Toxins, fillers, lasers—they've comprised the bulk of the beauty world's breaking news since the dawn of Botox for cosmetic use. And for good reason: Line-smoothing shots (Botox and now Xeomin and Dysport) and contour-restoring hyaluronic acid fillers (like Restylane and Juvéderm) are pretty freaking miraculous. And remember when we heralded the arrival of skin-tightening treatments, like Thermage and Ultherapy? Sharpen a jawline without a single prick!
But against this backdrop of flashy nonsurgical breakthroughs, a veteran anti-ager has been quietly rising up. More people—over 28 percent more—got face-lifts in 2015 than in 1997 (five years before the birth of Botox), according to the American Society for Aesthetic Plastic Surgery. Turns out, all those quick shots and no-downtime lasers haven't nudged the surgery closer to extinction. They've actually brought it out of the shadows. Noninvasive treatments “have de-tabooed plastic surgery by letting people dip a toe in the waters of this world,” says Marc Zimbler, an assistant clinical attending professor of facial plastic surgery at NYU Langone Medical Center in New York City. And soon they're ready to jump off the diving board.
It helps, of course, that the face-lift has enjoyed a makeover of its own in recent years. “Twenty years ago, the surgeon who did the tightest face-lift was considered the best,” says David Rosenberg, a facial plastic and reconstructive surgeon in New York City. Not so today, as significant advances are helping surgeons achieve far more natural-looking results while minimizing scarring and downtime. That's even piquing the curiosity of fortysomethings who've experienced the limitations of nonsurgical tools—namely, their inability to transform the lower face and neck in a meaningful way.
Techniques like Thermage and thread lifts can raise skin by a millimeter or two, and fillers that lift and swell the skin can take up a bit of slack, “but they're not going to replace a face-lift,” says Paul Jarrod Frank, a clinical assistant professor of dermatology at Mount Sinai Hospital in New York City. “I'm not going to load someone up with filler and turn her into a Cabbage Patch Kid just to make her skin a little tighter.” And noninvasive neck procedures effective enough to stave off surgery just haven't kept pace with face-focused ones, notes Karyn Grossman, a dermatologist with offices in Los Angeles and New York City. Now, let's get down to brass tacks.
What Can—and Can't—a Face-Lift Fix?
The face-lift's main goal is to remedy laxity in the lower face and neck, not to erase every little flaw. With age and the hormonal upheaval of menopause, the skin slackens and its underlying support system of fat and muscle collapses, ushering in droopy cheeks, an ambiguous jawline, and a neck marred by wattle and bands—all of which “can be mostly or completely corrected with a face-lift,” says Lawrence Bass, a clinical assistant professor of plastic surgery at the Manhattan Eye, Ear and Throat Hospital in New York City. Nasolabial folds, the parentheses offsetting the mouth, may also look a bit better after surgery but probably won't disappear entirely, he explains. Tugging that area enough to iron out deep creases can distort the mouth into a telltale Joker smile.
While the face-lift does bolster and reshape flattened cheeks, it doesn't address hollows or the tone and texture of the skin. Things like brown spots and fine lines around the mouth will persist, says Haideh Hirmand, a clinical assistant professor of plastic surgery at Weill Cornell Medical College in New York City. Which is why many surgeons now routinely perform laser treatments and fat transfers directly following surgery—right after skin is stitched closed, while you're still under anesthesia—stacking the downtime for the freshest result. The standard face-lift also ignores the upper face completely, furrows and crow's-feet included. You can tack on a separate yet simultaneous eye job or brow lift for an added cost.
What Advances Have Been Made?
Many—starting with a biggie: the depth of treatment. Rather than simply pulling back and cutting away lax skin, surgeons now lift and reposition underlying muscles. “The skin-only lift of the past produced immediate results, but given the skin's remarkable ability to stretch, the benefits lasted only about four or five years,” explains Konstantin Vasyukevich, a clinical assistant professor of head and neck surgery at the Albert Einstein College of Medicine in New York City. To compensate, “surgeons overpulled the skin, creating that wind-tunnel look,” he adds. Today, doctors use sutures to tighten either the connective tissue enveloping the muscles of the midface and neck (a so-called SMAS, or subcutaneous musculoaponeurotic system, lift) or the underside of the muscles themselves (a deep-plane face-lift). This allows surgeons to redrape the skin without stretching it to freaky effect. Changing the direction of the lift—pulling up as much as back—also contributes to a less pinched appearance. The old-school horizontal hike could betray a face-lift by giving “a weird, winged look to crow's-feet and neck lines,” says Dara Liotta, a facial plastic and reconstructive surgeon in New York City.
