Facelifting involves elevating and rejuvenating the midface (cheek area), jawline, and neck. It does not include brow lifting, blepharoplasty (eyelid lift), or fat grafting, which rejuvenate the upper third of the face. Furthermore, a facelift does not improve skin texture and wrinkles, which may require skin therapies like MesoBotox or dynamic/static fillers, among other treatment options, to improve these surface problems.
Instead, a facelift is intended to elevate sagging cheeks, the jawline, and the neck that are part of the aging process in most cases. An exception to this rule is noted in younger individuals who simply have a very full neck, for whom Dr. Lam may perform an isolated deep neck lift (see below) to address this fullness. He also combines this with his deep-plane facelift when there are signs of both aging/gravity and excessive fullness that may also worsen with aging.
This 38-year-old male underwent an isolated deep neck lift procedure with no lateral elevation of his jawline. That is, he did not have a deep-plane facelift along with his neck lift.
In the past, a facelift was considered a major procedure with a difficult and prolonged recovery period. That is no longer true, even with Dr. Lam’s advanced methods.
In the past, only individuals in their 60s and 70s would undergo a facelift, as the term was taboo for anyone younger. Today, with shorter recoveries and improved outcomes, the facelift has become much more accepted in individuals in their late 30s to early 50s who may only show signs of early aging.
This page will review Dr. Lam’s advanced surgical technique, which he uses to help you achieve balanced, natural, and substantive rejuvenation.
This 36-year-old lady underwent a deep-plane facelift and deep neck lift to improve a jawline and neck that were too full, even in her youth.
What Vector of Elevation Does Dr. Lam Perform in His Facelift Procedures, And Why?
In short, Dr. Lam performs a multi-vector lift, elevating the tissues at different angles for optimal results. For example, nowadays, the goal for the jawline is to re-establish a longer jawline rather than just improving the sagging jowl. Accordingly, Dr. Lam anchors the deeper tissues (SMAS) along the mastoid behind the ear so that the jawline is better delineated from the jowl all the way to the back end of the jawline near the ear.
The direction is near horizontal for this jawline elevation. He also continues this horizontal elevation down the neck to help elevate and improve the neck contour. As he moves upwards along the side of the face toward the temple area, he progressively lifts the vector to a vertical vector to ensure that the sagging tissues are elevated against gravity.
Facelift Tutorial Part 1: The Multi-Vector Lift: Why I Don’t Lift Just Vertically
What Kind of Facelift Does Dr. Lam Perform?
There are many marketing terms for different types of facelifts, which only serve to confuse the prospective patient.
The simplest and most scientific categorization of facelift types are SMAS and deep-plane. For the first decade of his practice, Dr. Lam performed SMAS facelift techniques, which showed good but not excellent results. In the past decade, he has entirely switched from SMAS to deep-plane for every procedure, with far superior results and without adding recovery time, swelling, bruising, or discomfort.
So, what’s the difference? Both strategies involve elevating the SMAS (Superficial Musculo-Aponeurotic System). The SMAS is the tissue that lies immediately below the fat of the skin, but is still superficial to the deeper tissues like the parotid gland and the overlying parotid fascia/collagen layer.
The deep-plane facelift involves releasing some ligaments that attach the SMAS to the underlying parotid gland before elevating the SMAS. There are four ligaments (shown in the diagram) that serve to prevent a good elevation of the tissues if not released, so a deep-plane facelift allows for better outcomes and longer-lasting results for the patient.
Facelift Tutorial Part 2: Deep-Plane Vs SMAS Facelift: Why I only Do Deep-Plane Facelift
Is Dr. Lam’s Facelift Considered A Mini Lift Or Mini Facelift?
The term “mini facelift” has been used primarily in marketing to describe a facelift with shorter incisions and downtime, but it has little scientific meaning. If a “mini facelift” implies a simple SMAS elevation (see above section and video), then no, Dr. Lam does not perform this kind of facelift.
