Details: Frontal View- Although there is a dramatic improvement of the neck bands and jawline, the fact that the patient is smiling is misleading. When a person smiles it can makes him/her look an additional 5-7 years younger, by lifting the cheeks (smiling gives you a cheeklift and also fills the cheek area). Smiling also makes it impossible to evaluate if the facelift actually improved the marionette or puppet lines and it also changes the angle and shape of the smile lines.

If this is the case, why am I showing a non-smiling "before photograph" compared to a smiling "after photograph"? In order to get your attention! The only thing that a non-smiling "before photo" compared to a smiling "after photo" is good for is getting attention from potential patients. If I started with Angle 2 (the frontal photos shown below), then you may not be reading the this caption. The difference is that I pointed out the areas that was actually improved by surgery and the areas that were improved by smiling, and should not credited as a result of the surgery or to the surgeon's expertise. In fact, it is very misleading. Over the past six months, I have now started to take before photos with the patient smiling at each position in addition to the standard set of before photos, in order to compare smiling "before photos" with smiling "after photos".

Going through my Before and After Gallery, I will describe to you about how to evaluate face & necklifts, eyelids lifts, and other facial rejuvenation procedures. I will point out what and where to look for the finer details that distinguishes "good work" from an "exceptional work". Ultimately, the difference IS IN THE DETAILS. If the plastic surgeon doesn't see the detail or lack of detail, he or she will not be able to correct/improve or prevent the problem when they are performing the procedure time after time, patient after patient. Continue reading to learn more about evaluating: Facelift Before and After photos.

Now that I have your attention, to truly assess before and after photos of a facelift and/or necklift, it is vitally important to replicate the same lighting, as well as, have the patient in a standardized face and neck position ... everytime. Looking straight ahead, lips closed, teeth together, chin position not too high and not too low. For my photos in particular, I like to intentionally show the front of the ear which helps me to track how well th incision is healing. Also I like to make sure that there isn't any distortion or changes to the ear compared to before surgery.

Interestingly, you can also tell alot about your plastic surgeon by the consistency of their photographs. We all claim to be perfectionists, take pride in our work, artistic, use meticulous technique and have extreme attention to detail. If positioning a patient consistently time and time again is too difficult to reproduce, isn't performing surgery on different patients with different anatomy much more difficult than taking a picture. Don't you think that the attention to detail to the before and after photographs, might act as a good barometer to how skilled and consistent a plastic surgeon is?

To see the real improvement for this patient from the facelift, look at the next three sets of non-smiling Before and Afters photos.

Details: In this Frontal Before and After view, you can truly see the difference that the facelift made. If you look closely the upper half of the face, there was nothing done. The patient is tanner than she was preoperatively. On the lower half of the face, you can see that the marionette or puppet lines are improved by about 50% and the jowling of the jawline is less square and more heart shaped in the after photos. Also, the necklift with platysmaplasty, addressed the neck muscle bands, which were tenting the skin foward creating a blunting of the chin/neck angle. The neck skin is smoother; however, a necklift will not improve the quality of the skin.

Keep reading to learn about facelift incisions.

Details: Look closely at the front of her ear, where the incision goes in front of the ear cartilage. In my experience, I do not subscribe to placing the incisions exclusively in front of the ear cartilage or exclusively behind the ear cartilage.

Many patients ask me which is a better incision, and my answer is "it depends on what shape your ear cartilage is, where you have a wrinkle in front of you ear cartilage and how low your sideburn hair goes down in front of your ear." If it goes down very low, there can be hairbearing skin pulled onto the ear cartilage.

I will explain more with close up examples of different facelift incisions in another section.

Details: Note the curvilinear incision in front of the ear cartilage. Although there is a modest color contrast of the tan facial skin with the pale ear cartilage, over time the skin closer to the ear will get paler from the sun protection that the sideburn hair provides, and match even better. I will show example of patients who had facelift incisions several years prior to show you how well this type of incision heals.

DESCRIPTION CONTINUED. She asked me if I would recommend anything else, and I asked her if anything else bothered her. She said no. We discussed whether rejuvenating the lower face would create a mismatch to the upper face and eyelids. I gave her an analysis of her eyelids and forehead. She had good eyebrow position, with a good distance from the eyebrow to her eyelid crease. Also, looking at her upper eyelids, she had a well defined upper eyelid crease without the eyelid skin touching her eyelashes or any hooding of the outer portion of her upper eyelids. Her lower eyelids did not have any significant shadowing or bags. In general, she was aging more gracefully with her forehead, brow and eyelids, but her lower face was aging out of proportion to to the rest of her face.

Benefits of not doing the eyelid surgery together would be, that her full lower face and necklift, could still have a fairly rapid recovery. I explained that many of the "Rapid Recovery" "Minimally Invasive" Facelift-like as well as "mini-facelift" procedures, intentionally do not include eyelid procedures. In general, eyelid procedures are considered a minimally invasive procedure with a relatively short recovery time. However, bruising and swelling of the eyelids can last 1-2 weeks, and is very obvious to the public unless you are wearing sunglasses. Also, eyelid swelling can be very obvious, because the eyelid area is so small, even the slightest amount of eyelid swelling is visible to the casual observer.

I will post additional photos of patients during their recovery period to demonstrate the type of swelling and bruising at different points in the recovery. Also, This patient's testimonial is listed in the Recommendation section where she eloquently describes her experience with the facelift and how she felt during the recovery period.

Counterintuitively, facelifts are considered much more invasive relative to eyelid lift surgery; however, if performed alone without touching the forehead or eyelids, a person could potentially go out in public in 3-4 days, and cover the sides of their face (to cover the incisions and bruising), as well as, hide the bruising of their neck with a scarf or turtleneck. For the general public, most people who don't know you, would not be able to notice the swelling of your face. Why, you might ask. Since the neck and lower face is skin, muscle and fat, this area can "take on" a lot of swelling without showing it. Half of the swelling goes inwards toward the body while the visible half the of swelling goes outwards. The swelling around the eyes, cheekbones (from a mid-facelift, or forehead can be very obvious, because the swelling is pushing against the bone of the forehead or cheekbone and all of the swelling is visible. Interestingly, this is the same swelling that can make the initial month or so after a facelift look "extra good" in a thin faced person, but can be slightly "distorting" for a full, round faced person. That first month is the "honeymoon" period where the extra swelling softens all the fine lines and wrinkles, but when the swelling goes away, many of these lines will return.