The 8 Best Procedures To Combine With A Facelift

Call it the ‘Zoom effect’: Many of us are spending more time than ever staring at our faces on videochat cameras each day, and, perhaps due to all those hours spent studying our own features, plastic surgery requests have skyrocketed. According to the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), 70 percent of facial plastic surgeons have seen an uptick in bookings during the pandemic. And patients are looking for more than just injectables — a recent report says that demand for surgical procedures, like facelifts, is on the rise.

Once you’ve reserved that time on your surgeon’s table, you want to make it count. Choosing to undergo multiple procedures at once helps minimize recovery time, saves the (even slight) COVID-19 risk of visiting a doctor in-person again, and, maybe most importantly, maximizes the impact of the results. The tried-and-true rhytidectomy (read: facelift) is one such surgery that can greatly benefit from strategic pairings, and we spoke to top plastic surgeons about the procedures they most often combine with facelifts.

Why Combine?

“It’s important for patients to understand that facelifts alone do not address the perioral areas [around the mouth] and, in general, do not address nasolabial folds,” says Charles Pierce, MD, a double board certified plastic and reconstructive surgeon at Rowe Plastic Surgery. To put it in layman's terms: A facelift isn’t a be-all, end-all solution for signs of aging around the face. This distinction highlights the utter importance of making sure you and your doctor have an honest conversation about desired results.

If you’re hoping for tighter, more youthful-looking skin around the nose and mouth or have concerns about your upper face, you may be better suited for a combination procedure — and your doctor should walk you through the possibilities and projected results step by step. “One of the things I love most about plastic surgery is that I have the tools and the creativity to help patients on their journey to accomplish their goals,” says David Shafer, MD, a double board certified plastic and reconstructive surgeon and founder of Shafer Clinic in New York City.

What to Combine with a Facelift

As we’ve learned, the best pairing for your facelift depends on your aesthetic goals, but there are some common surgical and non-surgical combos that address a wide array of cosmetic concerns. “Facelifts reposition tissues but do not replace volume lost with age, relax facial muscles, or resurface skin,” explains Adam Schaffner, MD, a triple board certified plastic and reconstructive surgeon in NYC. “It may be of benefit in some patients to combine a facelift with non-surgical or minimally invasive procedures.”

Bring these suggestions to your own consultation, so your surgeon can work with you individually to customize a combination tailored to your desired results.

1. Facelift + Blepharoplasty

Blepharoplasty (a.k.a. eyelid surgery or eyelid lift), is combined with facelift about 50 percent of the time in Dr. Shafer’s office. Because a facelift focuses on the lower and mid-face, patients with aging or tired eyes may not see the results they desire in the upper portion of the face without additional intervention. The blepharoplasty procedure removes excess fat and sagging skin around the upper eyelids, lower lids, or both. In conjunction with a facelift, it creates the appearance of a rejuvenated eye area and overall refreshed look.

2. Facelift + Brow Lift

Like a blepharoplasty, a brow lift (a.k.a. forehead lift) can improve the appearance of the upper face. “Usually, the aging face isn’t just plagued by sagging, loose skin,” says Lauren Chmielewski, MD, a board certified plastic and reconstructive surgeon in NYC. To truly meet the patient’s needs, additional ‘lifts’ are needed, and a brow lift can tighten excess skin in the upper third of the face, restoring sagging brows and helping to get rid of the wavy lines on the forehead.

3. Facelift + Necklift

Procedures that address the upper face aren’t the only add-ons. “Usually, when I’m treating the aging face, I concentrate on the face and neck,” Dr. Chmielewski says. A taut, youthful-looking face can look off atop a sagging neck. Since the neck often ages faster than the face, pairing a rhytidectomy (facelift) with a lower rhytidectomy (neck lift) can address any discrepancies in one fell swoop. Performed alone or in conjunction with a facelift, a neck lift tightens and eliminates the excess skin, fat, and/or banding that often forms as we age.

4. Facelift + Chin Implant

We’ve already covered the benefits of combining chin augmentation and rhinoplasty, but enhancing the chin can improve facelift results, too. Dr. Shafer says it helps to “strengthen the chin projection,” which improves the balance and harmony of the entire face. While filler and fat grafting (more on that below) can also be used to augment the chin and jawline, a chin implant involves placing a synthetic implant on or around the chin to alter the shape of the face.

5. Facelift + Fat Grafting

“Fat transfer or using injectable fillers, such as Restylane®, Juvéderm®, or RHA® products, will help to restore facial volume,” Dr. Schaffner shares. Fat grafting involves taking fat from one area of the body (i.e. a donor site) via liposuction and repurposing it elsewhere. The donor site is often the thighs or stomach (basically, anywhere you have excess fat), and, once processed, the fat can be used to plump the cheeks, under eyes, lips, chin, hands, and even earlobes. Unlike synthetic fillers that are temporary, fat grafting is considered a permanent solution with no risk of rejection. With that said, the final results of fat grafting can take three to six months to reveal themselves. This is the length of time it takes for the graft to become established in its new location, and, during that period, the body re-absorbs a percentage of the fat (usually around 30 to 50 percent).

6. Facelift + Neurotoxins

Another injectable that can be paired with a facelift? Neurotoxins. “Using Botox®, Dysport®, Jeuveau®, or Xeomin® will help relax muscle causing facial wrinkles associated with repeated movements,” Dr. Schaffner says. These neuromodulators can be employed to treat the areas of the face not addressed by the facelift surgery — like horizontal forehead lines, glabellar lines (i.e. frown lines), crow’s feet around the eyes, and more.

7. Facelift + Lasers

Sure, a facelift addresses the shape of the skin, but it can’t do anything about the look of it. Enter lasers treatments. “Lasers can be used to help resurface the skin to reduce wrinkles,” Dr. Schaffner explains. There are many types of lasers, but, for patients with the right skin tone, ablative devices can resurface the skin, diminish dark spots, minimize the appearance of scars, and promote collagen production. “Because there is some downtime after a facelift, getting an ablative laser treatment at the time of your facelift is a great way to refresh your skin as well,” Dr. Pierce says.

8. Facelift + TCA Peel

If you're looking for another way to address the tone and texture of the skin, a chemical peel may be it. Short for trichloroacetic acid, a TCA peel is a medium-to-deep intensity chemical peel that addresses fine lines and wrinkles, hyperpigmentation, melasma spots, and skin texture. Dr. Shafer performs this non-invasive procedure in conjunction with facelift quite often — about 75 percent of the time. Like laser resurfacing, combining a chemical peel with a facelift allows you to make the most of your downtime and recovery period and more holistically address the quality of the skin.