Neck Lift

Neck lifting is a specialized procedure that combines techniques such as liposuction, platysmaplasty (addressing neck muscle bands or cords), and subplatysmal SMAS elevation. This is achieved through small incisions near the earlobe and behind the ear. This precise sequence of surgical steps effectively improves neck skin laxity, refines the neck and chin angle to approach a 90-degree contour, reduces submental fat under the chin, and smooths deep wrinkles in the neck area.

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 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.

—Dr. Maas

Why Choose Dr. Maas

Dr. Corey S. Maas, MD has over 30 years of experience and has performed more than 3,000 rhinoplasty surgeries. He is double board-certified (American Board of Otolaryngology; American Board of Facial Plastic & Reconstructive Surgery) and has received accolades, including Best Cosmetic Surgeon from the SF Examiner and SF Weekly. For facelift patients, Dr. Maas offers his modified deep plane technique, the Deep Plane SMASplasty Facelift™, developed at UCSF and refined over decades at The Maas Clinic™, delivering natural, long-lasting results without an overly tight or pulled appearance. He is Founder & Director of The Maas Clinic and Director of the Facial Plastic Surgery Fellowship Training Program. He has received the Sir Harold Delf Gilles Award and the AAFPRS National Community Service Award.

Career Highlights:

Learn More About His Experience

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Facelift Procedures FAQs

Am I Too Young for a Facelift?

No. The need for a facelift depends on individual conditions, not age. While most patients are in their 50s and 60s, younger individuals, especially those with premature aging from smoking, sun exposure, or genetics, may also be good candidates. Some people in their 40s or early 50s choose a facelift to match their youthful energy with their appearance. If your facial conditions justify it, a facelift is appropriate at any age.

How Can I Avoid Looking Overly Tight or Pulled?

Patients may end up with overly taut results due to unrealistic expectations, the choice of surgeon, and the surgical technique used. It's crucial to set realistic goals, communicate them clearly, and choose a skilled surgeon who uses comprehensive techniques like Dr. Maas' Deep Plane SMASplasty Facelift™ for natural, lasting results.

Are There Alternatives to a Facelift?

Many prefer non-surgical options over a facelift, but no alternative matches a facelift's results for improving facial contours, the neck, and the jawline. However, for fine lines, wrinkles, and mild volume loss, facial fillers can effectively enhance areas like the cheeks, lips, and jawline, offering a subtle, facelift-like effect.

How Long Does it Take To Recover from a Facelift?

Facelift recovery typically takes 10 days to 2 weeks. During the first week, expect significant swelling, so it's best to avoid social activities. Bruising, which usually lasts about 10 days, is the main factor in determining when you can resume normal activities. Fortunately, it can be concealed with makeup, and the incisions are hidden in discreet areas, making bruising less noticeable.

Is the Ribbon Lift a Facelift?

The ribbon lift uses a special suture, the eye guide, beneath the neck, forming a crisscross pattern. It incorporates a dissolvable polylactic acid device called Endotine, which lifts soft tissues. Commonly used for midface elevation, the procedure involves small incisions in the hairline and under the lip. While effective, alternative techniques like the endoscopic mid-face lift may provide better results for midface lifting.

Non-Surgical Facelift: Does it Exist?

No cream can replicate a facelift, which is defined by its ability to contour the lower face and neck. While laser resurfacing tightens skin and smooths wrinkles, it doesn't alter facial contours like 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 typically target the lower two-thirds of the face, lifting and tightening muscles and sometimes transferring fat. Mini facelifts, a less extensive procedure first performed in 1908, vary by surgeon. Dr. Maas’ mini facelift addresses the SMAS layer, lifting the skin from the jawline to the cheek and even the temporal region. It specifically targets the jawline, marionette lines, and lower nasolabial folds. Incisions are hidden behind the ear and hairline for a natural look. Depending on the correction needed, anesthesia options range from local with sedation to deep sleep.

What Is the Deep Plane Facelift?

It targets deeper facial tissues for more substantial, longer-lasting results (often 10-15 years), adjusting muscles, fat, and ligaments rather than just pulling skin, for a natural look without an overly tight appearance. At The Maas Clinic™, Dr. Maas performs a modified deep-plane facelift, the Deep Plane SMASplasty Facelift™, which combines this deeper-tissue release with SMAS repositioning for comprehensive, long-lasting results.

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

A SMAS facelift targets the SMAS layer to avoid the overly pulled look of skin-only facelifts. A deep plane facelift goes further, addressing the tissue beneath the SMAS and releasing supporting ligaments. Dr. Maas' Deep Plane SMASplasty Facelift™ is a modified deep-plane technique that releases the deeper ligaments while repositioning the SMAS, combining the benefits of both for natural, long-lasting results.

What Type of Facelift Is Right for Me?

Plastic surgery advancements offer various facelift options, but there's no one-size-fits-all. Procedures are tailored to individual needs. A mini facelift might suit younger patients with early jowling, while older patients with significant sagging may need a deep plane facelift and neck lift. Dr. Maas will help you choose the best option based on your goals.

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?

Unnatural cheek volume often results from improper use of facial fillers. While some swelling is normal after treatment, it subsides. Dr. Maas focuses on natural-looking results, restoring your youthful appearance rather than altering your features. Bringing photos of your younger self to your consultation helps him accurately assess and plan the restoration.

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

Your options depend on your unique needs, and Dr. Maas will guide you in making an informed decision. Long-lasting solutions include customizable cheek, chin, and temporal implants, or autologous fat transfer for natural volume. Stimulatory fillers like Radiesse boost collagen production for mid-face rejuvenation. For minimal downtime, hyaluronic acid fillers like Juvederm Voluma or Restylane Lift offer quick, in-office results that last up to two years.

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

Facelifts typically target the lower two-thirds of the face, lifting muscles and sometimes transferring fat. Dr. Maas' mini facelifts go beyond simple skin elevation, addressing the SMAS layer and lifting from the jawline to the cheek, and even the temporal region. Incisions are discreetly hidden, ensuring natural results. Depending on the extent of correction, the procedure may use local anesthesia with sedation or deep sleep anesthesia.

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