Facelift & Necklift

A facelift is one of the most rewarding and impactful procedures in facial rejuvenation. Common patient goals in facelift surgery include tightening the neckline, reducing “jowl” formation along the jawline, restoring volume to the cheeks, and imparting a refreshed and well rested appearance to the face.  As is discussed below, there are many variations to the facelift procedure, but overall, these share common principles of safely repositioning the soft tissue of the face.

Dr. Pepper’s philosophy of performing Facelift Surgery is a balance of two priorities: safety and efficacy.  As the Director of Stanford Facial Nerve Center, he is deeply knowledgeable about the anatomy of the facial nerve.  This nerve resides underneath the plane of dissection during a facelift surgery.  Several times per year, Dr. Pepper is called into consultation from colleagues around the country regarding injury to the facial nerve.  Although no surgeon can provide a 100% guarantee of a complication-free surgery, Dr. Pepper is uniquely knowledgeable about facial nerve anatomy and avoidance of potential complications of its injury.  On the other hand, facelift surgery should be effective.  The most effective techniques involve manipulation of the SMAS (superficial musculoaponeurotic system).  Dr. Pepper published this technique with his mentor, Dr. Shan Baker, who is now retired ⁽¹⁾.  This facelift technique leads to excellent and durable results, as demonstrated by the patient below shown 1 year and then more than 5 years after SMAS lift by Dr. Pepper using a short scar approach. 

In general, a facelift is the most effective means of achieving a good necklift.  In most cases they are identical procedures.  There are two important exceptions, however.  First, some younger patients have congenital excessive fat underneath the chin.  This is treated with a submental liposuction, which is a minimal liposuction procedure performed through a small incision just under the chin.  The second situation where treatment of the neck may call for a procedure other than a facelift is in the male patient with a significant amount of redundant skin in the neck and under the chin.  This is typically treated with a submentoplasty, which involves excision of the excess skin underneath the chin.  The differences between these procedures are straightforward for a board-certified surgeon who specializes in facial surgery to guide you through.

“Skin only” facelifts are simple to perform and involve minimal downtime.  However, they typically are less satisfactory for patients due to their short lifespan and limited effect on the appearance of the face.  This is partly due to the nature of skin.  When skin is used as the means of tightening the face, the skin responds by relaxing significantly after around 6 months after the procedure.  Facelifts that reposition the tissue layer deeper to the skin, called and SMAS (superficial musculoaponeurotic system) have a much longer duration.  A typical effective SMAS lift will last approximately 10 years, much longer than a “skin-only” facelift which may lose impact after less than a year in some cases.

Patients are asked to limit their activity in the first several weeks after facelift and to ice the face to limit bruising.  Pain should be well controlled with prescribed medication.  Most patients are comfortable working from home the second week after surgery, but this depends on the patient and the extent of surgery.  Patients typically return to work one to two weeks after a facelift, but this can vary depending on occupation and other factors.  Patients are seen 1 day, then 1 week after surgery for assessment by Dr. Pepper and suture removal.

Although everyone is different, a facelift is typically NOT a painful procedure.  It certainly creates a “tight” sensation, but patients typically report little pain after a facelift.

Natural complementary procedures to a facelift include: fat transfer, laser resurfacing or chemical peel to smooth skin wrinkles, blepharoplasty (eyelid tightening), and brow lift surgery.

If you would like a consult for facelift or facial rejuvenation, please call us at (650) 736-3223 (FACE).  

1. Pepper, Jon-Paul, and Shan R. Baker. 2011. “SMAS Flap Rhytidectomy.” Archives of Facial Plastic Surgery 13 (2): 108. https://doi.org/10.1001/archfacial.2011.11.