Facelift and Neck Lift Overview
Most of this website is written in the third person as it conveys my teams efforts. I am writing this page in the first person as facelift surgery is so personal to me!
This page is designed to provide some basic explanations of face and neck lift surgery. The other pages in the facelift menu provide specific in depth detail on various aspects of face and neck lift. If you are considering this surgery, please get a glass or cup of your favorite beverage and spend some time on these pages, I guarantee it will be time well spent. Don’t forget to look at my videos and hopefully you will understand why I have developed one of the largest facelift practices on the East Coast.
Facelift surgery is my clinical passion and signature procedure. I do not perform body surgery my concentration is totally on the face. I have performed over1,300 facelift procedures and do over 100 a year, which is many times the number performed by the average cosmetic or plastic surgeon. I do not perform “quickie” or short-cut procedures, but rather contemporary comprehensive lifts that address aging changes properly for natural and long lasting result.
I perform all surgeries so there is never a doubt about whom is doing your surgery. I am a surgeon, teacher and author and I have written one of the most popular textbooks in the field of cosmetic surgery and my facelift contributions are well recognized on an international basis. I have lectured on face and neck lift surgery on six continents which remains the focus of my practice.
It is possible to hide mediocre body surgery with clothes, but the face is right there out in the open for the world to see. If you don’t look good, I don’t look good. It is your face and my reputation, so safe surgery and natural results have always been my goal.
1,300 facelifts and going strong
We performed our 1,300th facelift and neck lift this year on 11-23-20. This is a goal that few cosmetic surgeons reach, but because Dr. Niamtu only does faces and because of this, he performs many more lifts than the average cosmetic or plastic surgeon. He performs over 100 lifts a year and face and neck lift has remained his signature procedure.
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 traditional surgery. It seems that everyone is touting some alternative to facelift surgery, but they cannot hold a candle to the improvement and longevity of contemporary facelift surgery. I 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 I 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.
What is a Facelift?
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. I treat each patient in a specialized manner to address their own personal aging, which is never a “cookie cutter” treatment.
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.
In my practice I 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. I also refer to the medium size facelift as a “minilift” as it is a conservative procedure for moderate aging. I refer to the larger lifts as a “comprehensive facelift”. This is a more extensive procedure for more aging of the face and neck and in reality is what most patients need.
Weekend lifts and mini lifts sound great and are fine for the correct patient, but in reality these smaller procedures don’t address aging or last as long as the more comprehensive lifts.
Dr. Niamtu performs Deep Plane and SMAS face and neck lifts with the goals of safe surgery and predictable outcomes.
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 there is only a single surgery center and anesthetic fee. 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. Some of my happiest patients perform multiple procedures at a single setting while other patients are more conservative an opt for single procedure surgery. When I sit down to perform surgery, I love it and what is best for the patient is best for me. 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 I 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 and most importantly “what bothers them”
- The general health of the patient.
- The ability to take time off of work or play.
- The budget of the patient.
Patients should never be “talked into” a procedure. Remember, this is elective surgery and you should only do what bothers you. Good surgeons may suggest various procedures but should never be pushy. I provide each patient a “menu” of procedures that I think would benefit them and let them they don’t need to get everything on the menu. In the end it is up to the patient. Patients should be skeptical with surgeons that insist a procedure.
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 tests (if applicable). 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. I tell patients they will be on their phone the next day and their computer in 2-3 days. 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 two weeks. This is 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, I recommend 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 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. Dr. Niamtu does not shave any hair during facelift surgery.
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, anesthesia was more difficult. 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. 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 (shown below). 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 (shown below). This very conservative incision makes this a perfect procedure for the patient with minor aging changes desiring minor to moderate correction without significant downtime. Most patients that are over 45 are not candidates for such a small lift.
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 perform hidden and natural incisions. This patient is shown 8 weeks after facelift with the hidden incisions described above.
Chin Implants can enhance facelift results
Many patients have recessive chins which can affect the normal and youthful profile. Performing a face and neck lift on a patient with a recessive chin can lessen the positive results of the operation. A chin implant is a simple procedure that is performed through the same “under the chin incision” used in the facelift. Enhancing the chin with an implant is a very small procedure that can make a big difference on the final result. The patient shown below is a great example of how a chin implant can enhance a facelift result. Although a facelift without a chin implant would have tightened this patient’s skin, the implant allows a more normal and youthful profile.
