This patient came to see me at 55 because she felt much younger than she looked. She worked full-time, exercised regularly and had plenty of energy. But when she looked in the mirror, she felt that her face was beginning to tell a different story.
She wanted to look more refreshed, but I did not want to begin by simply recommending a facelift. I wanted to understand what had changed in her face and what we would need to correct to make her appearance more consistent with how she felt.
When I examined her, I saw several things happening at once. The outer part of her eyebrows had descended. Her cheek volume had shifted downward. There was some early fullness along the lower face and laxity through the neck.
Each of those changes required a different part of the surgical plan.
I wasn’t trying to make her look like a different person. I wanted to restore the facial contours that had changed with aging while preserving the features that made her recognizable.
THE PATIENT JOURNEY
Watch Her 4D Facelift Journey From Consultation to Results
In this video, I walk through my patient’s facial analysis, explain why I recommended each part of her surgical plan and show her recovery at approximately one week and two months. At the end, she shares her own experience with the surgery and her results.
What I Saw During Her Facial Analysis
When I evaluate someone for facial rejuvenation, I like to work from the top of the face down. I am looking at how the different areas relate to each other rather than treating each concern independently.
Her Eyes Looked Tired, but the Problem Wasn’t Just Eyelid Skin
She had beautiful blue eyes, but there was fullness around the outer part of the upper eyelids, particularly on the right.
At first glance, you might think she simply needed excess upper eyelid skin removed. But when I looked more closely, much of that appearance came from flattening and descent of the lateral eyebrow.
That matters because removing eyelid skin does not necessarily correct a low eyebrow. In her case, I wanted to address the brow position as part of restoring a more open, rested appearance around the eyes.
Her Cheek Volume Had Moved Downward
The next thing I noticed was the position of her malar fat pad, which contributes to the fullness of the cheek.
In a younger face, much of that volume sits higher over the cheekbone. With aging, the relationship between the cheek tissues and the rest of the face changes. Some of that fullness appears lower, and the face gradually loses the sharper transition between the upper cheek and lower jawline.
With this patient, I could see that her cheek fullness had descended. I wanted to restore its position and also address areas where she had lost volume.
Her Neck Needed Attention Even Though Her Jawline Was Reasonably Good
Her jawline was not particularly bad when she faced forward. But there was fullness along the lower face, and when she lowered her head, the laxity underneath the chin became much easier to see.
That is why I like evaluating the neck from different positions. A straight-on photograph does not always tell me everything I need to know about what is happening underneath the jawline.
THE SURGICAL PLAN
Why I Recommended a Customized 4D Facelift
After examining her and discussing what she wanted to change, I developed a surgical plan that addressed the areas we had identified.
The foundation was my 4D Facelift™ approach, incorporating several different components of facial rejuvenation.
Deep Plane Facelift for the Midface and Lower Face
I used a deep plane facelift to mobilize and reposition the facial tissues that had descended.
The goal was not to pull her skin tighter. I wanted to restore the position of the deeper tissues so the cheek could sit higher and the lower face could have a more natural contour.
Deep Neck Lift for Definition Under the Chin
I combined the facial work with a deep neck lift to improve the contour underneath her chin and create a cleaner transition from the jawline into the neck.
I wanted that improvement to be visible not only when she looked straight ahead, but also from the side and when she lowered her head.
Facial Fat Transfer to Restore Volume
Repositioning facial tissue is one part of rejuvenation. Restoring volume that has been lost is another.
I used structural facial fat transfer in selected areas to restore fullness and create softer transitions through the face.
I did not want a hollow or overly tight result. I wanted a face that looked naturally full in the right places, with definition where definition belonged.
Brow and Lower Eyelid Surgery
Because the position of her lateral brows contributed to the tired appearance around her eyes, I also performed a temporal brow lift.
Lower eyelid surgery was included to address the concerns we had identified beneath her eyes. The plan also incorporated a regenerative treatment component.
These additional procedures were not automatically part of every facelift. They were included because of what I saw during her examination.
The facelift addresses tissue position. Fat transfer addresses volume. The brow and eyelid procedures address changes around the eyes. Each part of the plan needs to solve a specific problem.
EARLY RECOVERY
What Her Face Looked Like Seven to Eight Days After Surgery
One of the things I show in the video is how she looked approximately seven to eight days after surgery.
Even at that early stage, I could see a significant change in the position and shape of her face.
Her cheeks had more fullness in the upper midface. The eyes appeared more open. The lower face looked better defined, and the transition from the jawline into the neck was much sharper.
In the profile photographs, you could also see the improved neck contour. Her incisions were still healing, and there was some postoperative pinkness around those areas.
But I want to be careful about what those early photographs represent.
At one week, there is still swelling. The tissues have not completely settled. Some areas may look fuller than they eventually will, and the incisions are still in the early stages of healing.
That is why I show recovery photographs as part of a progression rather than presenting an early result as the finished operation.
If you want to see more examples of this stage, I have a separate article about what the first week after a facelift looks like.
At one week, I am looking for the direction of the result. I am not expecting to see the final result.
