Facelifts and Neck Lifts
Facelift surgery is Dr. Niamtu’s clinical passion and signature procedure. Since he does not perform body surgery his concentration is totally on the face. He has performed 1,000 facelift procedures and does several facelifts a week, which is many times the number performed by the average cosmetic or plastic surgeon. He does not perform “quickie” or short cut procedures, but rather contemporary comprehensive lifts that address aging changes properly for natural and long lasting results.
Dr. Niamtu performs all surgeries so there is never a doubt about whom is doing your surgery. He has written one of the most popular textbooks in the field of cosmetic surgery and his facelift chapters are well recognized on an international basis.
Types of Face/Neck Lifts
Click a photo below to view information and thousands of pictures of various types of facelifts performed by Dr. Niamtu.
Facelift surgery is probably the best-known cosmetic facial procedure and is the absolute gold standard for lower face and neck rejuvenation. Although there are many new technologies that supposedly address skin and neck tightening, none of these can come close to the improvement and longevity of traditional facelift surgery.
Facelift surgery was developed and refined over a century ago and has undergone many changes. The facelift that your parents may have had is not the same as today’s contemporary techniques. A generation ago, a facelift had an average hospital stay of 3-4 days. Most of our patients today are home by 2:00 the same day and have the procedure performed in our fully accredited surgery center . With the recent advances in instruments, technology and anesthesia, facelift surgery has never been easier or more affordable.
Another difference in today’s facelift patient is the age. Today’s patients do not want to wait until they look old to have cosmetic surgery. They want to stay younger looking all their life. In the past, most patients waited until their sixth decade and underwent a big operation with an extended recovery. Today’s patients opt to have smaller procedures along the way and avoid the overhaul their parents had. Performing smaller cosmetic procedures along the way may require the patient to have them again later in life, but again, they will avoid looking aged.
If it sounds too good it probably is! Don’t be fooled by any technology that reports facelift type results without surgery. This includes Thermage, Fraxel, Ulthera, CoolSculpting and Thread Lifts. This is not to say that these therapies do not have merit, but they cannot hold a candle to the improvement and longevity of contemporary facelift surgery. We routinely see patients in our office that were treated somewhere else with a “new miracle technology” to tighten their face and neck and are embarrassed and frustrated that they wasted enough money to have paid for a real facelift. If any doctor reports significant results from a non-surgical procedure, ask to see 20 STANDARDIZED before and after pictures at least 1 year after the procedure. Also make sure they are pictures of actual patients taken by this doctor and not company pictures. If someone can show you results like this, then the procedure may be worth consideration. So far we have never seen any technology meet this challenge. We see many disgruntled patients every month who wasted their hard earned money on a promise that sounded too good to be true.
Facelifts are like snowflakes as no two procedures are exactly the same. Each patient has different aging characteristics and requires customized treatment. Failure to observe this fact will result in an unnatural appearance. Dr. Niamtu treats each patient in a specialized manner to address their own personal aging, which is never a “cookie cutter” treatment. Dr. Niamtu has performed 1,000 facelift surgeries and strives to provide a natural result through age appropriate elegance.
One interesting question is “What is a facelift”? Different patients and doctors have different definitions for this. In reality, a facelift is a procedure with incisions in front of and/or behind the ear and under the chin. A facelift by definition tightens the lower face and neck. Some patients have a facelift and at the same time have other surgical procedures such as eyelid surgery , brow surgery , etc. Some patients call the combination of all of these procedures a “full facelift, which is antiquated nomenclature. A facelift by itself addresses the lower face, jowls and neck. Facial aging changes elsewhere on the face are treated with additional procedures at the same time or later, depending on patient preference.
The best way to understand facelift options is to realize that facelifts come in three sizes; small, medium and large. Patients with minor aging need small lifts, patients with moderate aging need a medium lift and patients with major or severe aging need a larger lift. The “medium” and “large” facelifts are basically the same operation adjusted to the patients aging. The “small” or “weekend” lift is a more conservative procedure but in reality is only suited for a small percentage of patients with minor aging changes. Performing a “small” lift on a patient that needs a larger procedure will produce disappointing results that will not be long lasting.
The above illustration shows the changes that occur as we age . The patient on the left has minimal lower facial aging and would be a candidate for the “weekend facelift” . The patients in the middle and right images have larger aging changes are candidates for the “comprehensive” facelift to address these changes.
There are exceptions to this. For instance an older patient may need a large lift but they may not be healthy enough for a large procedure and may need to settle for less improvement with a smaller surgery. A similar situation may be a patient who needs a bigger procedure but does not have enough time off work or finances for the bigger procedure. These patients may settle for moderate improvement as a trade off.
In our practice we sometimes refer to the small lift as a ” weekend facelift ” because much of the healing occurs over that period. It is not uncommon for patients having this type of lift to have surgery on a Thursday and return to work on the following Tuesday. We also refer to the medium size facelift as a ” minilift ” as it is a conservative procedure for moderate aging. We refer to the larger lifts as a ” comprehensive facelift “. This is a more extensive procedure for moreaging of the face and neck.
How do I know if I need a “Full” Facelift?
Comprehensive Facial Rejuvenation
If you look closely, you will notice that many of the patients on the various facelift pages have had other procedures besides facelift surgery. It is most common for patients to have other cosmetic facial surgery procedures at the same time as their facelift. There is some economy of scale in this case as the patient can have multiple surgical procedures but only endure a single recovery and anesthesia. Also, when multiple procedures are performed at the same time the fees are frequently discounted. The biggest advantage of multiple procedure surgery is the ability to perform comprehensive rejuvenation with a single recovery and anesthetic. If a patient is in good health, there is usually no reason not to perform multiple simultaneous procedures if the patient desires.
