Bulletin Board for Patient's Questions and Answers
Facelift / Neck Lift (Rhytidectomy - Rhytidoplasty)

Explore what others have to say about cosmetic face and neck surgery with answers by Dr. Michael Bermant, MD.

Michael Bermant, MD
Board Certified by the American Board of Plastic Surgery

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This is the page where you can review questions and stories from patients, view the opinions of lay persons, and see answers from Dr. Bermant and other physicians. Do you want to ask a question, post an answer, or make a comment? Information E-mailed to me will be considered for posting.

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Facelift

Subj: Face
I am considering a face lift and am interested in comments from anyone that has had facial plastic surgery. I am 50 years old and am wanting to remove wrinkles and sagging skin around my jaw line. I've read about the new laser surgery for wrinkle removal. I am interested in any and all comments regarding your experiences. Pro and Con.

Dr. Bermant comments:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

You need an analysis by a reputable plastic surgeon before deciding what techniques are best suited to your problems. There are various types of surgery that each has different strengths and weaknesses. One of our newest tools is laser resurfacing. This is for some of the finer wrinkles. The laser will not correct for underlying fat bulges, weakened or sagging muscles or skin. Surgical facelifts do not address the finest wrinkles. Laser techniques may replace some of our chemical peels (phenol or TCA). Laser / chemical / surgical can compliment each other in the right setting.

But be careful. We have only a very short track record with the newest laser techniques. Do not get me wrong, this may be an exciting new technique that may pan out to have long lasting results. The prior response has no factual evidence since there just are no studies that go that far back for the laser technique. Also watch out, the laser unit is very expensive. Guess what - this can taint the "sell" to pay the rental / purchase price. An ethical surgeon will go over your problems with you, map out the various risks, benefits, and ALTERNATE METHODS OF CARE.

If you are looking for a local physician: The American Society of Plastic and Reconstructive Surgeons can be reached by calling 1-800 635-0635. They will send some preliminary information and a list of board certified surgeons in your region.

If I can be of further assistance, please let me know (E-mail preferably)


Subj: Re:Face Lift

From: DoctorDave,

I am a plastic surgeon (certified by the American Board of Plastic Surgery) in Salt Lake City, and I am certified on the UltraPulse CO2 laser. I use both conventional and laser techniques and find they both have a place in the treatment of facial aging.

I would like to comment on some of your observation:

1. Laser facelifts do not last longer than conventional lifts. The pulsed CO2 laser has only been around for about 3 years, and NOBODY has enough experience to say how long they will last. 20 years sounds a bit optimistic, I would say. More likely 5-8 years.

2. Conventional facelifts do not make the skin more "open to wrinkling". (see below)

3. Facelifts (here in Salt Lake City) cost about $6000, about 1/2 your estimate. Maybe some surgeons go higher, but not many.

4. Laser face lifts are not without risk, and I have seen several patients with scars from improperly done laser lifts.

5. Conventional face lift techniques have come a long way, and excellent results lasting 10 years or more are not uncommon. Also, conventional facelifts offer correction of more problems than just "wrinkles". If you had a pair of old pants that were too large, and all wrinkled, you would first tailor the pants to fit you (that's a conventional facelift), then you would press out the wrinkles (that's a laser lift, or chemical peel, or dermabrasion, or Retin-A). Each procedure has it's place.

Conventional facelifts can also be done in the office as outpatients.

If you (or anyone else) have any questions about this or other plastic surgery topics, please drop me an E-mail at DoctorDave. Thanks!


Subj: Re: Facelift

I am 47 yrs. old and am planning to have a facelift--my friend in California had one last month and said she had a new procedure called a "deep-plane" face lift. How is this different from a standard facelift?

Thank you.

Dr. Bermant responds:
This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Deep plane facelifts differ in the layer elevated is just over the bones. In SMAS facelifts, the muscle plane is the tightened layer. Other planes worked on is the skin layer. Working on each layer involves specific risks. Sometimes elements of each method are combined into a technique specific for that patient.

Different patients benefit from various techniques. It depends what has happened to your face. A direct person to person evaluation is necessary to recommend what combination of techniques are best suited for any one patient.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


I am writing this from Calgary, Alberta. Canada. I am 21 years old and want to know can you send me some information about cheek contouring. I want to get some fat <buckle fat> remove so that I can have a more hollow cheek apperrance look like model <Kate Moss>.

Thank you for your time.

