As time passes, skin stretches and gravity pulls it down. This happens to everybody, and is one of the hallmarks of the aging process. These changes occur at different rates in different people, and are unavoidable. Anything that will cause the skin to lose elasticity will hasten the process: familiar examples are sun exposure and weight fluctuations, but heredity is probably the most important factor.

Pulling the skin tighter and raising it back up constitute the traditional goals of facelift surgery. This "tucking" is quite analogous to the job of the tailor: when the tissue has stretched out and is too loose, the only way to make it fit is to pull it tight and take a little tuck out. Unfortunately, we do not have a"skin shrinker" that will perform this job without surgery. Note one other very important similarity: taking a tuck does not alter the nature of the fabric! Thus, satin is still satin, velour is still velour and corduroy will still have wrinkles. Similarly, the texture of the skin will not be changed by a facelift, and acne scars, age spots, fine lines and "smokers creases" will soon return to their original texture, no matter how tight the skin is pulled. Contrary to popular opinion, a face lift will not give someone beautiful skin unless they have beautiful skin to begin with. Only chemical peels or other skin treatments can change the nature of the skin.

In addition to elevation of sagging skin, modern face lift surgery involves removal of localized fat deposits in the jowl, cheek and neck areas using a more precise technique of liposuction that I have termed "micro liposuction". In some cases. micro liposuction of the jowl, cheek and neck allows facial rejuvenation without actual lifting of the skin (although elevation and removal of excess skin will often improve the result).

Newer face lift techniques often incorporate elevation of the smile muscles and the cheek (malar) fat pad. I have developed and published reports of a technique that allows such repositioning without scalp incisions previously required for access to these areas. While the face lift operation may seem like a major surgical undertaking, surgery is limited to superficial structures (skin, fat and occasionally muscle) and thus it is in actuality a much more benign procedure than so called major procedures involving surgery on the chest, abdomen, etc. Most patients experience minimal postoperative discomfort and are able to return to work and/or social activities within 2 weeks.