Face Lift

Facelift and Neck Lift Overview

Dr. Niamtu has been performing face and neck lift surgery for over 20 years and this website represents transitions through these decades of experience.  His current technique is deep plane face and neck lift which is a culmination of experience in over 1,600 facelifts.

Don’t miss our Facelift Video Page for the most information.

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 facelift and neck lift surgery. The other pages in the facelift menu provide specific in depth detail on various aspects of facelift 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 over 1,600 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 deep plane 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 5 editions of some of the most popular textbooks in the field of cosmetic surgery. My facelift contributions are well recognized on an international basis, and I have lectured on face and neck lift surgery on six continents. I love facelift surgery and it remains the focus of my practice. I also perform the other common procedures done at the same time as facelift such as eyelid surgery, brow lifts, facial implants and more.

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.

Call Today! 804-934-FACE (3223)   Schedule a Consultation

Dr. Niamtu has many more facelift videos 

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 4:00 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.  Dr. Niamtu performs deep plane facelift technique.  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. . 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 a more conservative lift. The patients in the middle and right images have larger aging changes are candidates for the a more comprehensive facelift to address these changes.  Dr. Niamtu performs deep plane face and neck lift for his procedures.

How do I know if I need a “Full” Facelift?

Click here to view Dr. Niamtu’s Blog on this confusing question

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.

Today’s patients frequently have face and neck lift surgery at a younger age as they don’t want to wait till they look old, to look young.  In other words, they want to reverse aging changes before they come severe.  In reality there is no specific age for a facelift.  We do them on 39 year old patients with premature aging and 85 year old patients who are still conscious about their appearance.  When patients ask me when is the optimum time for a lift I smile and say “when you can’t stand it”!

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.  The incision in front of the ear can be made just in front of the tragus or just behind it and numerous factors go into this decision.  Both way produce excellent aesthetics.

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.

Facelift, side view
Facelift, side view

TO see many more pictures of facelift with chin implant click here

Dr. Niamtu has an extensive facelift video collection

click the above link to view Dr. Niamtu’s facelift videos.

Click Here for Dr. Niamtu’s Facelift Videos

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 and uses deep plane facelift technique. Paying close attention to our instructions also helps reduce post operative problems.

Some Kind Words from facelift patients


5 out of 5 stars

Wow! You must have ESP, I was just thinking a couple of days ago I never did get these pictures and then you send them. Thank you. I wanted you to know I think you are a wonderful doctor and you did a great job, also your staff was awesome. It was well worth being out of commission for the recoup time (which actually was not that bad). Thanks so much to you and your staff.

- Sandy


The changes are amazing!!!!
5 out of 5 stars

Dear Dr. Joe, Thank you for sending the before and after pictures. I have been staring at them all afternoon. The changes are amazing!!!! I am so very pleased and grateful to you. All the bags and dark circles are gone from my eyes (I have eyelids again!!!) and my saggy jowls and wrinkly neck look so much better all thanks to you and your talent and skills. I can't help but smile now every time I look in the mirror. Even my husband has noticed a change for the better in my disposition. I could go on and on about how happy I am with the results and the entire experience (including your knowledgable and friendly staff) but suffice to say I would do it all again tomorrow and recommend it to anybody who wants to change something if it will make them feel better about themselves like it did me.Forever grateful, KayP.S. I am planning to have the laser procedure done this fall.

- Kay


The right surgeon for the job...
5 out of 5 stars

I traveled from the West coast to have my surgery performed by Dr. Niamtu. Though I had never met him in person, I felt that he was the right surgeon for the job. I sent photographs to his website He viewed them personally and called to discuss my expectations. He even suggested that I wait on surgery unless I was particularly distressed by my appearance. He NEVER pressured me into surgery. I flew to Virginia and had an informative conversation with him and again he asked if I was sure about surgery. I was and I am extremely satisfied because he took no shortcuts. His technique is meticulous and exacting. I live 20 minutes from the cosmetic surgery capital (California) yet I feel I choose the best surgeon for my needs. Interestingly enough my husband who accompanied me on the trip said he didn't like Dr. Niamtu (said he was full of himself) after the consultation his whole attitude changed. Dr. Niamtu was humble, gracious, informative and set everyone at ease.

- Anonymous


Click here to view above letter

Since Dr. Niamtu has performed over 1,600 facelifts and performs deep plane face and neck lift his contemporary videos are here.

The videos below may be older but still full of useful information for patients considering face and necklift surgery