Surgeons have also mastered the nuances of replicating facial anatomy. “We now know exactly how much skin we need to lift up and which specific tether points [of the musculature] we have to snip to boost everything into place in a very focused way,” says Bass—meaning without taking apart the entire face and causing massive swelling and bruising. Some surgeons also use energy-based devices that help firm and lift the skin and melt unwanted fat during surgery, “so we can do less cutting and really limit bruising to just around the ears,” says Julius Few, a clinical professor of plastic surgery at the University of Chicago Pritzker School of Medicine. Doctors also cater to our collective intolerance for downtime by offering partial lifts—mainly to younger (mid-40s to early 50s) people who've used lasers and injectables over the years. With her “jowl lift,” Hirmand can fix the neck and jawline while sparing the face, easing patients' anxiety over looking different and shaving about a week off their recovery. In Rosenberg's office, the midface lift is hugely appealing to fortysomethings without neck issues, who just want to redefine their cheeks and jawline. He did 38 of them in 2015, compared with only 17 the year before.
More-discreet scars are a happy by-product of these advances. Those with a considerable amount of loose skin, however, may still require traditional incisions, which travel from the temple down along the front of the ear—or sometimes inside the ear—then around the lobe and up the back of the ear and into the hairline. Though no small thing, “they tend to heal really well and can be tailored to the individual, so they're almost completely hidden in the hair or creases of the ear,” says Liotta.
More on plastic surgery:
- A Guide to Injections: 6 Things to Consider Before Going Under the Needle
- The New V: Noninvasive Face-Lift Procedures
- The Most Innovative Anti-Aging Treatments to Try in 2017
What About Recovery, Cost, and Upkeep?
Count on surrendering between $12 and $40 grand (depending on the surgeon and the scope of the procedure) and being out of action for anywhere from one to three weeks. Doctors generally urge patients to hire a nurse for the first night to provide around-the-clock icing and emotional support. “You have wrapping all over your face; you look swollen and crazy,” says Liotta. “It's worth it to have a professional reassuring you that everything is normal and you're going to be fine.” While doctors do prescribe painkillers, patients report feeling mostly stiff and uncomfortable. “The face-lift is maybe a two on the pain scale,” says Bass, whereas a tummy tuck or C-section would rank an eight.
The smooth, sculpted results of a good face-lift will generally last 10 to 15 years, but “the neck, because it's the most mobile area, may start to give way sooner,” says Few. “I have patients from 15 years ago coming back now for tune-ups. But many are opting for nonsurgical fixes because they still look better than they did when they originally came in.” Then there are those who got a lift in their 40s and are signing up again 20 years later, says Bass, noting that face-lifts done on younger skin—“that hasn't yet lost all of its elasticity”—tend to last the longest.
A Patient's Tale
“I'm not shy about surgery,” says Amy*, a 49-year-old nurse. “I work in an OR, and I've had elective procedures in the past—a nose job, a boob job. I've gotten lasers and peels, Botox and fillers. Still, I was very hesitant to have a face-lift. I worried about looking completely different or like a superpulled old lady. I wrestled with the decision for about two and a half years. The thing that finally spurred me on was seeing a picture of myself taken by my 11-year-old daughter. It showed off my neck in the worst way and made me very self-conscious. After that, I was like, I'm just going for it. I was 48—and had just signed my divorce papers.
“The day of my face-lift, I got myself to the doctor's office at 8 A.M. and planned to have a friend pick me up around 2 P.M. When I woke from surgery, I was still pretty sedated and wasn't in any pain. I threw up from the anesthesia on the car ride home but felt fine after. Since I am a nurse, I didn't find it necessary to have a professional with me that first night, but I did ask a friend to stay over just to keep me company. Sleeping on my back with my head propped up on three pillows got old fast. And repeatedly getting out of bed for ice—I was icing for days—that was kind of a pain in the ass. My doctor prescribed Percocet, which I took for the first two days to help me sleep, but I really wasn't in any pain postprocedure, just uncomfortable. I'd had some laser work done under my eyes during the surgery to even my skin tone, so that area was especially swollen and oozy. My incisions were weepy, too. But the hardest and most stressful part was not knowing what I was going to look like. I was all bandaged up and scarily swollen. My eyes were slits. Did you ever see that Twilight Zone episode where the woman wakes up with wrappings around her face, and when she takes them off, she looks like a totally different person? For days, I kept thinking, Holy shit, that's gonna be me!
“But it wasn't. I healed really fast and was out running errands four or five days after surgery. And I looked so natural—like myself but more defined. Now the laxity in my jawline is gone. My neck is smooth but not at all fake-looking. And with the exception of the one or two people I told, nobody seemed to notice I'd had anything done—not even my ex-husband. My daughter was away at camp during my surgery, and when she came home, she never said a word. I have scars around my ears, mostly hidden in the folds, but really, my face looks so good, I don't even care. And the little things that used to irk me about my appearance, like the lines across my forehead, don't bother me anymore. I haven't had any injectables since my surgery. My forehead does what it does naturally, and it doesn't make me look older. I look so much better, and I feel freer and more confident. I'm online-dating, and I don't Facetune my profile pics anymore. And when my daughter plays photographer, I don't feel the need to hide my chin or neck. To me, the face-lift was absolutely worth the $12,000 and two weeks of recovery. I'd do it again in a heartbeat.”
*Not her real name.
Now that you've read all you can on the face lift, here are 13 plastic surgery stories that'll make you cringe:
