Facelift! It was the hallmark of Cosmetic Surgery, and all that most people thought about 40 years ago when they considered Cosmetic Plastic Surgery. But now there seems to be more options than ever…and some of them not so good!! One element shows a change in the way we think about facial aging. We used to think of this as just a result of sagging skin. We now think more in 3-D, feeling that it also may include the loss of volume of the face, which can give an older appearance. So now we see the advent of volume fillers to the face, from implants to fat grafting to injections…One key thing to consider is the age old dictum in Plastic Surgery…”Small incisions give small results”, and this is very true of Facelift. Traditionally the Facelift incision started above the ear, down towards the earlobe, around behind the lobe and ear and then straight back into the hairline. But apart from just the incision, the skin is actually undermined and lifted away from the face, pulled tighter, the excess trimmed, and then re-draped in hopefully a very natural appearance, (although there are many in Hollywood that have missed the “natural” part!) This can then be combined with tightening of the underlying muscle and fascia as well. So with this approach, the areas tightened would extend from the corner of the eyebrow all the way down to the neck. This can be done with some type of skin resurfacing as well, such as chemical peel or laser. Another option is to break up a Facelift into its components, or Mini-Facelift and do whatever part bothers the patient. Many people come into my office just complaining of the “turkey neck” and we can treat just that area and again, with much less downtime. But other options have been popularized lately and have their pro’s and con’s, as with anything..Some modalities use a smaller incision just around the ear and with very limited undermining or lifting of the skin. It is more of a FacePull if you will, rather than a FaceLift!! It can work and give a younger, tighter look and with much less swelling and downtime. But it may not last as long as the traditional type and patients need to weigh this with their overall goals. This FacePull technique is done at times as well, with sutures or strings placed in the face.And when is the right time??? Many women are choosing to start earlier with a less dramatic lift and thereby staving off the results of aging. Again, this can sometimes be done by doing “parts” instead of a full lift!! And you don’t want to wait too long! You might miss out on years of enjoying your new look if you start at 80!!And a word about Facelift in men. I have found that with men, less is more. My preference is to freshen up the look of a man’s face, but really resist the temptation to pull too tight….At all…It makes men look too different and most of the time, worse, as seen on TV!!!