Answer: There are many types of faceliftprocedures advertised. What is most important is for you to find a qualified, board certified plastic surgeon with whom you are comfortable and confident, and allow that surgeon to perform the procedure that he or she feels is best for you in their hands. A traditional facelift is still the gold standard by which all other modified procedures are judged. Some alternative procedures involve advances in technology (endoscopic facelift) and some represent partial facelift procedures (mini-facelift, mid-face lift, necklift). Many however are more marketing gimmicks that promise less scarring, minimal anesthesia and more rapid recovery. For some patients, these may be reasonable alternatives that provide reasonable results, but usually are not as effective or lasting as more traditional procedures.

Complete facelift procedures should equally address the parts of the lower two thirds of the face, those being the cheeks and the neck, with the jawline being the transition zone between the two. For those patients with more pronounced aging changes in one or the other of these two areas, a partial facelift procedure may be appropriate.

It is also important that a face or neck lift procedure address the deeper tissue planes beneath the skin and fat. These are the fascia or SMAS layer in the face and the platysma muscle in the neck, which are continuous. Procedures that involve tightening or lifting of these layers by flap advancement, resection or suture plication should provide more dramatic, more natural and more lasting results.

Answer: There is certainly a time when a traditional facelift or other surgical procedures such as a brow lift or blepharoplasty are better options than less invasive facial rejuvenation procedures. Although threadlifts and “liquid facelifts” with Botox and fillers are useful alternatives to more extensive surgical procedures, they should in no way be considered equivalent as far as their effects. In exchange for less scarring and minimal recovery time and their potential to be performed with little or no anesthesia, minimally invasive procedures generally produce less dramatic results. For those with early signs of facial aging and minor cosmetic defects or deformities, these procedures may be perfect solutions. As aging changes become more severe, larger quantities of these injectable products or implanted devices may be required for correction. At some point, the minimally invasive procedures can become even more costly than surgery and begin to give unnatural and distorted results. Non-surgeon practitioners may continue to perform these procedures when they cannot offer a more appropriate surgical procedure. One of the benefits of having qualified plastic surgeons performing your treatments is that when a more extensive surgery becomes a better option, they will inform you of this and be able to provide you with the more appropriate procedure.

Answer: Minor, partial facelift procedures can be performed with local anesthesia only. Although technically possible, it would be extremely difficult for most patients to tolerate a full facelift procedure under local anesthesia only. Most facelift procedures are performed under IV sedation or general anesthesia. General anesthesia should not be considered more dangerous than IV sedation for this or any other surgery. On the contrary, especially in patients with sleep apnea, gastro-esophageal reflux, or any other condition that could compromise the airway, IV sedation could have greater risk. Any patient having a facelift who has medical problems such as hypertension, diabetes, etc. should be evaluated by their primary care physician and cleared to undergo the specific procedure and type of anesthesia planned.

Answer: At your age, other procedures that are less invasive or less extensive than a full facelift may be more appropriate. You may have some early changes of facial aging, but these could most likely be corrected to your satisfaction with more minor procedures. The first step toward improving your appearance would be appropriate skin care. Use of quality skin care products and treatments such as facials and microdermabrasion by a licensed aesthetician can relieve inflammation, restore hydration and collagen and correct superficial blemishes and pigmentation. Laser resurfacing can have the same effects with more dramatic results, and will improve fine and medium depth wrinkles and tighten skin. Botox can improve wrinkles in the upper part of the face and lift the brow. Injectable fillers can correct wrinkles and animation lines in the lower parts of the face and can restore volume lost from aging at the cheeks, jawline, temples and around the eyes. For more permanent correction of wrinkles and lines and restoration of lost volume, facial rejuvenation with fat grafting can give excellent results. If none of these options are acceptable to you, or if they fail to give the desired improvement, then a limited or partial facelift may be indicated at that time.

Answer: Distortion of the ear, including the lobe is not uncommon after a facelift. Your particular problem is known as a pixie ear deformity. If the skin flap is trimmed excessively in the area where the earlobe is reattached, the lobe can be pulled forward or down from the tension on the closure and the normal dangling shape of the lobe is lost or distorted. This problem can be fixed with a minor procedure under local anesthesia. Usually the best technique is a V-Y advancement. The new lobe attachment is reopened along the scar in a V-shape. The lobe is advanced up and/or back. Closure is then performed in a Y-shape. The vertical limb of the Y ends up on the cheek, below the lobe, but is usually a short scar.

Answer: I do not think that ten years is too soon after a facelift to have a secondary procedure. The changes that you are describing are those that would be expected to recur after a certain period of time following your initial procedure. If you are bothered by those changes, it may be worthwhile to investigate having them corrected. Although it sounds to me like it would be a reasonable option, you would not necessarily have to have another full facelift. A partial (mini-, or midface) lift may be adequate to meet your goals. By not waiting too long, you may also be a candidate for even less invasive procedures such as temporary fillers or fat transfer. I would recommend that you have a consultation with one or more board certified plastic surgeons to see what they advise.