Facelift surgery, also known as a rhytidectomy, is a procedure that raises certain structures in the middle and lower parts of the face. Few facial plastic surgeries have the same dramatic effects that a facelift provides. At City Facial Plastics in Manhattan, NY, we utilize cutting-edge techniques to give our facelift patients natural, long-lasting results. The best-in-class plastic surgeon in New York City, Dr. Gary Linkov specializes in customized facelifts for our patients, helping them enjoy a rejuvenated, youthful appearance.
What is a Facelift?
A facelift is a surgical procedure that rejuvenates the central and lower face and the neck. It smooths the creases between the cheeks and the upper lip and reduces the loose skin that develops between the cheek, chin, and jawline. It can also define the jawline and correct droopy or wrinkled neck skin. The procedure involves removing excess skin and tightening facial tissue to provide long-lasting results. Because facelifts can be performed alone or in conjunction with other facial enhancements, downtime depends on the extent of your procedure. There are many types of facelifts, but the best one is a customized approach that addresses your problem areas and concerns.
Who Is a Good Candidate for a Facelift?
Anyone who is in good health and has noticed sagging skin and tissue around the jowls, chin, and neck, may be a good candidate for a facelift surgery. There are different levels of facelifts, depending on the extent of lifting or tightening needed. Men and women from their early forties and beyond may be good candidates for this type of cosmetic procedure. Some may only need a “mini facelift” or even a non-surgical facelift. Others may need to combine a neck lift, brow lift or eye lift with a facelift to get the results they desire. Dr. Linkov at City Facial Plastics in Manhattan’s Upper East Side personalizes every facelift procedure with regard to the patient’s expectations and desired results.
What Is the History of a Facelift?
Facelift surgery originated in Europe in the early 1900s. It wasn’t until after World War I when soldiers suffered facial injuries, that plastic and reconstructive surgery became more well known. In the 1930s, surgeons started to apply these techniques for surgical treatment of the aging face, targeting wrinkles, cheeks, and the neck.
As time passed, with new developments in medicine and anesthesia, elective cosmetic surgery became more popular. With increased interest and demand came more research into facelift surgery, and evolution into the surgical techniques that are used today.
What Is the Anatomy of the Face?
To fully understand facelift surgery and what it can accomplish, it is important to be familiar with the basic facial anatomy of the different layers of the face and how each of these layers can be affected over time.
The skin is the outermost layer of the face and our body’s largest organ. Each person’s skin has its own color, thickness, texture, elasticity, scars, and other lesions. Wrinkles, or rhytids, form when the skin becomes more elastic and droopy, which is a part of the normal aging process. There are several factors that can accelerate this process, such as smoking and exposure to the sun and radiation.
Adipose tissue (fat)
Adipose tissue, also known as fat, is the layer just below the skin’s surface. Fat not only cushions and insulates our body, but also plays an important part in hormone regulation and energy storage. In the face, fat helps provide volume, which is often associated with a more youthful and healthy appearance.
The SMAS, or superficial musculoaponeurotic system, is a network of muscular and fibrous tissue that connects the muscles of the face to the skin. It helps coordinate the muscles of the face to allow for facial expression. In some types of facelift surgery, the SMAS is manipulated to achieve the aesthetic goal.
The face consists of various ligaments, which are bands of strong, fibrous connective tissue. These ligaments attach the skin and facial muscles such as the SMAS to the underlying, deeper connective tissue allowing for stabilization. During facelift surgery, these ligaments may need to be cut so that the SMAS can be released and repositioned.
The face is an extremely vascular part of the body, meaning there are a significant amount of blood vessels arranged in a very complex and intricate pattern. Blood vessels help supply blood rich with oxygen and nutrients to the skin, muscles, and ligaments. While it is necessary to cut some very small blood vessels during surgery, it is important to avoid damaging the major blood vessels to reduce the risk of bleeding and promote proper wound healing.
Even more intricate and delicate than the blood vessels of the face are the nerves. There are 12 main cranial nerves that originate directly from the brain and split off into hundreds of smaller nerve endings in the face. These nerves are responsible for all functions of the face, including controlling muscles of facial expression as well as the five senses (sight, hearing, smell, taste, and touch).
What Are the Types of Facelift?
There are several different types of this plastic surgery. These types vary based on the involvement and amount of facial tissue involved. Your specific aesthetic goals, along with the specific, individualized characteristics of your anatomy, will determine which type of facelift surgery is most appropriate for you.
