A facelift is one of the most visible procedures in all of plastic surgery. The simple goal is to improve the appearance of a face which has been changed by the effects of age and gravity.

A quality result, however, requires utmost diligence, sensitivity and meticulous skill on the part of a surgeon. Numerous important details must be carefully addressed in turn and quality cannot be rushed.

What to Look For in an Excellent Facelift

An excellent facelift is a result in which the subject appears brighter, fresher and more alive. An excellent result may also make the subject appear younger than his or her real age. However, the subtle complexities of aging will never allow the patient’s appearance to return to the appearance that was present at age 20, or even age 30.

What Are the Causes of an Aged Appearance?

The details that cause a face to look aged are quite complex and incompletely understood by even the most advanced and experienced surgeons. Aging and gravity cause changes in the following areas:

  • Underlying skeleton and bone
  • Facial soft tissue and retaining ligaments
  • The composition, position and thickness of the fat in various areas
  • The thickness, quality, luster and water content of the overlying skin
  • Hair, eyebrows and eyelashes may thin and change color
  • Cartilaginous structures such as nose and ears may continue to grow, stretch or change in shape

There is no technique, or even set of techniques, that can address all of the above list of changes in most cases. In addition, the human eye and human brain are carefully programmed – from birth – to recognize even the most subtle changes in facial appearance. Studies have shown that even a newborn baby is programmed genetically to respond best to the appearance of a human face. In fact, research has shown that babies respond to a woman’s face more favorably than a man’s face, and will also respond to a beautiful face more favorably then a less beautiful face!

These facts make it critical that a surgeon not only carefully understands the aging process, but also carefully understands what current medical technology can and cannot change. Nothing is worse than an overdone, over-pulled or “stretched” result in which a surgeon has attempted to compensate for too many aging changes with tightening of facial soft tissue only. A careful surgeon, therefore, will know which features can be safely adjusted to maximize appearance, outcome and function.

So What Should One Look For in an Excellent Facelift?

An excellent facelift should convey an improved and fresher appearance. Any incisions or scars should be meticulously closed and well-hidden around natural skin creases. Straight lines are avoided and incisions, which are hidden in natural folds and creases in areas such as the ear, will naturally be much more difficult for an observer’s eye to follow. This is especially critical in areas such as the tragus, or small cartilaginous portion in front of the ear canal, and earlobe. Neither of these areas should have a pulled or stretched look.

Dr. Granzow knows that most facelifts can now be performed with more limited scars or incisions, especially those which may extend back into the hairline behind the ear. This is an area which is especially prone to widening and is most visible, especially if the hair is put up.

Excessive raising or elevation of the sideburn area, or hair in front of the ear, should be avoided.

Telltale signs of a “face-lifted” appearance include:

  • Pulled-down earlobe.
  • Excessively opened, scarred or a forward-pulled tragus (small piece of cartilage in front of the ear canal).
  • Any excessively wide incisions or scars, especially behind the ears, which run into or beneath the hairline at the back of the neck.
  • Unevenness or lack of distribution of wrinkles. Having complete lack of wrinkles in the lower portion of the face and the neck and excess wrinkles around the eyelids or in the other portion of the face look odd and are a dead giveaway.
  • Excess pulling or widening of the mouth or lips.
  • Excess pull or tension on the overlying skin itself, or “wind tunnel” look.
  • Overaggressive thinning of the fat or wrinkles under the neck.
  • Overaggressive brow lifting, or elevation of the eyebrows, which may result in a “surprised” look.
  • Overaggressive or unnatural directions or pull in any portion of the face, including underneath the jaw and underneath the eyelids or mid face.
  • Excess removal of skin in the upper and lower eyelids, especially if this causes excess show of the sclera or white portion of the eye.
  • Over tightening of the eyelids, especially the lower eyelids, which may result in a “cat eye” appearance.

There are multiple, additional subtle giveaways are present and are too numerous to list here.

What Should You Expect From an Excellent Facelift

The best result is a result where a patient does not appear to have had an operation at all. The result will make the patient look fresher, brighter and possibly younger. An excellent facelift will not cause a woman who is 60 to look like a woman who is 20. Current medical technology simply cannot address all the subtleties of facial aging, and overzealous surgeons and patients who wish to achieve such a transformation have always come up short, often with disastrous results. Wrinkles should be reduced but not every last wrinkle can or should be effaced or removed. Incisions should be meticulously repaired to allow proper healing with almost invisible scar lines. Limiting the length of the incisions will also further improve a result.

Adjuncts such as facial fillers, which may include Juvederm, Restylane or fat injections, may significantly improve the results of a facelift by the subtle addition of volume in critical areas, wrinkles and folds.

What is a Necklift?

