Double board-certified facial plastic surgeon Dr. Michael Boggess is a facelift specialist in the Nashville area who answers a few of the questions he is most commonly asked by the women and men who visit him for facelift surgery in Brentwood.
Procedures:Facelift / Reflection LiftFat TransferBrowpexyUpper BlepharoplastyLower BlepharoplastyFull Face CO2 Laser Skin ResurfacingResults:Patient is a 48 year-old male who presented with multiple cosmetic concerns related to aging of the face and neck. He had marked brow ptosis and hooding of the upper eyelids, bags under the eyes, ma... Read More
Procedures:Facelift / Reflection LiftLower BlepharoplastyFat TransferResults:Patient presented in her early 70’s with concerns related to aging of the face and neck. African-American patients tend to have thicker dermis of the skin and don’t typically wrinkle the way Caucasians do as they age. However, they commonly experience volume los... Read More
Procedures:Level 3 Reflection LiftFractional CO2 Laser Skin ResurfacingResults:Patient is a 60 year-old female who had a previous facelift performed by another surgeon 9 years ago prior to her initial visit with Dr. Boggess. Over the years following that initial procedure, she noticed progressive sagging in the neck and jawline and wrinkling... Read More
Procedures:Level 3 Reflection LiftBrow LiftFractional CO2 Laser Skin ResurfacingResults:Patient had noticed progressive aging of the face and neck for a few years before she finally decided to see what could be done for her. She had a lot of sun exposure during her youth and now was noticing facial wrinkles and brown spots that were wors... Read More
As we age, the effects of gravity, loss of volume in the midface, and loss of skin elasticity lead to progressive laxity of the skin and soft tissues of the face. The result is sagging along the jawline and neck, and deepening of the nasolabial folds and marionette lines around the mouth. A facelift, technically called a rhytidectomy, is a surgical procedure intended to lift the skin and soft tissues of the face and neck, thereby restoring a more youthful contour to the neck and jawline, and softening the depth of the nasolabial folds and marionette lines.
A facelift procedure primarily addresses aging changes of the lower face and neck. A facelift is commonly performed in combination with other facial rejuvenation procedures, such as a brow lift or mid-facelift to address aging changes of the upper face and midface. However, these additional procedures are not routinely considered part of a facelift.
What are the different types of facelift, and how do they differ?
This is a complex question because there are so many different techniques that have been described for facelift procedures, and the terminology is not always used consistently. However, all properly performed facelifts employ the following common basic principles:
First, a variable-length incision is made in the hairline in front of the ear, extending down along the natural creases around the front of the ear, and then possibly extending up along the backside of the ear and down along the hairline behind the ear for a variable length, depending on the needs of each individual patient. A separate small incision may be made in the natural crease under the chin to permit access to the midline of the neck if needed.
The skin of the face and neck is then elevated from the underlying soft tissues, called the SMAS in the face and the platysma muscle in the neck. This deeper layer of fascia and muscle is more resistant to stretch (less elastic) than the skin; it is this deeper layer that is elevated and secured to re-contour the neck and jawline.
Once the SMAS and platysma have been lifted and secured in a more youthful position, the excess redundant skin that comes back with the lift is trimmed along the incision lines and sutured back in place.
Depending on the needs of the patient, liposuction of the jawline and neck, and tightening of the platysma muscle in the midline of the neck, may be performed through the incision under the chin for patients with significant fat accumulation or laxity in the neck. The thing that distinguishes different types of facelift procedures is the technique used for the management of the SMAS and platysma.
SMAS plication involves folding the SMAS over onto itself as the tissues are lifted and suturing the layers together to support the lift.
SMAS imbrication procedure involves excising or removing a variable width strip of SMAS and platysma around the ear and approximating and securing the free edges together to support the lift.
Deep plane facelift involves developing a separate plane of dissection underneath the SMAS layer to release the ligamentous attachments along the jawline and in the midface to allow additional mobilization of the SMAS during the lift. This is primarily to allow additional improvement in the nasolabial folds and midface.
There are other variations related to suturing techniques and vectors of pull that distinguish facelift techniques. There are pros and cons to each facelift technique, and the choice of facelift technique is dependent on the skill, experience, and preference of the operating surgeon. However, there has been no consistent evidence in the medical literature to demonstrate any advantage of one technique over another, in terms of outcome, complications, or longevity of results. Most experienced facelift surgeons have likely performed all of these techniques and utilize each to some degree based on the anatomy, concerns, and goals of each individual patient.
Considering a Facelift?
Start With Our Expert's Guide
"An Expert's Guide to Facelift Surgery" provides essential information for anyone thinking about getting a facelift. Double board-certified facial plastic surgeon Dr. Michael Boggess is considered Nashville's facelift expert after performing thousands of facial rejuvenation procedures with consistently remarkable results.