Dr. Niamtu has an extensive facelift video collection
Every Surgical Procedure can have risk or unpredictable results
Severe complications are very rare when performed by experienced facelift surgeons. All patients differ in their anatomy, recovery and healing potential. Detailed discussion of these details will be covered during the preoperative process. Dr. Niamtu strives for patient safety and natural results. Paying close attention to our instructions also helps reduce post operative problems.
More information about Facelifts from Dr. Niamtu's library of articles
These are common complaints that will improve or resolve over the first days or weeks of recovery.
Dr. Niamtu discusses the art of making natural and invisible facelift incisions.
Dr. Niamtu discusses the importance of platysmaplaty in face and neck lift.
Having great facelift results with invisible scars and telltale signs has everything to do with choosing the right surgeon.
For more information about these procedures or cosmetic facial surgery in general visit www.lovethatface.com
Joe Niamtu, III DMD
Cosmetic Facial Surgery
One of our favorite patients discusses her cosmetic facial surgery experience with Dr. Niamtu. This patient underwent facelift, eyelid surgery and chin implant. It is our honor to have such wonderful patients.
For more information about facelift surgery or Dr. Joe Niamtu, III visit www.lovethatface.com
Cosmetic surgery can improve aesthetics and self-confidence and can be very rewarding to the patient and surgeon. I am so lucky to have so many great patients like the one in this video.
Joe Niamtu, III DMD
Cosmetic Facial surgery
TV commercial where Dr. Niamtu talks about removing decades of aging with Facelifts / Necklifts
This is a letter from a pleased facelift patient.
Dr. Joe Niamtu, III cosmetic facial surgeon in Richmond, Virginia discusses face and neck lift surgery options with ABC TV Channel 8 Richmond’s Matt DiNardo.
Facelift surgery is the ultimate cosmetic procedure for improving aging of the lower face and neck. Dr. Niamtu frequently recommends chin implants for facelift patients as this small procedure can make a big difference in the result of the facelift. A simultaneous chin implant can enhance the facelift by extending the chin and thus improving the profile. In addition, some patients develop a droopy chin (sometimes called a “witch’s chin”) and a chin implant can lift and support the sagging chin which greatly enhances the facelift. Browsing the pictures in the facelift pages on this site will show numerous cases of facelift with simultaneous chin implant augmentation and illustrate the beneficial effects of combining these two procedures.
The patients below had simultaneous facelift and chin implant surgery.
This is a frequently asked question and the answer is frequently no! Dr. Niamtu routinely sees plus sized patients that were told by other surgeons that they needed to lose 50-80 lbs. before having a facelift.
As long as patients are in good health, many patients who are overweight can successfully have facelift surgery without losing weight. Dr. Niamtu employs a progressive sculpting technique along with his comprehensive facelift and submentoplasty and has produced very dramatic results in plus sized patients. The fact is that many patients have much more skin than fat in their face and neck. In many plus sized patients, the face and neck fat can be liposuctioned and sculpted to slim and tighten the face and neck.
The patient above is shown before and after facelift surgery by Dr. Niamtu employing facelift with submentoplasty and progressive sculpting.
Dr. Niamtu’s procedure for facelift surgery on full figured patients has been featured in Cosmetic Surgery Times Magazine who termed it the “Diva Lift”.
After performing almost 1,000 facelift procedures, Dr. Niamtu has been able to eliminate bandages and drains from all facelift operations. The only bandage Dr. Niamtu uses with facelift surgery is a light “collar” that fits loosely around the neck which is only required for the first night after surgery. In addition, Dr. Niamtu does not use traditional bulky drains with facelift surgery. Eliminating drains and bandages has greatly streamlined the post operative recovery for patients.
The decision to have cosmetic surgery is a big one and involves much planning on the part of the surgeon’s office and patient life. It is not a decision to rush into and experience has shown that patients that rush into surgery without the proper planning and details have more problems than patients that think out and prepare for the process.
