How to Avoid a Bad Facelift

By Dr. Carlos Farias with Larry Rondeau

Editor’s Note:  Dr. Carlos Farias is one of America’s most experienced plastic surgeons in face and neck rejuvenation procedures.  He has performed over 6,000 facelifts in his career.  As a Medical Director for a busy national plastic surgery practice, Dr. Farias trained and supervised facial plastic surgeons throughout the Midwestern United States.  He is now in private practice at InsideLook of Chicago.

The American Society of Plastic Surgeons reports that in 2014 no less than 376,894 facial plastic surgeries were performed.   Clearly, many want to avoid the consequences of looking older and enjoy the benefits of a younger, rejuvenated look.  But just as many want to avoid a bad facelift.

You know what I mean.  Celebrity media often features stories about bad facelifts.  You can spot one across the room.    Here are some of the telltale signs:

  • The “windblown” look with skin stretched tight
  • An unnaturally young look with no nasolabial folds (lines that naturally run from the corners of the nose to the Woman - surprised lookcorners of the mouth)
  • Horizontal lines in the face
  • The “constantly surprised look,” signifying a browlift gone wrong
  • An artificially shortened hairline (at the temples)
  • The “open ear,” with a greatly diminished tragus (the skin covered cartilage in front of the ear canal)
  • The “Pixie Ears” look with unnaturally stretched earlobes

The media plays up the bad facelifts that unfortunately happen every year.  Yet, a properly trained, highly skilled and experienced plastic surgeon can guarantee natural-looking results.  How?

Avoiding a Bad Facelift

Bad facelifts often result from the surgeon’s inadequate level of experience.  The expression “practice makes perfect” certainly applies to facial plastic surgery.  The American Board of Cosmetic Surgery recommends when consulting with facial plastic surgeons:

Ask about their specific training and experience in facial cosmetic surgery. Also, find out how many facelift procedures each has performed, and be sure to look at plenty of before and after photos during your consultation—this will help you get a feel for a cosmetic surgeon’s aesthetic style.

This is important.  The surgeon must decide how to proceed in a number of areas, depending on each patient’s individual characteristics and condition.  Highly experienced surgeons know what works well in different situations – and what doesn’t.  Patients do well to find out how many procedures of the type they’re considering a prospective surgeon has performed.

Most plastic surgeons operate on the entire body and often perform fewer than 20 facelifts annually.  In contrast, for a number of years, I trained and supervised facial plastic surgeons as Midwest Medical Director for a very busy national facial plastic surgery practice.  We did nothing but facelifts and other face/neck surgical procedures.  Each of us often performed 400-600 per year.  We entered our private practices with unparalleled levels of experience.

dr-carlos-farias-patient-before-after-ls

The Right Technique

Highly experienced plastic surgeons who employ the SMAS Facelift method can virtually guarantee that their patients will never get a bad facelift.  Surgeons who perform the Deep Plane Facelift cannot make this promise.

The reason? The SMAS facelift tightens an underlying layer of connective tissue known by its acronym, SMAS (Superficial Musculo Aponeurotic System) which envelopes the facial muscles.   This results in a long-lasting facelift, with firmer soft-tissue and skin. This technique leaves all of the face’s underlying structures in place, tightening each layer to produce a younger-looking version of your natural face.

For instance, it will smooth your natural nasolabial folds, but will preserve them.  That avoids the unnaturally young look that is the hallmark of a bad facelift.  The SMAS facelift pulls facial layers upwards, not horizontally.  This prevents the stretched look some patients have had to endure.

In contrast, the Deep Plane technique that many plastic surgeons employ cannot guarantee a natural look.  Deep Plane facelifts actually move the face’s soft tissues to new positions in relation to the facial bones, putting them where they’ve never been before.  And since much of the surgical dissection is done near important facial nerve branches, this technique carries additional risks.  A truly skilled surgeon working with the right patient can make this work.  But why take the chance?

The naturally younger look you want

Black woman After facelift LS-CBlack woman Before facelift LS-CTo achieve a naturally younger look, your physican must also follow the right strategy in other ways.  Well-trained plastic surgeons put incisions where scars will be hard to see.  Those also highly-experienced take additional factors into consideration.  For instance, hiding incisions deep in the hairline sounds great.  But tightening and trimming excess skin can leave you with an unnatural hair loss that can appear feminizing for a man and unnatural in a woman.

So, to get the new look you want, be certain that your plastic surgeon has a lot of experience in the procedure you need.  If he or she performs a SMAS facelift, you will avoid the windblown look that is the hallmarks of Deep Plane Facelifts gone wrong.  You’ll get a naturally-attractive appearance that can help you look younger for years to come.


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