The Expert's Guide explains:
How to choose a surgeon you can trust
What to do before your facelift
Why a Reflection Lift is more than a facelift
When you'll be ready for a big social event
Get Your FREE Expert's Guide to Facelift Surgery
What is a Reflection Lift?
I am not a believer in a “one procedure fits all” approach to facial rejuvenation. Every patient is unique and different in their anatomy and the effects of aging. I have performed over 3,500 facelift procedures, and with that experience, I have been able to develop techniques to optimize results for all of my patients. I tailor every procedure to the individual anatomy, concerns, and goals of each patient. The Reflection Lift utilizes my unique approach for lifting and securing the SMAS and platysma to optimize results and achieve a natural, more youthful look for my patients. The Reflection Lift can be performed in an office-based setting using light sedation and local anesthesia, thereby eliminating the risks and costs associated with general anesthesia.
Level I Reflection Lift (called a mini facelift at other practices) is a conservative SMAS facelift approach for younger patients with mild to moderate laxity along the jawline and mild sagging in the neck.
Level II Reflection Lift involves a SMAS facelift, in addition to liposuction in the face and neck, to address mild to moderate laxity and fat accumulation in the jowls and neck.
Level III Reflection Lift is a more aggressive facelift approach for patients with moderate to severe laxity in the face and neck. This procedure involves more extensive skin flap elevation in the face and neck to allow tightening of the platysma muscle in the midline of the neck and more aggressive mobilization of the SMAS and platysma with the lift, in order to optimize results.
Can a facelift be performed without general anesthesia?
The simple answer is yes. A facelift can be performed very safely without the use of general anesthesia. I have performed thousands of facelift procedures in an office-based setting using light sedation and local anesthesia. I have a perfect, untarnished safety record utilizing these anesthesia techniques. I actually prefer to perform facial rejuvenation procedures without general anesthesia because it reduces the risks and the cost for the patient. There are two alternatives to general anesthesia.
Oral medication such as valium is taken by mouth to relax the patient. The oral valium tends to relax most patients enough that they will doze off and sleep during the procedure. However, they may be awake or aware at times, and that is okay because we use local anesthetic injections to numb the areas on which we are working so that the patient does not feel pain during the procedure.
IV sedation involves the delivery of sedating medications to the patient through an IV to allow for more rapid titration of the level of sedation throughout the procedure. This method is still not general anesthesia, so there may still be times when the patient is awake or aware during the procedure. IV sedation also requires the use of an anesthesia provider to deliver the anesthesia, so there is an additional cost associated with IV sedation.
I do also offer general anesthesia to my patients, but I feel that this unnecessarily increases the risk and the cost of the procedure for the patient.
By focusing exclusively on facial procedures, Dr. Boggess provides patients a level of expertise rarely found at other plastic surgery practices in the Southeast. Certified by both the American Board of Facial Plastic & Reconstructive Surgery and the American Board of Otolaryngology, Dr. Boggess combines exceptional technical skill with a down-to-earth demeanor that puts patients at ease from the moment they meet him.
Why do I look older than my friends who are the same age as me?
There are a number of factors that contribute to the differences in how people age, including genetics, sun exposure, skeletal structure, and lifestyle habits. Some of these factors you can control, but many you cannot. There are common things that happen to everyone as they age:
Drooping of the brow and upper eyelids
Bags under the eyes
Lax face and neck tissue
Facial rejuvenation can reverse these signs of aging and turn back the hands of time.
Will a facelift get rid of chubby cheeks?
A facelift does not address the cause of “chubby cheeks” in many people, which is the buccal fat pad. This excessive fullness, often due to genetics, makes the face look round and chubby (even when you are not overweight) and obscures the cheekbones. While a facelift rejuvenates the lower 2/3 of the face, Dr. Boggess can perform buccal fat removal during facelift surgery to contour the cheeks.
Will I still look like me?
We do not try to change the face that God gave you but restore youthfulness that has been lost due to the effects of age and gravity. Dr. Boggess performs procedures to provide very natural-looking results. Most people won’t be able to tell you had surgery; they may think you’ve changed your hair or lost weight. You’ll still look like yourself, just a few years younger.
How will I look different?
Dr. Boggess specializes in rejuvenation of the aging face and neck. Procedures are performed in a conservative manner to address the concerns and achieve the goals of each individual patient while providing natural-appearing results. You will look refreshed and younger, not different or operated on.
How much younger will I look after a facelift?
When performed by an experienced surgeon who lifts the SMAS layer of the face, this procedure can make patients look 10 to 12 years younger; although, results vary from person to person. It’s important to understand that the aging process continues, but you will continue to look younger than if you had not had a facelift.
