Check out surgeon carefully before a facelift

Q: I just saw one of my friends who had a facelift. She looks fantastic. I have another friend who had a facelift and she looks terrible. Why do some people look good and some people look terrible when they have facelifts?

A: It's all about the surgeon and the surgeon’s aesthetics. It is also about the patient's desires and perception of what is aesthetically pleasing.

I have been doing facelift surgery for more than 30 years and have seen the evolution of the process. At first, surgeons were pulling the skin as tight as they could to make the droopy skin appear less droopy.

Over the years, however, many of the surgeons doing facelift surgery recognized that tightness did not necessarily equate to a youthful look. New surgical techniques were developed including SMAS, sub-SMAS, muscle plication and deep plane facelifts. These techniques are used in combination with one another or individually.

More recently surgeons have recognized that a youthful look is achieved by restoring the roundness and loss of volume of the face. To that end, fat grafting has become an integral part of the facelift technique. Fat grafting restores the loss of volume in an aging face.

So my suggestion to you if you are thinking of having a facelift is this: Pick a board-certified facial plastic or plastic surgeon. The technique he or she uses is irrelevant, as long as the end result is what you want. Look at before and after pictures, ask questions about the risks and benefits and make sure you get comfortable with your surgeon.

Even though your surgeon may have the best intentions, sometimes things don't go as planned and you want to make sure he or she will be there for you.

Dr. Carlos Wolf is a partner in Miami Plastic Surgery and is board certified. Email your questions to him at: