A Complete Approach to Facial Aging - Why I Do Not Perform a Mini-Facelift

A Complete Approach to Facial Aging - Why I Do Not Perform a Mini-Facelift

As we age, many of us develop sagging of the skin of the face and neck. This leads to heavy jowls sagging down to the jaw line and baggy skin under the chin. This can be upsetting, as these changes often make you look much older than you feel. The facelift (also known as a full face and neck lift) is a plastic surgery procedure designed to restore a more youthful appearance. The goal is a nicely defined jaw line, more contoured cheeks, and removal of excess sagging skin.

In the past, facelifts were considered a skin tightening procedure.  However, a more accurate way to think about a facelift is by first fixing the underlying structure of the face that has started losing fullness due to the aging process causing the skin to begin hanging off the lower areas of the face (especially along the jaw line and neck) and then redraping the skin over the repaired foundation.

A full face and neck lift involves re-suspending the structures under the skin that are descending down the face, re-draping the overlying skin, and trimming any skin excess. This can be likened to re-arranging the pillows on the bed, then draping the sheets on top. In other words, the change in the appearance of the face is not achieved by “pulling the skin tight”. The facelift in fact does not rely on a high tension closure.

Facelifts typically take about 2.5 hours to perform at our accredited outpatient surgery center.  You will be asleep under general anesthesia under the care of a board certified anesthesiologist.  We strive to give a superb experience for the patient. The environment is private, the care kind and gentle, and the entire process is stress free.

During a facelift, other facial rejuvenation procedures can also be performed, including upper eyelid lift (blepharoplasty) and facial fat grafting.  Fat grafting is sometimes essential for restoring fullness to the underlying structures of the face to get the best facelift result.

So why don't you perform a mini-facelift?

A mini-facelift does not adequately correct the underlying structures of the face that have caused the skin to slide down in the first place.  A mini-facelift only tightens the skin, which brings an additional problem with a high-tension closure.  A high-tension closure can result in thick, noticeable scars next to your ears.

Why can’t you just tighten my excess skin?

The skin is the part of the aging process that we see, so historically facelifts focused on redraping, tightening, and removing loose skin. However, we have since learned that in the absence of correction of deep structures of the face, these surface changes only result in temporary improvement. Simply removing the excess skin hanging off can also bring the possibility of an over-tightened look, which I describe as “an old person skydiving”. These unnatural results do not make the patient look younger and sometimes can look strange.

Why is keeping a low-tension incision so important?

Some facelift techniques such as a mini-facelift only rely on skin tension and that can have undesirable results, such as distortion and elongation of the earlobe, known as “pixie ear”, and widening and thickening of the scar tissue around the ear.  I only perform the full face and neck lift procedure to provide a tension free closure which results in a minimal scar, often unnoticeable within two weeks especially because it can be hidden by hair around the ears. The result is a long lasting, natural appearance with minimal down-time.

Do you perform just a neck lift?

No, due to the inter-connectivity of the facial structures, excess skin on the neck is best corrected by fixing the underlying structures of the face and neck.  The neck is just where the aging makes its appearance because that is where the sagging is visible.  A necklift on its own results in a sub-optimal scar pattern that is very visible on the front of the neck and I do not perform this procedure.


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