May 6, 2025 • 23 mins
Drs. Bass and Edinger break down what a facelift can and can’t do.
Facelifts are great for tightening loose skin, lifting jowls, and restoring volume in the face and neck—helping you look more refreshed and youthful. But they don’t address everything. Wrinkles, sun damage, and changes around the eyes and brows usually need other treatments.
There’s a big difference between how facelifts are described online and how surgeons talk about them. The doctors break down that language gap so you know what those buzzwords actually mean.
Bottom line: A facelift is the gold standard for sagging skin, but knowing its limits is key to getting natural-looking results.
Find out who’s a good candidate for a facelift, how long the results typically last, and whether combining it with other procedures might give you the outcome you're really looking for.
Learn more about facelift surgery
About Dr. Kylie Edinger
Dr. Kylie Edinger is a plastic surgeon currently spending a year training as an aesthetic plastic surgery fellow with Dr. Bass and a host of other world class plastic surgeons at Manhattan Eye, Ear, and Throat Hospital in New York City. She’s part of the prestigious Northwell Health program—one of the top aesthetic plastic surgery fellowships in the country. Before making her way to NYC, Dr. Edinger completed her plastic surgery residency at the University of Wisconsin.
Follow Dr. Edinger on Instagram @kylieedinger
About Dr. Lawrence Bass
Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond.
To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc
Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:01):
Welcome to Park AvenuePlastic Surgery Class,
the podcast where we explore controversiesand breaking issues in plastic
surgery. I'm your co-host, Summer Hardy,
a clinical assistant at BassPlastic Surgery in New York City.
I'm excited to be here with Dr. LawrenceBass, Park Avenue plastic surgeon,
educator, and technology innovator.
Today's episode is the start ofa new series about the facelift.
(00:25):
What are we talking aboutin this episode, Dr. Bass?
To put it in simple terms,
Dr. Edinger and I are going totalk about what the facelift does
and what the facelift doesn't do.
So overall, what does the facelift do?
The facelift is really aprocedure that number one chases
(00:46):
skin laxity in the facethat's loose or hanging
skin.
It's also a face shapingoperation and increasingly is
associated with facial volumerestoration through things like
fat grafting. So ingeneral, in this series,
when we say facelift,
(01:08):
we'll be referring to the mostcommonly performed procedure,
which addresses featuresin both the face and the
neck.
And in medical terms mightbe called cervical facial
plasty. So that's neck and face.
That's what most patients are having,
except in selected circumstancesvery early in the game
(01:32):
or late in the game or after aprevious lift where only a portion
needs to be redone.
So we'll get to all of thesesubdivisions elsewhere in this series,
but we'll focus most on whatpatients at most ages are
having done.
There's a big difference inthe terminology that beauty magazines and internet
(01:55):
marketing use and the terminology that
surgeons use medically whentalking to each other about
facelifts, that's probablymore technically accurate.
So Dr. Edinger and I willtry to relate commonly used
terminology on the internet withwhat that technically translates
(02:16):
into in the surgery to theextent that that's possible.
Okay, that makes sense.
So who's the patient who shouldbe thinking about a facelift?
So that's another way of sayingwhat does the facelift fix?
Because if you have thethings the facelift fix,
then maybe you should bethinking about facelift.
(02:38):
And that's really thepoint of this episode.
We're talking about what a facelift does,
what it can fix or improveand what it doesn't.
So a facelift is really a surgicalprocedure that's performed in the skin and
the muscular layers of the face andneck with a goal of restoring midface
volume, eliminating jowling,softening nasal labial folds,
(03:00):
and then also creating a cleanerand sharper neckline for patients.
And basically when you thinkof these different areas,
I mean the jowl sits along the jawline.
There's also fullness in an areaabove the jowl just to the side of the
corner of the mouth that's notnecessarily well corrected by a facelift.
(03:20):
That jawline irregularity,as Dr. Edinger said,
is sharpened up and a number of
things in the neck get chased.
Things like vertical bands thatmay come from muscles hanging
skin under the chin and under the jawline.
And also the angle betweenthe vertical part of the
(03:45):
neck that goes from our Adam's appledown or a little bit above that,
and the horizontal part that'sunder our chin that gets more
oblique or obtuse as we age insharpening what we medically
call the cervicomental angle isan important part of the left.
So all of those changes in the necksoftening the nasolabial folds and
(04:08):
marionette lines as Dr. Edinger said.
And part of that is doneby resuspending the midface
and upper face tissues, butparticularly the midface tissues.
