Facelift Overview

A facelift is one of the most recognized facial rejuvenation procedures in cosmetic surgery, but it is also one of the most misunderstood — particularly when it comes to what it can and cannot do for the eye area. Patients frequently arrive at an oculoplastic consultation expecting that a traditional facelift will refresh their tired-looking eyes, only to learn that the eyelids, brows, and forehead are essentially untouched by even the most advanced lower face techniques. Understanding this distinction is critical to achieving a natural, balanced result and avoiding the “pulled lower face with old eyes” appearance that betrays incomplete rejuvenation.

This overview is written from the perspective of oculoplastic surgery — the subspecialty dedicated to the eyes, eyelids, brows, and midface. Rather than duplicate the comprehensive facelift content available from facial plastic and general plastic surgery sources, our focus is on what every facelift candidate needs to understand about the eye and midface components of comprehensive facial rejuvenation, and why an ASOPRS fellowship-trained oculoplastic surgeon is the right specialist to address that portion of the face.

What a Facelift Addresses

A facelift — technically called a rhytidectomy — is designed to rejuvenate the lower two-thirds of the face and the neck. The procedure targets the visible signs of aging that develop as the deeper support structures of the face weaken and skin loses elasticity. Specifically, a well-executed facelift addresses:

• Jowls – the descent of cheek and jawline tissue that blurs the once-crisp mandibular border
• Nasolabial folds – deepening creases that run from the sides of the nose to the corners of the mouth
• Marionette lines – the vertical folds that descend from the mouth corners toward the chin
• Mid and lower cheek laxity – sagging tissue along the mid-face and below
• Neck banding and submental laxity – loose skin and platysmal bands of the neck (when combined with a necklift)

What a standard facelift does not address is equally important. Despite the name, a facelift does not lift or rejuvenate the upper third of the face. The forehead, brow position, upper eyelids, lower eyelids, tear troughs, and even most of the central midface are largely outside its anatomical reach.

SMAS vs Deep Plane vs Mini Facelift

Modern facelift surgery has evolved significantly from the “skin-only” lifts of decades past, which produced the unnaturally tight, windswept appearance that gave facelifts a poor reputation. Contemporary techniques work on the deeper structural layer of the face called the SMAS — the superficial musculoaponeurotic system — a sheet of fibromuscular tissue that envelops the facial muscles and connects to the platysma of the neck.

Traditional SMAS Facelift

The SMAS facelift involves separating the skin from the SMAS layer, then tightening the SMAS separately through plication (folding) or imbrication (overlapping). The skin is then redraped without tension. This approach has been a workhorse of facial rejuvenation for decades and produces excellent, durable results in well-selected patients.

Deep Plane Facelift

The deep plane technique releases specific retaining ligaments and lifts the SMAS and overlying skin as a single composite unit, working in a plane beneath the SMAS. Proponents argue this provides more powerful midface elevation, better correction of the nasolabial fold, and a more natural vector of lift because the skin and deeper tissues move together. It is technically more demanding and involves working near the facial nerve branches.

Mini Facelift (Short-Scar Techniques)

Mini facelifts, often marketed under various branded names, use shorter incisions limited to around the ear and address primarily the jowl and jawline. They are appropriate for younger patients with mild to moderate laxity but offer limited correction for advanced aging or significant neck changes.

Why Facelift Patients Need Eye Surgery

The eyes are the focal point of the face. They are what people look at during conversation, what photographs draw the viewer to, and what most strongly communicate fatigue, age, or emotion. Yet the periocular region ages independently — and often earlier — than the lower face. By the time a patient considers a facelift, the eye area has typically been showing changes for years.

This creates a predictable problem after isolated facelift surgery: the lower face looks rejuvenated, but the eyes look comparatively older. The contrast can actually highlight periocular aging that previously blended into an overall “mature” appearance. Patients return to the mirror expecting to look refreshed, only to find that their attention is now drawn directly to their upper lids and under-eye bags.

The aging changes that a facelift cannot address but that frequently coexist include:

• Upper eyelid dermatochalasis – excess skin that hoods over the lid crease, sometimes touching the lashes
• Ptosis – true droop of the upper eyelid margin due to levator muscle attenuation
• Brow ptosis – descent of the brow that contributes to upper lid heaviness
• Lower eyelid steatoblepharon – herniated orbital fat creating “bags”
• Tear trough hollowing – the dark, sunken groove from inner canthus to mid-cheek
• Lower lid skin laxity and festoons – crepey skin and malar mounds

The most natural-appearing rejuvenation results come from addressing each anatomical zone with the appropriate procedure. A facelift handles the lower face. Blepharoplasty handles the eyelids. A Brow Lift handles the forehead and brow position. Trying to use one procedure to do the work of three produces compromise everywhere.

The Oculoplastic Surgeon’s Role

An oculoplastic surgeon — formally an ophthalmic plastic and reconstructive surgeon — completes a residency in ophthalmology followed by a two-year ASOPRS-accredited fellowship dedicated exclusively to the eyelids, lacrimal system, orbit, and surrounding facial structures. This training produces a surgeon whose entire career is built around the most delicate and functionally critical region of the face.

