As we age, facial changes occur that lead to a tired appearance. The skin begins to loosen on the face and neck, and facial lines and wrinkles become deeper. The jawline softens into jowls, and vertical folds appear at the front of the neck beneath the chin. A rhytidectomy, or “facelift,” is a surgery that can address many of these changes and restore a more youthful appearance. Dr. Daniel Rousso, our expert facial plastic surgeon at the Rousso Facial Plastic Surgery Clinic, routinely performs facelift surgery to reverse these signs of aging. With over 25 years of experience focusing exclusively on aesthetic facial surgery, Dr. Rousso is recognized for his skill and artistic ability in achieving natural results for his patients.

Who Can Benefit From Facelift Surgery?

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Sagging Cheeks and Jowls

Sagging cheeks and jowls can manifest over time due to the depletion of collagen and elastin in the skin. Shifting fat deposits can also produce sagging jowls. For those struggling with laxity in their lower face, a facelift can remove the excess skin and redefine the jawline. This procedure improves facial definition and contour by rejuvenating the appearance of the lower face.

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Neck Laxity and Muscle Banding

Age-related tissue laxity can create pockets of loose, hanging neck skin. Weakened muscles can also lead to muscle banding on the front of the neck, sometimes called a “turkey wattle.” Through a small incision under the chin, Dr. Rousso can trim and tighten the excess skin and loose muscle bands. This will significantly rejuvenate the appearance of the neck and create a smoother and more defined neckline.

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Excess Fat in the Lower Face and Neck

Natural fat deposits can shift over time as the tissues become increasingly lax. The body can also accumulate more fat in the jowls, neck, and other unwanted areas. Typically included in facelift surgery, liposuction can remove excess fatty deposits in the lower face and neck. This can eliminate a double chin and improve the definition of the neck and jaw.

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Forehead and Brow Laxity

Gravity and aging can lead to brow sagging, forehead wrinkles, and frown lines that create a look of perpetual exhaustion. With a facelift, forehead and brow laxity can be lifted to produce a more rested appearance. Using endoscopic techniques, Dr. Rousso can tighten the forehead to reduce horizontal lines and crow’s feet wrinkles. He can also sculpt the corrugator muscles between the eyebrows to minimize vertical frown lines.

Facelift Procedure

Dr. Rousso incorporates the latest techniques in facelift surgery to accommodate each patient’s unique needs. Not all facelift techniques are alike. Since most of our patients do not want a stretched or “plastic” look, Dr. Rousso employs a technique that produces long-lasting results and avoids the appearance of an “operated look.” The result of the procedure is a natural, rested appearance. This procedure has been refined over the past 25 years and usually involves the following techniques.

Addressing Tissue Laxity in the Lower Face and Neck

In order to address cheek and neck laxity, the procedure begins with incisions hidden in the folds around the ears. The incisions are placed in a fashion that helps to minimize many of the scars often seen with other facelift techniques. The skin is raised, and the underlying connective tissue (SMAS) is tightened and secured using sutures beneath the skin. Elevation and suspension of the SMAS layer, which connects many of the muscles in the face and neck, produces more natural and longer-lasting results while simultaneously decreasing tension on the incisions for reduced scarring. A strip of SMAS tissue may also be trimmed away, and it can be used to enhance the lips or other areas of the face.

In some cases, a “mini facelift” can be performed with limited SMAS undermining. This procedure elevates and excises the facial tissues as necessary, but it is less invasive than a traditional facelift. The mini facelift may be best suited for younger patients with minimal sagging skin beneath the chin.

Eliminating Fat and Muscle Bands

Facelift surgery often includes liposuction to address fat pockets. Liposuction is used to remove excess fatty tissue from the cheeks and neck. Additionally, the procedure addresses muscle banding due to the neck muscles weakening with age. Any loose muscle bands present on the front of the neck can be tightened and trimmed through a small incision under the chin. After removing the excess skin, the incisions are closed with fine sutures.

