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Facelift Surgery

Facelift Surgery
The aesthetic skills required to perform a facelift take a surgeon years to hone and perfect. Dr. Miguel Delgado’s 30 years of experience performing facelifts has established him as one of the most well-respected and experienced facelift surgeons in California. His expertise in facial regeneration is a never-ending journey to provide individually specific results for each patent seeking to improve their appearance and restore their youthfulness. Dr. Delgado takes the time to create the best surgical plan for each patient to help them achieve their desired surgical outcome.

What Is a Facelift?

A facelift is a cosmetic procedure designed to restore a more youthful version of you! As we age, we begin to see sagging tissue in the lower face, decreased elasticity of the skin, and the loss of facial volume. These changes progress slowly over time. Excessive sun exposure and smoking can accelerate the aging process. A successful facelift will tighten the skin of the lower face, eliminate sagging jowls, and reduce obvious facial wrinkles. Some facelifts incorporate fat transfers to help fill the hollowness. Dr. Delgado listens carefully to each patient to understand their individual surgical goals.

From performing thousands of facelift procedures, Dr. Delgado has a keen artistic eye for facial aesthetics—but, most importantly, he also has the ability to listen to your personal concerns, understand them, and propose a customized facelift surgical plan. Your facial aging and facial fullness (or lack thereof) may dictate a facelift that enhances facial volume or makes the face look thinner. The treatment of the neck is a critical component of a facelift. This region is highly customized for each patient. Dr. Delgado evaluates the amount of skin sagging and platysma muscle laxity, the fat content both above and below the platysma muscle, and the position of the submandibular gland. Each of these components needs to be assessed, discussed, and treated.

One last point: facial rejuvenation will also include a discussion of your skin and a possible laser or chemical peel. Dr. Delgado may discuss your facial proportions and the balance of your profile and talk about some options, such as a chin augmentation. If needed, he will evaluate facial volume options as well. This is only a discussion to lay out your smorgasbord of options.

The bottom line is that your facelift surgery will be strategically planned in great detail. Dr. Delgado can also perform computer imaging to discuss and show predicted changes.
 

Who Is a Candidate for Facelift Surgery?

Most facelift patients are men and women between 40 and 60 years of age, though this does not mean individuals who fall outside this range are automatically not good candidates. Instead, candidacy for facelift surgery is generally determined based on the presence and severity of one or more of the following concerns:

  • Skin laxity and/or sagging
  • Prominent jowls
  • Neck laxity and fullness
  • Platysma bands or cords that are seen under the chin 
  • Loss of the jawline or mandibular angle
  • Lack of fullness in the face

In addition, the ideal candidate will understand that a facelift is intended to enhance the appearance, not to give an entirely different look. It is vital that you are realistic with your goals. You can have dramatic results, but it is not designed to make you look like someone else. Dr. Delgado is well known for providing a natural and un-operated appearance. What a facelift does is turn the clock back eight to ten years.

Traveling for Facelift Surgery?

Dr. Delgado has treated patients from all over the globe. If you live outside the Bay Area, please don’t hesitate to ask us about our travel packages and accommodations. Dr. Delgado’s international following has grown so much over the years that we have developed a travel program we tailor to each patient’s specific needs. Several of our patients from overseas have even travelled with their own interpreters. 

Once you have chosen Dr. Delgado as your surgeon, we begin preparing you for your surgical experience. We provide you with your surgical booklet that has all the information you need to get ready for surgery. Whatever your needs are, we work with you to make certain your surgical experience with us is successful in every way. 

Are There Different Types of Facelifts?

Today, there are many types of facelifts: Liquid Facelift, Fat Injection Facelift, Short-Scar Facelift, Mini Facelift, and the Modern Facelift. Other options exist—such as the Lunchtime Facelift, the Weekend Facelift, and the Lifestyle Lift—although these names are more marketing terms than anything else, and they actually fall into the categories of Mini or Short-Scar Facelifts. 

  • Liquid Facelift

    “Liquid Facelift” is a term used to describe injections of products to fill various facial areas and create more fullness. A patient’s own fat is commonly used, but products such as Sculptra® Aesthetic, Radiesse®, and JUVÉDERM VOLUMA® can be utilized as well. A Liquid Facelift can often be a great option for patients do not need and/or desire surgery to address their aesthetic concerns. Depending on the specific injectable(s) administered, periodic retreatment will be necessary to maintain lasting results. This is not a facelift but a volume enhancer, which expands the skin—much like inflating a balloon—and provides a lifting effect.

