OK, you have decided that you want a facelift.  Easy enough, but now you are worried.  Should you have the Lifestyle Lift or maybe the Quicklift or possibly the Acculift?    These procedures can be viewed on slick advertisements with glowing testimonials on TV and in print ads.  Of course, all of these are names for facelift type of procedures.  Why are they named?  Well, it’s the new (pardon my pun) wrinkle in cosmetic surgery, the copyrighted procedure!  The government in its wisdom has, appropriately so, prohibited the use of patent restriction of any surgical procedure.  However, anyone can take an existing surgical procedure, alter it or not alter it and give it a name, which is then copyrighted.  What this means is, any doctor who performs facelift procedures, can do any procedure on you but cannot call it by the name that has been copyrighted.  Only a franchise doctor can use the copyrighted name.  This then is an advertising and promotional gimmick.  There is no secret magic to the surgical procedure.

So you ask, what is different when evaluating these cleverly named procedures?  All facelifts are not the same.  Most of the procedures currently performed were developed over many years, by a variety of contributors.  Traditionally cosmetic surgeons named the procedures with rather unsexy but descriptive names such as the SMAS  facelift, the deep plane facelift or the minilift.  Facelift procedure techniques  have always been reported upon at professional meetings and in medical journals.  Techniques evolved because of the willingness to share knowledge and to further the skill sets of both cosmetic surgery colleagues and new physicians.  In the current advertising market,  old techniques are renamed and branded as spanking new techniques that may only be performed by a select few doctors.  The truth is that any real plastic surgeon that is certified by the American Board of Plastic Surgery and a member of the American Society for Aesthetic Plastic Surgery and the American Society of Plastic Surgery has been well trained in all of these techniques, regardless of whether or not he utilizes the cool new name.  The choice of which technique would most benefit the individual patient is what is truly important.  In my industry, one size does not fit all.

The facelift procedure by any name is designed to rejuvenate your facial appearance.  The problem with your facial appearance may be skin, muscle and/or neck laxity possibly combined with fat excess and/or atrophy.  Some patients may need only a skin tightening procedure.  Others may need a procedure that tightens both skin and muscle or possibly the neck bands.   Of these,  some may need an extremely limited procedure and some may need an extensive procedure to achieve maximum benefit.  The skin itself may need to be resurfaced to correct aging changes.  The facial skeletal structure may need to be supplemented with fat or a dermal filler,  or perhaps a chin or cheek implant.   The bottom line… multifactorial facial aging changes means one procedure does not serve all needs.

If you go to a heavily advertised facelift mill or copyright promoted surgeon and receive only the promoted procedure, you are generally receiving a minimally invasive procedure that does little more than skin tightening (often costing more than the same procedure with your local plastic surgeon).   The allure of many of these promoted procedures is that there is minimal downtime,  minimal cost, rapid recovery and can be done under local anesthesia.  This sounds wonderful.  It’s kind of  cheap and quick with no anesthesia risks, and I can go back to work in a couple days.  Who would not want that?  Cosmetic surgeons who are well-trained and aware of all the variables that are involved in achieving an optimal outcome, would be doing these lesser procedures without the copyrighted name on every patient,  if indeed they were all you needed.  Also,  in my many years of performing cosmetic surgery in Marin County, I rarely have seen a facelift that does not require at least a week of downtime to look socially presentable.

In some of the TV and print ads that I’ve seen  for procedures with copyrighted names, the results as shown were wonderful.  However, most often the individual in these ads  has obviously also had a brow lift, a blepharoplasty (eyelid lift) , dermal fillers,  fat removal and/or repositioning and a neck band revision.  The cost of these additional procedures  would certainly exceed the baseline advertised price.  The time involved to perform the additional surgeries would monumentally add to the  complexity of the case.  The advertised 1 hour procedure would certainly be extended to  four or five hours, making it virtually impossible to perform the procedures comfortably or safely on a patient without general anesthesia.  Is this a bait and switch?  Consider this as well, if you read the fine print on the bottom of the TV screen, the advertising physician is not the one who has performed the surgery on the individual shown.  And, your chances of getting the doctor who did perform the surgery that you are admiring are slim to none.  You have seen a great before and after that was not performed by the doctor advertised.  Also, if you have the surgery at that facility, you may never see the doctor who operated on you again.  Follow-up, even if you have problems, may be done by ancillary personnel.