It is somewhat different for the experienced surgeon as we do numerous surgeries every day. Although Dr. Dr. Niamtu has performed over 20,000 facial surgery procedures, each patient presents a unique recovery process due to multiple variables.
A younger patient, with numerous local family members and a supportive spouse may have a great recovery experience. She has plenty of help for transportation, post op care, errands, food preparation and spousal support. All she has to do is heal.
A different patient may be older, not have a group of friends to assist, no one to help her at home with chores while she is recovering. She may also have a family member who is not supportive as they may have been against her decision to have surgery and now have to care of her. “I told you that you should not have done this” are not words any patient wants to hear when they are recovering.
So, what is a Caregiver?
The word caregiver should not be used loosely when referring to the recovering cosmetic surgery patient. A caregiver can be a spouse, a family member, a friend, or a professional caregiver or nurse. A caregiver “gives care”. As simple as that sounds, it is a problem for many patients.
Cosmetic surgery patients can be impetuous and impulsive. They make their mind up to have surgery and jump into it without much planning forethought. When asked about a caregiver, these patients may say “oh, I am fine my daughter will take care of me or my husband will take care of me.” The problem is that her son is 18 and not very dependable; he knows very little about taking care of a surgical patient and won’t be able to take her to the bathroom or perform other personal recovery functions. The husband may be an older man or have arthritis and may have physical difficulty getting the post anesthesia patient into the car at the office and then get the patient out of the car and up two flights of stairs at home. The bottom line here is that “all caregivers are not created equal”.
Why Do We Need a Caregiver?
The level of the caregiver depends upon the cosmetic procedure performed. For instance, a patient that came to the office only for upper eyelid surgery may not require any assistance. On the other hand, a patient that just had a facelift, upper and lower eyelid surgery, full face laser and cheek implants will have a lot more discomfort, swelling; require more wound care and ambulatory assistance. A young healthy person may do well without help where an older patient can’t do it.
When a patient is healing, depending upon the procedure, some are very swollen, some have blurry vision, some may have nausea or vomiting, some may require various level of wound care and some may simply need an understanding and compassionate person for emotional support.
The best way to think of it is “who would you leave with your children or grandchildren to baby sit?” It certainly would not be just anybody; you want an honest, competent, engaging and physically able person to guard your precious family. The same goes for a caregiver. You have to have someone smart enough make decisions and dispense medications on the proper schedule. You have to have someone strong enough to assist with lifting, walking, and trips to the bathroom. You need someone mature
enough to understand the physical and emotional needs of a recovering patient and the ability to fully support them. m
How Long Do I need a Caregiver?
That is a variable question and depends upon your age, health and how much surgery you had. The short answer is usually 24-28 hours. Some patients only need a caregiver for the first several hours and then do fine, others need longer support. If the patient has eye surgery or is on pain medicine, they cannot drive to the office. You need a caregiver until you can perform normal daily functions unassisted.
Who is the Best Caregiver?
Again, most responsible adults can provide basic post-surgical support. Our office can provide nurses or non-nurse professional caregivers to assist patients from a matter of hours or days. Recovering patients should not be in direct contact with sick family members or any infections. Also direct contact with pets can provide a source of infection. You definitely don’t want to sleep with your dog while recovering from your surgery.
Who is an Inappropriate Caregiver?
Back to the baby sitter analogy, don’t trust your care to someone you would not trust to care for your children or grandchildren.NEVER lie to your doctor and say that you have a caregiver when in reality you do not. This has happened and seriously complicates the entire process.
What do We Suggest?
For smaller procedures, your spouse can probably suffice. If you are having a facelift with other simultaneous procedures, we recommend a private duty nurse or non-nurse professional caregiver for the first night.
Joe Dr. Niamtu, III DMD
Cosmetic Facial Surgery
Like any surgical procedure all patients heal differently. Most patients require at least 2 weeks of recovery after a bigger lift. Some patients heal faster and some take a few more days.
The patient below is shown throughout her healing process after facelift and laser to lower eyelids and facial scars and is featured in the video below.
The following video follows a facelift patient through 8 weeks of recovery
The video below shows a patient 1 day, 1 week and 3 months after facelift and full face CO2 laser. Well all patients recover at a different rate, this patient is typical for facelift and laser.