Simply put, the procedure is inferior to a deep-plane facelift and, in his opinion, is not worth performing even in younger individuals. However, if a “mini facelift” refers to shorter downtime with little discomfort, swelling, bruising, and well-camouflaged incisions, then perhaps yes, Dr. Lam performs a mini facelift.
Even though Dr. Lam’s incisions are not as short as a purported mini facelift (where the incision does not go behind the ear in general), he believes that his incisions heal very well and the extra skin that comes with a facelift really needs that extension to avoid visible bunching. (See the next section of this page where Dr. Lam describes his facelift incisions and why he performs the ones he does.)
He does perform what he calls a “preservation facelift,” in which he elevates very little superficial skin — which he simply does not need to do in order to achieve excellent elevation of the tissues (since most of the elevation occurs in the deep plane).
How Does Dr. Lam Manage Neck Sagging? Does He Always Perform A Deep Neck Lift?
Dr. Lam performs two types of neck lifts: a standard neck lift that is part of every deep-plane facelift and a deep neck lift, which can also be combined with a deep-plane facelift. Many times, the word “neck lift” simply means facelift. Men often do this because it sounds better to them.
A standard neck lift is really the first step of a facelift procedure, in which Dr. Lam ties the two separated muscle bands (platysma muscle) back together before elevating the sides of the face. The platysma muscle is connected to the SMAS, so when it is put together in the midline of the neck and the two sides of the face are elevated, it can serve like a hammock to pull up the entire contents of the neck.
However, when there’s excessive fullness in the neck, a specialized technique is required that 99% of facelift surgeons do not know how to perform. As we age, the submandibular glands start to fall in our necks, leading them to look too full. That’s why neck liposuction will not reduce a bulky neck and, in many cases, will make it look worse by removing the precious underlying fat under the skin to expose the muscle bands underneath prematurely. Dr. Lam’s technique is incredibly safe, as he discusses in this video tutorial on the subject:
Facelift Tutorial Part 3: The Deep Neck Lift: When, Why, and How
This 72-year-old patient appears to have neck fullness but, in fact, just has sagging muscle and skin. She underwent a standard neck lift along with a deep-plane facelift procedure.
This 58-year-old woman underwent a deep neck lift/deep-plane facelift with some removal of deep neck fat and without any removal of superficial fat in the neck (liposuctionable fat).
This 64-year-old woman underwent a combination of a deep-plane facelift and a deep neck lift, with fat removed in the deep neck as well as in the superficial, subcutaneous plane.
What Kind of Incisions Does Dr. Lam Use During a Facelift?
The key is that facelift incisions must be long enough to remove excessive, unwanted skin without tissue bunching and also permit access to perform the procedure. However, they need to be short enough that the incisions do not cause hair loss or visibility in exposed facial areas.
The graphic below shows the standard facelift incisions Dr. Lam performs in green. In red are the ones he believes are unacceptable, either because they’re too long and can be visible (left diagram) or go into the hair-bearing areas, which can lead to a hairline that is repositioned backward (right diagram). The latter is the worst of the two bad options.
Dr. Lam meticulously creates incisions with no tension (so they should not stretch back). That is because with tension, they would lead to a visible incision. He never pulls the skin.
In addition, the incisions are meticulously curvilinear (not straight) and are hidden along areas where your eye won’t see them. Other attributes of his incisions include thinning down the tragal region (in front of the ear) so that it looks natural. Dr. Lam also does a trichophytic incision, intentionally cutting through a row of hairs to allow them to grow through the incision to further camouflage and mask it.
For more information on Dr. Lam’s facelift incisions, please watch this video on the subject:
Facelift Tutorial Part 4: Facelift Incisions: How Long, Where, Why, Etc.
Tell Me About The Actual Facelift Procedure
In 95% of his facelift procedures, Dr. Lam performs them in his office, which has a state-of-the-art Joint Commission-accredited surgical facility. After 20 years of running his surgery center, he completely tore down the entire facility and rebuilt it from scratch to further enhance the safety and quality of healthcare delivery.
