​Facial aging is a three-dimensional change. Contrary to previous beliefs, it is not only the skin that ages, but also the deeper structures including the fatty layer, the muscles, the fascia and the bones! The modern facelift addresses all of these layers. Even though it is called a facelift, the aim is to improve the mid-facial tissues, the jawline and the neck. ​The aim is to create a better smile, fuller cheeks, a strong jawline, and a firm neck.

Analysis of the youthful face allows us to determine what is possible and how. Attention is paid not just to tissue laxity and ptosis, but to tissue fullness, position, arches, curves, prominences, hollows and proportions.

There is no such thing as the “standard facelift” as it simply gives a ho-hum result without the beauty inherent in all of us. Look at our method of analysis, planning and techniques and review our results to get an idea of what is possible and our approach.

Cosmetic approach to the three facial zones

“I have spent time today reviewing your point-by-point description of everything you did for me and how you did it; I referred to the before and after photos countless times. I am in absolute awe. Your facelift results are nothing short of miraculous. You are absolutely correct, If you had told me what you intended to do, I would have most likely taken a pass from being confused and fearful of the results. You have a gift. Your skills are beyond my comprehension. You have taken a woman, me, who had spent the better part of 15 years being injected with Juvederm to ward off my hereditary jowls, then the signs of aging. I had gotten to a point, that there was not enough Juvederm to keep up with my aging process. I had resigned myself to forever having my Grandmother’s jowls. I became discouraged. Though I loved Grandma dearly, I did not love her jowls. I also never realized I had such a gobble neck not seeing myself in 3-D on a regular basis. Then I discovered your gifts through Marlene. Though I had always said I would never, ever get a face lift due to fear of a possible adverse outcome, the joy and confidence, plus the fabulous results from Marlene sealed the deal. I can’t even begin to tell you how very pleased and joyful I am by my results thus far and I know they will only improve with time. Thank you for doing such an amazing job for me and on me! ” -Toni J


Dr. Patel has designed a very reliable way of showing you exactly the result you will get with a facelift. Over innumerable cases, this technique has been successful in predicting results much more accurately than what we used to use before: computer graphics. The trouble with computer graphics was that we were changing the appearance in two dimensions, whilst with the method we will show you, you can assess the results you can expect in three dimensions. ​

With proper attention to the aging process, excellent results can be obtained with anatomically performed facelifts, blepharoplasty, browlifts. This beautiful lady almost looks better now than she did 30 years ago!

Old to young just by changing the neck!


In the drawing to the left, I have only changed the contour and the fullness of the neck. All other anatomical parts are exactly the same! This illustrates the perception of aging and facial appearance imparted by the appearance of the neck. Together with the neck, of course, go the jawline and chin.

It is for this reason that I stress that the “money is in the neck”. The better the neck I give you, the better your face looks. Of course, some improvement of the neck may be obtained with local neck procedures, but the best improvement of the neck is obtained by performing a proper face and necklift.


Aging in Females with changes in skin, fat and bones

​It is vital to review photographs from younger days. In particular, we would like to see photographs where you think the face, the jawline and the neck look the best. An examination of the skin texture, skin laxity, subcutaneous fat, excess or deficient fat, prominences, depressions and bony changes allows us to determine the type of facelift that would serve you the best. Any prior history of trauma or Bell’s palsy is taken into consideration, as is any prior surgery to the brows, eyelids or face. Based upon experience as well as predictable analysis of findings, we will give you a reliable idea of what to expect with a facelift. Our aim is to make you look younger even though you may be several years older as seen here:

A sequential approach to rejuvenation: first the brows and eyelids were operated upon, followed by a facelift and necklift yielding beautiful results


​It is common to perform a facelift with fat grafts, lip augmentation, cheek lifts,  laser to lip lineLip Liness and skin rhytids, and, sometimes with upper and lower blepharoplasty.