And this takes some of thatslack out of the nasolabial area,
but it also brings thetissues back up over the cheek
(04:31):
where they came from and helpsto shape the cheek back to
that youthful uniform shape rather than
individual sags and bagsand flattened areas.
Okay. And how does thefacelift achieve these changes
basically?
(04:53):
To really simplify things,
facelift addresses both the overlyingloose skin that we develop as we age,
and it also addresses that deeper muscularlayer of the face and neck that Dr.
Bass was talking about.
There are several surgical techniques totighten that muscular layer of the face
and neck, which we'lladdress in later episodes,
but all of them serve the same purpose.And for storing your midface volume,
(05:14):
tightening those deeper structures,
removing excess skin and trying to putthings back where they first started
before the aging process kicked in.
And so this draws heavily on
understanding what changestake place during aging,
and we're going to discussthat in an upcoming episode.
What changes in the face as we age,
(05:36):
but we're trying to take thingsthat shrank and maybe fat graft
them, take things that havespread out or descended,
bring them back both atthe skin level and at
the muscle and muscular fascia level.
And that mass layer is basicallyconnective tissue that sits between the
(05:57):
skin and the muscles themselves.
So modern facelift generallyinvolves repositioning
and working on all ofthese tissue planes as part
of the procedure, as Dr. Edingersaid, different ways to do that.
Kind of like saying morethan one way to skin a cat.
(06:18):
Not necessarily a best way,
but a variety of wayswhich we will discuss,
but repositioning those thingsin a vector back where it came
from,
which increasingly is upnot back like in historic
facelifts,
although it's not as simple as thatbecause different layers may and in
(06:39):
different parts of the face and neck,
the direction of draping needsto be somewhat different.
Got it. So when is it the time forthe facelift? Is there a best age?
Well, our statistics tells what'shappening in the United States population.
According to a 2023 statisticfrom The Aesthetic Society in
collaboration with CosmetAssure,
(07:00):
8% of patients are in the35 to 50 year age range,
48% of patients, the majority,are in the 51 to 64 age range,
and 44%, just less than the majority,
are in the 65 age range and up.
So that's kind of the answerto your question Summer by age,
(07:22):
but it's also really about findingsbecause everyone ages according to
a standard kind of process. There arethings that to all of us as we age,
but when those things happenis a little different.
Some people age prematurely,
most people are aging with the herd,
with the whole group ofother folks their age,
(07:43):
and some folks are lucky andthey're aging more slowly.
So if you are noticing a lot of changes,
you can confirm with a plasticsurgeon and they'll tell you what they
think. If they think it's too early,
you're taking your big playing cardof the facelift and using it too soon,
they'll tell you that.
(08:04):
And if they think you should havebeen in five or 10 years ago,
they'll tell you that as well.
But those ages give you a generalsense of who's doing facelifts.
And this is a lot different thanwhen I first went in practice.
When I first went in practice,
facelift age was muchyounger on average than
(08:26):
is today.
And part of the reasonthat age has moved to
older numbers is because we have healthier
lifestyle. We smoke anddrink less, we exercise more,
hopefully we try to eat better,
but also we have all of the nonsurgicaltreatments that help reverse early
(08:47):
aging changes and help slow facial aging.
So I think that's pushed the age up below.
Now we're seeing a trend backtowards younger ages a little bit,
but what those numbers tell youis that very few people in their
thirties need a surgical lift. And if so,
(09:07):
it would probably be some kindof a mini lift. Sometimes actors,
models, newscasters,
people that make their living in frontof a camera or lifting in their late
thirties, but fortieslifting really begins.
Fifties is a hot time for lifting.
But for people in their sixties andbeyond who may not have gotten to it
(09:31):
previously,
you can see that 44% are 65 or older,
so it's not too late if youdidn't get a chance to do it
previously.
And that's still a common agegroup for surgical lifting.
Absolutely,
and I think deciding when to have afacelift like Dr. Bass was saying,
is a very personal choice.There's no set point,
(09:53):
but it's the same for every patient or amagic number that patients should shoot
for.
The best time to do a facelift is whenyou start to notice those changes in your
appearance and they start to bother youspecifically regarding loss of volume in
your cheeks, steepeningof those nasolabial folds,
the jowling along the neckline,loose skin in your neck,
and then banding in your neck as well.
(10:13):
These are all signs of aging that can beaddressed whenever they start to bother
you and whenever you decide you want todo something about them to restore your
appearance, and confidence again.
Yeah, I think that'sexactly right Dr. Edinger.
If it doesn't bother you yet,
you may know you don't lookthe same as 25 years old,
but maybe it doesn't bother you much yet,
(10:35):
then it's probably not timeto have a facelift right then.
