10 Steps to a Successful Facelift

New York, NY (February 6, 2003) — Today's skilled cosmetic plastic surgeon knows that getting the best results from any cosmetic operation requires a customized surgical plan for each patient. Facelift surgery is particularly challenging, since patients differ widely in their underlying facial structure as well as the extent of their visible aging. According to an article in the American Society for Aesthetic Plastic Surgery (ASAPS) publication, Aesthetic Surgery Journal, there are at least ten important considerations in designing a great facelift.

"If patients are aware of the process their plastic surgeon goes through to develop a surgical plan, they can be more active participants in some of these decisions," says the article's author, plastic surgeon Robert Bernard, MD, of White Plains, NY, who is ASAPS' president-elect.

A well-designed facelift will take into account factors including:

  • Hairline Position. A small shift in the position of the hairline is considered acceptable and usually is not noticed, but patients starting out with an elevated hairline position may need special techniques to avoid raising it further.
  • Incision Placement. "Many patients and their friends judge the success of a facelift on the basis of minimally detectable scars," says Dr. Bernard. Where to place incisions depends on factors such as the amount of excess skin and whether the patient has pre-existing creases in front of the ears.
  • Cheek Volume. "If the cheek area appears flat because of inadequate bony projection, I sometimes use fat injections to provide better definition," says Dr. Bernard. "Implants and other materials are also available for augmenting the cheeks."
  • Fat Pad. In rare instances, a herniated or prominent buccal fat pad, located in the cheek area, may need to be removed or sutured at a deep level.
  • Cheek Folds. Cheek, or "nasolabial" folds are difficult to treat, but a facelift that pulls in a vertical direction will help to restore sagging soft tissue to its natural position in the cheek area, says Dr. Bernard. Injection with a soft tissue filler, such as fat, may also be necessary to achieve optimal results.
  • Jaw Line. Jowls are caused by sagging soft tissue that must be elevated. If excess fat is present, it may be removed by suction (lipoplasty).
  • "Trough." "There is a region defined by the angle of the jaw where it interfaces with the neck that I call the 'trough,'" says Dr. Bernard. "A shallow trough gives the face a rounder look, whereas a deeper trough contributes to a more chiseled look generally associated with youth and attractiveness." Dr. Bernard recommends, when necessary, defatting this area to give it better definition.
  • Chin. The profile of the chin plays an important role in an attractive appearance. An overly prominent chin, "weak" chin, "double chin" or "witch's chin" all can be addressed with additional procedures performed at the same time as a facelift.
  • Glands. Sometimes the glands located in the neck, underneath the chin, appear prominent and can detract from the neck's appearance. While most patients find some fullness in this area acceptable, surgical removal or repositioning of the glands is an option, though not without risks.
  • Neck Cords. If neck cords appear prominent from the frontal view, correction may require a small incision underneath the chin, nearly undetectable when healed.

"These elements of a successful facelift do not include every preoperative consideration in facial rejuvenation," says Dr. Bernard. "But if similar evaluations are made regarding the eyes, forehead and skin, the final result should be very harmonious."


The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world's leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; Active Members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and nonsurgical aesthetic procedures. International Active Members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.


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