Facelift

Around the ear

The incision hugs the earlobe in a natural skin crease, extends inside the front of the ear, and curves around into the hairline. In men it is left in front of the ear to avoid facial hair growth on the ear.

Behind the ear

Placed just above the ear crease to prevent scar bands, then gently extended into the hairline high enough not to be noticeable. Patients can style their hair any way they like afterward.

Beneath the chin

A small incision in the lower chin crease treats the neck, and is virtually invisible once healed. It is also where neck liposuction is performed if needed.

Incision lines are difficult to see within a few days of surgery, even with the sutures still in place. They continue to fade over the first several months. An actual patient of Dr. Sandel.

Modified deep plane facelift

The modern evolution of the deep plane facelift, and his preferred technique for most patients, for established laxity through the face and neck. The muscle layer is released and repositioned and the skin re-draped over it, with a corset platysmaplasty where the neck calls for one.

Deep plane facelift

The original operation. The full deep plane release is the right choice for a small number of patients, and Dr. Sandel performs it in those cases. For most patients its modern evolution, the modified deep plane, is the better answer.

Tuck-up facelift

For patients who have had a facelift before and have aged since. The skin and muscle are lifted again to address the change that has happened in the years between.

Mini-lift

For a more subtle result, and often for younger patients with less to correct. Less extensive than the full lift, and less downtime with it.

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Why not local for a deep plane lift

It is hard to get the deep layer fully numb, and it takes a great deal of lidocaine with epinephrine to do it. The injection alone is uncomfortable at that extent.

Patients also carry anxiety, sometimes without knowing it, and that raises blood pressure and heart rate. Higher pressure means more bleeding during the operation, and more swelling and bruising afterwards.

If I am worried something may cause pain, my attention is divided. Surgeons hold back when they think a patient may feel something, and that shows in the result.

What being asleep changes

An anesthesiologist keeps you free of pain and keeps blood pressure and heart rate low, at a depth light enough that you wake easily and quickly. I stop thinking about comfort and focus on the lift.

A general anesthetic here stays light, and I inject the local once you are asleep. That keeps medication and narcotics to a minimum, because you are not feeling pain in the first place.

Patients wake with much less of a hangover, rested rather than anxious, with less swelling and bruising.

The anesthesiologist’s fee is already part of the figure we quote, not billed on top.

If the skin on your neck and jawline is so loose that creams, injections, and other nonsurgical treatments don’t make much of a difference, a facelift is probably the only way to restore a more youthful look. If you feel self-conscious about sagging skin on your face and neck, think the face you see in the mirror is older than you feel, or worry that your aging looks are holding you back at work, schedule a consultation with us to find out how a facelift can help.

Yes. A facelift rejuvenates the middle and lower parts of the face, below the eyes. It can be combined with a brow and forehead lift to smooth and tighten facial skin above the eyes and to raise drooping eyebrows, or with eyelid surgery to correct overhanging upper eyelids. Because a facelift does not correct problems with the texture and tone of the skin, you might consider following it with laser skin resurfacing, or dermal fillers for volume loss in the cheeks.

Like all plastic surgery procedures, a facelift does leave scars, but they are carefully placed to be virtually invisible once they have fully healed. Depending on your procedure, they may be hidden under the chin, in the natural creases of your ears, or behind your hairline. Scars are more noticeable in the first months after surgery, before they fade to match your skin color.

The face wrap and the drain come off the morning after surgery, and an ice wrap takes their place for a day or two. Pain is usually minimal — Tylenol is what most patients need. You will feel tight and swollen through the first week, and the job that week is to rest and keep your heart rate and blood pressure down, because that is what keeps swelling and bruising down. Sutures come out at day 7, flying is fine from about a week, most patients are presentable in public around day 10, and full activity resumes at two weeks. Dr. Sandel provides detailed post-operative care instructions, and follow-up appointments are arranged to monitor your healing. Recovery varies by individual.

It is the operation Dr. Sandel performs every week: a modified deep plane rhytidectomy combined with a corset platysmaplasty. The SMAS layer is fully elevated across the cheek, the jawline and the upper neck, and that release is carried up over the cheekbone in the deep plane to free the attachments that hold the midface down. The lifted layer is anchored to two fixed points, the firm tissue in front of the ear and the bone behind it, so the lift is held by the deep layer rather than by tension on the skin. What it does not include is dissection beneath the midface periosteum or undermining out to the corner of the mouth — steps that in Dr. Sandel’s experience add swelling and nerve exposure without a result patients can see. It is not a lighter operation. It is a complete one that stops where the anatomy stops rewarding you for going further.

Flying is fine from about a week after surgery. Full activity resumes at two weeks, coming back gradually rather than all at once. Sutures come out at day 7, and most patients are presentable in public around day 10. Recovery varies by individual, and Dr. Sandel will give you a realistic timeline for your own case at your consultation.

Most patients hold their result for seven to ten years, though it varies with age, genetics and lifestyle. What that does not mean is that you go back to where you started. You carry on aging from the new position, and your skin keeps losing elasticity at its normal rate, so the fair comparison is with where you would otherwise have been rather than with the week after surgery. Patients rarely if ever return to their starting point. If you want to keep a sharp neck and jawline beyond that, a smaller tuck-up facelift or a mini lift at seven to ten years is usually all it takes. A good skin care and aesthetic routine makes a real difference to how long it holds, as does eating well and not smoking. Sun protection, medical-grade skin care, and treatments that maintain skin quality all work in the same direction as the surgery.

Yes. The neck lift is part of every full facelift we perform, as a corset platysmaplasty: the neck and the angle beneath the chin and jawline are treated in the same operation, and that is what defines the jawline. For most patients the neck and the lower face loosen together, which is why they are done together rather than separately. If your concern is limited to fullness under the chin rather than loose skin, chin and neck liposuction may be all you need. Dr. Sandel will tell you which of the two fits your anatomy at your consultation.

Less than you would get by adding the two prices together. A facelift already accounts for most of the operating time, so a smaller procedure added to it costs considerably less than the same procedure on its own day. Eyelid surgery, a brow lift and a chin implant are the usual additions. Chin and neck liposuction is the exception in your favor: done as part of a facelift there is no extra charge for it at all, because the neck is already part of that operation. The Facelift cost section above sets out the figures and what they include. Financing is available.