How Her Result Changed Over the Next Two Months
A couple of months later, I could begin to evaluate the result with more confidence because some of the early postoperative changes had settled.
Her face had retained the higher cheek volume we wanted, with a softer appearance through the midface. The jawline and neck remained well defined, and the eyes looked more open and refreshed.
One of the things I noticed was how naturally those changes worked together. She had fuller cheeks, but the lower face still had definition. Her neck looked sharper, but the face did not appear pulled or tight.
Her incisions were also healing well, which is something I pay particular attention to when reviewing a facelift result.
She was smiling in nearly every postoperative photograph I took. I was pleased to see that, but I was also looking at how the result held up from different angles and whether she still looked like herself.
Two months is an encouraging milestone, but it is not the end of healing. Residual swelling can continue to resolve, and scars and tissues continue to mature.
What She Said About Her 4D Facelift Result
At approximately two months, she shared her experience in the same video.
She explained that she had originally come to see me because she was concerned about the skin around her eyes, her jowls and what she believed was excess facial skin. A friend who had undergone a facelift with me had been very happy with her result, which encouraged her to schedule a consultation.
One of the things she was particularly pleased about was the fullness we restored through her face. She felt that her cheeks looked more youthful, her jowls had improved and her overall appearance was softer.
She also mentioned how nervous she had been about adding fullness to her lips because she did not want them to appear unnaturally large. She was happy that the result looked natural to her.
Why Her Previous Filler Treatment Mattered
There was another part of her experience that I think is worth discussing.
During her lower eyelid surgery, I encountered residual Bellafill from a previous treatment. That required additional work in the lower eyelid area.
In her testimonial, she described being nervous about how that area would heal because of the previous filler and the additional correction that was needed.
She was very happy with the appearance of her eyes as she recovered.
This is also why I want patients to tell me about previous facial procedures, injections and surgeries. Those treatments can change the anatomy I encounter and sometimes affect the plan.
Her 4D Facelift Before and After Photographs
I like showing several views of the same patient because each photograph tells me something different.
The front view helps me evaluate the relationship between the eyes, cheeks and jawline. The profile shows the transition from the face into the neck. And the downward-facing profile is particularly useful for seeing what happens beneath the chin when the head changes position.
These are three views of the same patient featured in the video above, not results from three different people.
BEFORE & AFTER
Her 4D Facelift Results
Why I Planned Her Surgery This Way
When she first came to see me, she knew she wanted to look more refreshed. But she did not necessarily know which anatomical changes were creating the appearance that bothered her.
That was my job to figure out.
I saw a relationship between her brow position, descending cheek tissues, facial volume and neck contour. Correcting only one of those areas would not have addressed everything we discussed during her consultation.
Her surgery was therefore a combination of structural lifting, volume restoration and targeted work around the eyes.
I am pleased with the improvement in her facial contours, but I am also pleased that she still looks like herself. Her face is fuller where I wanted it fuller and better defined where I wanted definition.
For a detailed explanation of the technique itself, including how I evaluate candidates and the different components that may be included, you can visit my 4D Facelift™ procedure page.
Her result came from understanding her anatomy and choosing the procedures that addressed it. That is the part of facial rejuvenation I want patients to understand.
FREQUENTLY ASKED
Questions About This 4D Facelift Patient Journey
These questions focus on understanding the surgical planning, recovery and before and after photographs shown in this patient’s story.
Why did this patient need both a facelift and facial fat transfer?
Facial aging involves changes in both tissue position and volume. A review of midface anatomy and aging discusses changes in the fat compartments and supporting structures that guide surgical planning. In her case, I wanted to address both descended tissue and lost volume.
Can a low eyebrow make the upper eyelid look heavy?
Yes. Brow descent can contribute to upper eyelid hooding. A clinical review of brow lift evaluation emphasizes assessing brow position and eyelid skin together rather than assuming that every heavy-looking upper eyelid requires skin removal alone.
Are facelift results at seven days the final result?
No. Swelling and tissue changes continue well beyond the first week. A study evaluating lower-face and neck changes throughout the first year after facelift surgery documented measurable changes at multiple postoperative intervals.
Does facial fat transfer produce permanent volume?
Some transferred fat can survive long term, but not all of it is retained. A systematic review of 27 facial fat-grafting studies found considerable variation in retention, with a pooled estimate of 47%. Individual outcomes cannot be predicted from that average.
Why compare a facelift from the front, side and with the head lowered?
Different views reveal different facial and neck contours. Published standards for preoperative and postoperative facial photography emphasize consistent camera equipment, lighting and patient positioning so results can be evaluated more accurately.
Can a facelift be combined with brow and eyelid surgery?
Yes, when the anatomy and surgical plan support it. A cohort study of combined facial rejuvenation procedures described the use of brow lifts, eyelid surgery, neck lifts and fat transfer alongside facelift surgery. The combination still has to be individualized.
How long can the improvements from a facelift remain visible?
Facelift improvements can remain visible for years, although aging continues. In a 5.5-year follow-up study of 50 facelift patients, 76% were assessed as still appearing younger than before surgery, with different facial regions retaining correction to different degrees.