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Cheek recontouring is done either by liposuction (removing localized collections of fat with a suction machine) or by moving the fat through an open incision around the eye or in front of the ear or inside the mouth. Sometimes the cheek can be highlighted by adding to the cheek bone with bone or synthetic material. Not all patients are candidates for all operations What may feel like fat may just be your important gland (the parotid) that makes saliva. Foreign material can cause problems, so putting something in the face for appearance needs to be investigated carefully. All of this surgery can cause injuries to nerves, scars, asymmetry, and dynamic irregularities.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: Post Op facelift

I am a 43 year old male generally considered young (and cute) looking for my age. Over the years I had gained and lost some 70 pounds which caused some excess skin sagging on my face, neck and eyebrows. On February 11 of this year I had a facelift (SMAS) and upper and lower Blepharoplasty. Admittedly, I was not prepared for resultant healing process. Although it had been explained to me, those words paled by comparison to the actual experience. Now, seven plus weeks later, I have been taping my eyelids for the past three and half weeks to correct the ectropion that has developed as a result of the surgery and each day face myself in the mirror horrified by the distorted shape of my now 'fat' face. Although a lot of healing has occurred reducing the facial swelling and the operation, regarded as successful had no other complications, I am afraid that gone forever is my youthful cute appearance, replaced by some hideous monstrous mask which is now my 'face' . I am feeling quite hopeless, having already passed through depressed and angry. I'm not even certain if I have a question at this point. The thought of having additional surgery to correct the way I look to regain my thin face or correct my ectropion nauseates me. I don't know what you or anyone could possibly offer me at this point. I doubt I will become the cosmetic surgery poster child this year. I do think anyone considering this should be aware of what can result even in procedures deemed very successful .

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Your result CERTAINLY does not sound typical for those performed by a skilled plastic surgeon. Was your surgeon board certified by the American Board of Plastic Surgery or some "want to be" plastic surgeon whose boards are by some other specialty? Even skilled board certified surgeons, however, have complications. The nature of surgery is to have potential complication. The knife and healing are nothing like manipulating an image on a computer.

An ectropion can be a complication of eyelid and facial surgery. The more a surgeon pushes the "envelope' to make an eye look younger, the higher the risk for an ectropion. Some problems are temporary and work themselves out with some massaging, taping, and time. Others require surgical intervention. In certain patients are at much greater risk for eyelid complications with only a marginal tone before surgery. I recommend techniques to improve the lid tension AS PART of the facelift surgery in such patients.

Just what do you mean by a fat face? Usually after a face lift the face is more tight, extra fat and excess skin are removed. Many patients have some diminished sensation in the elevated skin flaps near the ears. Some have described this temporary (rarely permanent) loss of sensation as a feeling of "fullness".

At just over 7 weeks you are early in your recovery. It really depends on the extent of the surgery, method of the operation and the individual's healing patterns. Some of the deeper plane facelift methods have extended swelling and healing after surgery courses. Does your surgeon know about your feelings? If you were my patient, I would certainly want to know. Sometimes the problem can be expectations beyond what surgery has to really offer. Sometimes it just takes some time to get the results we want, tissues healing is never as fast as we would like. What does your surgeon say?

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: face neck healing time

I am considering having work done around my jawline and neck . I have had a brow lift and love the resluts. How long will I need to heal so I can go out in public and it will not bve noticeable

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Time before going "out in public" varies with MANY factors. The type of surgery is the first unknown. "work around my jaw line and neck" can be as simple as a minimal liposuction to an extensive face and neck lift. Recovery time involves reduction of swelling and bruising until the patient feels comfortable being seen. The amount of residual swelling that bothers each person varies. Women can cover bruising with makeup and have less of a concern with the discoloration. Each person resorbs blood at different rates - how fast does the black and blue regions tend to go away in that individual? How does that person heal, some stay swollen longer.

Some face and neck lifts can be fine for public in 2-3 days, others need several days to 10 days before they feel comfortable. I have posted an eight day after surgery set of photographs to demonstrate this point. Certain operations and patients may need more time. There are just too many unknown factors to give time limits on someone who is not my patient that I do not know what they really need..

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: Scar /facelift

Please help! I have extensive built up scar tissue as a result of a face lift that didn't go well. I trusted the doctor's explanation and let him perform a second operation. Now it is much worse. Area's of my face are very firm, hard in fact. He tells me he will not t ouch it for 6 months. I don't know what to do. I am distraught and depressed. As if the situation wasn't bad enough. I have no money left to seekout another doctor to repair my face. What can I do? Please advise me.

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Yours is not a typical problem. Facelift incisions are hidden to minimize exposure. Although bad scars are possible, they are very rare. Scars do evolve over time. Many times waiting about 6 months (with scar care) changes occur that obviate the need for further surgery. I work with MY patients to try to optimize their scars after surgery. I cannot comment about a patient's scars without an examination and evaluation nor can I imagine any good plastic surgeon who would. The scars seen on the photographs I have posted ARE typical for my facelift surgery.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

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