The following video is a patient of Dr. Niamtu’s seen at her 24 hour follow up. She underwent comprehensive facelift with platysmaplasty, upper laser assisted blepharoplasty and full face comprehensive CO2 laser resurfacing. This is a good example of a patient with an easier recovery. Recovery is variable and some patients breeze through and others find it more challenging. Attitude, family support, preparation and understanding of what to expect can make a big difference.
The same patient is shown at 6 days after her procedure.
The patient below underwent facelift chin implant and lower eyelid laser. She is shown at 2 weeks after surgery.
The same patient is shown below at 90 days after surgery
Facelift recovery must be discussed in relative terms because smaller facelifts have smaller recovery times and larger lifts have bigger recovery periods. Also there is individual variation between patients. A patient with a small (“Weekend Facelift”) facelift may only need 4-5 days to recover while a patient with a very large facelift may need 2 weeks or more. Our average facelift is the minilift and most of these patients are able to return to work or play in about 2 weeks.
The patient shown on the left had a larger (Comprehensive Facelift) facelift and eyelid surgery and is shown 7 days after her lift. Her before and after picture is shown below at approximately one month after surgery. Not all patients have this small degree of swelling and bruising. Some are similar and some have more.
The patient below is shown 2 weeks after comprehensive face and neck lift.
SMAS stands for superficial musculoaponeurotic system and represents the deeper tissues in the face. It is a well recognized fact that the SMAS must be tightened to achieve a tight, natural and long lasting facelift.
Some surgeons do not routinely treat the SMAS tissues when performing facelift surgery. These types of lifts simply do not last as long as when the SMAS is treated. BEWARE of a skin only facelift; it may be faster and cheaper, but will not last as long. Dr. Niamtu discusses the importance of treating the SMAS in facelift surgery in his textbook on cosmetic facial surgery.
Although there a numerous ways to treat the SMAS layer in facelift, Dr. Niamtu generally uses a procedure called SMASectomy. In this procedure, a section of the SMAS is removed (middle picture below). This serves to not only slim the facial region, but allows the edge of the SMAS excision to be pulled towards the ear and sewn together. This produces maximum tightening of the SMAS which will serve as the foundation of a long lasting, natural appearing facelift. Dr. Niamtu uses numerous, deep permanent sutures in this region which helps the result last. Some surgeons place 1-2 “purse string” sutures to support the SMAS which can easily stretch or tear and affect the final result.
The left hand figure shows a representation of the SMAS under the skin. The middle figure shows a SMASectomy where a section of excess SMAS tissue is removed. The right hand figure shows the SMAS tightened and sutured with permanent sutures.
The goal of a facelift is to provide a natural appearance and avoid an “operated look”. Ideally, only the surgeon, the patient and his or her hairdresser should know.
Virtually all but the smallest facelifts require a procedure called platysmaplasty or submentoplasty. This step is omitted by many surgeons as it is more technically difficult and takes more time.
If you are considering having a facelift make sure to ask you surgeon if he or she will be addressing the midline platysma muscles and submental regions. A tighter, longer lasting and more natural result will result from these important procedures. Unfortunately, some surgeons are simply lazy and do not perform them. A facelift without addressing the midline deep tissues may look fine for a year or two, but when the neck bands and sagging return, patients will wish they had this performed.
The image above shows a left sided platysma muscle. Dr. Niamtu comprehensively addresses this muscle by tightening the platysma muscle in the center of the neck (this improves neck bands and “turkey neck”) and the lateral platysma which also creates a natural appearing, long lasting lift. Submentoplasty involves tightening the deep tissues of the floor of the mouth, which is also very important to improve chin/neck aesthetics. Liposculpture involves sculpting the excess fat in the chin, floor of the mouth, neck and at the border of the jaw. Some of this fat is “bad fat” and needs removed with liposuction, while much of the fat under the skin is “good fat” and is needed for a natural result. This fat is not suctioned away, but rather is sculpted to blend in and provide youthful contours of the unique area of the chin, jaw border and neck. Over treating the fat in this region will make a patient look gaunt or cause irregularities.