However,
if it's starting to really bug you everytime you're fixing your hair or putting
makeup on or getting ready togo out and look in the mirror,
you notice some of those changes or everytime you see yourself in a photograph,
(10:58):
you see that saggy areaand it's bugging you,
that's telling you that maybeit's time to start chasing it.
Okay. So I think I have the ideaof the what, when and how now,
what is it that the facelift does not do?
So if we think about featuresthat are not treated,
(11:18):
they basically fall intoa couple of categories.
There are some things thatwill have a little bit of
impact when you have a facelift,
but if it's your primary concern area,
you should probably be doing adifferent treatment or procedure.
And then there are some things thatthe facelift simply doesn't address.
(11:42):
They're just not part of either theanatomic area the facelift works in
or they're not part of what thefacelift is changing because of how the
facelift works.
And so you need a separate treatmenteither done at the same time,
because we often do afew procedures together,
which can be safely done and doesnot have a big impact on recovery
(12:05):
time or sometimes treatments thatneed to be done at a separate sitting
or separate office visits.
So things like skin quality facelift is
going to reposition the skin,
but your skin is still decadesolder than it was in your twenties,
and you're going to need separatetreatments to make that skin
(12:29):
quality look better,
even though the facelift puts the skinback where it came from. That's pretty
logical.
Things that are outside the anatomicarea of the facelift are things like
eyelid bulging fat or hanging skin
drooping of the eyebrow,
(12:49):
lip wrinkles like lipstick,
bleed lines and crepey changes,
which are analogous to wrinklesin the lip that occur in the lower
eyelid area and wrinkles likecrow's feet at the side of the eye.
So those are things thefacelift does not explicitly
(13:10):
chase and need to be addressedoften with an additional
procedure done at thesame time as a facelift.
And then there are things onthe face that the facelift
helps you with, as I said,
but if you're reallyconcerned about that feature,
it's probably going totake a separate treatment.
(13:30):
So facial volume bypositioning and shaping the
volume, you get somerestoration of youthful shape,
but you have lost volume,
and that sometimes needs to be boostedwith fat grafting. Wrinkles on the
face will look a little lessprominent as that skin is
(13:50):
redraped, but that's really a wrinklein the fabric of the skin and just
repositioning the skindoesn't eliminate that.
So things like laserpeels, chemical peels,
or some other options likethat are a typical option.
Nasolabial and marionettelines, as Dr. Edinger mentioned,
(14:12):
these do improve and that's a good thing,
but if you sit and look in themirror and pull those lines,
pull your facial skinuntil those lines go flat,
you'll see that your face looks distorted.
And that's exactly what we'renot trying to do with a facelift.
We don't want any distortionor change in appearance.
(14:35):
So predictably,
the facelift is not going tocompletely eliminate those features,
and that's part of the reason why Americanindustry developed fillers that are
injectable and why we pursuethings like fat grafting.
And the last one that I wouldmention is transverse lines or
(14:56):
side to side lines on thelower part of your neck. Again,
redraping some of that skin helpsthem look a little less noticeable,
but those lines are verytough to completely eliminate,
and that takes energy treatmentsthat do skin resurfacing
that's safe for the neck,
(15:16):
or sometimes active dermalmatrix fillers that can
stimulate collagen and tryto fade those lines somewhat.
I agree with all of those things.
I just want to reiteratesomething that Dr. Bass said,
which is something that the faceliftdoesn't do or should not do,
which has changed the way you look andmake you unrecognizable or no longer you.
(15:37):
A facelift should help reset the clockand restore your youthful appearance,
but you still want to look like you andyou want the features that make your
face who you are. So a refresh versionof yourself, but not something distorted.
Okay. All of that makes a lot of sense.
So what can you tell me aboutthe durability of the facelift?
This is also an answer thatvaries from patient to patient.
(15:58):
We typically tell patients that afacelift will reset the clock by about 15
years,
but you're going to continue to age asyou normally did after your facelift.
Some patients age slowly, they may onlyneed one facelift in their lifetime.
Others may age at a more rapid rate,
may require another facelift 10 to15 years after their first facelift.
(16:19):
It depends on many factorsincluding your skin quality,
your skin elasticity andcollagen composition, your genetics and other factors.
So it's variable from person to person.
That's a great point,
and the important thing toremember is aging never stops.
We would like it to, but it doesn't.
(16:40):
That's just a reality. However,having done a facelift,
you'll never look as old asyou would have had you done
nothing. So even 10 to 15 years later,
if you didn't have a facelift,
you would look 10 to 15 years older fromwhere you started before the facelift.