After a thorough workup with Dr. Lam (which his staff will guide you through), you will most likely qualify to have your procedure performed at his surgical facility. If not, he also does about 5% of his facelifts in the nearby Texas Presbyterian Health Hospital, where he has been on staff for the past 23 years.
The procedure is performed under sedation or general anesthesia. You won’t need to stay overnight in the office or the hospital. For out-of-town patients, you will come in the day before to meet with Dr. Lam and his staff, and then usually stay for a few days to a week after the procedure.
His staff can recommend many local hotels if need be. If you do not have a companion traveling or staying with you the first night after the procedure (as required by law), we can assign you a care provider at a small extra cost.
What Is The Recovery Like Following A Facelift?
In the past, facelift recoveries were marked by prolonged pain, visible incisions, excessive bruising, and swelling that made people wary about it, especially if they live busy lives and want to re-enter the workplace as soon as possible. Today, most facelift recoveries are much shorter and different.
First of all, Dr. Lam has invented a technique to immediately eliminate any facial pain using hyper-dilute Botox. He can also get rid of a sore throat, nasal congestion, nausea, etc., on the first postoperative day, something that no one else in the world can achieve with his patent-pending methodology.
In short, you should not be in any kind of pain, as he will definitely treat you. Usually, these issues are resolved entirely after one treatment. But if any persist, he can treat you again to ensure that these symptoms go away. This is offered at no charge to you.
Second, Dr. Lam rarely encounters significant bruising (although he certainly cannot promise the complete absence of it), which he believes is the major risk of a prolonged recovery period.
Dr. Lam can minimize bruising significantly through five methods:
- Performing a “preservation facelift,” in which very little skin is elevated or undermined, even though he is still performing a deep-plane facelift
- Using tumescent fluid (dilute lidocaine with epinephrine) that literally dissects the skin tissue with little trauma
- Placing TXA (tranexamic acid) into each dissected area and leaving it there for 45 minutes to further soak up any bleeding (as opposed to injectable TXA into the tissues, which is not as safe)
- Using TXA intravenously (through an IV), further reducing bruising
- Being a very gentle surgeon
Your recovery can still vary depending on your health history and compliance with our instructions. Despite those factors, most patients have a consistent recovery period and experience with Dr. Lam.
The major limitations Dr. Lam emphasizes are:
- No driving for 7 -10 days
- Only light workouts being resumed after 10 days
- No exercises that cause excessive neck stretching for 6 weeks, like yoga, Pilates, tennis, golf, and swimming
For more information on the nature of your recovery, please watch this video:
Facelift Tutorial Part 5: Facelift Recovery
How Much Does a Facelift Cost?
Dr. Lam’s approach is unique, so he charges a proportionate degree for his skills and services. If you require a deep neck lift in addition to a standard deep plane facelift, the cost will be higher.
Meeting with Dr. Lam in person is critical to see what strategy would be ideal for you. He will share the costs of your treatment plan, along with any reduced prices for multiple procedures like blepharoplasty, fat grafting, etc.
We do not publish prices online but would be happy to answer any questions via phone or in person. That being said, the quoted price may not be 100% accurate until Dr. Lam sees you to determine what would best benefit your facial profile. He can help guide you based on your budget to get you the ideal results based on any financial constraints or limitations you may have.
Frequently Asked Questions about Facelift
How long should I expect my facelift result to last?
In short, the results are permanent. However, you will continue to age, so Dr. Lam likes to say they are permanent minus further aging. The best way to think of it is that if you had an identical twin sister or brother who had the same stress, sun exposure, diet, and lifestyle as you, you should always look 10 to 20 years younger than your sibling. But in 10 years both of you will have aged 10 years, but you should most likely still look significantly younger than your sibling. Besides genetics, the best way to preserve your result is to avoid poor lifestyle choices like stress, lack of sleep, bad diet, excessive sun exposure, and maintain some small maintenance measures like Botox, fillers, light peels or lasers, that will help keep your results optimized until you would benefit from more rejuvenative surgical procedures.