Skin only facelift surgery
Skin only facelift surgery is the oldest type of facelift procedure. Incisions are made in front of and behind the ears, pieces of only the superficial skin layer are removed, and the incision is closed, pulling the skin back and thus lifting the face.
While it is the least invasive and safest type of facelift surgery, it is also the type that has the least permanent results, sometimes only lasting one year or less. The scars tend to heal poorly due to the amount of tension on the thin skin. Further, the results can have a “sweeped” appearance with an over-exaggerated pulled back look.
SMAS plication facelift surgery
SMAS plication is a slightly deeper type of facelift surgery that involves not only removal of some skin and subcutaneous fat but also addresses the SMAS. In SMAS plication, while SMAS is not removed, it is folded onto itself in such a way that it is shortened and pulled upward. SMAS plication is relatively low risk and results tend to last longer than skin only facelift surgery, but there is a risk of the sutures breaking through the SMAS and not holding it in its intended position.
SMASectomy facelift surgery
SMASectomy is more complex than SMAS plication as it involves the removal of pieces of the SMAS and then suturing the remaining SMAS back together, along with the superficial skin. Because there is greater involvement of the deeper structures, results are more permanent than skin only facelift surgery and SMAS plication. However, there is a greater surgical risk of damaging the deeper facial structures such as the nerves.
SMAS flap facelift surgery
SMAS flap facelift surgery is a type of “deep plane” surgery. It involves making an incision in the SMAS, but SMAS tissue is not removed. Rather, a flap of SMAS tissue is created, and this flap is then pulled back and sutured onto a more posterior part of the SMAS in front of the ear. SMAS flap facelift surgery is more technically challenging and there is also a risk of nerve injury with this type of surgery, but results are longer-lasting.
Full ligamentous release facelift surgery
Full ligamentous release facelift surgery is similar to SMAS flap facelift surgery with one additional step. This is the type of procedure required for a mid facelift surgery. Once the SMAS flap is created, the ligaments underneath the SMAS flap are cut, which allows the SMAS flap to become loose. The SMAS flap is then able to be pulled back even more so that there is less tension on the SMAS when it is sutured back in place posteriorly.
Thus, in full ligamentous release facelift surgery, both the skin and the SMAS are tightened which generally leads to the most permanent and natural-appearing result. However, it has the greatest risk of bleeding and nerve injury amongst the various types of facelift surgery, as well as the longest recovery period.
Why Get a Facelift in NYC?
Most people desire a plastic surgery facelift to look like a younger version of themselves. This cosmetic procedure results in a reduction of wrinkles and tightening of skin to give an overall more youthful and rejuvenated appearance. In order to achieve this aesthetic outcome, certain parts of the face can be targeted. Many people desire a facelift to remove jowls, which refers to sagging skin below the neckline. Others wish to get a facelift to remove a double chin. Yet others are looking to soften the nasolabial folds and are tired of fillers.
Can a Facelift Remove Acne Scars?
Acne scarring can occur in up to 95% of people with acne, with an estimated prevalence of 1-11% in the general population. While a facelift NYC can help remove or reduce wrinkles, jowls, and double chin, it cannot remove acne scars. Acne scars are best addressed with laser or chemical peel.
Facelift is one of the most well known plastic surgeries. In 2018, it was the sixth most common procedure performed by plastic surgeons in the United States. While popular, it is a highly complex kind of surgery that requires not only extensive knowledge of anatomy and wound healing, but also precision and extreme attention to detail on behalf of the surgeon.
Can a Facelift Be Combined With Other Procedures?
Facelift surgery can, and sometimes should be combined with other procedures to achieve the most optimal results. Some of the most common combined procedures include:
- Facelift and neck lift. A facelift and neck lift are often performed together to enhance the overall youthfulness of one’s appearance. They can be done through the same incision, though sometimes requires an additional incision. Because the SMAS in the face is continuous with the neck muscles (platysma), facelift results can be even more pronounced when the neck is also addressed.
- Facelift and eyelift. A facelift and an eyelift are often performed together as well. A facelift typically targets the mid and lower parts of the face, so the area around the eyes is sometimes best addressed with either an eye lift (upper and/or lower blepharoplasty) or a brow lift.
- Facelift and lip lift. A facelift and lip lift can be combined for people who would like both the central and lateral aspects of the face addressed. A facelift will not change the appearance of the philtrum, which can elongate with aging or upper lip. A lip lift can address these areas with little to no increase in the overall recovery period when done at the same time as a facelift.
