Question: I am a 36-year-old female who had a mid facelift about seven months ago. I have noticed some of my skin still sags around my nose. Is there another alternative to help fix this problem?

Answer: Mid facelifts can certainly lift the soft tissue of the cheek and elevate it to a more aesthetically pleasing position, but they really do not do much for the smile lines between the nose and the sides of the mouth. My recommendation for that area is fillers such as Juvederm and Restylane since they are extremely reliable at giving excellent natural looking results, and they last a relatively long time at about nine to twelve months. If you are in need of rejuvenation of the jowls and upper neck then I would recommend consideration of an extended SMAS deep plane facelift since this type of procedure will not only improve the smile lines and elevate the cheek, but it will also eradicate any jowling and laxity underneath the chin. Ultimately, this is a highly customized approach to facial rejuvenation and would, therefore, require proper evaluation and consultation.

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Question: How young is generally too young for a facelift?

Answer: I am not sure if there is necessarily an age that is too young for a facelift, though certainly anybody who is in their 20s really should not need a facelift. I feel that if there are signs of aging on the face that even younger patients may benefit from a facelift. Currently, the youngest patient I have performed an actual facelift on is 31 years old, which seems very young, but she had a significant amount of laxity in her soft tissue of the jowls and neck area and felt like she needed a lift, which the mini lift in the office certainly accomplished. Patients in their 40s may even need a more advanced and sophisticated surgical technique that I perform in the operating room for adequate rejuvenation. That is called an extended SMAS deep plane facelift with special work on the muscles underneath the chin, which can create a very elegant and rejuvenated appearance for my patients, and this technique provides extremely long-lasting results.

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Question: What anesthesia is the facelift usually performed with? Is it possible to avoid using general anesthesia?

Answer: For my personal practice, it really depends on what style of facelift we are going to perform as to whether a general anesthesia is required or not. I perform in-office facelifts with a SMAS imbrication technique using strictly local anesthetic or a small amount of oral sedation with local anesthetic. These involve incisions hidden around the ears like a standard facelift and, for the most part, it is very similar to what surgeons do in the operating room. For more advanced signs of aging or for those who want more significant rejuvenation and a longer lasting result, I perform an extended SMAS deep plane facelift in the operating room, and this surgery really needs to be performed under general anesthesia or, at the very least, deep sedation due to the fact that it is significantly more technically difficult, and we are operating on a much more significant portion of the patient’s face. The results, however, are amazing and are certainly well worth the extra effort.

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Question: I am in my mid 70s and have a lot of wrinkling between my eyebrows and around my eyes. I would like to get this fixed and was curious to see if a browlift would be the right decision. What would you recommend?

Answer: It really depends on the shape and height of your brows as to whether I would recommend a browlift. But, if your brows are low set especially along the sides then a browlift would definitely improve these lines. If your brows are in, otherwise, normal position then I would recommend consideration of some sort of a chemical or laser peel in combination with Botox and even wrinkle fillers as more of a combination treatment for your problem.

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Question: What exactly is an endoscopic browlift and how is it different from a regular browlift or forehead lift?

Answer: An endoscopic browlift is performed through very small incisions up in the hair and then small scopes that are called endoscopes are placed through these small incisions and used to visualize the tissue as we use special instruments to perform the surgery through these other small incisions in the hair. Therefore, it is called an endoscopic browlift since we are performing it using these endoscopes, and we are lifting the brows. A more standard browlift involves a long incision that starts above the ear and then passed across the top of the head all the way to the other ear. The scalp is essentially reflected downwards to the brow as the soft tissue is separated from the bone. Some muscles are released and the brow is elevated. Excess hair bearing scalp is removed and then the incision is closed with sutures and frequently skin staples. A forehead lift is simply another name for a browlift. There are several other different techniques to perform a browlift including a direct browlift, a midforehead lift, as well as what is called a trichophytic or a hairline incision type of a browlift, and each of these needs to be customized for each individual’s facial features. But, for the most part, I tend to perform endoscopic browlifts on the far majority of my patients. In then those with very high foreheads or high hairlines, I will consider a combination endoscopic/trichophytic (hairline) type of a browlift. I feel it is very important to look for an experienced board certified facial plastic surgeon so that your particular anatomy can be assessed and the best treatment option then can be selected for you.

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