Don’t Believe the Noise About Facelifts Replacing Filler — Here’s What Your Face Actually Needs

A plastic surgeon on social media is probably telling you that everything that I do as a cosmetic dermatologist is a huge waste of money. Don't get Botox, don't resurface, don't tighten your skin, and instead get a facelift or get surgery. I'm here to tell you today that the person who's paying for that opinion is your face. Any extreme is a bad idea. Today we're going to be covering what changes in your face decade by decade, and it happens that 1 out of 3 things is what a facelift fixes. Only 1. Someone in my own family recently had a facelift, but 6 months later she had her jowls reappear. But her facelift was still excellent, and I'll tell you why. What to do in your 30s, 40s, and 50s so that you can prolong the phase of that life and do less. So let's jump in. Your face is like a couch. The wooden frame is your bone structure. The stuffing is your fat, your muscles, and your collagen. And the fabric of your couch is your skin. But this is what nobody is telling you. A facelift is a solution to get rid of that excess fabric once the structure of the couch shrinks. That is what it does. It removes excess skin and repositions your fat, basically tightening fabric over an old frame. Sorry, but it doesn't give you back fat. It doesn't help with your bone structure. It doesn't help with your skin quality, pigment, texture, tone. That is where skincare and in-office procedures can still make a big difference for you. So I want you guys to keep this in mind as we go through the 4 peaks of life when your face actually shifts. Now, just to mention, these 4 peaks I've noticed anecdotally through myself, my own life experiences, and my patients as well. The last 2 have now been proven by science. We love that. But the first 2 are still anecdotal through my own experience. But the first peak happens in your late 20s to early 30s, where over the course of 6 months, something shifts in your face and you can't quite put your finger on it. You are losing about 1% of collagen a year starting in your late 20s, and that is the stuffing of your couch. And a facelift Does nothing for that. The second peak happens in your late 30s, and it happens a little bit faster, and people get more frightened. But over the course of a month or so, the tail of our brows start to drop more, our cheeks get a little bit flatter, and we start to notice the beginnings of the dreaded jowl. This is because, in addition, your bone density is starting to change, plus we continue to lose collagen, and our hormones are starting to shift. Thank you, perimenopause. And this is the frame and the stuffing of the couch, and a facelift Does nothing for that either. The third peak is in your mid to early 40s, around 44 to be precise, when your face shifts overnight and you wake up and you don't really recognize yourself because your fabric has given way and you notice your elasticity is kind of going. This is the first moment where a facelift might actually be targeting the fabric and answering the actual question. And for most of you though, it is still too early. And the fourth peak, I will say, is around your early 60s where we have the frame, the stuffing, and the fabric all at once are shifting. And that is when it's time for a facelift. And now it's time for some math, because how long does a facelift actually last? And I'm not asking you how long does a facelift look good for. I'm asking you how long until you're back to where you started. There was a 30-year study of deep plane facelifts where the average duration was 10.9 years. If you did the facelift before 53, you might get an extra year or so, but that is about it. So if you're getting a facelift at 35 and reconsidering a lift, It will last you till you're about 47, and then probably not again until you're about 59, and then probably not again until you're about 68. And personally, as a doctor, I do not recommend surgeries for funsies after 70 because you cannot metabolize anesthesia as well. So that comes down to 4 major surgeries and recoveries, and every single one of them harder than the last because your surgeon has to cut through your old scar tissue every single time. Subsequent time. And are we really going to be getting a facelift every 10 years starting at 35? And I say 35, and I know some of you gasped, but I have had patients in my own practice ask me if they need a facelift starting around 35, and I have been very adamant to say no. And this, my friends, is the multiplication and the viewpoint that you have to have that is never put on a consultation form in a plastic surgeon's office. So my own mother recently had a facelift, and 6 months after the fact, she started to notice her jowls reappear. But I can honestly tell you guys that her facelift is excellent. Now, both of these things, having your jowls come back and having a beautiful facelift, can be true. And I want you guys to understand this part because a very good plastic surgeon has to stop short, because if they pull too much, they will look like this. And we've all seen the fish mouth after a facelift look where your mouth looks huge, and it's not a good look. And the honest plastic surgeon has to underpull, which means that if your part of your jowl is a fat pad that has dropped or your jawline is receding underneath it, you can't pull your way out of that. You have a stuffing problem and you have a frame problem, not just an excess skin problem. So you have to look at the person's frame to understand how much you can pull. And the facelift does not recreate your bone structure. It does not change the frame of your couch. The facelift does not give you back the stuffing necessarily where you lost it. So you really have to understand the face as a whole from the inside out, your bone structures, your stuffing, your fabric, in order to understand where you fall in terms of a facelift and how much pull you could expect. Which leaves us now with the thing that almost nobody really wants to connect, and this is the most useful 90 seconds of this video, and it also applies to what I do in my office and how best you can maintain yourself without having to go under the knife. But if you know you want to get a facelift one day, but you have 1,000 Sculptra treatments in your face, or you've done 1,000 tightening treatments in your face because you don't want injectables, it is going