    Injection of your own fat to the face can accomplish much more volume replacement than the above techniques, and the fat will be permanent for as much as 50% of the volume.

  • Fat Injection Facelift

    A Fat Injection Facelift refers to the transfer of fat to the face with the intention of increasing volume and achieving a rejuvenated appearance. With the Coleman Technique—which was developed by Dr. Sydney Coleman of New York City—fat is selectively grafted from regions such as the abdomen or legs with the assistance of liposuction. Once harvested, the fat is processed via centrifugation, which separates fat into several layers: an upper oil layer, a central purified and concentrated fat layer, and a bottom level consisting of blood.

    Extensive studies have discovered that the lower 20% of the fat layer contains an excess of fat cells and growth factors that are beneficial in the healing process. When this fat layer is used in facial injections, its survival rate is tripled. The Coleman Technique promotes a cross-hatching effect that causes fat cells to thrive at and around the injection site. Unlike other fat transfer methods, the Coleman Technique generally offers over 50% of fat cell survival.

    Many patients interested in the Fat Injection Facelift method question how long the fat lasts. The answer is based on technique and the site of injection. For instance, cheek injections may respond better, whereas fat injection in the lips that are constantly in motion might have a more limited lifespan. Since the survival rate is roughly 50%, Dr. Delgado tends to overcorrect to account for some of this loss in fat graft survival.

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  • Mini Facelift

    The Mini Facelift involves only the skin. This is not a deep lift and does little, if anything, to improve the neck. If you pull the skin back and upwards in front of the ears, this will mimic the effect of a Mini Facelift. Since the procedure only pulls the skin, the effects will not last for more than a few years. Unlike the underlying facial muscle, the skin is not structural and stretches easily. The degree to which the skin will stretch is determined by your genetic makeup and amount of sun exposure. The Weekend Facelift and the Lunchtime Facelift are examples of the Mini Facelift.

    The Mini Facelift incision for women is often within the tragus of the ear, which will avoid the incision in front of the ear. However, for men, the incision is often in front of the ear to avoid pulling the beard or hair-bearing skin into the ear. This takes longer to fade but results in a more natural ear appearance for male patients.

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  • Short-Scar Facelift

    The Short-Scar Facelift is a relatively new procedure that was introduced around the year 2000. The demand for this procedure among Dr. Delgado’s patients is strong, because the lift can be significant and the incision is limited to the front of the ears. The keystone of the Short-Scar Facelift method is that it lifts the deep structure called the Superficial Musculoaponeurotic System (SMAS)—a firm and fibrous network that runs under the skin but over the facial muscles and forms the framework of the face. When the SMAS is tightened, it can yield significant and long-lasting results. This is a powerful facelift for the length of the incision. Since the SMAS connects to the neck region, that area can also be improved modestly with this approach. A Lifestyle Lift falls into the Short-Scar Lift category.

    Dr. Delgado will often suggest a Short-Scar Facelift for patients who have minimal to moderate laxity of their skin—and it can even make improvements in the neck. For these individuals, the Short-Scar Lift is a good option because it can correct what is required without over-operation.

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  • Modern Facelift

    The Modern Facelift has evolved over many years, starting with the discovery of the SMAS (Superficial Musculoaponeurotic System). Surgeons have dissected and pulled the SMAS every which way as they learned how to best utilize this tissue plane.

    The Modern Facelift technique often includes an incision in front of and behind the ear and into the hairline, which is needed if a significant amount of redundant skin is present, especially in the neck. The SMAS is more extensively supported with this technique than in any of the other facial rejuvenation surgeries. As a result, it is considered the gold standard for face-lifting and will typically be long-lasting.