Would a Reflection Lift work for me?
If you’re not happy with the reflection you see when you look in the mirror, a Reflection Lift could work for you. There is no standard age or profile for a Reflection Lift. Each Reflection Lift is customized to meet your individual needs and desires.
How long does it take to perform a Reflection Lift?
Because each Reflection Lift is customized to suit each patient’s needs, the time will vary but typically takes 1 to 3 hours.
What are the risks of facelift surgery?
The risk of complications with facial rejuvenation surgery is extremely low. However, as with all types of surgery, the risks include, but are not limited to, infection, bleeding, scarring, nerve injury, and unsatisfactory result. We take precautions to minimize the incidence of all of these potential complications. If a complication occurs, it can typically be managed with conservative measures and does not tend to affect the results of the procedure.
How long is the recovery from facelift surgery?
As with all types of injury or surgery, there is a healing process that occurs over a period of 9 to 12 months, during which time the body restores itself. Although it may take 9 to 12 months before the final results of a facelift are fully apparent, patients will look good and feel good long before the healing process is complete. Most patients want to know when they can get back out in public and others won’t be able to detect that they have had surgery. The typical visible signs of surgery, which can vary from one patient to another, are bruising and swelling.
It typically takes 1 to 2 weeks for the visible bruising and swelling that others can see to resolve to a point that others can’t tell. Some patients may take a little longer if they bruise badly. However, the vast majority of patients can get back out in public within 2 weeks. That doesn’t mean that all of the swelling is gone or the healing is complete within that time. There will still be swelling that can be felt but not seen that may take several weeks, or even months, to resolve. However, you will look good and feel good long before the healing is complete.
I typically tell people to allow at least 3 to 4 weeks before any important event, such as a wedding, reunion, or speaking engagement where they want to look their best. In most patients, the majority of the soft tissue swelling has resolved by 6 to 8 weeks, but this can vary from one individual to the next. It is important that you be patient with the healing process and follow all postoperative care instructions to optimize healing and results.
How long will the effects of a Reflection Lift last?
As with all cosmetic procedures, the longevity of the results will vary from one person to the next. How you take care of your skin after the surgery will have an effect. We will give you tips for taking care of your skin post-surgery.
All facial rejuvenation procedures are intended to turn back the hands of time for the individual patient, and you will always have a more youthful appearance than you would have had if you had nothing done. However, you will continue to age in the way that you naturally age, which varies from person to person.
What can I do to get the best facelift results?
Dr. Boggess and the Youthful Reflections team will provide detailed instructions for achieving the best results every step of the way. It is very important to follow all instructions, in order to optimize your results.
Will I be in pain after facelift surgery?
Pain and discomfort vary from one person to the next, but after a facelift procedure, the pain is typically mild to moderate and easily controlled with pain medication. Most people take pain medication, as needed, during the first week, but we’ve had many patients tell us that they didn’t need anything stronger than acetaminophen (Tylenol®) after the first night.
How much does a Reflection Lift cost?
Since your Reflection Lift is customized for you, costs vary for each patient.
Can I afford a Reflection Lift?
By eliminating the cost of general anesthesia and by performing our procedures in our office-based operating room, we can significantly reduce the cost of most cosmetic procedures for our patients. We work individually with each patient to determine the best approach to achieve their goals within their budget. We can help you prioritize your goals to optimize your results within your budget to achieve the Youthful Reflection that you desire.
Am I too old or too young for facial rejuvenation?
People age in different ways and at different rates. Our patient population ranges in age from mid-30s to early 80s. Dr. Boggess will make a detailed assessment of your anatomy, goals, and physical health to determine if facial rejuvenation is right for you and what treatment will best achieve your goals.
Can a man get a Reflection Lift?
Yes, anyone can get a Reflection Lift. We’ve had many men who have had this procedure.
Do I have the option of having a Reflection Lift under general anesthesia?
Most of our procedures are performed in our office-based surgical suite using light sedation and local anesthesia. This eliminates the risks and costs associated with general anesthesia and is the preferred method for the majority of our patients. Dr. Boggess has performed thousands of procedures in this setting. However, we offer the option of procedures under general anesthesia for patients who prefer this method. There is an additional cost for an outpatient surgical facility and anesthesia provider in these circumstances.
How do I get started?
The first step in learning about what Dr. Boggess can do for you is scheduling a personal consultation. Dr. Boggess is known for putting no limit on the time it takes to learn about your concerns and expectations and to recommend the procedures best suited to your goals. To get started, request a consultation using the online form or call our office at
(615) 942-8016 to schedule an appointment.