A necklift is a lifting or tightening of the loose and sagging skin which may occur at the front or sides of the neck with age. The procedure can be very effective at improving the neck contour and neckline. Loose skin folds at the sides of the neck tend to be easier to correct than loose skin at the front of the neck.

The operation is performed through an incision similar to a facelift and may be done as part of a complete facelift. Excessively loose skin may require a longer incision behind the ear and into or next to the posterior hairline.

The Surgery

Dr. Granzow has studied with many of the world’s top surgeons, both in the U.S. and abroad. Sufficient time is required to address each small detail which goes into optimizing a result, and a meticulously performed quality facelift usually takes 4-8 hours depending upon its complexity. Each procedure is quite unique, and Dr. Granzow will take care to discuss the individual nuances of each patient’s procedure in great detail.

A facelift is performed under heavy intravenous sedation or, more commonly, under general anesthesia. This will allow you to be completely asleep and comfortable during the entire procedure. Dilute local anesthetic is injected underneath the skin and in critical areas. The loose folds of skin are elevated through meticulously designed incisions, which fall along natural skin creases, that can be closed in an irregular pattern and made more easily hidden from an observer’s eye.

The skin is carefully elevated to allow the underlying more critical areas to be addressed. The underlying fat, ligaments and fascia and muscle are then carefully shaped using sutures and removal of tissues to allow for improvement in the position of these structures and the overall appearance. After this is complete, the skin is gently and carefully laid back down without excessive tension. This avoids overly “stretched” or “wind tunnel” look and will provide for an optimal result.

The excess skin corners are then carefully trimmed and meticulous layered sutures are placed in all key points.

Where is the Surgery Performed?

A facelift procedure may be performed at either an outpatient surgery center or a hospital, depending upon the wishes and comfort of the patient and the patient’s overall physical health. A surgery center has the advantage of often providing more personalized care in a more intimate setting, while a hospital may be more beneficial for patients with additional medical problems or who may require a higher level of medical care.

In all cases it is important that your surgeon be able to offer you the choice of a hospital or a surgery center. Be very suspicious if a surgeon is not allowed to perform the procedure in a hospital as he may lack the proper credentialing and accreditation.


Recovery for a facelift can range from one to two weeks, to several months or longer. Dr. Granzow will perform a complete and proper operation in meticulous fashion and most patients begin to look good between the first and second week after surgery. At this time, much of the swelling and bruising will subside.

A facelift can cause some soreness in the face, but is typically not overly painful. Some numbness will be present over the cheeks, but this almost always resolves with time. For this reason, it is important that patients do not place excess hot or cold packs on the skin for the first while after their surgery.

Most sutures which Dr. Granzow uses are self-dissolving, although there are some critical sutures which will need to be removed at specific time intervals after surgery.

Standard Risks of a Facelift

Standard risks exist for facelifts, regardless of the surgeon or the facility in which it is performed. However, a facelift is a safe procedure and the overall risks are quite low. Standard risks include, but are not limited to bleeding, infection, pain, damaged nerves and vessels and collections of fluid or blood underneath the skin. Transient or permanent facial weakness or numbness may occur and the scars may widen or be unsightly. Irregularities in skin and facial contours may occur.

Who is a Good Candidate for a Facelift?

The best candidates for facelifts are men and women who have a clear definition of where the areas of concern are and, specifically, which areas may be addressed. They will desire a brighter and fresher look with improvement of most, but not all wrinkles. They will not insist on removing every last wrinkle or smoothing out every last line on the face. They seek the procedure to improve their appearance for themselves and not just to please another person. Good candidates are not excessively overweight or vacillating back and forth on the weight scale.

Who is a Poor Candidate for a Facelift?

Poor candidates also have had excessive exposure to sun and/or have smoked for a long period of time. The sun and smoking cause significant permanent irreversible detrimental changes to the skin which are often almost impossible to repair with current medical technology.

The Effects of Smoking on a Facelift

Smoking has repeatedly and absolutely been shown to cause trouble with patients undergoing facelifts. Smoking causes constriction of small vessels and decreases the oxygen-carrying capacity of the blood. It significantly worsens wound healing and decreases the skin’s ability to survive during a surgery. The medical literature is full of examples of patients who have secretly smoked and then undergone facelifts only to have significant portions of the skin wither and die, leaving wide scars and terrible results.

If you are actively smoking, please inform your doctor, try to quit, and do not have a facelift!

Procedures Which May Be Performed With Your Facelift

Facelifts lend themselves to be performed with additional procedures. The extent and type of these procedures will vary considerably from patient to patient and Dr. Granzow will go over the details with you specifically during your consultation.

Procedures most often performed include upper and/or lower eyelid surgery (blepharoplasty), brow lifting if needed and neck liposuction. In addition, injection of fat or fillers such as Juvederm or Restylane maybe performed quickly, using it quite effectively at the time of the facelift. A light skin resurfacing may also be performed in certain cases.