- Facelift and fat transfer. As we age, we not only experience loss of skin elasticity but also loss of volume due to a decrease in the amount of facial fat. Facelift and fat transfer can be performed together to tighten the face and at the same time, restore volume. However, a facelift alone can sometimes provide enough volume enhancement in the right places such as the lateral cheeks.
- Facelift and chin implant. To optimize the neck results that come with a facelift, sometimes a chin implant is recommended to better suspend the neck and create a beautiful neckline, over a well-projected and supported chin.
Where Are Facelift Scars?
Facelift scars are located at the site where the incision is made for the plastic surgery facelift. These scars are typically in two places on each side of the face: in front of the ear and behind the ear. The scar in front of the ear typically starts at the hairline, which helps hide the scar, and extends downward in front of the ear. The scar behind the ear starts at the bottom part of the posterior ear and extends upward toward the hairline. In order to gain better access to the neck, an additional incision under the chin is often made and hides well in the crease.
How Is Facelift Surgery Done?
There are two main parts of facelift surgery: preparation phase, which is needed to achieve the best aesthetic outcome, and the actual surgery itself.
Preparing for your facelift
There are several steps you will need to take in order to best prepare for your facelift. These steps include:
- Stop certain blood-thinning medications and supplements, such as aspirin, NSAIDs (i.e. ibuprofen/Motrin and naproxen/Aleve), warfarin (Coumadin), and vitamin E to reduce risk of bleeding.
- Stop smoking, as the use of tobacco products is associated with poor wound healing.
- Pick up supplies for after surgery, including a topical antibiotic, gauze, hydrogen peroxide, and tape.
- Identify an escort to accompany you home after receiving anesthesia and plan for postop care for the days after surgery.
- Do not eat or drink after midnight the night before your facelift New York plastic surgery.
On the day of your facelift
On the day of your procedure, you will meet with an anesthesiologist to review your medical history before receiving anesthesia. For plastic surgery facelift, deep sedation is administered so you will be put to sleep but do not need a breathing tube placed. Best plastic surgeon Dr. Linkov will draw surgical markings with a special marker on your face to delineate the areas of the incision. You will receive an intravenous antibiotic before surgery to help reduce the risk of infection. Once you have received the antibiotic and deep sedation, Dr. Linkov will start the surgery.
Duration of facelift surgery
The length of facelift NYC procedure varies greatly depending on the type of surgery, the anticipated complexity, and the time it takes to awaken from anesthesia. Facelift procedure can take anywhere from 3 to 6 hours. The surgery may be even longer if it is combined with another plastic surgery such as rhinoplasty correction, eye lift, brow lift, lip lift, or fat transfer.
What Is the Recovery From a Facelift?
It is common to experience bruising and swelling after the facelift, and these will improve in 1 to 2 weeks after surgery. You may experience some facial numbness, and this will also typically resolve with time. It is important to be familiar with the potential complications of facelift surgery, as detailed below, and to inform Dr. Linkov of any issues that arise as you heal.
You will meet with Dr. Linkov in UES, Manhattan the day after your surgery to remove drains if placed and then 5-7 days after your surgery to remove your stitches. Most people can resume their regular activities in 2 weeks after surgery and depending on the type of work, return to work in 1 to 2 weeks after surgery. Full results are usually seen at least 3 months after surgery, once the swelling has mostly resolved.
What Are the Complications of Facelift Surgery?
Facelift surgery is major plastic surgery, and sometimes complications do occur. The possible complications of this type of plastic surgery are summarized below.
Hematoma is a collection of blood outside of the blood vessel. Hematoma is the most common complication after facelift surgery and occurs in 2 to 15% of patients. Hematoma typically presents with pain and swelling in the face within the first 12 to 24 hours after surgery. If the hematoma is small, treatment may include the use of a pressure dressing, removal of a suture, suction, or needle aspiration. Rarely, if the hematoma is very large, additional surgery is needed to remove the blood.
Can facelift cause nerve damage? Nerve damage can occur in facelift surgeries, especially that involve the SMAS. Most commonly this involves injury to the nerves that supply sensation to the face and can occur in 1-7% of patients. Nerves that supply motor function (movement) to the face are damaged less commonly. It is important to repair the nerves right away to reduce the risk of permanent nerve damage if detected during the surgery. A facelift may also be associated with a recurrence of a condition called Bell’s palsy, where half of the face is temporarily paralyzed.
Infection is not common after facelift surgery due to the administration of preoperative antibiotics. If an infection does occur, it is typically mild and treated with a course of oral antibiotics. Rarely, if the infection is significant, it may require drainage and the use of intravenous antibiotics.
