Q: Dr. Eppley, I am confused about the whole facelifting thing. I am 53 years old and am beginning to show it. My neck and jowls are getting droopy and they make me look like a bulldog. I saw one plastic surgeon who said I needed a complete facelift (which I didn’t agree with) and I would need two or three weeks for recovery. Then a second plastic surgeon told me I just needed a ‘tuckup’ (I forget the name that he actually called it but it was something that used the word fast or quick in it) and I would be fine in a week. Why is there such a difference between the two recommendations and what do you think I really need?
A: The concept of facelifts and their variations that have evolved in the past decade can be confusing. Combined with how they are marketed and advertised also lends an almost mystical quality to them. In reality, it is far simpler than what it appears. Facelift surgery traditionally speaks to correction of aging of the lower face only, the neck and jowls. As we age, jowling develops first which then leads to neck sagging and eventually wattles. Thus facelifts can be done either as a partial (aka mini-facelift) or a full version. The partial facelift is done when jowling is the main problem and any neck issues are either non-existant or minor. A full facelift is needed when the neck problem is the main issue or just as prominent a concern as that of the jowls. Thus, partial or limited facelifts are usually done on younger patients (less than age 55 or so) who have yet to develop significant neck sagging. The recovery from mini-facelifts is quicker because the operation is shorter and less invasive. These are also the type of facelifts that have become very popular, largely driven by people in the workface trying to look younger and refreshed to remain competitive. They have been given a lot of different marketing names that imply less surgery and faster surgery and recovery, all of which is true. But don’t let the names fool you, they are all very much the same surgery. A full facelift is usually needed in patients 55 to 60 years and older when the neck is a noticeable aging feature and either flaps around and/or gets in the way of shirts and neck wear. In these more complete facelift patients, other procedures may be beneficial and are combined with it such as eyelid tucks and browlift surgeries.
Between the mini- and full facelift patients lies an almost third category and may well be where you lie. In this facial aging patient, a partial facelift is not enough and a full facelift maybe more than they need. (this may be why you had two ‘different’ opinions.) In this type patient, I use what I call the 3/4 facelift whose level of invasiveness and recovery is somewhere between a partial and full facelift.
Dr. Barry Eppley