About Facelift Surgery
The negative effects of aging
As we get older, we inevitably experience the negative effects of aging. Loss of skin elasticity, firmness, and volume can significantly change the contour of the face. These changes typically lead to the development of wrinkles, creases, and hanging skin on the neck (commonly referred to as a “turkey neck”).
While a healthy diet and good skincare routine are useful ways to slow the aging process, other factors like genetics, smoking, and sun exposure also contribute to facial aging and may be difficult to avoid.
Reducing the signs of facial aging
A facelift is a surgical procedure that aims to reduce the signs of facial aging. The areas addressed with a facelift are the neck, jowls, and cheeks. The facelift tightens the underlying muscle layer. After this is done, the excess skin is then removed.
Dr. Bustillo often combines the facelift operation with additional procedures as needed. For example, because the face loses volume with time, a fat transfer procedure is often performed at the same time. Patients that may need to have their eyelids rejuvenated can also have a blepharoplasty or eyelid lift done at the same time.
Facelift surgery delivers truly transformative results for the aging face. However, many patients worry they’ll look unnatural after treatment. Looking years younger doesn’t necessarily mean you will look entirely different
Facelift Before and After Photos
Fine lines and wrinkles are completely natural for mature skin, but they can also be a source of insecurity for many people. Although we can’t stop the aging process entirely, options are available to restore your youthful features and shave years off your appearance. Often called the “gold standard” of facial rejuvenation, the facelift is a cosmetic procedure known for its ability to dramatically improve skin laxity and smooth out deep facial wrinkles.
* Each patient is unique and individual results may vary.
Custom Facelift Procedures
Dr. Bustillo customizes the facelift surgery for each individual. His signature deep plane facelift lifts the cheek fat back to its natural position and redistributes the excess skin. Because the lift works on the deeper muscle layer, patients never look pulled or stretched.
Fat is often used to help replace facial volume that patients may lose with age. Dr. Bustillo almost always performs a platysmaplasty as part of his facelift procedure. This portion of the surgery tightens the neck muscles and is essential to a well-defined neck.
When to Get a Facelift
Transformations of an aging face
There are three visible transformations that the aging face goes through as a result of the aging process. These are facial descent, deflation, and radial expansion.
Descent refers to the inferior displacement of the facial soft tissues. Deflation refers to the loss of facial fat. Radial expansion is the loosening of the facial tissue. As the face ages, the layers of the face (skin, fat, and muscle) separate and loosen. A properly planned and executed facelift should address these in order to fully rejuvenate the face and neck.
The aging process
As a consequence of the aging process, the facial skin and underlying tissues descend. This can be first seen in the midface, where the malar fat pad (cheek) begins to descend. This descent of the cheek fat has two effects. In the area between the lower eyelid and cheek, hollowness forms as the cheek fat descend. The other effect is the creation of the nasolabial fold. As the lower face ages, the jowls begin to appear as the facial tissues begin to descend forward and downward.
The platysma muscle originates in the lower face and runs down the entire neck. This muscle descends in both the face and neck as we age. In the lower face, its descent creates the jowl. The jowl is actually the sagging front end of the muscle. In the neck, the platysma descends with aging, sometimes causing the bands that appear in the front of the neck.
A Properly Executed Facelift
Elevating the midface to its natural position
A properly executed facelift procedure should elevate the midface, or cheek, to its natural position. This cheek elevation will restore the fullness to the area between the cheek and the lower eyelid.
I believe that this is an area that certain types of facelifts fail to correct. It is also an area that, if corrected, can restore the youthful look to a face (Figure 3a, 3b, 4a, 4b, 5, 6). The facelift should reposition the platysma muscle back to its original position, in order to correct the jowls. In addition, fat transfer is often used to help shape the cheek to a more youthful appearance.
The second visible change is deflation. This describes the hollowness that is sometimes seen in some areas of the aging face. Deflation can be due to either a loss of fat volume or a descent of the facial fat. The area underneath the cheekbone can undergo deflation in some patients.
The surgical rejuvenation of the face must take into account these shifts in volume and attempt to correct them. The first step is the recognition, followed by a surgical plan aimed at repositioning the facial deep tissues to replenish the volume. This can be accomplished by either repositioning the fat during the facelift or by performing an autologous fat transfer.