Poor scarring can occur when sutures are placed with too much tension on the skin. Scarring tends to be worse with skin only facelift surgery. Enlarged, prominent scars can sometimes be treated with steroid injections, laser resurfacing, or scar removal surgery.
Skin necrosis may occur during the healing phase if there is a decrease in blood supply to the affected area. This is less common with deep plane facelift surgery. The lack of blood results in injury to the cells, turning the skin a dark brownish-black color. Smoking and diseases such as diabetes and peripheral vascular disease can increase the risk of skin necrosis. Most skin necrosis typically gets better with time and needs to be closely monitored.
Can facelift cause hair loss? Hair loss can occur when the incision line is made in certain areas of the hairline or if there is too much tension on the skin when the sutures are placed. Most commonly the hair loss occurs near the temples but can occur at any point where the incision involves the hairline. While the hair typically grows back within 3 to 6 months, if the hair loss is permanent then additional procedures can be done to restore the hair. Dr. Linkov is also a hair restoration surgeon and understands the complexities of hair follicles and their importance in facelift surgery.
Since facelift surgery incisions are made in front of and behind the ear, the position and appearance of the ear and earlobe can change after surgery. While earlobe deformities are not common after facelift surgery, they require additional surgery and can be difficult to treat.
Neck deformities can occur when a facelift is done with attention to the neck. This can lead to a “cobra deformity”, which refers to a hollowed appearance in the middle of the neck, with looser skin on the sides. Cobra deformities, as well as the other neck deformities, require additional surgery to correct.
Parotid gland damage
The parotid gland is a gland located in front of either ear and is involved in saliva production. It is very rare for the parotid gland to be injured during facelift surgery but it is possible. If damage to the parotid gland does occur, it is typically repaired immediately during the facelift procedure. It may result in additional swelling which may be treated with a pressure dressing or needle aspiration.
What Are the Contraindications for a Facelift?
There are several reasons why a person may not be a candidate for facelift surgery. Potential contraindications to facelift surgery include:
- Severe kidney, liver, or cardiac disease, unless cleared by a specialist for anesthesia and surgery.
- Certain autoimmune diseases, such as lupus or scleroderma with facial skin involvement, as well as Sjogren’s syndrome and autoimmune vascular diseases.
- Poorly controlled diabetes.
- Prior radiation treatment to the head and/or neck.
- Current use of isotretinoin for acne.
- Allergy to certain anesthesia medications.
What Are the Alternatives to a Facelift?
There are procedures other than facelift that can also result in a more youthful and rejuvenated appearance. The advantages and disadvantages of the most common procedures as compared to facelift are described below.
Facelift vs filler
Filler injections can be used to provide volume in areas of deep creases, thus smoothing out the skin and improving the appearance. Filler injections are quick but temporary and typically need to be repeated in about 6 to 12 months. Risks of the filler include permanent skin necrosis and vascular occlusion, with rare cases of blindness.
Facelift vs botox
Botox can be used to paralyze certain muscles in the face, thus decreasing the formation of wrinkles. The most common areas of the face that botox can be used to decrease signs of aging are the forehead, glabella, and crow’s feet. Botox is a quick and low-risk procedure but results are temporary, lasting about 3 to 6 months, and it is not always helpful to completely eliminate wrinkles in the older population.
Facelift vs laser resurfacing
Laser resurfacing refers to the use of a laser beam to remove layers of the skin, thus removing superficial facial flaws such as scars, wrinkles, and other aging spots. The types of lasers used for deep resurfacing include carbon dioxide (CO2) or erbium. Laser resurfacing is a relatively low risk, and healing can take up to 10 days. Results can last on the order of years, but signs of aging will eventually reoccur as new layers of skin regrow. Laser resurfacing is often combined with facelift surgery.
Facelift vs ultherapy
Ultherapy uses ultrasound energy to directly stimulate collagen production by changing the temperature under the skin. Collagen is a protein normally found in the skin and is responsible for keeping the skin tight. Ultherapy is non-invasive, but results can be mixed and typically last under one year.
Facelift vs mini facelift
Mini facelift surgery is a variable term used to describe a limited type of facelift. There is no one standard mini facelift surgery, rather it varies based on the surgeon’s preference and expertise. For example, mini facelift surgery can exclude mid facelift surgery to only focus on the lower face and neck. Mini facelift surgery can target a certain aspect of the face, but depending on the areas involved, it can still be considered major surgery and has similar risks as a regular facelift.