I’m afraid of the incisions from a Facelift procedure. Please tell me about them.
The incisions should not be a great concern for you in Dr. Lam’s hands. There are several key points to making incisions virtually undetectable even at close inspection and even with your hair worn up. First, there should be no tension on the skin on closing the incision. A good lift has nothing to do with pulling the skin. In fact, the skin is never pulled but follows with elevation of the deeper tissues. Accordingly, the excess skin is easily trimmed away without tension on the incision leading to very favorable healing. Second, the incision follows the contour of the ear so that your eye will natural not see it since it is in an area where there already is a border or line, making the incision very well camouflaged. Third, there are no straight incisions so that every little curve of the incision makes your eye have a hard time seeing it. Fourth, the incision has the natural contours of the ear where the skin is defatted, fat removed, in the area in front of the ear to match exactly how skin should look there. Fifth, the incisions near the hairline, both in front and behind the ears, undergo what is known as a trichophytic incision meaning hairs grow through the scar making the scar very hard to detect.
It is important to discuss not only the kinds of incisions Dr. Lam makes but also the kinds that he does not. Too often the standard facelift incision travels way up along the front of the sideburn and very far down into the neck. These areas do not heal well and are avoided during Dr. Lam’s facelifts. In contrast, some surgeons try to hide their incisions inside the hair but this option is far worse. By doing so, the hairline is moved back, which makes an individual look older and less natural. In addition, sometimes these kinds of scars become visible within your hair-bearing scalp, which also looks bad. Unfortunately, Dr. Lam has had to perform a number of hair transplants to fix this problem.
I have wrinkles on my neck. Does a facelift fix that?
Yes and no. Some of the wrinkles should be improved in terms of elevating the excessive tissues that come along with tightening the neck since a lot of the sagging skin is removed during the procedure. However, a facelift or neck lift does not directly address crepey skin or sun damage on the skin surface. For these issues Dr. Lam uses a mixture of light lasers, fillers, Botox, and microneedle to make the necessary complementary interventions to achieve the ideal results. However, if you are contemplating a facelift sooner than later, he recommends not to bother with any of these minor therapies since the facelift may provide enough improvement that you do not need much else or you could do fewer therapies to get you to your ideal result. Also, repeated and excessive microneedle is less ideal before facelift as it may at times lead to more initial unwanted swelling during your facelift recovery.
Are there alternatives to a facelift?
This is a complicated answer since there really is almost nothing that compares to a facelift in terms of the power of rejuvenating the neck, jawline, and midface. That being said, there is a spectrum of therapies that can provide improvement, especially if your major complaint is mainly skin problems like wrinkles or you only have very early neck banding (the two vertical platysmal bands) that are only just showing up. For example, Botox into the plastymal muscle, if done every few months, can partially reverse these bands and help minimize their progressive worsening. However, Botox does not typically provide immediate results and only works decently well in very early neck banding. As mentioned, radiofrequency microneedle can also help with skin tightening. Photofacials and bleaching creams can help with the surface skin damage. Fillers along the jawline can mask the jowl if you are early in the process of visible jowling but does not do well in very advanced cases. As mentioned before, there really is no such thing as a liquid facelift or a deep fill filler that would somehow cause your face to be lifted. Fillers simply do not have the power to do that in any discernible capacity.
Are there special facelift considerations for me if I am a man?
The second major consideration is that you will not be allowed to shave for two weeks following the surgery. You should come clean shaven to the day of the procedure. After the first two weeks you must use an electric razor and still be careful around the incisions. After 30 days you can resume a normal shaving routine. One major benefit is that not shaving covers the incisions well and also masks any swelling. Interestingly, most men actually heal faster than women due to the richer blood supply in the beard area from the hair follicles. Finally, Dr. Lam recommends getting some light makeup camouflage to cover the incisions during the first month of healing if you wear shorter hairstyles.