Radial expansion can be best described as the outward push seen in some areas of the aging face, which causes a loss of jawline definition. This is most commonly seen in the lower face in the areas of the jowls and the lower border of the jawbone. It is a consequence of the weakening of facial retaining ligaments. As they weaken, the tissues loosen and separate from the deeper tissues.
This is a very difficult problem to fully correct surgically. The facelift technique must be able to elevate and secure the underlying deep tissues in order to recreate the definition of the jawline that is associated with youth.
The aging neck is one of the most challenging areas to treat in facial rejuvenation surgery. The transformations that occur in the neck as a result of the aging process are increasing skin laxity, inflation, and muscle descent. The facelift surgeon should plan and address these to maximally improve the neck contour.
The platysma muscle runs from the lower face and down into the neck. With aging, this muscle descends and may cause the neck bands that are commonly seen in the neck. In addition, the loosening of the muscle may add fullness to the neck below the jawline (Figure 7). The facelift procedure should address the muscle by tightening it centrally below the chin and laterally near the corner of the jawbone. This is commonly called a platysmaplasty.
The submental area, just underneath the chin, is an area where the accumulation of fat can cause inflation in the neck. Fat removal should be performed judiciously in order to sculpt the neck adequately, yet maintain a natural appearance (Figure 8, 9). Overzealous fat removal in this area can skeletonize the neck and allow the underlying neck structures to be visible through the skin.
Over time, the neck skin can lose elasticity and become lax. This leads to a redundancy of the skin over the neck. While the facelift procedure tightens the underlying neck muscles and removes the excess skin, it does not address the inherent laxity that the person’s skin may have. The person with excessive skin laxity may have a less than ideal result in the neck as a consequence. This patient may benefit from certain skin tightening non-invasive procedures after the surgery. It is a well-known fact that facelifts may not satisfy all patients in the neck area. The reason is usually excessive skin laxity, which surgery cannot address.
About Mini Facelifts
Easy and fast, the results are also usually “mini.”
In recent years, the mini facelift has become very popular. Those that market them have given them “brand” names. The idea sounds promising. Mini is a term that is associated with easy and fast. However, the results are also usually “mini.” My belief is that if a person demonstrates signs of an aging face and wants a surgical solution, the procedure of choice is a facelift.
I often see patients in my practice that had mini facelifts and are unhappy with the result. They ultimately end up having a facelift to improve the poor result they obtained from the mini facelift.
Non-Surgical and “Liquid” Facelifts
A non-surgical facelift, also known as a liquid facelift, is a procedure performed with injections to rejuvenate the face. It usually consists of Botox or Dysport used to improve the wrinkles in the upper third of the face. These include the glabellar lines (also known as the “elevens”), the crow’s feet, and the horizontal forehead creases.
Dermal fillers are then used to elevate the cheeks and smooth the nasolabial and marionette folds. The downside of this treatment option is that it does not treat the sagging neck or heavy jowls.
The Facelift Procedure
Facelift techniques developed over the years
There are many facelift techniques that have been developed over the years. Initially, the lifts were “skin only,” meaning that all of the pull was placed on the skin. The results were mostly short-lived. This led surgeons to search for more reliable and long-lasting techniques. The next advance came in the form of the SMAS facelift.
The SMAS (abbreviation for superficial musculoaponeurotic system) is a fibrous layer underneath the skin of the face. It envelops the facial muscles. The SMAS technique involves the removal of a strip of the SMAS and the advancement of this layer to tighten the underlying tissues. This was a major advancement and improved the facelift results over the skin-only technique. However, there were still areas of the face and neck that the SMAS lift did not address. These areas were the midface and the neck.
Deep plane facelift
The facelift technique used by Dr. Bustillo is the deep plane facelift. This comprehensive lift allows the correction of the facial descent, deflation, and expansion that occurs in the aging face. The deep plane facelift involves the elevation of the SMAS and the facial muscles. After they are elevated, they are lifted, repositioned, and secured in their new position.
The malar fat pad is elevated, allowing for the correction of the deflation and descent seen in the midface. In the lower face, the platysma muscle is elevated and secured to achieve a defined jawline, thereby eliminating the jowls and decreasing the radial expansion. In the neck, the fat is carefully removed and the platysma muscle is tightened centrally (below the chin) and laterally.
