Apples and Oranges: Not all Facelifts are Equal

My favorite surgical procedure is facelift and I am one of the busiest facelift surgeons in the state, as I will do about 90 face and neck lifts a year. The average plastic surgeon performs less than 10 facelifts per year (1). The reason I enjoy performing facelifts is that it is truly the ultimate rejuvenation procedure.

No other procedure carries the physical and emotional impact as a well done facelift. You can hide mediocre breast or abdominal surgery, but with a facelift, there is no hiding. Good facelift surgeons are busy as you can’t do poor face and neck lifting and have repeat business. My biggest source for new facelift patients is referrals from previous patients on whom I performed face and neck lifts. The mere word facelift is very confusing. You hear upper facelift, lower face lift, full facelift, half facelift and facelifts named after people or franchises. A true facelift is called a rhytidectomy which literally means to “remove wrinkles”. This procedure has been around for a century and is still the basis of a “real” facelift.

Over the past century, surgeons have attempted to manipulate the real facelift procedure by omitting steps in the hopes of making it easier or shorten recovery. The problem is that every single step of the classic facelift procedure is integral to have natural and long lasting results. If one step is omitted, then the result is affected. Like so many other things in life, there is a right way to do something and a short cut way to do something and rarely is the short cut as good as the correct way. The same thing goes with facelifts. It is very fashionable for certain surgeons or corporate franchises that advertise on TV to promote “short cut” facelifts. The TV commercials often imply that the procedure is “revolutionary” or a “medical breakthrough”. Frequently, the procedure sounds too good to be true; “no anesthesia, minimal recovery, affordable”. Remember, most things that sound too good to be true usually are. Almost all of these procedures are smaller lifts that omit two extremely important parts of face lifting. Number one is the incision in the back of the ear (figure 1). Many surgeons want to omit this part of the procedure because it is harder to do this technique and takes much more training and experience. It is
this incision that allows the excess neck skin to be tightened in a natural direction. Doing a facelift without an incision behind the ear is OK for very young patients, but even patients in their early 40’s need a bigger lift or they will have excess skin come back in a matter of a year or two.

 Figure 1. This image shows the preferred incision for a true comprehensive facelift. Most of the incision is hidden in the hairline. The dotted lines and dashes indicate areas where the incision is hidden behind the ear. It is the yellow incision that is so very important in facelift surgery. Small or short cut facelifts only use the blue incision and therefor are only 50% as effective in tightening the neck and jowls.

The other frequently omitted step is the Platysmaplasty (figure 2). This important step is done by making a one inch incision under the chin and freeing up the skin and platysma muscle from the deep tissues. Then the platysma muscle is reduced and tightened with sutures similar to a shoe string. This is an extremely important procedure to eliminate the neck bands that appear with aging. Omitting the Platysmaplasty does not address the banding in the neck and the patient will still have banding or it will return in a year or two. Doing a small lift will produce small results and short longevity when compared to a more comprehensive lift. I always perform facelift surgery with all the comprehensive steps and techniques that enable a safe, natural and long lasting result. 

Figure 2. The above image shows the Platysmaplasty procedure which is an integral part of all facelifts.

Figure A show the sagging and pulled apart muscles and figure B shows how they are trimmed and sutured for a tight and long lasting sculpted chin and neckline.

So, back to the Apples and Oranges. A short cut facelift cannot and will not be as effective as the classic procedure. It can’t! You cannot omit important steps and get the same natural and long lasting result. Before patients make a significant investment in money, time and recovery they should carefully research the procedure. It is imperative to know exactly you are getting done (or not getting done) and the experience of the surgeon who is doing it. If you are considering a facelift that does not utilize an incision behind the ear or does not include a platysmaplasty, beware. You are not getting the comprehensive procedure that has proven safe, natural and long lasting for almost a century.

You get what you pay for! This is not just in surgical fee, but also in recovery. A facelift that heals in several days cannot compete with a larger lift that takes two weeks to heal. That extra week may seem like a long time, but to reverse 50 years of aging, a two week recovery is not unreasonable. I have no problem with surgeons that perform short cut facelifts. Some of them are beginners and we all do that when we start out. Some of them work for corporate franchises and they have no choice on what lift to offer. I may perform one or two “short cut” facelift each year. These are always on younger patients (rarely over 42) with minimal aging.

Most patients may only have one facelift in their lifetime so it is important to know what you are getting and what you are not getting. All facelifts are not created equal. A comprehensive facelift will have a more dramatic result and last longer than smaller lifts. The recovery will be longer, the surgical fee may be slightly higher but again, you get what you pay for. Also important is who is doing the actual surgery while you are asleep? Dr. Niamtu does 100% of all the surgery from the first incision to the last stitch.

There are many examples in everyday life where you get a bargain on something, but end up with an inferior product or job that is substandard or needs redone. Our facelift fee may be higher than some offices, but rest assured that you are getting a comprehensive procedure without short cuts. You also get the experience of one of Virginia’s most experienced facelift surgeons in Dr. Niamtu as well as access to our fully accredited in office surgery center and caring staff.

They say there are no bargains when shopping for parachutes or fire extinguishers. I think your face belongs on that list.

Reference
1. American Society of Plastic Surgeons, 2011 Plastic Surgery Statistics Report.
Joe Dr. Niamtu, III DMD
Cosmetic Facial Surgeon