1. What types of face lift surgery are available?

There are many different types of facelifts and one of the problems is that many surgeons use different names to describe the same procedure. For example, what one surgeon would call a "full facelift", might be a lower facelift and a browlift to another surgeon. To add to the confusion, some companies/surgeons are even trade marking their procedures (e.g.Lifestyle Lift). I think names are less important than WHAT the surgeon is going to do. While some people may simply have a little bit of lax skin, most need to have the deeper tissues tightened to have lasting, natural results because skin is very elastic. If the surgeon simply tightens the skin, s/he must pull enough to overcome elasticity which can result in the infamous "pulled" or windswept look. Also, tension on the skin incisions can lead to wider scars or more pain so most surgeons incorporate some muscle tightening so that tension is not placed on the skin. This can be done under the skin through many different types of incisions or even deeper, against the skull bones. I believe that since every person is unique, there will not be one type of facelift that will fit every person. I like to tailor the procedure to the patient which leads us to the next question which is:


2. Are there other alternative procedures?

Are there alternative procedures? Sometimes what a patient needs more than facelift surgery is resurfacing of very wrinkled, sun-damaged skin. In this case laser, dermabrasion or chemical peels may be used. If the skin is very lax, surgery may ALSO be needed but the patient may be happy enough with their new improved skin that they don' t mind a little laxity. Or alternatively, since some people lose fat from their faces as they age, they may benefit enough from fat grafting, fillers or cheek implants that they do not need facelift surgery. I once dated a guy whose mother gained 15lbs from medications and everyone thought I did a facelift on her because her wrinkles went away! Some doctors are using thread lifts to try and tighten tissues without surgery; care must be taken that the threads are not placed unnaturally and there is always a concern that they can break. There are many other new technologies which have promise in restoring youthful skin or shrinking lax skin such as ultrasound or plasma or radiofrequency treatments. Your best bet is to consult with a professional, preferably more than one, to see what s/he recommends for you. Ask them to explain their reasons why they chose what they did and why they wouldn' t consider something else and see what makes sense! The surgeon ought to be able to explain what their thought processes are; the days of just meekly submitting to the doctor are long gone!


3. Is face lift surgery painful?

Facelift surgery is usually not painful, not compared to abdominal surgery or bone surgery. Most patients are pleasantly surprised. It is surgery though so there will be some discomfort. Your surgeon can prescribe medication to lessen that.


4. Can I be awake during face lift surgery?

Some surgeons are comfortable doing the surgery on awake patients under local anesthetic. Some patients don t want to be awake! I usually leave it up to the patient and the anesthesiologist. The anesthesiologist is an expert at making sure the patient has no pain; I also don' t want the patient to twitch at a bad time when I am near a big blood vessel or important nerve. I want to concentrate on making the patient look good so I want the anesthesiologist there to make sure I can do that, not worry about causing pain.


5. What does SMAS stand for?

SMAS stands for "superficial musculoaponeurotic system." This is a condensation of the fascia of the facial muscles and is fairly tough so that it will hold stitches. Many surgeons will tighten this layer, rather than rely on the thin, stretchy skin to hold the neck/cheeks up. I know I do!


6. What is an endoscopic face lift?

An endoscopic facelift involves lifting the tissues through small puncture wounds through which an endoscope is placed to help view the deep layers. The dissection and suturing is done through the scope. The advantage is that the scars are so small; the disadvantage is that the scars are so small. Most of my facelift patients have a lot of extra skin; where will it go if it is not cut off? But for a select group of patients without a lot of extra skin, whose faces have just sagged, an endoscopic lift may correct the problem. Usually, the muscles are loosened off the underlying bones with the endoscope and positioned higher. This is not as common as the more standard facelift.


7. What is the average cost of face lift surgery?

The average cost of a facelift is hard to predict. We ve already seen how many different types there are and each patient is unique. An 80 year old will probably need more work than a 50 year old (but not necessarily). A young patient in her 40 s with just a little loose skin might be able to have some tightening done for $2000 but the typical facelift in Southeast Florida will cost somewhere between $6000-10,000. If eyes or foreheads or lasers are done, that can add to costs. Get estimates from more than one surgeon and don t pick a surgeon on price alone! Find out whether the surgeon has a good reputation; with any procedure, even remodeling your kitchen, there can be some unexpected things. How does your surgeon deal with any complications that could arise? Will they charge extra if a scar turns out worse than expected?