And having a facelift,
(17:00):
you'll always look better than whatyou would've looked like without the
facelift.
And then what do patients say or ask ina consultation where they often don't
understand the limitations of a facelift?
For me,
my experience is that patients oftendon't understand that all of the
wrinkles on the face are not goingto be eliminated by facelift.
(17:24):
Again, that's typically a laserresurfacing or a chemical peel,
and that will minimize wrinkles,
but not necessarily eliminate all of them.
Areas like the nasolabialfolds, I mean, first of all,
we're not trying to eliminate thembecause 15 year olds have nasolabial
folds. So that's a natural facial feature.
(17:45):
We just want it to bevery gentle and minimal,
but that's commonly donewith fat grafting or fillers.
It will improve with facelift,
but not be fully corrected andupper facial areas like the
areas we typically put Botox in,
the lines between the eyebrows,lines in the forehead,
(18:08):
those are not treated by facelift.
It's outside the anatomic area wherethe surgery is taking place and
changes likewise in theeyelids themselves and the
eyebrow. The other thing I wouldsay about what the facelift
won't do for what needs tobe done is that a lot of
(18:29):
patients come in and they feellike they only have a little
drop of aging change,
and partly it's the plastic surgeon'sjob to try to show them where some of the
changes are, and we do this withphotography during the consultation,
but if you are in your seventiesand you never had a lift,
(18:49):
there's not just one little spotin your face or your neck that's
aged. You're squarelyin facelift territory.
And chasing that skin laxityand getting it reasonably
corrected is an importantpart of looking your best.
If it concerns you, andif it doesn't concern you,
(19:09):
then you go out and enjoy your life.
The other thing is to recognize, again,
just that there are all these differentaging changes and the tendency
of a lot of what's happening outthere in internet, social media,
beauty magazines is to squashall these changes together.
And the really importantthing is to do the opposite,
(19:33):
to tease these out,
identify which featuresare concerning to you,
and then determine with yourexperienced plastic surgeon,
what procedure or treatment is goingto correct those features that you're
concerned with.
Okay. And before we endthis episode, Dr. Edinger,
(19:54):
do you have any takeawaysfor our listeners?
Yeah, I couldn't agree morewith what Dr. Bas just said.
The biggest things are that you've justgot to do your research and you have to
know the limitations of the facelift,what it can do and what it can't do.
Hopefully this episode helpswith that. And then again,
just remembering that these changesare happening to each of us and when we
decide to do something about them asdependent on the patient, remember,
(20:17):
the goals are to restore a naturalappearance and just do a more refreshed
version of yourself.
We're not trying to change whoyou are or what you look like.
Just trying to reset the clock for you.
And Dr. Bass, can youshare your takeaways?
Well, I think Dr. Edingersummarized it beautifully,
but I'll take a shot at it.
So facelift is about skin laxity.
(20:38):
It's the big facial resetin restoring your aging
face. It has the biggestimpact of anything we do,
and the gold standard forcorrecting facial and neck
skin laxity,
the greatest degree of correctionand the greatest durability.
We chase hanging skin inthe neck and under the
(21:01):
chin, neck banding andjawline, irregularity,
jowls and flattening of the cheeks.
This is never going to be ahundred percent correction,
but most of the time we getmost of it. As I mentioned,
it doesn't fix all things.
All of our treatment optionsreally focus on particular
(21:24):
aesthetic features.
So you may have a mild defecton a whole bunch of features,
but you're primarily going tochase the laxity and restore facial
shape. Skin quality inparticular, pigment,
pigment, irregularity, brown spots,redness, wrinkles, rough texture,
or things that really have tobe treated with other kinds of
(21:48):
interventions,
not the facelift andother aging changes in
other anatomic areas in theneighborhood like the eyes, the eyebrow,
need separate procedures, andit's okay to leave those off,
but you don't want to leave them off andthen be looking at them after you have
the beautifully restored face and beback in three months to do another
(22:11):
procedure. It would've beenbetter to do it all at once.
If you don't think you'll do itany time in the next several years,
reasonable to leave it off.
So as I mentioned earlier in the podcast,
it is very common to do additionaltreatments at the same time as the
facelift to maximize the result. Thingslike fat grafting, chin implants,
(22:33):
and some of the associated proceduresfor skin quality or other areas of the
face like eyelids.
But things like fat graftingand hin implants in particular,
can help with that missionof restoring facial shape and
maximizing the redrapingof the skin. So finally,
your aesthetic concerns matedwith the advice of an experienced
(22:57):
facelift surgeon is animportant partnership
in you achieving yourbeauty goals successfully.