If you are considering responding to ads that you’ve seen, I would ask that you first see a local board-certified plastic surgeon (names readily obtainable from the ASAPS online).  During this consultation, have the doctor explain what needs to be done:  skin, muscle, fat, fillers, resurfacing.  Ask specific questions regarding scar placement and what your anticipated recovery time will be.  Remember that just because an ad makes a claim, reality may look very different.  Make sure that you view before and after photos of actual patients that have had a procedure performed by the doctor that you are considering.  If your budget is limited, tell him what you can afford and ask what his recommendations would be.  Remember, if a surgical procedure is quick, minimally invasive, and cheap;  you usually don’t get much no matter where you have the procedure.  You may indeed benefit if you need  minimal correction from less of a procedure.  However, if the procedure will do little or nothing to correct your concerns (example:  sagging neck skin),  it is unethical for the doctor to take your money.  The maximum benefit that you will receive is best called, a wallet lift.

Her friend was correct in questioning the procedure. After examining this delightful lady, it was clear that she had many of the typical aging changes associated with being in her 60′s with no prior corrective procedures. Her neck had lost definition and had sagging skin. Her jowls, midface and facial muscles were lax. What she really needed was a complete facelift that would resuspend and redefine her neck. Her facial muscles needed to be lifted and skin needed to be removed from in front of the ear and behind to lift the face and neck homogenously. To have kept this lady comfortable, general anesthesia would have been necessary for a 3 to 4 hour procedure, not 1 hour. A minifacelift would only have lifted the skin in front of the ear and would not have addressed her concerns adequately. Her neck would have remained the same and her muscles would not have been lifted. She would have seen very little improvement based on her initial facial issues.

When digging a little further, she had seen before and after photos but wasn’t sure they were the results of the doctor that had consulted with her, or even if he would be performing the surgery. She was pressured that she needed to sign up today for this great deal. Her free consultation turned into a $400 visit by the end of the appointment.

My opinion is this: here in the San Francisco Bay Area, we are lucky to have many plastic surgeons certified by the American Board of Plastic Surgery and that are members in good standing of the American Society of Plastic Surgeons . Additionally, many of those are members of the American Society of Aesthetic Plastic Surgery, a society that recognizes experience and proficiency in aesthetic cosmetic surgery. Both of these organizations represent the gold standard for plastic and cosmetic surgery training. In California, any doctor can represent themselves as a cosmetic surgeon if he or she is board certified in something, anything. Think about a OB/GYN, ER doctor or radiologist taking a weekend course and viola, a procedure is learned. Experience, training and education matter. Research your doctor, do not be pressured, go in for as many consults as you need and don’t fall in love with the salesperson at the office that promises great things. The surgeon is the one doing the surgery and should answer all of your questions until a complete understanding is achieved. Photos that are presented should be of patients your doctor has performed the surgery on, not of someone else’s work . Make sure the surgeon is doing your followup and will be accessible for hand holding after a procedure. A patient should know how often followup will be scheduled and that a drop in appointment is available for concerns, any concerns.

The patient I just discussed went on the further research the clinic that had seemed so promising and realized she would not have been happy with the procedure. She is now making a plan to have a facelift procedure that will actually correct her concerns when she is ready to schedule.

Let me give you an example,  the patient below needed a facelift and eyelid lift.  Her neck had lost definition, her jowl lines were softened and her midface was sagging.  To have merely injected dermal fillers and Botox into her face would have created relaxed muscles in the areas that were already relaxed and a puffiness to her face that did not match her distinctive look.  She was better served by performing a facelift and an eyelid lift, followed by strategically utilizing  injectable dermal fillers, Radiesse and Restylane, to correct the nasolabial lines.  Her facial muscles were tightened, her midface was lifted with her eyelid lift, her neckline redefined and the extra skin from her face and eyelids were removed.  No Botox was used on this patient.

The next patient was an excellent candidate for Botox and injectable dermal fillers, but again, they were used as an adjunct to cosmetic surgery.  Before surgery, this patient had lower lid puffiness and upper lid drooping that was correctable only by an eye lift.  She had midface laxity and her nasolabial lines were prominent,  as were the lines between her brows.  Botox was  utilized to weaken her brow lines and the the lines in her crow’s feet areas, and to slightly lift her brows.   Restylane was used to correct her nasolabial lines.  However, the greatest correction was seen following her upper and lower eyelid lift.  At that time, extra skin and muscle were removed, the malar fat pads (over the cheekbones) were repositioned and the midface was lifted.

There are certainly times when the physical anatomy of the face or financial choices make the usage of Botox and injectable dermal fillers, without cosmetic surgery, a wonderful choice.  My concern is that patients need to be informed of all methods, tried and true, that may be of benefit  for the cosmetic concerns that they are trying to solve.  Dermal fillers and Botox are great temporary solutions, but when used in great quantities to avoid a surgical solution, their costs can be equally as daunting.

My recommendation:  By all means utilize these valuable nonsurgical solutions, however, an informed plastic surgeon can assist you in providing a reality based plan for your short-term and long-term goals.  At my Marin County plastic surgery practice, I evaluate every patient’s individual needs so that you understand all of your options prior to treatment.