I want to talk to you today about indications or times to get a facelift. I’m smiling because it’s fairly subjective, and a lot of patients come in thinking they “need a facelift.” I’d say from a chronological age standpoint, most patients are getting facelifts towards their late 40s, going into their 50s, and certainly in their late 50s and 60s and on.
The reason why is that as people age, we tend to develop laxity. The laxity that’s more common to develop is normally along the jawline, and then you start to get what we call jowling. That’s where a facelift comes into play to help tighten that area up and make it look more refined and defined.
Oftentimes with a facelift, you’ll be combining a little bit of liposuction as well if you have a little bit of fat, or in medical terms adiposity, in this submental area.
Facelift vs. Necklift: Age and Skin Elasticity
One of the questions that I’ve encountered over the last 15 years of my practice is patients asking if they are too young for a necklift or facelift.
There’s really no hardline answer for this to say yes or no, as there’s a lot of subjectivity.I would say that doing a facelift on somebody who’s younger than 40 is very uncommon.A necklift is something that’s more common in people who are younger than, let’s say, 40.
Many times, patients will still have that definition on the jawline, so they don’t have a lot of jowling, but you can have some laxity in the neck area as well as some adiposity which could need to be addressed with a necklift.
Minimal Surgery and the Impact of Weight Loss
One of the questions I get is that in this day and age, we want to have minimal surgery and maximum improvement. Many times, patients will come in wanting to know if they can just have a necklift or if they can have a mini lift. I see this often in my patients who are—don’t take any offense—older.
What I mean is, people who are 55 and older tend to have a little bit more laxity in the skin. When they inquire about a necklift in that age group, what can be difficult is if you have a lot of laxity and you try to tighten up the tissues below it, that skin laxity will tend to become redundant and you get some pleating here.
In those situations, I try to talk to patients about thinking about doing more of a facelift. If you’re going to do one procedure and you’re 50 plus from an age standpoint, I would tend to favor doing a facelift versus a necklift.
If there is any excess skin, I think you get a better result with a facelift than you do with a necklift.
Whereas on the flip side, if you have somebody who is, let’s say, 40 and younger, if they want to get a little more definition along the neckline, I think that’s where a necklift is a better procedure than necessarily having to do a facelift.
A lot of that has to do with the skin in the younger age group. When our skin is a bit more elastic and more youthful, it tends to contract better and layers out much smoother. I think a perfect example of this is doing liposuction in somebody who’s 20 years old. You have really good elasticity, and when you want to address someone’s adiposity by removing that excess fat, you create a dead space there.
The skin will tend to tighten up, cinch up, and layer out much more smoothly compared to somebody who’s in a higher age group, like 50 plus for instance.
Now, for the other part of what’s going on in our society and medically, people are losing weight. Part of that is facilitated by pharmacological meds, and also people taking an active interest in themselves, eating better, and working out.
If you have extremes in weight loss, you can develop a lot more laxity at a younger age. That is something that I think is going to become more prevalent as people lose significant amounts of weight. I mean, we’re talking 30, 40, 50 plus pounds, and that’s where you can have excess skin. That, too, could be addressed with a facelift.
But for the most part, when you’re talking about a facelift, you’re talking about addressing this part of the face—what we call the lower part of the face and the upper part of the neck.
Understanding Facelift Incisions for Men and Women
Oftentimes, patients have a misperception because when they think of a facelift, they think of an incision going from stem to stern, all the way up and around, elevating the brow and everything, and they get a little bit overwhelmed and a little bit scared.
A facelift incision is normally going to involve making an incision up in front of the sideburn area for women, and then normally it follows the contour of the ear, comes behind the earlobe, and goes behind the ear into the hairline.
Now, for men, we normally can bring the incision up higher in the temporal area. The reason why is that men have hair-bearing skin that can be pulled up, so it won’t distort this area as the hair grows back.
Whereas in females, if you bring the incision up here and you pull non-hair-bearing skin into this zone, women can get what’s called a temporal body, which doesn’t look good, obviously. So, we’ve modified that incision over time to come into the sideburn area for females, so that way the incision can be camouflaged.
Another difference between a male and female facelift is that with women, we tend to adhere very tightly around the earlobe to maintain that earlobe shape and to camouflage it. Whereas in men, we tend to bring the incision a little bit below that because of the hair-bearing aspect and because we don’t want to pull the beard up underneath the earlobe, because then it will become very difficult to shave if you desire to do that.
What Does a Necklift Address?
Oftentimes, patients come in asking about a facelift versus a necklift, and there’s a lot of overlapping with the terminology. In my practice, when I’m talking about addressing the neck, I’m normally talking about this central area here. There’s a muscle called the sternomastoid, and we’re kind of addressing this central area between these parts of the muscle.
What we’re trying to do in that situation is address bands. As we age, you can start to develop bands, and you can see these here in my neck, but as we age, they can become a little bit lax. So, what you’re looking to do is tighten those up.
When you’re doing a necklift, you make an incision underneath the chin in this area, and normally there’s a natural crease that we all have between the chin and neck, so it’s a nice place to camouflage it. That allows us to tighten up those bands and redrape the skin.
Combining Procedures
Now, I’m sure some of you are wondering if you can combine a necklift with a facelift. The answer is absolutely. I’ve had plenty of patients who opt to do a necklift with a facelift. Do you have to do both at the same time? No, it’s really up to you as the patient.
I hope this sheds some light on a facelift versus a necklift. If you have any questions or comments, feel free to contact us!
