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The face is the foundation. As an artist and a surgeon, my goal is a natural well-supported look. The cheekbones and jawline should be well defined, the neck should be clean and the skin should never, never be tight and pulled. That’s where the two layers of the face come in. Support the face with deep layer and allow the superficial layer, the skin, to drape naturally. Don’t pull too tight!
–Andrew Barnett, MD

Facelift procedures have been performed for more than one hundred years in an effort to reverse the signs of aging. Modern techniques have evolved which allow for a natural, long-lasting result. Much of the wrinkling and sagging can be eliminated, providing a youthful and attractive appearance.

How is a facelift performed?

In simplest terms, a facelift repositions the skin and muscle which has sagged as a result of time and gravity and removes the excess skin which has formed as a result of stretching. This is done as a two-layer procedure. Fat that has been deposited at the lower jaw and neck is also removed.

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What do you mean by a two-layer procedure?

As originally developed, facelifts were performed by simply lifting the skin, pulling back, and removing the excess. This placed all the tension on the skin, resulting in a tight, unnatural, pulled back appearance. The reason for this unacceptable result is well understood. Skin is like a rubber band, in that it stretches in response to tension. As you continue to pull on a rubber band, eventually it stops stretching. Additional tension will make it break. Skin responds the same way. As tension is applied, the skin eventually stops stretching and begins to look like an overstretched rubber band. This is the cause of the tight, unattractive look so often associated with the “overdone” facelift. This is unacceptable. A tight look is neither natural nor attractive. Tight skin is not normal.

In the mid 1970’s, the new two-layer facelift procedure was developed. In this procedure, the skin is lifted, but in addition, a second layer of fibrous tissue and muscle, called the SMAS-Platysma, is elevated. All tension is placed on this second or deeper layer, and the skin is then allowed to drape naturally without any tension, over a smooth, supportive base. Because the SMAS and skin layers are connected, repositioning the deeper layer also repositions the skin, but without putting direct tension on the skin. It is analogous to making a bed by pulling on the top sheet to smooth out the wrinkles, then allowing the blanket on top to lie smoothly. If you don’t pull on the top sheet, you’ll need to pull much more on the blanket, with a result that never lasts as long or is as smooth. The blanket is analogous to the skin, the top sheet to the deeper muscle layer. This technique provides excellent improvement in the lower face and neck.

In the late 1980’s, a very exciting improvement in the two-layer facelift was developed with the goal of reducing the droop in the middle face. This droop is most evident in the flattening of the cheekbone area and development of heavy folds between the nose and lip, called the naso-labial fold. The new procedure, referred to as the Deep Plane Rhytidectomy, builds on the SMAS-Platysma two layer facelift. Along with the browlift, which improves the upper face and brow, and blepharoplasty, which enhances the eyes, complete facial rejuvenation is now possible.

“I highly recommend Dr. Barnett”


After thoroughly consulting with 5 top surgeons in the Bay Area, I chose Dr. Barnett. My surgery for neck, lower face, upper lip, brow lifts, upper eyelids and facial fat transfers was done two months ago. He is incredibly talented, skillful-a fantastic surgeon! And my results are fabulous and I hear will only get better with time I’m very happy! About me, I am a RN in the Bay Area and as a RN I am very thorough and knowledgeable. And, I am very picky. Dr. Barnett from the first consult (which he spent over 1 hour with me, no one else did) and throughout the whole course (pre and post op) of surgery has been wonderful! He’s a patient (I’m a list person), considerate, hands on, pleasant and caring surgeon. He always puts me at ease at every step. 10 days post-op I bumped and opened up the incision in my upper eyelid (I had watched 3 episodes of GOT before bedtime and had a nightmare-not recommended :(. I called him at 1am and he was so supportive and kind and mended me the very next morning. I highly recommend Dr. Barnett.

by Karen S., Morgan, CA

What can I hope to accomplish with a two-layer facelift?

The most important goal is to look natural. The ideal facelift will give you a dramatic enhancement, yet be undetectable. When I hear prospective patients say “I never see good plastic surgery” I agree with them completely. You should never “see” good plastic surgery, it should be natural. What this means is that while maximum improvement is the goal, we sometimes accept a few wrinkles or a less “pulled” appearance if this is the price of a natural result. A few wrinkles are acceptable, looking like you’ve had plastic surgery is not!

Do all plastic surgeons perform the two layer and deep plane facelift?