    The SMAS layer is well defined. It is common knowledge among plastic surgeons that this is the key for a long-lasting and natural facelift. The issues have been how extensively should it be dissected, which is the best direction of pull, and where are the best anchoring points. The clinical studies by the top plastic and cosmetic surgeons in the world have shown that the lower portion of the SMAS needs to be pulled along the jawline and anchored deeply just below the ear. This creates jawline definition and tightens the entire neck. Remember, this is not the skin but a strong fibrous network underneath the skin. The other component is that the SMAS needs to be released and anchored above the jawline to drastically improve the jowl region and midface. The last component is the midline of the neck. This platysma band (which is connected to the SMAS) needs to be tightened, and the fat component also needs to be addressed above and below this platysma muscle layer. This is the foundation of the Modern Facelift.

    The modern approach to facelift surgery has also recognized the importance of facial fullness.  As we age, fat is lost in many areas of the face, such as the cheeks, eyes, lips, temple region, and more. When this occurs, we look older—the skin loses its fullness and begins to appear deflated and starts to sag. In this situation, if a facelift is performed alone, the face may appear slightly pulled and/or flat with less contour or curvature (such as in the cheek region), which can result in a more operated and unnatural look. For this reason, Dr. Delgado often incorporates fat injection into his Modern Facelift approach. Additionally, he may overlap the SMAS (as opposed to removing a segment of this structure) to further restore fullness to the face.

    It is important to note that even though fat is a key component in facial aging, men do not require quite as much fat volume replacement as women; volume restoration with fat for men should be much more subtle and not exaggerated, like a full cheek.

    Ultimately, the Modern Facelift is the most extensive technique, but it tends to hold up the best and last the longest (8–10 years).

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  • Composite SMAS Facelift 

    This is a great technique for elevating the SMAS (Superficial Musculoaponeurotic System), and it is one of Dr. Delgado’s favorites. With this technique, the SMAS is raised with the skin attached—unlike the other SMAS method in which the SMAS and the skin are separated. The final result can be a very smooth and one-piece, natural look.

    It is important to note that the Composite SMAS Facelift does not work as well with patients who have an abundance of loose skin. In this situation, the face has much more skin to remove than SMAS. Therefore, by separating the two layers, the skin can be pulled and trimmed independently.

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  • Hollywood Facelift

    Dr. Delgado has a special facelift procedure that is centered around less conspicuous incisions (or scar locations) known as the Hollywood Facelift. For appropriate candidates, many of the previously discussed facelift techniques can be performed using this method; even the Modern Facelift. The beauty of the Hollywood Facelift is that there are no incisions beyond the ear—the incision is confined to the ear anatomy so that one can wear their hair up, for example, and no scars will be seen. This is a great technique for men, especially bald men (and even women) who have lost their hair for a variety of reasons. The best patient is one who does not have a significant amount of neck skin.

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How Do I Prepare for Facelift Surgery?

A consultation with Dr. Delgado can be scheduled at either his San Francisco office or his Marin County office in Novato. During this appointment, he will listen as you express your aesthetic concerns and describe your short- and long-term goals regarding your face. He will also examine your face to evaluate the extent of skin laxity and assess other aspects that may need correction in order to achieve a balanced and natural appearance.

Dr. Delgado will ask what goals you want to achieve with your facial appearance. Do you want to look “younger” or “rejuvenated?” A rejuvenated look is using your tissue to achieve a very natural look without added techniques, whereas the younger look may require additional procedures—such as fat volume replacement to the entire face—to attain an appearance more similar to the way you looked at a younger age. Old photos help with this planning. Since the nasal tip begins to drop as we grow older (creating more of an aged look), you may also need the tip of the nose to be thinned and lifted upward. In addition, a chin implant or a pre-jowl implant may be necessary—though these are just examples. The skin quality is also a critical component for all facelift procedures.

Based on this information, Dr. Delgado will explain your facelift options and provide his recommendation as to which technique would be best for your needs. This conversation might also include evaluation of your eyes and eyebrows, as any desired improvements to these areas may require the addition of blepharoplasty and/or brow lift surgery to your treatment plan.

To help demonstrate the results that can potentially be achieved, Dr. Delgado may use computer imaging, which displays a visual impression of the proposed outcome. This is a popular tool that is extremely helpful and enhances communication—particularly when planning facial rejuvenation surgery. Additionally, he will show you before-and-after photographs of patients on whom he has performed facelifts so you can see actual results of his work. He also has over 100 videos of his surgeries, including a documentary of a patient’s experience through the entire facelift procedure over a nine-month period of time.