Deep plane facelift advantages
The deep plane facelift has several advantages over other facelift techniques. The technique allows the repositioning of the cheek up to its youthful position. In addition, the jawline definition is greatly improved due to the muscle work that is performed in the lower face and neck. The most significant advantage is the natural appearance that is attained with the deep plane facelift.
Patients in their mid to late forties and on
The majority of patients that undergo the facelift operation do so in their mid to late forties and on. Occasionally, patients with premature facial aging or weight loss will undergo the surgery at an earlier age. People are many times confused about what exactly a facelift corrects. This uncertainty can be compounded by the advent of the different types of lifts. The goal of a facelift procedure is to rejuvenate the neck, the lower face, and the mid-facial regions. A facelift repositions sagging facial tissues thereby achieving a more youthful appearance. A facelift does “not stop the clock, but it turns it back”; the natural aging process continues after the procedure.
The decision about having the facelift operation is a very important one. You should consult with your surgeon to see if you need a facelift and if he can provide the result you are looking for. Patients that undergo a facelift with Dr. Bustillo feel that they look refreshed and have an increase in confidence. They feel rejuvenated and feel more comfortable in social settings and in pictures.
The ideal patient should have the proper expectation before undergoing surgery. Although with the deep plane facelift technique, results are better than they ever were, there are still limitations. It is important that the patient has a good understanding of what can be achieved. For example, patients with poor skin laxity in the neck may not have a tight neck contour. Clear communication between Dr. Bustillo and the patient is very important.
While most facelift patients enjoy the benefits of an improved face and neck, it is important to remember that surgery, like all other human actions, is not perfect. A skilled facelift surgeon can achieve near perfection. However, one must remember that the skin and soft tissues the surgeon works with can have inherent laxity and weakness.
Facelift surgery with no visible scar
A facelift performed by Dr. Bustillo will not have visible scars. This is because Dr. Bustillo will hide all incisions along natural curves, folds, and inside the hair. One of the biggest “tip-offs” to facelift surgery is a visible scar.
Scars After a Facelift Surgery
Facelift scars may be visible for several reasons. The number one reason the scars are visible is due to excessive tension placed on the skin. When an incision is closed with tension, it heals poorly, and as a result, will widen (Figure 10, 11). A wide scar is always a visible scar.
The surgeon should use a technique that places the pull and tension on the deep tissues. This skin closure should be meticulous and tension-free.
The second reason the facelift scar may be visible is placement. The incisions should be placed along natural curves, folds, and inside the hair. They should not be placed in the hairline behind the ear, because they may be visible.
I will describe the incision that I use in my facelift. The superior portion of the incision is placed inside the temporal hair, completely hidden (Figure 12a). As it comes down, it hugs the helix and enters behind the tragus (Figure 12b, 12c). The tragus is that small round or square cartilage in front of the ear. This part of the incision is known as a “post-tragal” incision because it is hidden behind the tragus. This is in contrast to the “pre-tragal” incision used by some surgeons.
I believe that the post-tragal incision gives superior results, as it completely conceals this part of the incision. The incision then comes down a natural crease between the ear lobule and the facial skin. In the back of the ear, it travels up in the crease behind the ear. It then crosses into the hair, where it is completely hidden. This allows my patients to wear their hair up without any scars being visible. Any incision outside this course has the potential to be visible (Figure 12d).
Ear Shape after Facelift
When Dr. Bustillo performs a facelift, the natural shape and position of the ear will be maintained after the facelift. (Figure 13, 14, 15). The ear can change when the incisions are closed with tension or are improperly placed.
For example, there can be changes to the tragus. The tragus can be pulled forward or simply removed. The ear lobule is a very delicate portion of the ear. It is fat-filled and the skin is very soft. It is therefore inherently weak and susceptible to stretching or pulling by the healing forces. The extreme case is the “pixie ear,” where the ear lobule is pulled inferiorly and blends with the face. It gives a surgical appearance and looks very unattractive. The surgeon must be meticulous in his incision placement and closure to avoid alterations in the shape of the ear.
Facelift Consultation in Miami
The consultation begins with a discussion about specific concerns that our facelift Miami patients may have about facial aging. It is important to discuss whether facial aging has occurred slowly over time or recently in the last several years. Any recent weight loss or plans for weight loss are discussed so that the surgery can be planned at the appropriate time.
