Face-Lift 2.0: Hollywood's New Faster, Multitasking Surgery
Full face-lifts are on the rise again as targeted lipo, bone paste and shorter recovery times are still the ultimate fix beyond Botox and fillers.
This story first appeared in the Sept. 4 issue of The Hollywood Reporter magazine. To receive the magazine, click here to subscribe.
With vanity pressures in Hollywood increasing by the hour, even the good old face-lift needs a face-lift.
Despite the rise in noninvasive tools, "the amount of face-lifts is up since 10 years ago," says Beverly Hills plastic surgeon John Joseph. "There's less social shame about it." Not to mention that the putting off of surgeries in favor of small, noninvasive procedures that occurred after the 2008 economic crash has swung the other way, says Los Angeles cosmetic surgeon Lawrence Koplin: "The housing market has skyrocketed, people have money, so they're having surgery again — because nothing reverses aging better than a face-lift." True, Botox has managed to nearly kill the brow-lift (though Bernard Markowitz, considered by many to be the town's finest, does a refined "temporal brow-lift"), but fillers — Restylane, Belotero, Perlane, Voluma, Sculptra — merely have delayed the face-lift. "We're doing face-lifts later," says Beverly Hills cosmetic surgeon Kevin Brenner, "because fillers last longer than they did a few years ago. It's easier to lift a face with volume and better texture." These days, full face-lifts are performed on patients in their 40s to 70s (the typical age range) looking to spend at least $25,000 (the starting cost of a Beverly Hills surgeon) and spend 10 days to two weeks in the house recovering (as opposed to yesteryear's one to two months). According to Hollywood's top docs, there are six new techniques of note:
1. Doing Everything at Once
"The old face-lift was just pulling on skin," says Koplin, "but skin, fat and muscle all fall, and bone recedes. Surgery is getting more anatomic — we understand better how the face ages. If you do it in a blended manner, you make a person look like themselves but 10 to 20 years ago."
This means moving both the skin and underlying muscle while simultaneously fat grafting during the face-lift ($25,000 to $35,000, not including fees for surgery center or anesthesia). Fat grafting is an increasingly popular permanent filler: During liposuction of a patient's belly, hips, butt, thighs and/or knees, a doctor will have small amounts of the fat harvested, cleaned and then injected — but only the fat that's the right texture — into the hollow areas of the face. With fat grafting, "there's less skin to pull, which means you have less to recover from," i.e., less bruising and swelling, says L.A. plastic surgeon Jason Diamond. "You can get back to work sooner. I just did an actress who's 42, and she was back onscreen in two weeks."
2. The Short-Scar Mini-Lift
A mini face-lift is recommended for someone who doesn't need that much pulling, either because they're younger (in their 40s), have great genetics or have been doing fillers and noninvasive lasers, peels, etc. The results are more moderate, as are the scars. "There is a swing in the last five years to make smaller incisions," says Joseph. "The smaller the incision, the shorter the scar." Adds New York surgeon Gerald Imber, who helped create the technique: "There's no incision behind the ear. Instead, it curves from the bottom of the sideburn down behind the little piece of cartilage between the ear canal and the cheek, into the crease in front of the lobe and ending invisibly in the crease just behind the lobe. So women can wear their hair up." With fat transfer, it's back to work in eight to 10 days (from $20,000).
3. The Tip-Off
A telltale sign of aging is the drooping nose. "Over years, the soft tissue of the nose loses the battle with gravity, like everything else," says Imber. "The tip begins to point downward, particularly when smiling. Lifting the tip and restoring the nasal angle with a tip platy (from $7,500) is a simple, quick fix and instantly makes one look younger."
4. Sucking Face
Ladies, lipo of the jowls is here: "Microsuction of the jowls can be transforming," says Imber. Sutures are under the skin so there is less scarring (from $1,500). "You can now do lipo all over the face," says Rogers. "Mostly in the jowls and nasolabial folds, then use fat grafting to put volume back in hollow areas" (from $2,500).
5. Pumping Up the Volume
As surgeons recognize how key volume is, they're innovating new procedures as well as retooling old ones. Bone paste — composed of carbon, calcium, hydrogen and phosphorus — was created to fill holes in bones during orthopedic surgeries. But using it in a face-lift is very new. "Instead of a silicon implant," suggests Rogers, "you inject bone paste into cheekbones and sculpt it with your fingers. Your body replaces it with your own bone. Your cells grow into it — it becomes part of you." At the same time, those silicone implants that have been around for 30 years are being used in a targeted fashion: Rogers employs them in the chin (from $4,000) and says, "Building up the chin looks more youthful."
6. Future Face-Lifts
What's up, docs? No more needles, as topical Botox and other nonsurgical drugs and fillers are developed in clinical trials. "In two years," confides Joseph, "the doctor will smear on liquid Botox for half an hour and wipe it off." Also, pharmaceutical companies are jumping on the Kybella wagon and working on new versions of the injectable fat killer, or "lipo in a bottle." No pain, no knife, full gain: Imagine, a face-lift as easy as a facial.