This is a common question among people who are considering a facelift. When facelifts look “bad”, it’s usually because they look like facelifts instead of a face that exists naturally. In medicine we call these problems the “stigmata” of facelifts. As an Oculofacial Plastic Surgeon, I can tell you that it’s difficult to go out to an event – or even dinner -- without seeing at least one example that almost breaks my heart.
This is because the stigmata that screams, “I’ve had a facelift!” is almost always completely avoidable. Here are the problems I see most often:
1. A facelift was performed on significantly sun-damaged skin or skin that lost its collagen for other reasons, like smoking. This shouldn’t be done for two reasons. One is that there’s a disconnect between the perceived age of the skin and the perceived age that the contour is signaling. Also, the skin can get drapey looking once any swelling subsides. Thus, even if it’s subconscious, the observer is getting a what’s-wrong-with-this-picture message and that in turn stimulates a recoil reaction (it really does – there’s plenty of research on this). Second, and let’s be clear: a facelift will not pull the wrinkles out of your skin (at least not for long) even if it looks as though it should when you pull your face back with your fingers at home in the bathroom mirror. Wrinkles are from collagen loss in the skin and no amount of pulling can restore that. Collagen can be restored by other means, but that would not include a scalpel.
2. A facelift was performed without regard to the fact that significant volume had been lost in the face. This is a good part of why that “too tight” look exists or why a facelift can look like skin sitting right over a skeleton, the “Cruella de Vil” look. This can also result from the use of some outdated techniques. Arguably worse is when too much fat was injected, and it happened to “take” and the face looks disproportionate and like a chipmunk.
3. The person flexes their neck down and there’s that weird crease running up behind the angle of their jaw that just does not occur in nature. Again, poor technique.
4. The ears look strange. This can be what we call “pixie ears” (so very not as cute as it sounds) in which the surgeon has put too much traction on the skin and not enough anchoring underneath, causing the earlobes to pull down and almost disappear as they run into the jawline. Even more common is when the ears have been set too far forward and look pasted on. And even more common is a thick flap of skin right in front of the ear instead of that little dip that occurs in nature.
5. Easily visible scars. Everybody heals a little differently, but placement of the incision lines and a great deal of care in sewing those incisions closed is crucial. With rare exceptions, incision lines should be something noticeable only with a search. Furthermore, the incisions should be placed and closed so that the person with the facelift isn’t restricted regarding their hairstyle.
I do a significant amount of “revision work” in my practice on facelifts done elsewhere, and most of these problems at the very least can be improved. I would advise that seeing someone’s work tells you a lot more than their advertising, which can be woefully misleading. Also, the core specialties that are well-trained in doing facelifts are Oculofacial Plastic (or Oculoplastic) surgeons, ENT/Facial surgeons, and general Plastic surgeons. None of these specialties has a lock on technique, talent or most importantly, outcomes. (Some surgeons want to think their specialty does, but that’s just greedy, egotistical and political.) Your surgeon should come out of one of these three core specialties, but beyond that they should have the drive to keep up with this evolving field, the ethics not to cut corners or worry about their pocketbooks more than your well-being, a passion for their work and your result, and the artistic vision to know what your best version of yourself can look like and how to get there.