So this is a theme you'll hear againand again from both me and Dr. Edinger
during this series.
Thank you,
Dr. Edinger and Dr. Bass for gettingthis series off to a great start with a
discussion about what the faceliftdoes and what does not do.
(23:21):
It really focuses my attention onthe content to come. I can't wait.
Thank you for listening to the ParkAvenue Plastic Surgery Class podcast.
Follow us on ApplePodcasts, write a review,
and share the show with your friends.
Be sure to join us next time to avoidmissing all the great content that is
coming your way. If you want tocontact us with comments or questions,
(23:41):
we'd love to hear from you.
Send us an email atpodcast@drbass.net or DM us on
Instagram at @drbassnyc.
Welcome to Park AvenuePlastic Surgery Class,
the podcast where we explore controversiesand breaking issues in plastic
surgery. I'm your co-host, Summer Hardy,
a clinical assistant at BassPlastic Surgery in New York City.
I'm excited to be here with Dr. LawrenceBass, Park Avenue plastic surgeon,
educator, and technology innovator.
Today's episode is the start ofa new series about the facelift.
(00:25):
What are we talking aboutin this episode, Dr. Bass?
To put it in simple terms,
Dr. Edinger and I are going totalk about what the facelift does
and what the facelift doesn't do.
So overall, what does the facelift do?
The facelift is really aprocedure that number one chases
(00:46):
skin laxity in the facethat's loose or hanging
skin.
It's also a face shapingoperation and increasingly is
associated with facial volumerestoration through things like
fat grafting. So ingeneral, in this series,
when we say facelift,
(01:08):
we'll be referring to the mostcommonly performed procedure,
which addresses featuresin both the face and the
neck.
And in medical terms mightbe called cervical facial
plasty. So that's neck and face.
That's what most patients are having,
except in selected circumstancesvery early in the game
(01:32):
or late in the game or after aprevious lift where only a portion
needs to be redone.
So we'll get to all of thesesubdivisions elsewhere in this series,
but we'll focus most on whatpatients at most ages are
having done.
There's a big difference inthe terminology that beauty magazines and internet
(01:55):
marketing use and the terminology that
surgeons use medically whentalking to each other about
facelifts, that's probablymore technically accurate.
So Dr. Edinger and I willtry to relate commonly used
terminology on the internet withwhat that technically translates
(02:16):
into in the surgery to theextent that that's possible.
Okay, that makes sense.
So who's the patient who shouldbe thinking about a facelift?
So that's another way of sayingwhat does the facelift fix?
Because if you have thethings the facelift fix,
then maybe you should bethinking about facelift.
(02:38):
And that's really thepoint of this episode.
We're talking about what a facelift does,
what it can fix or improveand what it doesn't.
So a facelift is really a surgicalprocedure that's performed in the skin and
the muscular layers of the face andneck with a goal of restoring midface
volume, eliminating jowling,softening nasal labial folds,
(03:00):
and then also creating a cleanerand sharper neckline for patients.
And basically when you thinkof these different areas,
I mean the jowl sits along the jawline.
There's also fullness in an areaabove the jowl just to the side of the
corner of the mouth that's notnecessarily well corrected by a facelift.
(03:20):
That jawline irregularity,as Dr. Edinger said,
is sharpened up and a number of
things in the neck get chased.
Things like vertical bands thatmay come from muscles hanging
skin under the chin and under the jawline.
And also the angle betweenthe vertical part of the
(03:45):
neck that goes from our Adam's appledown or a little bit above that,
and the horizontal part that'sunder our chin that gets more
oblique or obtuse as we age insharpening what we medically
call the cervicomental angle isan important part of the left.
So all of those changes in the necksoftening the nasolabial folds and
(04:08):
marionette lines as Dr. Edinger said.
And part of that is doneby resuspending the midface
and upper face tissues, butparticularly the midface tissues.
And this takes some of thatslack out of the nasolabial area,
but it also brings thetissues back up over the cheek
(04:31):
where they came from and helpsto shape the cheek back to
that youthful uniform shape rather than
individual sags and bagsand flattened areas.
Okay. And how does thefacelift achieve these changes
basically?
(04:53):
To really simplify things,
facelift addresses both the overlyingloose skin that we develop as we age,
and it also addresses that deeper muscularlayer of the face and neck that Dr.
Bass was talking about.
There are several surgical techniques totighten that muscular layer of the face
and neck, which we'lladdress in later episodes,
but all of them serve the same purpose.And for storing your midface volume,
(05:14):
tightening those deeper structures,
removing excess skin and trying to putthings back where they first started
before the aging process kicked in.