While many excellent facial plastic and general plastic surgeons perform blepharoplasty, the depth of periocular focus differs meaningfully. An oculoplastic surgeon:

• Performs hundreds to thousands of eyelid procedures per year
• Is trained to recognize and treat Ptosis, which is present in many cosmetic blepharoplasty candidates and is often missed in cosmetic-only practices
• Understands the tear film, blink dynamics, and ocular surface implications of eyelid surgery
• Routinely manages complications such as lower lid retraction, lagophthalmos, and dry eye that can follow aggressive periocular work
• Operates under ophthalmic loupe magnification and uses techniques calibrated for millimeter-level precision

When a patient is planning a facelift, the oculoplastic surgeon’s role is to ensure that the eye component of their rejuvenation is handled with the same level of subspecialty expertise that the facelift surgeon brings to the lower face. This may mean operating concurrently with the facelift surgeon, staging procedures, or coordinating sequential surgeries.

Midface Lift and Lower Eyelid

The midface is the anatomical zone where facelift surgery and oculoplastic surgery overlap — and where the choice of surgeon and approach matters most. The midface includes the cheek mound, the area beneath the lower eyelid, the tear trough, and the anterior portion of the malar prominence. Aging here produces lower lid bags, a deepening tear trough, a long-appearing lower lid, and descent of the cheek away from the eye.

Traditional facelift techniques pull tissue in a posterior and superior-lateral vector toward the ear and temple. This vector is excellent for the jowl and lower cheek but provides limited lift to the central midface immediately below the eye. The tissue closest to the lower lid is the farthest from the facelift incisions and receives the least benefit.

For this reason, oculoplastic surgeons have developed dedicated approaches to the lower lid and midface complex, including:

• Midface Lift – elevation of the cheek mound through a transconjunctival or transtemporal approach, restoring volume and support to the lower lid
• Transconjunctival lower blepharoplasty with fat repositioning – addressing herniated fat and the tear trough simultaneously
• Tear Trough Treatment – surgical or filler-based correction of the lid-cheek junction
• Canthal support procedures – lateral canthopexy or canthoplasty to prevent and correct lower lid retraction
• Festoons and Malar Mounds – specialized techniques for this notoriously difficult problem

Staging and Combination Surgery

Patients pursuing comprehensive facial rejuvenation face an important strategic decision: should multiple procedures be performed in a single combined surgery, or staged over several months? There is no universally correct answer — the right approach depends on the patient’s anatomy, medical status, recovery tolerance, and the specific procedures involved.

Arguments for Combined Surgery

• One anesthetic, one recovery period
• Lower cumulative cost (typically)
• Tissue planes addressed simultaneously, allowing the surgeons to coordinate vectors and final positioning
• Avoids the inconvenience of multiple time-off-work periods

Arguments for Staging

• Shorter anesthesia time per procedure — safer for older patients or those with medical comorbidities
• More predictable swelling and healing in each individual area
• Allows refinement of each result before committing to the next
• Easier scheduling between subspecialty surgeons when calendars do not align

A general principle when combining facelift with periocular work: the brow position should be established before the upper eyelid is operated on. Removing upper lid skin before lifting the brow can produce an over-resected lid and a brow that cannot be safely raised afterward without causing lagophthalmos — an inability to fully close the eye.

Choosing a Surgeon for the Eyes

When patients consult a facial plastic or general plastic surgeon about a facelift, they are often offered an “all-in-one” package that includes blepharoplasty performed by the same surgeon. This is convenient and can produce good results when the operating surgeon has deep periocular experience. But it is not always the best approach for the patient’s eyes.

Consider that the eyelid is one of the thinnest, most functionally complex pieces of tissue in the body. The upper lid is approximately 1 mm thick. A surgical error of 1–2 mm — barely visible on the operating table — can produce permanent lower lid retraction, chronic dry eye, exposure keratopathy, or an unnatural lid contour. These are problems that the patient lives with every minute of every day, and they are difficult to fully reverse.

Questions worth asking any surgeon proposing to operate on your eyelids:

1. How many eyelid surgeries do you perform per year?
2. Are you ASOPRS fellowship-trained?
3. How do you evaluate for and treat Ptosis if it is present?
4. What is your approach to lower lid support and preventing retraction?
5. Do you offer transconjunctival lower blepharoplasty with fat repositioning?
6. How do you manage post-operative Dry Eye Disease?

For many patients, the ideal arrangement is a collaborative approach: a skilled facelift surgeon for the lower face and neck, working in coordination with an oculoplastic surgeon for the eyelids, brow, and midface. The two specialists can either operate together in a combined session or stage procedures appropriately, with each surgeon contributing their subspecialty expertise to the area they know best.

The goal of comprehensive facial rejuvenation is not simply to look “done” or to look “tighter” — it is to look like a rested, well-balanced version of yourself. Achieving that requires recognizing that the face is composed of distinct anatomical zones, each with its own aging patterns and each best served by surgeons who have devoted their careers to mastering that specific region.

Whether you are planning a facelift in the coming months or simply beginning to research your options, an oculoplastic consultation is the right first step for understanding what your eyes need — and how those needs fit into the larger picture of facial rejuvenation. The lower face and the eyes deserve equal expertise, and patients who invest in both consistently achieve the most natural, lasting, and harmonious results.