Lastly, an exact price quote will be explained, and you will receive an informative instruction booklet with precautions to follow before your procedure. The booklet will contain everything you need to know regarding medications to stop taking, as well as what steps to follow at home before surgery. It explains that, although you should stop taking aspirin two weeks before your procedure, Tylenol® is recommended to alleviate any discomfort. The instructions also detail vitamins and holistic options to help reduce swelling and bruising after your cosmetic procedure.

What Does the Facelift Procedure Entail?

Facelift surgery is performed at Marin Cosmetic Surgery Center, Dr. Delgado’s private surgery suite located on the Sutter Health Novato Community Hospital campus. This allows him to offer his patients private, concierge medical care while providing the extra measure of safety and reassurance afforded by the surgery center’s contiguous location to the Sutter Hospital campus.

The facelift procedure begins with preoperative markings—Dr. Delgado will use the facelift surgery plan sheet that was created at your pre-op appointment. He will make drawings on your face for the location of the incisions and the direction of the pull vector. You will then be lightly sedated and taken to the Operating Room. Once anesthesia is complete and all is sterilely prepped, the operation will begin.

Patients are often very concerned about surgical anesthesia. They are sometimes more concerned with the anesthesia than the surgery! Dr. Delgado uses a board-certified physician, Dr. Craig Riddle, who is also the active Chief of Anesthesia at Sutter Solano Medical Center. Dr. Riddle provides state-of-the-art anesthesia using the best short-acting drugs and the lightest general anesthesia.

To perform the surgical aspect of treatment, an incision is first made in front of the ear. If a Mini Facelift is done, the cheek skin is undermined and pulled, and the redundant skin is excised and finally sutured. If a Short-Scar Facelift is done, the skin is further undermined into the cheek area and down toward the neck. The SMAS is then elevated and anchored, pulling the neck tissue and facial tissue upward. The skin is trimmed and closed. A chin incision is sometimes used to further tighten the neck region. If the Modern approach is used, the incision continues behind the ear and into the hairline. This incision exposes much of the neck and cheek area. The SMAS can be completely modified to achieve a stronger face and neck improvement in a natural fashion. Much more skin can be excised and then meticulously closed. A drain is often placed, and a light compression dressing is used. At the same time, additional facial procedures can be done, such as an eyelid lift, brow lift, a chemical peel, fat injection for facial fullness, or a lip or chin augmentation, to mention a few.

Generally speaking, the male facelift should produce a strong jawline; this may even require a chin implant. The female jawline should be very distinctive but in a softer way. More attention is spent on the female neckline to achieve a naturally snug and smooth appearance. It is imperative for both male and female facial rejuvenation that the hairline not be altered. This is especially true for the male who does not, in general, wear long hair. 

Anesthesia

Most facelift procedures are performed while the patient is under non-twilight anesthesia; however, in some cases, local anesthesia with intravenous sedation may be utilized. At Marin Cosmetic Surgery Center, only a board-certified anesthesiologist will administer anesthesia and monitor you throughout the procedure to help ensure optimal comfort and safety. The night before your facelift, the anesthesiologist will call to confirm your medical history and answer any last-minute questions before your procedure. Dr. Riddle is our chief anesthesiologist and has impeccable credentials

What Is Recovery from Facelift Surgery Like?

The first few hours after facelift surgery will be spent in the Recovery Room. Depending on the specifics of your treatment, you may be able to go home with someone to assist you once you are completely alert and oriented. At home, you are to apply cold packs around your face and neck area for 48 hours to reduce swelling, as well as sleep with your back and head elevated at 45-60 degrees for approximately four to five days. This is critical in reducing swelling.

Some patients will spend the night in the Recovery Room at Marin Cosmetic Surgery Center, especially if a complete facelift is performed. If you are staying overnight, your care will be provided by a Registered Nurse with post-operative training, including ACLS (Advanced Cardiac Life Support) certification. An additional person will be assisting her overnight with your care. These recovery personnel have been hand-picked and trained by Dr. Delgado to provide the highest level of surgery aftercare.

Dr. Delgado will see you the next morning and inspect your incisions. If drains were placed, they may be removed, but most often they are left in if extensive neck work is performed. You will be discharged with a responsible adult to transport you to your home and settle you into your recovery environment. You may shower and wash your hair in 48 hours even if the drains are still in place.