Facelift vs ponytail facelift
A pony tail facelift technique involves using incisions only behind the ear so that a patient can pull the hair back into a pony tail and the incisions are invisible. Most areas of the lower face and neck can be accessed with this approach. It is not a preferred method for older patients with significant skin excess.
Facelift vs thread lift
Thread lift surgery involves physically lifting up the layer just deep to the skin with suture material and tying it down in place. In doing so, collagen production is stimulated in the areas of suture which helps tighten the skin even further. Thread lift is a relatively low-risk procedure in experienced hands with minimal recovery time. Thread lift, however, can only lift the skin a few millimeters, so the results are less dramatic than regular facelift surgery, and the results only last up to one year. Bunching of the skin can occur by the ears.
What Is Revision Facelift?
Sometimes people are not satisfied with the results of their initial facelift surgery or as time passes, there are new areas of the aging face that develop and need to be addressed. These people may be candidates for facelift revision surgery. Since this revision surgery can be even more complex than an initial facelift, it is important to seek out a revision plastic surgeon in Manhattan for this level of care.
What Is a Male Facelift?
Traditionally a facelift was considered to be more for women. Now, as predictable and natural facelift results are obtained using deep plane approaches, men are seeking male facelifts.
There are a few nuances that need to be considered in male facelift surgery, including:
- Incisions are not typically able to be hidden by the hair so optimizing the appearance of the incision lines is important
- Location and presence of beard hair must be taken into consideration when designing the incision around the ears
- Not pulling too tight on the skin is critical to avoid a feminized skin-tight appearance
- Risk of bleeding after facelift surgery may be higher in men and must be carefully controlled during surgery and all precautions taken after surgery
The best male facelift surgeons understand the specifics of what makes a male facelift different from a female facelift.
What Is the Cost of a Facelift?
There are several factors that go into determining facelift cost. These factors include the type of facelift, location of your surgeon, experience of your surgeon, use of anesthesia, anticipated length of surgery, and whether or not this cosmetic surgery is combined with other surgeries. For facelift surgery in NYC, the price for facelift surgery alone ranges from $10,000 to $30,000 or more if additional procedures are done at the same time.
Are Patients Satisfied After a Facelift?
Most patients are extremely satisfied after facelift surgery that is performed by an experienced facial plastic surgeon such as Dr. Linkov. Many people ask “facelift is it worth it?”. As the results of facelift surgery are long-lasting, it may be a worthy investment if you are interested in a more youthful and refreshed appearance.
Who Is the Best Facelift Surgeon in NYC?
Dr. Gary Linkov is proud to be among the best plastic surgeons in NYC for facelift. Given his extensive training in head and neck surgery, he has special expertise in the anatomy of the face and neck including the deep structures involved in facelift surgery. You can view some before and after photos from real patients who underwent facelift surgery with Dr. Linkov below:
Facelift Surgery Before and After
Frequently Asked Questions About Facelifts
Facelifts are one of the most commonly requested surgical procedures at City Facial Plastics in Manhattan, NYC. It is understandable that our patients have many questions about the procedure and what to expect.
Here are some FAQs and answers:
- How long is recovery from facelift surgery?
- Since there are different types of facelifts, the answer can vary. Mini-facelifts can be a “weekend” procedure only requiring a few days to recover. For complete facelifts, most people can return to work or normal activities in about two weeks.
- Will a facelift make my skin looked stretched?
- Poor facelifts that only tighten the skin do not last and have an unnatural appearance. Dr. Linkov uses advanced surgical methods to elevate both the tissue and the skin for a natural, rejuvenated appearance that can last for many years.
- Where will the incisions be placed?
- In most facelift procedures, the incisions are located by the ear and are discreetly hidden in the hairline. Dr. Linkov uses cutting-edge techniques to minimize any noticeable incision scars.
- What type of anesthesia is used during the procedure?
- In most cases, general anesthesia is used for facelift procedures. Dr. Linkov and our team will discuss the anesthesia protocol and go over your health and medical history prior to scheduling your facelift procedure.
- How soon will I be able to see results?
- There is bruising and swelling to be expected after a surgical facelift, but most of this will diminish in the first two weeks after surgery. A noticeable difference can be seen as soon as the bandages are removed. Results will improve as the bruising fades and the swelling goes away.
If you are ready to explore the benefits of looking years younger, contact City Facial Plastics in Midtown, Manhattan today. We will schedule a facelift surgery consultation with a top-rated plastic surgeon Dr. Linkov. In just a few weeks, you could look many years younger and feel more confident in your appearance.