Dr. Bustillo will perform a thorough physical examination. The midface is evaluated for the descent. Dr. Bustillo usually performs a fat transfer procedure at the same time to help with volume loss in the midface. The lower face and jowls are then palpated and mobility of the facial skin and tissues is assessed. The neck is then examined. The amount of fat and muscle descent is determined and the amount of skin laxity is assessed. The eyes and eyebrows are evaluated to see if the patient is a candidate for any other adjunctive procedure, such as a blepharoplasty or a brow lift.
Dr. Bustillo will then have a discussion about the result that he believes can be achieved with the facelift surgery. The patient should understand exactly what the facelift procedure will achieve for them so that an informed decision can be made. The procedure is explained in detail and all questions are answered.
The cost of a facelift varies from patient to patient, from doctor to doctor and from city to city. Jessica, our patient care coordinator will meet with you personally after the consultation.
The cost of a facelift with Dr. Bustillo ranges from $16,675.00. This includes the operating room and anesthesia. A board-certified anesthesiologist (M.D.) from the Baptist Hospital Anesthesia Department provides the anesthesia.
Questions about your facelift procedure?
Schedule your consultation with Dr. Andres Bustillo.
Preparing for Facelift Surgery
Dr. Bustillo requires that all patients undergoing a facelift procedure obtain pre-operative labs and medical clearance from their primary care physician before surgery. Patients should stop taking all aspirin, anti-inflammatory products (naproxen, ibuprofen), and vitamins such as A, Ginkgo Biloba, and St. John’s wort ten days before surgery. Because they may affect blood clotting, they should be stopped ten days before surgery.
Patients should also stop any alcohol five days before the lift surgery to decrease swelling and bruising. Dr. Bustillo recommends that patients start high dose vitamin C (2000mg/day) one week before surgery and two weeks after the facelift surgery, to help with the healing and to reduce bruising.
Anesthesia for Facelift Surgery
Dr. Bustillo performs facelift surgery on an outpatient basis in his certified facility. Patients are allowed to return home or to a hotel the same day after facial rejuvenation surgery. Dr. Bustillo believes that patients recover best in a tranquil environment. All surgeries are staffed by board-certified anesthesiologists (MD), which are part of the Baptist Hospital Anesthesiology Department.
The facelift procedure can be performed under either general anesthesia or IV sedation anesthesia, depending on the patient. Certain patients may require general anesthesia for safety reasons. The anesthesiologist will decide which type of anesthesia will be the safest for the patient. The facelift surgery takes about three hours to perform.
Risks of Facelift Surgery
The facelift operation, like all surgery, does have risks aside from those of anesthesia. The highest risk patients are smokers.
Patients who smoke should refrain from smoking for approximately two weeks before the surgery. The nicotine patch is not a substitute for smoking cessation as far aesthetic surgery is concerned. Nicotine causes the small blood vessels to become narrower, which decreases the blood flow to the skin.
The potential complication in a smoker is the death of the facial skin, resulting in a poor outcome with facial scarring and possible infection. Facelift surgery will not be performed on an active smoker.
A hematoma is a collection of blood that can accumulate under the skin. Although rare, it can occur after a facelift. The risk of hematoma is about 1%. The treatment usually entails draining it in the office.
Most patients that have a hematoma after surgery recover well without any complications. Infections after facelift surgery are also rare. Patients are given antibiotics prior to surgery and after surgery to help prevent infections.
The patient is discharged home or to a hotel the same day after the facelift surgery. The first night should be spent relaxing. The patient should keep activity to a minimum. A liquid diet should be maintained for the first eighteen hours after anesthesia. The patient should keep the head elevated using two pillows to help reduce swelling of the face and neck. The patient should place small zip lock bags with frozen peas on the face every fifteen minutes for the first two days.
The face will be wrapped with a bandage used to keep the skin flat. Pain should be minimal. Tylenol is usually enough to control any minor discomfort. Additional pain medication will be provided, in the event that it is needed. Any significant pain should be reported to Dr. Bustillo immediately, as this may signal bleeding under the skin. If a blepharoplasty was performed, some mild bruising may be visible around the eyes.