Definitely not. The technique requires special training which was not widely available until recently, and the technique is time-consuming, as it is effectively two facelifts in one.

Where are incisions located?

The incision starts behind the hairline above the ear, or along the base of the sideburn, and continues in the natural crease at the top portion of the ear. The incision may then continue just in front of, or inside the ear, then around the earlobe, behind the ear, and into the hairline. The incisions are planned to fall in areas where they are least visible. With some patients, an additional incision must be placed under your chin, usually in the natural skin crease line. In general, thescarsare undetectable and allow you to wear your hair in any fashion.

Learn how we created a surgical plan for Maxine’s surgery.

Maxine tells us how she feels about her surgery and what made her decide to do it.

What is a necklift?

The muscles of the neck act like a hammock, stretched from ear to ear, supporting the area under the neck. With time, this hammock tends to stretch resulting in a loss of the youthful jawline, sometimes creating a double chin or “turkey gobbler”. In addition, fat may tend to collect under the chin. A necklift involves tightening the hammock of muscle and removing the excess fat. Interestingly, many people have poorly defined necklines from childhood, and decide to have a correction of this before they need a full facelift for signs of aging. This is commonly performed in patients in their early to mid-twenties.

What about pain during and after the surgery?

There is essentially no pain during the procedure. As with all surgery, anesthetic is used during the operation. Some patients wish to be completely asleep, while others are more comfortable with “twilight” sedation. At your consultation, we will determine what is the best approach for you. Although you’ll feel swollen and tight for a week or two after surgery, patients generally report there is very little pain. Medication for discomfort will be available, but most patients require very little.

What about recovery time?

Recovery time is variable and will depend on your own personal rate of healing. Bandages are generally not used. Stitches are removed in five to ten days. In general, significant swelling and a bit of bruising are present for ten to fourteen days. Most patients are ready to return to work in one to two weeks. You can expect that your face and neck will feel “tight” for one to three months and that there will be areas of numbness which lasts for three to six months.

How long does a facelift last? Much like healing, that depends on the individual, the quality of your skin, and the rate at which you continue to age. I often say, “We can turn the clock back, but we can’t prevent it from ticking on”. You will always appear younger than if you’d never had the surgery, but with time, aging catches up. In general, patients feel that they need additional work after seven to ten years, though this is variable.

Are there risks to face and necklifts?

As with all surgery, there are risks of bleeding, scarring, and infection. Infrequently, a small amount of blood called a hematoma may collect under the skin and need to be removed. Rarely, small areas of the skin flap may not heal well and require a prolonged period of recovery. This is particularly a risk in cigarette smokers as nicotine compromises circulation. Damage to a nerve in the face may occur, though this is very rare and generally self-correcting. These risks are explained not to frighten but to inform you. Though they are real, they’re quite small. At your consultation, we will have a comprehensive discussion of these and other risks.

Are there other procedures related to facelifts that I should consider having at the same time?

Absolutely! The most common procedures performed at the same time as the facelift are eyelid lifts and browlifts. Other commonly performed ancillary procedures are chin and cheek augmentation, lip augmentation, fat transfers for very deep folds, and resurfacing of the skin to reduce wrinkles around the mouth and eyelids. At your consultation, I will provide you with a comprehensive evaluation and plan for maximum facial rejuvenation. I recognize that not every patient is ready or able to have “everything” done at the same time, and I will devise a plan that works for you. This is why we spend so much time in consultation, and we will have as many consultations as necessary to assure that we have the plan that works best for you.

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What about computer imaging?

Computer imaging is a technique where digital photographs are taken of a patient and manipulated on the computer. While this is not meant to show a guaranteed result, it is an excellent tool to educate the doctor and patient about the potential results. I frequently use computer imaging and feel it is essential for all surgeons to have access to this technology. I was one of the first surgeons in the United States to utilize computer-aided design for operative planning and patient education.

Should I Have a Facelift?

That’s a question only you can answer. At your consultation, ask questions and explain your desires and expectations. The consultation is a two-way learning process. You will define your expectations, and I will describe what I feel can be accomplished. We’ll work closely together to make the decision that’s right for you.

How Much Does A Facelift Cost?

A facelift is a complex surgical procedure where techniques vary depending on the needs of each individual patient. The overall cost of the surgery depends on the degree of correction required to achieve the desired result and the overall complexity involved. We will customize your facelift treatment plan and discuss the cost of the surgery during your initial consultation.