Liposuction of the neck and the jawline is judiciously peformed to get a defined neck and jawline (see the before-and-after photographs, which illustrate the improvement of various different kinds of faces). ​


There is a troubling trend of aggressive marketing of quicker procedures, small-incision procedures, weekend facelifts, etc. Unless the various anatomic changes that need addressing are carefully assessed and corrected, a less-than-ideal result will be obtained.

​The very basics of a facelift involve:

-Incisions which are hidden in front of and behind the ear. Once healed, they are close to invisible.

-Some incisions will follow the temporal hairline and the occipital hairline (behind the ear). The aim is to design the incisions with a thorough knowledge of surface and cross-sectional anatomy so as to obtain almost invisible scars as seen here:

A facelift and necklift together with the use of lasers and fat grafts gives a nice jawline and neck

​-Elevation, repositioning and tightening of the important deeper aponeurotic system (the SMAS) is performed. This is where a thorough knowledge of anatomy is important. As we have anatomy dissection courses where we teach other plastic surgeons the anatomy of the face, it allows us to maintain the highest standard of anatomical and applied anatomical knowledge:

An accurate understanding of surgical planes is vital

​-The jowls are addressed.

-The jawline is defined.

-The neck skin and the neck bands are addressed.

-Fat grafts and lasers are frequently used to improve contour and skin appearance.


​1. We avoid using quick-and-easy procedures which are promoted by volume surgeons and organizations: be wary of aggressive capitalism. This gives them a standard result so they can move on to the next person.
2. We analyze the whole face and neck and aim for harmony as people don’t look only at your neck or cheeks.
3. With advanced training and detailed knowledge of aging, anatomy and physiology, we are much better able to address said changes with a view to a congruous outcome that lasts.
4. The skin is what everyone immediately sees: it is impossible to hide blemishes, deeper wrinkles, sun-spots, age-related discolorations, broken veins, large pores with make-up. We pay particular attention to getting the skin to look its best.
5. If necessary, the face and neck are broken up into thirds so you understand if the improvement is best broken up into two separate treatments. This reduces your anaesthesia time for any given procedure and also allows us to give you the best results as explained on the “Facial Aging” page.
6. We combine the use of fat grafts, tissue repositioning, volume augmentation, fat repositioning and removal where appropriate, proper tissue transfers, avoidance of pull-lines and three-dimensional tissue relationship positioning to give us results seen on this and other pages of our patients.


We see patients for second, third and fourth opinions all the time. Many changes after a facelift can be improved as seen in the photographs below and also on our Complications page. These changes can include inadequate improvement, unacceptable scars, ear lobes pulled forwards, loss of projection of ear lobes, weak jawlines, loose necks, pull lines (also called “kite lines”, asymmetry, irregularities, and many other changes. We will be happy to see you and assess you and advise you.

​Correction of a facelift and necklift to give a better jawline and neck

​Correction of a face and necklift and lower eyelids to give a better definition to the jaw, improve the neck and make the eyelids look more youthful



The aging process, whilst different in different people, is largely determined by genetics, lifestyle, sun exposure, diet, health, skin care and skin protection, and a few other factors. Whilst one cannot achieve the shangri-la of arresting aging, properly performed facelifts and necklifts when combined with appropriate fat grafting, use of lasers, augmentation of lips and chins, recreating age-appropriate fullness of cheeks, treatment of “smokers’ lines” around the lips, correcting the downward turn of aging mouths and lips and a few other factors can yield very pleasing reliable long-term results as seen in this patient 8 years after such surgery.

Simple protection of the skin and maintenance yields gratifying results in the long term.