Smoothing the Forehead and Brow Area

Endoscopic techniques minimize scarring and speed recovery of the brow and forehead areas. There is usually no need to use a large incision on the forehead. The endoscope is a special device with tiny lights and tools that allow Dr. Rousso to work under the patient’s skin. Dr. Rousso can guide his work by watching his progress and actions on a television monitor. This advanced technique requires only the smallest incisions and has minimal scarring. Using three small incisions (about half an inch each) hidden up in the hair, the endoscope is used to tighten the forehead, thereby reducing horizontal lines, brow sagging, and crow’s feet wrinkles. Dr. Rousso can also sculpt the corrugator muscles between the brows to reduce frown lines.

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Before and After Photos

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Factors to Consider

Candidate Qualifications

Candidates for facelift surgery typically have sagging jowls and cheeks, deep lower face wrinkles, fatty deposits on the cheeks and neck, neck muscle banding, and sagging skin on the neck. They may also have sagging brows and forehead wrinkles.


Twilight IV sedation is typically used during most surgeries at Rousso Facial Plastic Surgery Clinic. This type of anesthesia, similar to that employed during a colonoscopy, provides for a safe and rapid recovery. While anesthesia minimizes discomfort during surgery, any discomfort during recovery can be controlled with pain relievers. Most patients experience very little pain after facelift surgery.


Dr. Rousso’s facelift technique is not overly aggressive, which helps to minimize bruising, discomfort, downtime, and the risk of nerve injury. This allows the patient to return to normal activities as quickly as possible. Swelling and bruising can be minimized with the help of cold compresses applied during the first 24 hours. There may be a sensation of tightness for a short period. Temporary numbness around the ears, chin, and forehead usually resolves within a few weeks. Recovery takes approximately two weeks, with most patients returning to work at that time. The recovery after a mini facelift is shorter, typically lasting from seven to 10 days.


The goal of the facelift procedure is to achieve a natural, rested, and more youthful appearance. These results are very natural looking. Scars are usually not noticeable and diminish over time. Patients can look up to 10 years younger after facelift surgery. The technique of strategically tightening the SMAS layer enhances the quality and duration of the results.

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Frequently Asked Questions

What procedures can I combine with my facelift?

Dr. Rousso often combines brow lift techniques with facelift surgery to enhance the full face. He can also perform blepharoplasty (eyelid surgery) or skin rejuvenation treatments to produce even younger-looking results. If there is a specific procedure you’d like to request, feel free to ask Dr. Rousso about it during your consultation. Dr. Rousso will recommend the best treatments and procedures to help you achieve your aesthetic ideals.

How much will my facelift cost?

The cost of a facelift varies according to each patient’s needs. It is affected by the anesthesia fees, facility fees, physician’s fees, and other factors. A quote based on your needs and goals will be provided for you after your personal consultation with Dr. Rousso.

What factors accelerate facial aging?

Genetics play a major role as to how and when the face ages. In addition to the natural aging process, there are a variety of environmental factors that can contribute to how quickly facial aging occurs. Some of these include sun exposure, personal habits, cigarette smoking, large fluctuations in weight, and the pull of gravity. The combined effects of these factors can lead to accelerated facial aging. Facelift surgery can correct many of these effects of aging and rejuvenate your appearance.

What are the risks of facelift surgery?

As with any surgery, risks exist with facelift surgery. Some examples are nerve damage, infection, poor healing, scarring, fluid accumulation, and reactions to anesthesia. However, the risks are few in facelift surgery, and thousands of procedures are performed every year. Dr. Rousso can provide more information during your consultation.

How long do the results of a facelift last?

The results of facelift surgery last far longer than non-surgical facial rejuvenation treatments. Your results are likely to last for many years. Younger patients who undergo facelift surgery (before the age of 50) can expect even longer-lasting results. Future aging will continue as normal. To keep your skin healthy and youthful, minimize sun exposure, wear sunscreen, avoid smoking, and live a healthy lifestyle. Non-surgical treatments such as dermal fillers, skin rejuvenation treatments, and neuromodulators can help maintain youthful results over time.

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