Maintaining elevation of your back and head is very important to minimize swelling. You may experience minimal pain, but most patients report primarily a sensation of tightening from the swelling. Pain medication is prescribed, but usually it is needed for just a day or two.

Much of the swelling and mild bruising will resolve in seven to ten days, as long as proper care is taken. Makeup may be applied after one week. Most patients return to work or social activity after seven to ten days. Strenuous physical exercise is to be avoided for four to six weeks following facelift surgery.

Are There Any Facelift Risks and Complications to Know About?

As with any surgery, there are potential facelift risks and complications. That said, with a board-certified plastic surgeon, a board-certified anesthesiologist, and a well-trained surgical team, complications are rare.

The risks include: bleeding, infection, slow healing (usually behind the ears), and prolonged swelling. The face is different from side to side and asymmetry is always present and very normal. You will still have natural asymmetries afterward. Facial surgery also carries the remote possibility of temporary or permanent nerve injury, but this risk is minimal with a skilled, experienced surgeon such as Dr. Delgado. Occasionally, incisions need to be modified with scar improvement techniques, though in general they tend to blend and fade beautifully over time.

Male facelift surgery patients have a higher rate of post-operative bleeding due to the added hair to the face, which brings in more blood supply to the area. The blood pressure needs to be controlled after surgery, and the patient often stays overnight at the Marin Cosmetic Surgery Center after surgery for safety purposes.

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What Kind of Facelift Results Can I Expect?

The goal of facelift surgery is to rejuvenate the lower face, jowls, neck, and jawline while improving their respective relationships. The angle of the neck will be sharper and the jawline will be tighter and more defined. In addition, the fat component of the neck will be evaluated and often reduced. However, it is important to leave adequate fat on the skin to maintain a smooth contour as it re-drapes. The lower facial area will focus on the jowls and the contour of the cheeks. The jowl skin is repositioned and sometimes liposuction is performed. Dr. Delgado will evaluate the buccal fat pad in the lower cheeks to determine if it should be reduced to provide an improved facial contour. The best SMAS procedure will be selected for an optimal outcome.

The enhancements achieved with facelift surgery can be expected to endure for many years. In general, depending on when you have your procedure and which technique is employed, you will likely look eight to ten years younger. Although you will continue to age and gravity will continue to affect your face, the area should remain more youthful than if surgery had never been performed. Facial surgery can be done again in the future and combined with other procedures, as desired.

Are There Alternatives to Facelift Surgery?

Some patients do not want a surgical procedure. There are non-surgical techniques that can improve your appearance, but never as well as a surgical facelift. If the face lacks volume, it can be improved with facial fillers or fat injections under local anesthesia. The skin laxity can be improved with chemical peels or a variety of laser skin tightening procedures, which can also help eradicate sun damage.

What Is the Cost of Facelift?

In general, the cost of a face and neck lift surgery at our San Francisco and Marin County practice ranges between $13,000 to $14,000, which includes fees for the surgeon, anesthesia, operating facility, compression garments, and all follow-up care. Sometimes the fees may change due to the complexity of the surgery—for example, if it is your second or third face/neck lift or a complicated case. Dr. Delgado will explain this in great detail at the time of the consultation. He will also use computer imaging to explain the specific details in your surgery, the location of the incisions, and a computer image as to the potential outcome.

Facelift surgery usually requires general anesthesia, which is performed by a board-certified anesthesiologist at Marin Cosmetic Surgery Center. When comparing costs, be sure your plastic surgeon and anesthesiologist are both board-certified and that the facility has national and state accreditation as an outpatient surgery center, as does Marin Cosmetic Surgery Center.

Additional Frequently Asked Facelift Questions

Does a facelift address the entire face?

In general, a facelift is treatment of the lower face and neck. This includes the midface (which begins below the eyelid region), the lower face or cheek region, and the neck. A complete facelift would include the entire face, such as the eyes and eyebrows.

Do men have facelifts?

Yes, men are having facelifts at a higher rate year after year. The reasons are similar to women. Some of the most common are work-related issues, divorce, or simply wanting to look how they feel. Male facelift surgery requires special consideration and Dr. Delgado has vast experience with male facelift rejuvenation. The video below will review some of these special issues, such as the hairline, short hair, facial hair, etc.

