If are looking in the mirror and pulling up your face, you’re may be asking if this
is the right time to have a facelift.
I’ll try to help you understand how I approach this question in my practice every day.
I’m Dr Amiya Prasad.
I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculofacial Plastic and
I’ve been in practice in Manhattan and Long Island for over 20 years.
I have been performing every type of facelift from short scar quick recovery to deep plane
face and neck lifts in my practice throughout my career.
I would also add that although I’m a surgeon, I have integrated many minimally invasive
advances help my patients concerned about their facial aging changes.
This includes specific methods to treat volume loss, skin quality, the use of suture based
suspension, as well as non surgical skin tightening.
Men and women come to see me everyday with concerns about looking more aged and appearing
What’s particularly bothersome for these patients is that they feel their appearance
on the outside doesn’t match how they feel on the inside.
When a patient comes in for an evaluation for a facelift, I start by taking pictures
from different angles at rest and with expression.
I ask the patient to look at their photo and state what they feel is the most significant
areas which concern them.
Of course, many times, they look and say “Everything!”.
I then systematically review with them what I see in the upper, middle and lower third
of the face.
A perspective which is particularly helpful is a three quarters and side view.
I look for the presence of jowls and sagging neck skin.
If these areas are significant, I move the cheek and neck upward and back to see if there
is enough looseness to perform a facelift or face and necklift.
I also educate my patients about understanding that facial aging is not just about loose
skin which is sagging but facial aging is significantly affected by progressive bone
This means that volume correction has an important role in helping you look better with or without
In the past, it was often that a woman in her 50s would come in and I would recommend
a facelift procedure.
Often these were short scar facelifts sometimes referred to as mini lifts.
Currently, if there isn’t significant sagging of the skin, rather than recommend a short
scar facelift, I educate my patient about how bone loss and soft tissue loss is more
responsible for their facial aging changes.
I discuss considering volume correction with a method called structural volumizing using
long lasting fillers such as Juvederm Ultra Plus or Juvederm Voluma.
It’s very common for patients to be afraid of looking pillowy or puffy after having fillers
citing friends and celebrities who they feel look unnatural.
I explain how traditional filler placement is performed at the skin level in a skin structure
called the “dermis” or just below the skin.
This means that the weight and shape of the filler can have a significant negative impact
on aging skin which tends to be thin and loose.
When I perform structural volumizing, I apply my surgical knowledge and experience, particularly
with facial implants to place the fillers at the bone level comfortably with little
risk for bruising.
This is ideal since the bone level is where the most significant volume loss has occurred.
In contrast with traditional methods which can make the skin look puffy, this technique
actually results in improvement of the definition of bone structure and restores shape in a
way which looks more youthful.
For many patients who were considering a facelift, this procedure works out very well, without
If there is significant skin sagging, a facelift can be performed and structural volumizing
can be performed after surgery.
The main goal of facelift or face and neck lift surgery is to restore the anatomy of
the sagging tissue to improve cheek position, jawline definition and improve the neck angle.
My facelift patients are mostly women in their 60s and older.
Prior to surgery.
I always review the medical history and the results of the most recent physical exam with
their medical doctor including diagnostic testing such as EKG and blood work.
In terms of medical history, most people who have well controlled conditions such as high
blood pressure or diabetes can undergo surgery.
I am particularly concerned about patients who smoke as the effect of smoking on the
blood supply to the skin can be a problem for optimal healing.
In my practice, I routinely perform all types if facelift surgery from short scar mini lifts
to deep plane face and necklift surgery under local anesthesia with LITE intravenous sedation.
This is in contrast to traditional surgery which is performed under general anesthesia.
My patients appreciate how good they feel immediately after surgery and how quickly
they’re able to recover.
After surgery, a dressing is placed which is removed the next day.
I generally suggest taking 1 to 2 weeks off work depending on the extent of surgery to
Closing: The facelift has been the gold standard for helping people address the anatomic changes
of aging, particularly sagging and jowling.
In my practice, my approach to recommending a facelift is now part of a range of options
which I customize to meet the needs of each patient.
No two faces are the same so every face has to be looked at individually.
I hope you found this information helpful...thank you for your question