And so this draws heavily on
understanding what changestake place during aging,
and we're going to discussthat in an upcoming episode.
What changes in the face as we age,
(05:36):
but we're trying to take thingsthat shrank and maybe fat graft
them, take things that havespread out or descended,
bring them back both atthe skin level and at
the muscle and muscular fascia level.
And that mass layer is basicallyconnective tissue that sits between the
(05:57):
skin and the muscles themselves.
So modern facelift generallyinvolves repositioning
and working on all ofthese tissue planes as part
of the procedure, as Dr. Edingersaid, different ways to do that.
Kind of like saying morethan one way to skin a cat.
(06:18):
Not necessarily a best way,
but a variety of wayswhich we will discuss,
but repositioning those thingsin a vector back where it came
from,
which increasingly is upnot back like in historic
facelifts,
although it's not as simple as thatbecause different layers may and in
(06:39):
different parts of the face and neck,
the direction of draping needsto be somewhat different.
Got it. So when is it the time forthe facelift? Is there a best age?
Well, our statistics tells what'shappening in the United States population.
According to a 2023 statisticfrom The Aesthetic Society in
collaboration with CosmetAssure,
(07:00):
8% of patients are in the35 to 50 year age range,
48% of patients, the majority,are in the 51 to 64 age range,
and 44%, just less than the majority,
are in the 65 age range and up.
So that's kind of the answerto your question Summer by age,
(07:22):
but it's also really about findingsbecause everyone ages according to
a standard kind of process. There arethings that to all of us as we age,
but when those things happenis a little different.
Some people age prematurely,
most people are aging with the herd,
with the whole group ofother folks their age,
(07:43):
and some folks are lucky andthey're aging more slowly.
So if you are noticing a lot of changes,
you can confirm with a plasticsurgeon and they'll tell you what they
think. If they think it's too early,
you're taking your big playing cardof the facelift and using it too soon,
they'll tell you that.
(08:04):
And if they think you should havebeen in five or 10 years ago,
they'll tell you that as well.
But those ages give you a generalsense of who's doing facelifts.
And this is a lot different thanwhen I first went in practice.
When I first went in practice,
facelift age was muchyounger on average than
(08:26):
is today.
And part of the reasonthat age has moved to
older numbers is because we have healthier
lifestyle. We smoke anddrink less, we exercise more,
hopefully we try to eat better,
but also we have all of the nonsurgicaltreatments that help reverse early
(08:47):
aging changes and help slow facial aging.
So I think that's pushed the age up below.
Now we're seeing a trend backtowards younger ages a little bit,
but what those numbers tell youis that very few people in their
thirties need a surgical lift. And if so,
(09:07):
it would probably be some kindof a mini lift. Sometimes actors,
models, newscasters,
people that make their living in frontof a camera or lifting in their late
thirties, but fortieslifting really begins.
Fifties is a hot time for lifting.
But for people in their sixties andbeyond who may not have gotten to it
(09:31):
previously,
you can see that 44% are 65 or older,
so it's not too late if youdidn't get a chance to do it
previously.
And that's still a common agegroup for surgical lifting.
Absolutely,
and I think deciding when to have afacelift like Dr. Bass was saying,
is a very personal choice.There's no set point,
(09:53):
but it's the same for every patient or amagic number that patients should shoot
for.
The best time to do a facelift is whenyou start to notice those changes in your
appearance and they start to bother youspecifically regarding loss of volume in
your cheeks, steepeningof those nasolabial folds,
the jowling along the neckline,loose skin in your neck,
and then banding in your neck as well.
(10:13):
These are all signs of aging that can beaddressed whenever they start to bother
you and whenever you decide you want todo something about them to restore your
appearance, and confidence again.
Yeah, I think that'sexactly right Dr. Edinger.
If it doesn't bother you yet,
you may know you don't lookthe same as 25 years old,
but maybe it doesn't bother you much yet,
(10:35):
then it's probably not timeto have a facelift right then.
However,
if it's starting to really bug you everytime you're fixing your hair or putting
makeup on or getting ready togo out and look in the mirror,
you notice some of those changes or everytime you see yourself in a photograph,
(10:58):
you see that saggy areaand it's bugging you,
that's telling you that maybeit's time to start chasing it.
Okay. So I think I have the ideaof the what, when and how now,
what is it that the facelift does not do?
So if we think about featuresthat are not treated,
(11:18):
they basically fall intoa couple of categories.
There are some things thatwill have a little bit of
impact when you have a facelift,
but if it's your primary concern area,
you should probably be doing adifferent treatment or procedure.
And then there are some things thatthe facelift simply doesn't address.
(11:42):
They're just not part of either theanatomic area the facelift works in
or they're not part of what thefacelift is changing because of how the
facelift works.
And so you need a separate treatmenteither done at the same time,
because we often do afew procedures together,
which can be safely done and doesnot have a big impact on recovery
(12:05):
time or sometimes treatments thatneed to be done at a separate sitting
or separate office visits.
So things like skin quality facelift is
going to reposition the skin,
but your skin is still decadesolder than it was in your twenties,
and you're going to need separatetreatments to make that skin
(12:29):
quality look better,
even though the facelift puts the skinback where it came from. That's pretty
logical.
Things that are outside the anatomicarea of the facelift are things like
eyelid bulging fat or hanging skin
drooping of the eyebrow,
(12:49):
lip wrinkles like lipstick,
bleed lines and crepey changes,
which are analogous to wrinklesin the lip that occur in the lower
eyelid area and wrinkles likecrow's feet at the side of the eye.
So those are things thefacelift does not explicitly
(13:10):
chase and need to be addressedoften with an additional
procedure done at thesame time as a facelift.
And then there are things onthe face that the facelift
helps you with, as I said,
but if you're reallyconcerned about that feature,
it's probably going totake a separate treatment.
(13:30):
So facial volume bypositioning and shaping the
volume, you get somerestoration of youthful shape,
but you have lost volume,
and that sometimes needs to be boostedwith fat grafting. Wrinkles on the
face will look a little lessprominent as that skin is
(13:50):
redraped, but that's really a wrinklein the fabric of the skin and just
repositioning the skindoesn't eliminate that.
So things like laserpeels, chemical peels,
or some other options likethat are a typical option.
Nasolabial and marionettelines, as Dr. Edinger mentioned,
(14:12):
these do improve and that's a good thing,
but if you sit and look in themirror and pull those lines,
pull your facial skinuntil those lines go flat,
you'll see that your face looks distorted.
And that's exactly what we'renot trying to do with a facelift.
We don't want any distortionor change in appearance.
(14:35):
So predictably,
the facelift is not going tocompletely eliminate those features,
and that's part of the reason why Americanindustry developed fillers that are
injectable and why we pursuethings like fat grafting.
And the last one that I wouldmention is transverse lines or
(14:56):
side to side lines on thelower part of your neck. Again,
redraping some of that skin helpsthem look a little less noticeable,
but those lines are verytough to completely eliminate,
and that takes energy treatmentsthat do skin resurfacing
that's safe for the neck,
(15:16):
or sometimes active dermalmatrix fillers that can
stimulate collagen and tryto fade those lines somewhat.
I agree with all of those things.
I just want to reiteratesomething that Dr. Bass said,
which is something that the faceliftdoesn't do or should not do,
which has changed the way you look andmake you unrecognizable or no longer you.
(15:37):
A facelift should help reset the clockand restore your youthful appearance,
but you still want to look like you andyou want the features that make your
face who you are. So a refresh versionof yourself, but not something distorted.
Okay. All of that makes a lot of sense.
So what can you tell me aboutthe durability of the facelift?
This is also an answer thatvaries from patient to patient.
(15:58):
We typically tell patients that afacelift will reset the clock by about 15
years,
but you're going to continue to age asyou normally did after your facelift.
Some patients age slowly, they may onlyneed one facelift in their lifetime.
Others may age at a more rapid rate,
may require another facelift 10 to15 years after their first facelift.
(16:19):
It depends on many factorsincluding your skin quality,
your skin elasticity andcollagen composition, your genetics and other factors.
So it's variable from person to person.
That's a great point,
and the important thing toremember is aging never stops.
We would like it to, but it doesn't.
(16:40):
That's just a reality. However,having done a facelift,
you'll never look as old asyou would have had you done
nothing. So even 10 to 15 years later,
if you didn't have a facelift,
you would look 10 to 15 years older fromwhere you started before the facelift.
And having a facelift,
(17:00):
you'll always look better than whatyou would've looked like without the
facelift.
And then what do patients say or ask ina consultation where they often don't
understand the limitations of a facelift?
For me,
my experience is that patients oftendon't understand that all of the
wrinkles on the face are not goingto be eliminated by facelift.
(17:24):
Again, that's typically a laserresurfacing or a chemical peel,
and that will minimize wrinkles,
but not necessarily eliminate all of them.
Areas like the nasolabialfolds, I mean, first of all,
we're not trying to eliminate thembecause 15 year olds have nasolabial
folds. So that's a natural facial feature.
(17:45):
We just want it to bevery gentle and minimal,
but that's commonly donewith fat grafting or fillers.
