The Surgeon Minute

The Triumphant Return of the Facelift

The Triumphant Return of the Facelift

“I believe that in the last couple of years, we are seeing the triumphant return of the facelift,” says board certified plastics surgeon Dr. John Cook of Chicago. For awhile, the surgical facelift fell out of vogue. Patients became enamored with non-surgical modalities, such as fillers, Botox, lasers and radio frequency (RF), all promised surgical-like rejuvenation without any downtime, incisions or anesthesia.

While Dr. Cook feels that there is certainly a place for non-surgical procedures (and he uses them often in his practice), none will deliver the same effect as a surgical facelift. He discusses why the facelift is still the gold standard for facial rejuvenation, upon it’s triumphant reutn.

Non-Surgical Facelift is Like a Unicorn 

According to the latest statistics from the American Society for Aesthetic Plastic Surgery (ASAPS), there has been a 21.9% increase in the number of facelifts performed in a given year. Why? Part of the reason is that although patients, surgeons and the media have been talking about the “non-surgical facelift” for the past 5 years, “it’s just like a unicorn,” shares Cook. “It doesn’t exist.” Patients, thanks to the world wide web, among other things, are getting savvier about what these non-surgical methods can realistically achieve.

Non-surgical facelift picture.

Avoiding Filler Face

Dr. Cook uses non-surgical modalities all the time in his practice. Botox and the new line-up of dermal fillers can and do deliver lovely results. That said, he does not “pretend to our patients that the non-surgical methods are going to in any way create the effect that we could get with a facelift.”

Non-surgical methods are inherently limited tools. When you try to push past their limits, you get some very weird looking results. Patients are seeing these strange looking outcomes – often dubbed “filler face” – in the popular magazines. This is when the plastic surgeon or cosmetic dermatologist has tried to lift a face where the skin has begun to droop with filler. The end result is a face that is over volumized to the point where it looks strange, no longer resembles the person, and sometimes, doesn’t even move naturally. Additionally, fillers and Botox can do nothing to address loose skin.

A Thread Lift & RadioFrequency Do Not Equal a Facelift

There are other procedures, such as the thread lift which are marketed as minimally-invasive methods to lift the face. According to Dr. Cook, threads “can be of limited value” and give the patient a little bit of an improvement in tone, but it does not come close to what can be achieved with a surgical facelift – and the results don’t last as long.

Then there are the procedures in which radiofrequency energy is blasted from the outside down into the deeper layers of the skin in order to tighten loose skin. The problem with these, for Dr. Cook, is twofold. “What we’re seeing is a lot of people who have seen a certain amount of their facial fat melted away, which is certainly not what you want.” Secondly, these procedures can produce a scar in the deeper layers, which then makes it more difficult to get the result that you want once you finally decide to do a facelift. 

How Do You Know When It’s Time for a Facelift?

All of the non-surgical methods can be useful “when handled intelligently,” says Cook. Procedures such as fillers and Botox can produce some nice, modest changes, “but there does come a point where you really do need a facelift if you want to properly rejuvenate a face.”

Facelift results - Dr. John Q. Cook.

When is that point? It’s going to be determined by two things:

  • the physical facial structure of the patient
  • the patient’s desired outcome

Some people have a lower threshold for the signs of aging than others. They want to get back to their fundamental structure and there is nothing like a facelift to deliver on this desire. Dr. Cook is familiar with all of the latest technology, and hasn’t seen a single thing that can remotely approach the results of a facelift.

Benefits of a Facelift

With a facelift, the surgeon is able to do many things at once. It’s a procedure that can produce a change in the tone of the skin while also addressing the descent in the deeper structures of the skin. Once the latter happens, which manifests as loose, drapes of skin, typically in the jowl area, there is no non-surgical method that will properly lift this loose skin. If the surgeon tries to correct it by simply pulling on the skin or trying to tighten it externally, the patient is not going to get a good result. 

Facelifts, when done well, are going to last in the range of 8-12 years, assuming that the patient:

  • stays out of the sun
  • keeps his or her weight stable

Furthermore, a facelift can be the most cost-effective choice. “[Patients] will spend thousands of dollars a year on non-surgical methods and never approach the result that they can get with a facelift,” shares Dr. Cook. If you amortize the cost of the facelift over time, it is often a more economical choice. Dr. Cook loves doing facelifts, “because I think it is our most powerful operation.”

Triumphant facelift patient - Dr. Cook.

It can substantially and properly address all of the key variables of facial rejuvenation:

  • structure
  • volume 
  • expression
  • surface

When it comes to facial rejuvenation, the facelift still reigns supreme!

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