The greatest advancement in facelift surgery over the past several decades has not been a single new operation—it has been a change in philosophy.
Traditional facelifts relied primarily on tightening the skin. While these procedures often improved sagging, they also created the “windblown” appearance that gave facelifts a poor reputation. Distorted hairlines, stretched scars, and pixie-ear deformities resulted because the skin, rather than the deeper facial tissues, was responsible for creating the lift.
As our understanding of facial anatomy evolved, surgeons shifted their attention to the deeper support structures of the face, known as the SMAS (Superficial Musculoaponeurotic System). Elevating these tissues rather than simply pulling the skin produced more natural, longer-lasting results. More recently, the deep plane facelift has further advanced facial rejuvenation by releasing deeper facial attachments, allowing the cheeks and midface to be restored to a more youthful position while minimizing reliance on fillers or fat grafting to recreate lost volume.
The real lesson, however, is that there is no single “best” facelift. Terms such as SMAS, deep plane, or extended deep plane describe surgical techniques—not individualized treatment plans. Every face ages differently, and every patient deserves an operation designed specifically for their anatomy, aging features, and goals.
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My Journey in Facial Plastic Surgery
My passion for facial surgery has always been rooted in anatomy. Before entering medical school at Baylor College of Medicine, I had the extraordinary opportunity to learn operative technique while working with world-renowned cardiac surgeon Dr. Denton A. Cooley. During medical school, anatomy became both an academic passion and a professional foundation, culminating in a perfect score on the National Board Examination in Anatomy and later serving as a teaching assistant in anatomy.
Very early in my training, I realized that becoming an exceptional plastic surgeon required first becoming an expert in facial anatomy and facial plastic surgery. That conviction led me to complete training in both Facial Plastic Surgery (Otolaryngology–Head and Neck Surgery) and Plastic Surgery. Today I am honored to be dual board-certified by both the American Board of Otolaryngology–Head and Neck Surgery and the American Board of Plastic Surgery, a distinction held by less than 2% of plastic surgeons in the United States.
Elegant Precision™ Facial Rejuvenation
My approach to facial rejuvenation has evolved over more than three decades of experience and continual refinement. I call it Elegant Precision™ Facial Rejuvenation because successful facial surgery requires both artistic vision and meticulous surgical execution.
‘Elegant’ means achieving results that appear natural, balanced, and timeless.
‘Precision’ means both precision in design after carefully analyzing each patient’s anatomy and precision in execution when performing innovative surgical techniques.
There is no “White Facelift.” I do not perform the same facelift on every patient. Instead, each operation is customized. Some patients benefit primarily from rejuvenation of the upper face with a brow lift and eyelid surgery. Others are most bothered by changes in the jawline and neck and require a lower facelift and neck lift. Many achieve the most natural rejuvenation by combining procedures that address both the upper and lower face.
The consultation is the foundation of the entire process. Before discussing surgery, I spend time understanding what patients see when they look in the mirror and what they hope to achieve. I then explain why those changes have occurred anatomically and which combination of procedures can restore a refreshed appearance while preserving their individual identity.
Looking at the Face as a Whole
One of the most underappreciated procedures in facial rejuvenation is the brow lift. I often describe it as an “upper facelift” because elevating the forehead, brows, and upper face can dramatically refresh the eyes while maintaining a completely natural appearance.
Similarly, lower eyelid surgery should accomplish much more than simply removing fat. My preferred technique restores the natural transition between the lower eyelid and cheek by releasing tethered tissues, elevating the cheek, and repositioning existing fat rather than simply discarding it. The goal is to eliminate the tired appearance while restoring normal youthful anatomy.
For lower facial rejuvenation, I combine a High SMAS, Deep Plane facelift with careful neck contouring. The face should be lifted upward—not backward. The jawline and neck should be sculpted, while the skin simply re-drapes naturally without tension. This approach produces a refreshed appearance without the telltale signs of facelift surgery.
Meticulous attention to detail extends through every step of the operation, especially closure of the incisions. Beautiful facelift scars should become nearly imperceptible. In many ways, the quality of a surgeon’s facelift scars reflects the precision of the entire operation. Before selecting your facelift surgeon, I encourage you to carefully analyze numerous closeup photos of their facelift scars. If you are not impressed, it may suggest you keep looking.
When Is the Right Time?
The right time for facial rejuvenation is determined less by age than by anatomy.
Many younger patients first notice changes around the eyes and benefit from brow or eyelid rejuvenation alone. Others become increasingly bothered by loss of jawline definition or neck laxity. Older patients often focus on the lower face while overlooking the significant contribution that aging of the forehead and eyes makes to their overall appearance.
Rather than asking, “When should I have a facelift?” I encourage patients to ask, “What is causing me to look older or more tired?” Their answer guides the appropriate treatment.
Recovery
Recovery from facial rejuvenation varies greatly, depending on how the procedure is performed. Elegant Precision™ Facial Rejuvenation not only allows exceptional results, but it also facilitates a much faster and easier recovery.
Although some swelling is expected, patients are typically pleasantly surprised by how comfortable the recovery can be. More than 95% of our facelift patients require no narcotic pain medication, experience little, if any, bruising, and feel comfortable attending social events within one to two weeks.
Attention to detail is not limited to the operation itself. Our Optimized, Rapid Recovery™ Protocol combines meticulous surgical technique with nutritional support, selected supplements and medications, as well as hyperbaric oxygen and red-light therapy as indicated to expedite and enhance healing for optimal results.
The Greatest Reward
Perhaps the most gratifying moment comes a few months after surgery when patients tell me they feel like themselves again. The greatest compliment is not hearing, “You look like you’ve had a facelift.” It’s hearing friends and family say, “You look wonderful,” without being able to identify exactly why. My goal has never been to create a different face. It is to restore confidence by helping patients look like the best version of themselves.