It will improve with facelift,
but not be fully corrected andupper facial areas like the
areas we typically put Botox in,
the lines between the eyebrows,lines in the forehead,
(18:08):
those are not treated by facelift.
It's outside the anatomic area wherethe surgery is taking place and
changes likewise in theeyelids themselves and the
eyebrow. The other thing I wouldsay about what the facelift
won't do for what needs tobe done is that a lot of
(18:29):
patients come in and they feellike they only have a little
drop of aging change,
and partly it's the plastic surgeon'sjob to try to show them where some of the
changes are, and we do this withphotography during the consultation,
but if you are in your seventiesand you never had a lift,
(18:49):
there's not just one little spotin your face or your neck that's
aged. You're squarelyin facelift territory.
And chasing that skin laxityand getting it reasonably
corrected is an importantpart of looking your best.
If it concerns you, andif it doesn't concern you,
(19:09):
then you go out and enjoy your life.
The other thing is to recognize, again,
just that there are all these differentaging changes and the tendency
of a lot of what's happening outthere in internet, social media,
beauty magazines is to squashall these changes together.
And the really importantthing is to do the opposite,
(19:33):
to tease these out,
identify which featuresare concerning to you,
and then determine with yourexperienced plastic surgeon,
what procedure or treatment is goingto correct those features that you're
concerned with.
Okay. And before we endthis episode, Dr. Edinger,
(19:54):
do you have any takeawaysfor our listeners?
Yeah, I couldn't agree morewith what Dr. Bas just said.
The biggest things are that you've justgot to do your research and you have to
know the limitations of the facelift,what it can do and what it can't do.
Hopefully this episode helpswith that. And then again,
just remembering that these changesare happening to each of us and when we
decide to do something about them asdependent on the patient, remember,
(20:17):
the goals are to restore a naturalappearance and just do a more refreshed
version of yourself.
We're not trying to change whoyou are or what you look like.
Just trying to reset the clock for you.
And Dr. Bass, can youshare your takeaways?
Well, I think Dr. Edingersummarized it beautifully,
but I'll take a shot at it.
So facelift is about skin laxity.
(20:38):
It's the big facial resetin restoring your aging
face. It has the biggestimpact of anything we do,
and the gold standard forcorrecting facial and neck
skin laxity,
the greatest degree of correctionand the greatest durability.
We chase hanging skin inthe neck and under the
(21:01):
chin, neck banding andjawline, irregularity,
jowls and flattening of the cheeks.
This is never going to be ahundred percent correction,
but most of the time we getmost of it. As I mentioned,
it doesn't fix all things.
All of our treatment optionsreally focus on particular
(21:24):
aesthetic features.
So you may have a mild defecton a whole bunch of features,
but you're primarily going tochase the laxity and restore facial
shape. Skin quality inparticular, pigment,
pigment, irregularity, brown spots,redness, wrinkles, rough texture,
or things that really have tobe treated with other kinds of
(21:48):
interventions,
not the facelift andother aging changes in
other anatomic areas in theneighborhood like the eyes, the eyebrow,
need separate procedures, andit's okay to leave those off,
but you don't want to leave them off andthen be looking at them after you have
the beautifully restored face and beback in three months to do another
(22:11):
procedure. It would've beenbetter to do it all at once.
If you don't think you'll do itany time in the next several years,
reasonable to leave it off.
So as I mentioned earlier in the podcast,
it is very common to do additionaltreatments at the same time as the
facelift to maximize the result. Thingslike fat grafting, chin implants,
(22:33):
and some of the associated proceduresfor skin quality or other areas of the
face like eyelids.
But things like fat graftingand hin implants in particular,
can help with that missionof restoring facial shape and
maximizing the redrapingof the skin. So finally,
your aesthetic concerns matedwith the advice of an experienced
(22:57):
facelift surgeon is animportant partnership
in you achieving yourbeauty goals successfully.
So this is a theme you'll hear againand again from both me and Dr. Edinger
during this series.
Thank you,
Dr. Edinger and Dr. Bass for gettingthis series off to a great start with a
discussion about what the faceliftdoes and what does not do.
(23:21):
It really focuses my attention onthe content to come. I can't wait.
Thank you for listening to the ParkAvenue Plastic Surgery Class podcast.
Follow us on ApplePodcasts, write a review,
and share the show with your friends.
Be sure to join us next time to avoidmissing all the great content that is
coming your way. If you want tocontact us with comments or questions,
(23:41):
we'd love to hear from you.
Send us an email atpodcast@drbass.net or DM us on
Instagram at @drbassnyc.
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