How long does facelift surgery take?

The amount of time it takes a facelift to be performed depends on the type of facelift and if any other procedures are included. The Mini Facelift involves skin elevation and closure, which takes about two hours. The Short-Scar Facelift takes approximately three hours, and if the neck lift is performed, it generally requires four hours. The state-of-the-art Modern Facelift usually takes about five hours. This surgery is not very traumatic on the body because it is primarily skin and subcutaneous tissue surgery, unlike tummy tucks for example. You ask why does it take so long? The dissection is very meticulous to avoid structures like the facial nerve, and the suturing of anatomical tissues and framework back to their new form takes time.

Can I have other cosmetic procedures at the same time?

It is common for patients to have other cosmetic procedures at the same time. These procedures can include a brow lift, eyelid lift, nasal surgery, chin implant, chemical peel, and volume replacement in the face, such as fat injections. Dr. Delgado may advise you to consider one or more of these additional procedures in order to achieve the most harmonious and natural results possible.

Will I have facelift scars?

Dr. Delgado will make minimal incisions in well-concealed areas, and the incisions fade extremely well over time. It is always the goal to enhance the quality of the scars, as well as preserve the natural hairline. The incisions are slightly different for men and women and Dr. Delgado will review this issue. In all cases, Dr. Delgado wants a superior incision and the resultant scar. There are variables that you can help with to optimize your results. Smoking cigarettes is scientifically proven to result in poor scars. The nicotine in cigarettes causes vascular constriction, which leads to reduced blood flow to the healing incisions. Incisions require robust vascular flow with all of the healing components to heal well. If you have chronic illnesses like diabetes, this needs to be evaluated—including your A1C level.

Ultimately, there are many aspects involved in creating great incisions and scars. Dr. Delgado has excellent techniques for closure of the incisions with a state-of-art cosmetic and plastic surgery closure. He will evaluate your physiological condition and put a great plan in place to optimize your healing for the least conspicuous facelift scarring possible.

When can I return to work, exercise, and driving?

A typical patient undergoing a facelift procedure is generally very comfortable returning to work after approximately two weeks. Minor concealing makeup may be desired in areas where bruising has not yet completely resolved. You can plan to drive seven days after surgery, or as soon as you are comfortable and off pain medications. Exercise routines can be resumed approximately four to six weeks after surgery, advancing slowly. The post-operative goal is to reduce swelling as quickly as possible, allowing you to return to your usual activities looking as natural as possible. Men may require a little extra time because makeup is not usually worn.

How can I reduce swelling after a facelift?

The major contribution to reduce swelling after surgery is elevation of the back to at least 60 degrees. This will reduce fluid accumulation in the face and reduce swelling. Light ice packs around the face can be helpful for the first 48 hours. A facial wrap is used after surgery that compresses the area slightly, which aids in reducing swelling. You may also use a steroid medication—Medrol® pack—which reduces swelling as well.

How painful is a facelift?

Facelift surgery usually has minimal pain. Patients experience the feeling of pressure and tightness from the surgery and swelling. Occasionally, there may be discomfort from a suture or around the ears, but there is typically minimal overall pain for most patients—and individuals often respond well to light pain medication or Tylenol®.

Do I need a neck lift with my facelift?

A neck lift is a major part of a facelift. Sometimes, the patient complains more about the neck than the face. The most common presenting complaints for patients requesting a facelift is correction of the jowls, the laxity of neck skin, and platysma bands. Occasionally, a patient will present with minimal neck laxity and a Mini Facelift would be appropriate.

Is there an ideal age for facelift surgery?

The aging process is a little different for everyone and it depends on a person’s genetics, skin type, and the amount of sun damage. The “ideal age” in the past is about 50 years old. The face begins to show significant laxity and it progresses fairly quickly. However, many patients today are having surgery done earlier. The main reason is because people do not want others to notice a significant change in their appearance. The time to have a facelift is a personal decision and needs to be the right time for the patient.

Contact Marin Cosmetic Surgery Center

Dr. Delgado takes great pride in providing each patient with a natural and elegant facelift. To learn more about facelift surgery, or to schedule a personal or virtual consultation, please contact our practice online or by phone today.

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