The above image shows how Dr. Niamtu tightens the aging platysma muscle in the midline of the neck
We all have different sizes and shapes and some patients are better candidates than others based upon their anatomy. The position of the structures of the voice box (larynx), hyoid bone and muscles of the floor of the mouth may determine the relative appearance of a facelift result. Patients that have these anatomic structures located higher and further back in the neck (top images) are better candidates for the “90 degree neck” as there is room to move the excess skin back into an acute angle.
Patients that have these anatomic structures located low and forward in the neck (bottom images) do not have the space to pull the skin back into and even with face and neck lift, may still exhibit a more obtuse (curved) neck. The bottom line here is that some patients will get a more angled neck from facelift surgery than others and must realize this before surgery.
Patients with the more rounded necks can enhance their results by having a procedure called submentoplasty which can in some cases reduce the roundness. A chin implant can also extend the front of the lower jaw so that result is more angular.
The picture above shows the difference between neck anatomy and possible facelift outcome. The top images show a normal neck with the structures lying high and rearward. This allows the skin to be pulled back at almost a 90 degree angle. The bottom images show neck anatomy that is lower and more forward. Even when pulled tight, the neck will be less angled than the normal neck. Submentoplasty and or chin implant surgery can help this type of anatomy to have a more angular result.
The video below shows Dr. Niamtu making actual facelift incisions with Radiowave Surgery and also using a scalpel. Some patients desire to see actual surgical procedures, while it makes other patients uneasy, so only view the video below if actual surgical footage does not bother you.
Although there are many types of facelifts, Dr. Niamtu performs a multiple layer lift. This means that not just the skin is tightened, but the deeper layers as well. This type of lift is more technically difficult but the lift is superior, its results last much longer than skin only techniques.
The patient is sedated with IV anesthesia, and local anesthesia is used as well to decrease the amount of anesthetic drugs necessary. The local anesthesia also reduces blood loss and controls pain when the surgery is finished.
Like most things in life, there is no clear cut answer for this question, but doing some homework can pay off in the long run. There are several misleading myths that confuse patients. Myth number one is “only have a board certified plastic surgeon do your surgery”. Obviously, your surgeon should be board certified, but his or her specialty has very little to do with their competence and outcomes. This myth is propagated as a marketing tool for plastic surgeons. It is like saying “a Lexus is the only safe car”; we can all see through statements like this. In reality there are numerous types of competent specialists including plastic surgery, ENT, oral and maxillofacial surgery, dermatology and ophthalmology that excel at facelift surgery. The actual specialty is much less important than the experience of a surgeon. Most patients would choose a surgeon from, say a dermatologist that performs several facelifts a week instead of a plastic surgeon that performs one a month. Although there are many talented plastic surgeons that excel at breast and body cosmetic surgery, they may have very little cosmetic facial surgery experience and only “dabble” in facelift surgery. A oral and maxillofacial surgeon or ENT trained cosmetic facial surgeon are likely to specialize in head and neck surgery only.
The second myth is that “new facelifts” can be done with the same results but much less anesthesia, recovery, downtime, incisions, etc. As you browse the facelift pages on this site, you will understand why this remains a myth.
The following are some important indicators to consider when choosing a surgeon.
- Is your surgeon board certified in a specialty that deals with the face?
- Do they operate only in an accredited surgery center?
- How many facelifts does your surgeon perform a week?
- Can your surgeon show you hundreds of before and after pictures of their own work?
- Is your surgeon involved with teaching and scientific publishing on the topic of facelifts?
- Can your surgeon provide you with patients that have had facelift surgery to discuss their experience?
- Can you get in touch with your surgeon if you have a problem? Cell phone?
- Does your surgeon “dabble” in facelift surgery or is it one of the major parts of his or her practice?
Dr. Niamtu is very involved with teaching facelift to other surgeons in the USA and abroad. He teaches specialties including Facial Plastic Surgeons, Plastic Surgeons, Ocuolplastic Surgeons, Oral & Maxillofacial Surgeons, Dermatologists and other surgical specialties. Dr. Niamtu has written a comprehensive textbook about cosmetic facial surgery and facelift surgery, authored a comprehensive DVD live surgery series and has numerous publications on facelift surgery. In addition he is considered an opinion leader on facelift surgery and is frequently interviewed by cosmetic publications and TV and radio media .