More controversial is the question of when to proceed with such surgery. The first school of thought is that the aging process should be allowed to progress, after which drastic surgical rejuvenation of the face is carried out. Although this was the tendency in the past, patients are more frequently choosing to essentially maintain their youthful appearance by having cosmetic problems corrected as the signs of aging occur. By using this preventive maintenance approach, many patients find that their peers remark that they seem to age more slowly than others. This perception results from a continuing series of relatively subtle cosmetic changes to maintain a person's younger appearance without drastic changes.

Aging occurs as a continuous process. It is possible surgically to set the clock back in terms of the facial appearance; however, no surgical procedure can halt the aging process and the changes that the tissues go through with aging.

This animation depicts the approximate changes that occur in the face at ten-year intervals of aging. In general, facial rejuvenation surgery can set the clock back five to ten years, sometimes more and sometimes less. It is important for the patient to understand, however, that no surgical technique can stop this ongoing process. As the patient continues to age, facial tuck-up procedures can help to maintain the improvement effected with an original facelift.

Frequently, patients are born with the hereditary tendency to form bags beneath the eyes. This phenomenon typically occurs with the aging process as the elasticity of the tissues is lost, resulting in herniation of the fat pads that normally surround the eyeball. This causes them to prolapse beneath the skin of the upper and lower eyelid. When this problem is congenital, surgery may be indicated early.

In addition, younger patients frequently demonstrate a small double chin that is relatively amenable to facial liposuction as an initial treatment. Older patients may require facial liposculpture and tightening of the facial musculature with removal of excess skin to provide the most normal appearance. To remove the fine wrinkles that frequently accompany the changes of aging, a skin resurfacing (e.g., chemical peel or laser treatment) is often required. In general, surgery improves sags and bulges in the tissue, whereas, skin resurfacing improves fine wrinkling and changes caused by exposure to the sun.

Patients frequently ask whether a second facelift will be required. Many fear the need for increasingly frequent facelift tucks after the initial facelift. Again, each person ages at the intrinsic rate at which he or she would age with or without the facelift. Frequently, external aging in the face follows severe life stresses such as a divorce or the loss of a loved one. The effects of facelift and blepharoplasty are permanent in that the fat and soft tissue removed at the time of surgery are discarded; however, ongoing aging cannot be stopped or prevented. However, as newer techniques develop, longer lasting results have become possible. A series of carefully planned maintenance procedures can, however, provide significant improvement as aging continues.

Patients also are frequently concerned that their faces will appear stretched or windblown. This appearance results from the manner in which certain surgeons re-drape the facial skin and soft tissue during facelift surgery. We prefer to re-drape the soft tissue to better approximate it's position before the aging process, effecting a more natural result.

Patients frequently ask whether suntanning is possible after facial surgery. In general, sunblock with a high SPF (e.g., 15) should be used to slow down the effects of photoaging. However, patients who wish to suntan can resume such activities, however inadvisable,within six months to one year after surgery.

Patients frequently ask whether weight loss should be attempted before facelift surgery. In general, if more than 20 to 30 pounds of weight loss is anticipated, patients should stabilize their weight before proceeding with surgery. For more normal levels of weight loss (for example, less than 15 or 20 pounds), the patient is advised to proceed with surgery.

Patients frequently ask when they will be able to return to work or to resume their regular social activities after surgery. In general, after facelift combined with eyelid surgery, two weeks are recommended for resolution of bruising and substantial reduction in swelling. However, after approximately one to two weeks and with appropriate cover-over, most are able to return to work without difficulty. We can assist you with the makeup techniques needed to camouflage the effects of the healing process and general skin care maintenance after surgery.

Finally, patients are surprised to find that not everyone seeking facial plastic surgery is an acceptable candidate. Those with serious disease, severe obesity, unrealistic expectations, or improper motivation should not have surgery. In particular, patients should not expect any type of surgery to solve personal, professional, or domestic problems. The decision to proceed with plastic surgery is very personal; surgery should be directed at features that the patient wishes to have improved. Patients should not attempt to seek universal approval from family, friends, or acquaintances before or after surgery, because the level of misconception among the general public about cosmetic procedures is very widespread. The decision to proceed with surgery must be based upon a realistic expectation and a trust in the skill and knowledge of the surgeon. In most cases, patients are very satisfied with their results and recommend surgery to their friends and family members.

This drawing illustrates the progressive changes in facial features that occur with the natural aging process. In general, the hair thins, and relaxed skin tension lines deepen and become more pronounced. Fullness develops in the upper and lower eyelids. Nasal tip support is lost, frequently resulting in the formation of a nasal hump with age. With loss of tip support, the relative tip widens and the angle between the nose and the upper lip becomes more acute. Jowling begins to occur along the jaw line, and the effects of gravity result in submental fullness directly beneath the chin. In addition, the lips begin to thin with age, and the skin develops a crepe-like pattern of fine wrinkling.