It is important to remember that all cosmetic surgery is elective. Some patients desire to take baby steps and perform only a single procedure at a time. This type of patient may do their eyelids this year, a facelift next year, etc. On the other hand many patients prefer to get as much rejuvenation as possible from a single surgery and recovery. Each case is different and Dr. Niamtu can assist your decision making process.
There are four main things that determine what type of surgery can be performed and if multiple procedures are possible.
- The patient’s desires and expectations
- The general health of the patient.
- The ability to take time off of work or play.
- The budget of the patient.
If a patient is healthy, then multiple procedures are usually not a problem and routine facelift surgery can be performed. Since we are a fully accredited surgery center, we have most of the same requirements as local hospitals and all patients receiving facelift surgery must see their physician for history, physical and appropriate lab exam. Patient safety is our primary concern.
If a patient can only take one week off of work, then conservative procedures must be considered. Generally, larger procedures or multiple procedures require two weeks of recovery. The larger facelifts have about a two week recovery. Patients that have the ability to work at home can usually do this after the first week. Some of our patients occasionally return to work less than two weeks and once in a while a patient many take longer than two weeks, but our average patient is presentable by 2 weeks. Not two weeks before your class reunion! If a patient is having surgery in advance of an important event such as a family wedding or reunion, Dr. Niamtu recommends that they have their surgery 4-6 weeks before the big event. It is interesting that most patients want to keep their surgery a secret, while others will go back to work after a week and show off their healing surgery. Our staff can assist patients in getting back to work as early as possible and much can be hidden with hair and makeup.
When Should I Have a Facelift?
Patients often ask when they should have a face lift and how long will the effects last? Basically, a patient is a candidate for a facelift when the jowls (excess skin under the cheeks) and neck skin begins to sag. Put simply, if you think that you need a facelift, you probably do.
To get an idea of how you may look with a facelift, lie on the floor on your back, lift your chin and hold a mirror over your face. This counteracts the effects of gravity and can simulate the basic improvements of the face and neck that can be achieved with cosmetic facial surgery.
How Long Will My Facelift Last?
This is a very common question. In some respects the surgery will last forever. If I had a 55 year old patient with a twin and I performed a facelift on the patient but not the twin, the patient will pretty much always look younger because we turned back their clock.
Although we can turn back the clock, we can’t stop it, so all patients will continue to age. Most minimally invasive procedures will not last as long as more comprehensive ones. Dr. Niamtu performs facelifts that involve treating multiple layers of the face the neck including the muscle, connective, fat and skin. This type of facelift is more complex and precise and takes more effort on the part of the surgeon, but studies have shown these techniques to last 10-15 years. This does not mean that on the tenth year everything falls, but simply that as we age, the tightened tissues will slowly begin to sag with time. In rare cases some patients with elastic skin or weight gain may need a touch up procedure sooner after a lift. Other patients with healthy skin and those that take care of themselves may have cosmetic results that last 20 years or longer. No one can provide a guarantee on how long any cosmetic procedure will last and many variables are involved including the patients genetics, healing and after care as well as what type of surgical procedure was performed. One thing that can be safely said is that facelift surgery in experienced hands is an excellent long term investment.
The photo below shows one of Dr. Niamtu’s patients that had a facelift in 2002 and is shown before, after and 10 years after the facelift. Although the patient has continued to age, her lift has remained stable over a decade.
Does any of my hair need to be cut during the facelift procedure?
Absolutely not! Contemporary facelift surgeons pay extremely close attention to preserving the patients natural hairline. Although some surgeons do shave portions of the hair during facelift surgery Dr. Niamtu does not.
The Facelift Procedure
Most patients that present to discuss facelift surgery are apprehensive because the word “facelift” is scary. A generation ago, a facelift was much harder, took much longer to recover, required unplesant anesthesia and was more expensive. Patients are also nervous about the incisions and the final result. These concerns are understandable and it is easy to put their minds at ease regarding the common misconceptions regarding facelift surgery. Advances in outpatient anesthetic techniques have produced treatments with faster recovery and less complications such as nausea. Finally, the incisions are truly hidden and rarely problematic. Dr. Niamtu goes to great lengths to use the smallest incision techniques available and to make incisions that will be hidden and look natural. There is never a need to shave any hair as some patients fear. As for the “result”, today’s facelifts are much more natural when performed by surgeons that truly understand the face. For almost 30 years, Dr. Niamtu has limited his practice to surgery of the head and neck and has always been a “student” of the face. He understands that contemporary facelift surgery involves not only tightening, but also restoring youthful volume. It is easy to make a patient look tighter, but with modern techniques such as facial implants, fat transfer and filler injection, they can look younger and not just tighter.
For the medium facelift and larger facelifts the incision is made in front of and behind the ear. The incision is hidden in the hair in the sideburn area and behind the ear. It is also hidden inside the ear and behind the lobe and the ear (above right image). In reality, very little of the actual facelift incision is visible to others.
For the small or weekend type facelift the incision is only in the front of the ear as shown in the image (below left). This very conservative incision makes this a perfect procedure for the patient with minor aging changes desiring minor to moderate correction without significant downtime.
Facelift incisions heal extremely well and are rarely a problem in terms of scars. If an ungraceful scar does form, it can be improved with laser resurfacing. The images below are typical of healed facelift incisions and many other examples of Dr. Niamtu’s incisions can be seen in our incision gallery .
This patient is shown 90 days after comprehensive facelift and her healed incisions are barely visible. Dr. Niamtu takes great care to perfrom hidden and natural incisions.
This patient is shown 8 weeks after facelift with the hidden incisions described above.
The Truth About Facelift Surgery
This 3 part video series explains the truth about facelift surgery. Warning: Live surgery video in the third episode is graphic and may not be suitable for all patients.