The patient is then seen the morning after the lift surgery. The bandage will be removed on the first day after surgery. It is normal for some bruising to appear in the neck. A small bandage is then worn for one more day. On the fifth postoperative day, the small stitches in front of the ear and under the chin are removed. Patients can usually shower and wash their hair after this second visit.
Most patients return to work and daily activities about two weeks after surgery. Seventy percent of the swelling resolves in the first three weeks after the facelift. It is recommended that physical activity, such as running or lifting be resumed three weeks after the surgery. The remainder of the swelling can take up to three months to completely resolve. This remaining swelling is imperceptible.
The final results of the facelift surgery may not be completely evident until several months after the surgery. The results of a facelift operation usually turn back the clock approximately ten years and the results last about ten years. Dr. Bustillo will take before and after pictures and will give them to you once you are completely healed from the facelift operation. Most patients who undergo facial rejuvenation surgery are extremely happy with the results.
Unfortunately, a facelift cannot stop the aging process. A facelift does not change the quality or texture of the skin. A facelift can, however, give the patient a more freshened and rested appearance.
A common question that patients ask Dr.Bustillo about the facelift procedure is “How much younger will I look?” Dr. Bustillo believes that the facelift procedure may turn the clock back and allow the patient to look approximately ten years younger.
Dr. Bustillo performs the facelift procedure in an AAAASF-certified facility. Dr. Bustillo only works with board-certified anesthesiologists.
Dr. Bustillo takes close to three hours to perform the facelift procedure.
Most patients that undergo a facelift procedure with Dr. Bustillo do not have much pain. As you may know, everyone is different, and there are some patients that will have some mild pain. Dr. Bustillo will prescribe pain medication to help with any discomfort you may have.
There should be someone with you for the first two days after a facelift. Dr. Bustillo recommends that patients arrange for post-surgery help from family members or friends.
Most patients that undergo a facelift with Dr. Bustillo can return to work in fourteen days.
Most patients that undergo a facelift with Dr. Bustillo can resume exercise after three weeks.
Dr. Bustillo will remove the stitches underneath the chin and in front of the ears five days after the facelift and then ones behind the ears ten days after the facelift.
It is rare to have complications after a facelift performed by Dr. Bustillo. However, this is a surgical procedure and things can occur. Some of the potential complications associated with a facelift procedure are bleeding, scarring, infection, nerve injury, and poor healing. Dr. Bustillo will discuss these with you in consultation.
It depends on your definition of permanent! Yes, the results will stay with you forever. But, as you know, the aging process will not stop after a facelift. That being said, you will always look younger after your facelift than if you had never had one before. It is difficult to say how long the facelift will last, since everyone ages differently.
Patients often ask me what is the best way to cover up bruising after plastic surgery. I recommend that they start using makeup about a week after surgery. The makeup can be applied to the cheeks, jowls, and neck. It should be a light, liquid-based base concealer. Sephora has several that work very well. I do ask that the patient not apply the concealer to the incisions, as these need to heal without any substances being applied to them.
Protein S deficiency is a blood clotting disorder that can place patients at a higher risk for blood clots. A hematologist should evaluate you to see if you can undergo elective surgery. If you are cleared for surgery, there are things we can do to help prevent a blood clot from forming. The procedure should be done with IV sedation and local anesthesia. This may decrease the risk of clot formation as compared with general anesthesia. SCD’s, or sequential compression devices must be used. These are “booties” that compress the legs and help prevent clot formation in the lower extremities. In addition, aspirin may be started forty-eight hours after surgery. In conclusion, you are at a higher risk for having complications associated with elective surgery, as compared with a patient without protein S deficiency. While the risks are likely low, this is a decision that you must make after discussing the surgery with your hematologist and surgeon.
Why Choose plastic surgeon Dr. Bustillo
- American Board of Facial Plastic and Reconstructive Surgery
- American Board of Otolaryngology-Head and Neck Surgery
- Facial Plastic & Reconstructive Surgery Fellowship at The New York University
- Otolaryngology – Head & Neck Surgery Residency at The University of Miami, Jackson Memorial Hospital
- General Surgery Internship at The University of Miami, Jackson Memorial Hospital
If you’re seeking a facelift in Miami, contact us today to schedule a consultation with Dr. Andres Bustillo.
Our Practice in Miami, FL
6705 Red Rd #602
Miami, FL 33143
Hours of Operation
Monday-Friday: 9:00am – 5:00pm