A nonsurgical facelift is any type of nonsurgical procedure, technique, or injection that is felt to improve the overall appearance of facial laxity and, indeed, there are certainly countless individuals out in the medical community that promote what they consider a “nonsurgical facelift.”  Having said that, any nonsurgical facelift will truly pale in comparison to the results that can be achieved through surgery.  The advantage of a nonsurgical facelift is that there is little to no downtime involved with the majority of these types of procedures, and the only downside would be the limitation of the result and the longevity of the effect.  Some examples of a nonsurgical facelift would be an injectable or liquid lift where injectable filler material is placed in various areas of the face, specifically in front of the jowl, in the sulcus between the chin and the jowl to try to make the jawline more prominent and the jowl then less prominent.  Injections can also be placed in the folds around the mouth and up into the cheek area and certainly significantly rejuvenate a patient’s overall appearance but the overall effect is really quite minimal in comparison to a true and properly performed facelift.  These injectable lifts can last anywhere from six to 24 months, most lasting somewhere around one year.  Other nonsurgical facelift options would be skin tightening procedures such as Thermage or SkinTyte, which can tighten the overall skin of the face.  Both of these procedures are extremely limited in their capacity to tighten, and the majority of patients have very minimal effects that are not easily visible.  Most of the before-and-after photos that are available for these techniques are patients who had a rather significant effect, but these are only a very small proportion of the overall patients who are treated by these techniques.  More invasive yet nonsurgical techniques for “facelifting”, would be laser treatments such as Profractional resurfacing, which can cause significant amounts of dermal tightening and new collagen synthesis and, thus, overall skin tightening.  This effect can be rather significant from a skin tightening perspective but, again, does not compare to the effect of actually elevating and tightening the deeper layers of the face, which is what a facelift can achieve.  Results from all of these nonsurgical-type facelift procedures are limited in the duration and, typically, I will tell my patients to expect one to three years from any sort of a nonsurgical lift.  In fact, for minor surgical lifts that can be performed in the office, I will tell my patients to expect three to five years of longevity.  A properly performed, sophisticated facelift technique such as an extended SMAS, deep plane facelift with subplatysmal and platysmal muscle work, will typically last in the order of 10 years if not even longer and produce a much more significant and natural-appearing rejuvenation.

Tags: how long will the results last?, if so, Is there really such a thing as a nonsurgical facelift and
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There is certainly an esthetic tie between the nose and the chin in that a patient with a weak chin often appears to have a larger nose than a patient with a stronger chin.  I therefore frequently perform a chin implant in combination with a rhinoplasty in patients with a weak chin so that the benefit of the stronger chin will actually enhance their rhinoplasty outcome.  This is quite easily performed in combination with the rhinoplasty and I certainly would never suggest that someone postpone a chin implant just to have them performed as separate procedures.  I will perform computer generated imaging for the patient and show them not only their planned postoperative nasal appearance, but also the planned postoperative chin appearance and we can compare the before and after with and without a chin implant.  The far majority of patients see the significant improvement in their overall facial esthetics with the chin implant and the far majority of patients therefore choose to have the chin implant performed in combination with the rhinoplasty procedure.

Tags: I was told I should get a chin implant when I get my nose job. Is that a wise choice or should I wait?
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There seems to be a bit of confusion regarding the actual procedure of a facelift.  Many people including certain physicians feel that a facelift is treatment of all areas of the face at once.  I personally call this comprehensive facial rejuvenation.  Most would agree that a facelift treats the lower third of the face and a mini lift would be considered a type of facelift procedure.  A mini lift is any type of facelift procedure that is essentially done in a minimized or limited fashion.  Most mini lifts are performed through smaller incisions and most treat the underlying SMAS tissue by either folding it over or treating it with a purse string style suture to contract the SMAS and lift the jowl.  I personally usually perform a small amount of SMAS excision followed by elevation and imbrication of the SMAS and customize this for each patient that desires a mini lift.  My personal facelift approach that I perform in the operating room is an extended SMAS deep plane facelift.  This is a procedure where the SMAS is incised or cut and then the dissection goes under the SMAS, so that two distinct areas are able to be separated, one being up in the cheek and one being down just in front of the jowl.  Once these areas are released, I am able to elevate the soft tissue of the face and restore the facial contours much better than the standard style facelifting procedure that does not release these ligamentous attachments.  The advantage of this technique is that that I am able to elevate the facial laxity in a more vertical direction and in a much more significant yet natural appearing fashion.  All of the tension is placed on this deep layer and thus the incisions in the skin can be closed under virtually no tension allowing these to heal extraordinarily well and be extremely inconspicuous.  During a deep place facelift I also perform a rather aggressive submental platysmal work, which is the region below the chin.  This allows for creation of a flat shelf-like area below the chin and allows for significant rejuvenation of the neck itself.  Obviously this is a much more technically demanding procedure and only approximately 5% of facelift surgeons can perform such a procedure.  Its advantages are extremely significant and I feel that the extra time that is necessary to perform this is well worth the improved outcome.  Interestingly, the downtime really is not affected by this technique and most of my patients are back doing normal activities within one to two weeks.  A mini lift can provide significant rejuvenation for patients with very early signs of aging, but is a rather significant compromise for anybody with moderate to advanced signs of aging.  I caution these patients about the limitations of a mini lift when they are considering rejuvenation surgery.

Tags: What is the difference between a facelift and a mini lift?
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The short answer to that question is yes, rhinoplasty can fix asymmetric nostrils.  Frequently this would involve removing a small wedge of tissue along the corner of the ala or the side of the nose near the nostril.  This would include removal of some of the nostril skin so that when this incision is closed, the nostril is actually smaller.  In patients with asymmetric nostrils I will frequently perform reduction of the larger nostril in order to make this more symmetric with the smaller nostril and occasionally will have to take a small amount of tissue on the opposite side, but not remove any tissue from the inside of the nostril, so that we can create a symmetric nasal base, but not affect the nostril opening on the smaller side.  The resulting scar is hidden in the crease between the face and the nose and is extremely inconspicuous and seldom ever a concern to the patient.  These types of techniques are typically employed as part of an overall rhinoplasty procedure and are only one part of many that are performed in order to get the nose to appear as we desire.  Ultimately the sutures are removed six days after surgery at the same time that any nasal splint is removed and the result is apparent immediately and this does not add any downtime to the overall procedure of a rhinoplasty.

Tags: I have asymmetric nostrils. Can rhinoplasty fix that?
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The answer to that question lies in which type of facelift is performed. A mini lift in the office setting can have patients back to normal activities within two to three days depending on their age and amount of bruising. In fact, many patients have told me that they could go back to work the following day even though they have sutures in and around their ear area. For more invasive facelift techniques such as the extended SMAS or deep place facelift that I perform in the operating room setting, I tell my patients to expect five to six days of downtime due to some swelling and bruising though typically these are rather minimal. In either case, sutures are removed in six days and the far majority of patients that have these performed are able to go back to normal daily activities within that first week of the procedure.

Tags: How long until I can return to normal daily activities after a facelift?
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