Facelift considerations in Men
I have heard of using glues instead of drains. Why does Dr. Lam not use these glues?
These glues use human blood products, which Dr. Lam does not find a need to use. In addition, they have not been shown to truly minimize risks or speed up healing. Even though drains are less sightly to look at for a few days, they provide the fastest route to minimal swelling and bruising by the second week, which is the main goal. The drains do not hurt while they are in and they do not hurt when they are removed.
Does Dr. Lam perform a ____ lift?
As mentioned earlier, Dr. Lam is careful to avoid overly hyped terminology that is meant mainly for marketing purposes. As an academic surgeon who has published numerous textbooks, book chapters, scientific articles and lectures on a routine basis, he believes that a proper description of what he does is much more helpful for a prospective patient. The easiest way to understand what he does is a deep-plane facelift with or without a deep neck lift, all of which have been thoroughly described in this section earlier on.
Is a browlift part of this procedure?
Not necessarily. A facelift really addresses the midface, jawline, and neck. He believes that the upper third of the face must be addressed through a different procedure that can be performed at the same time. His main methods to rejuvenate the eyes include an upper blepharoplasty (removing upper eyelid skin), a transconjunctival blepharoplasty (no-incision eyebag fat removal of the lower eyelid), fat grafting around the eyes, and at times a temporal browlift, lifting only the very corner of the brow to avoid a surprised look. During a consultation, Dr. Lam will explore with you the options that you may have to improve your upper face together with your facelift or as a separate procedure in the future.
What if I have keloids? Can I still get a facelift?
The answer depends on whether you indeed have keloids and how severe your keloid history really is. In 80 to 90% of cases, people use the word “keloid” incorrectly to describe what is actually a hypertrophic scar. The difference is that a hypertrophic scar is just a thickened scar, and a keloid is an overabundant growth of abnormal tissue that goes well beyond the borders of the incision/scar.
Patients also confuse a “bad scar” from trauma with a surgically precise scar that is performed with no tension and is well hidden, as mentioned above on this page.
Finally, facial scars, if done correctly, heal tremendously well, unlike body scars that uniformly heal poorly due to the lack of sebaceous or oil glands that serve to regenerate tissues.
If you, in fact, truly have a keloid, then the question is how severe it is and whether it is worth the risk of undertaking a facelift. For example, if you have a small keloid, Dr. Lam uses Botox and a combination of 5-fluorouracil and dilute steroid to prevent and manage any keloid that arises.
However, if you have a significant keloid history, he will most likely not perform a facelift. For more information on true keloids and Dr. Lam’s management, you can visit his keloid page, which he is an expert at managing. (link)
If I am a person of color, is there a higher risk of seeing my facelift incisions?
Theoretically, the answer is yes, since you could have a white scar along your facelift incisions. That being said, Dr. Lam has never seen this outcome in his 23 years in practice because he pays meticulous attention and does not allow a tensioned closure that could predispose to this problem.
Does Dr. Lam ever perform thread lifts?
Absolutely no. These were originally in vogue about 15 years ago and recently resurfaced in popularity due to one marketing company’s efforts to revitalize them.
Dr. Lam used to perform thread lifts many years ago, and the technology has not changed. Remember that a full SMAS facelift without the deep-plane performed will still lead to inferior results (which is why Dr. Lam abandoned the SMAS-only facelift). Similarly, you can imagine how little a thread lift offers regarding rejuvenation.
The procedure also causes unwanted scar tissue in the face, making a facelift more difficult to perform in the future. Dr. Lam highly recommends that you do not undergo a thread lift. There will be no benefit, and it will only make facelifts harder to perform.
Videos
Photos
For more photos of Dr. Lam’s facelift results, please visit his before-and-after gallery.