Your Facelift and the Stages of Life- The Beauty of Experience

One of our most frequently asked questions is- “What is the best age to have a facelift?” There is no set age that applies to everyone.

We have performed facelifts on patients from their late 40’s to their mid-80’s. Each is individualized for the patient’s anatomy and goals. In a lecture, “My Experience with 5,000 Facelifts”, I discuss the techniques described in The Art and Craft of Facial Rejuvenation. This lecture is never the same however because each time I give it I do more analysis and research to determine how to improve patient outcomes. With experience we have learned to modify our procedure to obtain the best outcome and most natural result for each patient regardless of age.

Our patients in their early 50’s are generally seeking a natural look that will reverse the early signs of aging and build a strong foundation that will last for decades. Our research has shown that facial aging is primarily the result of gravity working on a progressively thinner, dryer, and less elastic skin. These changes are accentuated by sun exposure, smoking, heredity and other factors. The deeper tissues that support the face “descend” and with further aging there is loss of fat or “deflation”. The major lesson we have learned from performing so many facelifts on patients around 50 is that they do last well for decades. The restructuring performed on the underlying platysma muscle and associated support tissue (SMAS) is strong with excellent repositioning in a vertical direction. There are occasional times (a few percent) where a small “tweak” under local anesthesia is done, but most facelift patients do the procedure once and are quite happy long-term. A few seek consultation for another facelift usually about 10-15 years after the first. The changes seen then are mainly skin aging. It is fascinating that when we do a “tuck up” facelift on these patients we usually find the deeper tissues still firm and well structured. We end up doing some very minor tightening on this deeper layer and focus on the excess aging skin. This consistent finding has made me quite comfortable recommending the facelift procedure to patients in their early 50’s knowing it will likely last a long time. There are of course individuals who simply lack good skin elasticity and age more rapidly even after a facelift. I continue to research how to identify these patients and improve their treatment outcomes.

Older patients having a first-time facelift require a larger procedure and generally have excellent results. When there is significantly more skin to remove, incision placement to minimize contour irregularities is crucial. We tighten the SMAS in these patients also and then may need to undermine more of the cheek and neck skin to allow it to drape smoothly. These patients do well, and we can maintain their facial rejuvenation with the many non-surgical methods available including Botox to treat aging signs created by muscle actions and fillers for volume loss.

In our experience, there is a large age range of patients who can benefit from an individualized facelift and within reasonable parameters no one is “too young” or “too old”. What works best in our practice is to perform our deep plane facelift on appropriate patients and then maintain it with good skin care and aesthetic services. Our facelift patients are among our most satisfied, both short and long-term.

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