Although aging continues, improvements achieved with anatomically accurate facelifts and necklifts gives gratifying results in the long term
The jawline and the neck is where most aging occurs, especially in Caucasians: it is here that we try to give patients the best long-term results as illustrated here in a patient who still looks better than before surgery, even 8 years later


We see patients who come to see us for a second or third opinion because they got a “pulled look” after a facelift. There are many causes of this, including just tightening the skin, limiting the incisions to such a degree that too much tension is taken up by very limited areas of the skin, failure to address the other aging changes which would give a more three-dimensional result, and failure to address the fat and deeper structures. For this reason, we don’t perform any formulaic procedures but base the procedures on the needs of each patient. In this fashion, we get an improvement which is often described by our patients as “natural”,“rejuvenating”and “youthful”. We love hearing our patients say “I love my new face.”The “money” is in designing a beautiful neck and even more gorgeous jawline:

Advanced facelift and necklift pays attention to the jawline, neck and the submental fullness and laxity
Advanced facelift and necklift techniques may be applied to men and ladies with very natural results

“Dr. Patel fixed my messed up facelift which I had done three times by other surgeons. Nobody would help me with the botched surgery. I finally found Dr. Patel thanks to a hairdresser! I show everyone my photos to show what an amazing job he did fixing me.”  D. Jenks  Facelift and Necklift- Las Vegas, Nevada


Facelifts are performed in an operating theatre for the sake of sterility and your comfort. We have a team of anesthesiologists and nurses who are trained to specifically look after patients undergoing these procedures.

General anesthesia is best for facelifts, although in some instances, sedation anesthesia may also be used.

With a 3-D procedure, there are several layer of sutures, accurately placed to give the lifting, tightening and filling, without leaving any tell-tale pull-lines. Some are slow dissolving sutures, others are more permanent. The skin sutures are generally removed between 7 and 14 days. ​

Lasers will be used to treat peri-oral lines, “sleep lines” on the cheeks and other skin irregularities. The advantage of using all the skills and modalities available to us, rather than performing quick or weekend or one-hour facelifts is that it allows us to give you a remarkable improvement not only in the structure and appearance of the face, but also the health and smoothness of the skin as seen here:

A facelift combined with lasers, fat graft and tissue repositioning gives an improvement in the skin, facial tissues and the jawline and neck

Facelift surgery can take between 3 and 5 hours of surgery time, depending upon the planned procedures, patient’s face-type, age and other factors. ​

Bruising around the jawline and upper neck is common for the first two weeks. The face itself usually will not get much bruising, but may be pink from any laser work. Swelling is to be expected because of the extent of the surgery: the swelling abates over about two weeks. ​

Only if insurance will buy you a Rolls Royce (Phantom, of course). ​

A sensation of firmness will be there because of the swelling: this is present for the first few days. Most patients do not need prescription pain medication after the first two to three days. ​

We will provide you with a special neck dressing which you will wear as much as you can for the first couple of weeks. You will also apply a moisturizer (any brand will do) to the face as healing skin and lasered skin requires moisturizer. Icing the face also helps for the first two to three days. Many of our patients will ice the face for longer as it feels good. You may be up-and-about the day after surgery. Gentle exercise (treadmill and stationary bicycle) may be commenced by day 3. More vigorous exercise like skiing and tennis may be resumed by about day 10. ​

Ideally, you should be within about 3 – 5 pounds of your desired weight. Whereas I can create the most beautiful angles and curves in slim patients, if you are able to get close to your ideal weight, we can wonders as can be seen in this patient who lost some weight before her surgery and is absolutely chuffed at her result: 


Bruising and swelling are de rigeur! However, significant long-lasting complications are rare.
Bleeding is not common as we pay close attention to proper hemostasis. On rare occasions, a small hematoma may collect.

Everyone will experience some numbness in the face: this resolves over weeks to months. This occurs because of the dissection of the face. This is not a complication.
Because of the dissection and repositioning of the tissues, it is common for there to be small differences in the smile between the right and left sides: this is usually only noticeable to the patient and to Dr. Patel! It recovers over a few weeks.

All faces have asymmetry and there will be some degree of asymmetry. This is to be expected.
Permanent weakness of nerves and muscles is rare.
The scars are usually very well hidden. However, some patients may have a tendency to cause hypertrophic scarring: in such cases, certain lasers and treatments will help. By-and-large, scars are rarely a problem. With Caucasian skin, pinkness of scars is to be expected for several weeks. With darker skin, some hyperpigmentation may occur. ​

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