to be harder for your plastic surgeon to get through the different layers of your skin in order to achieve a nice even pull. But that doesn't mean that Sculptra or tightening treatments are the devil. It means that the dose makes the poison. So 5 things that we absolutely need to stop doing immediately. One, we need to stop treating more often is better. It's about the right cadence for every device and every treatment, and it shouldn't be done at every visit. You have to have a provider who's looking at how you age over years and not just months ahead. Number 2, we need to also stop thinking that Sculptra is better than fillers because it's natural. If you want surgery one day, it's not the better option. If you don't want surgery, sure, knock yourself out, keep getting Sculptra. But if you want surgery, do not demonize fillers, because I have never had a plastic surgeon call me to tell me that the fillers my patient received ruined the outcome of their facelift. Number 3, stop removing things in permanence from your face, and I'm talking like buccal fat pad. There was recently an article about veneer regret where people changed their teeth in permanence. Removing something from your face is something that you can never get back, especially the cushion in your face. So please stop doing permanent things at a young age to your face. And 4, stop freezing your forehead every 3 months. Botox lasts 10 to 12 weeks, but that doesn't mean you need to be frozen every 3 months. Allow your movement to come back so you can keep the essence of your face alive. And last, stop taking a facelift consultation as a diagnosis. It's a consultation. Now for the elephant in the room, and I'm talking about social media because we haven't addressed how social media plays into All of this. The social media algorithm is based on fear, and what I truly hate particularly is men who are preying on women's insecurities, putting us down because we're trying to help ourselves, and then selling us something bigger, more expensive, and less reversible because that is now the gold standard. It is wild to see people go from zero to doing the absolute most only because it seems that surgery is the only respectable way to get it done. And I would like to say this again the same way I've said it a million times before, but if So if somebody is telling you that surgery is the only option and don't do this, it's probably because they are selling you surgery and a facelift. The same way that if somebody is telling you only get fillers and lasers, it's probably because that is what they are selling you as well. So you should be asking yourself the same question about me because I am a dermatologist. I don't perform surgeries. I inject, I do lasers, I have a skincare line. So when I tell you guys, do not rush to surgery, You should always take that with a grain of salt, having understood the ecosystem. And that is why the most important thing for you is to understand the why behind how you are aging so that you can ultimately make the best decision for yourself, which is most likely a combination of skincare, in-office procedures, and maybe surgeries, but on the best timeline for you. So let's talk timelines in your 30s, in your 40s, and in your 50s. In your 30s, this is skin quality and prevention time, and I know it's boring, but having a solid routine with skincare ingredients that even out your pigmentation, a retinoid that you can actually tolerate, real sun protection behaviors, and not overdoing cosmetic procedures is how you're going to stay looking 31, 32, and not 38. In full transparency, by the way, I do make skincare, and this is where my products start to become useful because my products work on the fabric of your couch. They will do nothing for your frame. They will do nothing for your stuffing because skincare is never going to replace the foundation of your couch. And anyone selling you a cream for bone loss is lying to you, and that would include me as well if I ever did so, but I won't. In your 40s now, the structure starts to genuinely change, and this is where in-office treatments really help to keep you looking good as long as it's conservative and done correctly spaced apart. Collagen stimulation, energy at the right time interval to tighten your skin, small amounts of the right filler— not in the area where you necessarily think you need it, but filler in areas that give you an optical illusion of height and a lift. And for reference, I am 42 and I do it maybe once or twice a year in that cadence, and I do not inject my face quarterly. Number 50s now, 50s and beyond, the conversation does honestly start to change. And this is where I stop you from overspending with me, and I want to make sure that someone who does want a facelift or doesn't want a facelift, because this is where your frame now really affects how the fabric shows up. And if you are somebody who is spending a lot of money on trying to get the fabric tighter, you might need to cut that excess fabric off. So that's where I will take you from my practice as a cosmetic dermatologist to most likely a plastic surgeon's office. And then you will come back if you want to maintain those results. Which leads me to when is the right time for me to get a facelift or to consider it, and how would I know? So these are 3 honest signals. The first one is when you pull your skin at your jawline gently upwards and backwards in this motion, and it gives you the face that you want. That is a fabric problem, and the solution there is a surgical one. 2, you have stopped getting any sort of meaningful return from in-office procedures that you used to respond to. And 3, you're being asked to spend surgical money annually to hold on to non-surgical results And at that point, the operation is often cheaper and more honest for you. And I would tell you that here the same way I would tell you that in an exam room. And so there you have it. A facelift is a must at some point only if you want to age a certain way. And unlike what they are telling you online, you do not need a facelift at 35. So here is the rule and the only thing I want you to get from this video: nobody who profits from your decision should be setting your timeline, including me. So go look at your faces and work out which one of the 3 is actually bothering you? Is it the frame, the stuffing, or the fabric? If it's the fabric, then one day maybe surgery. But if it's the other 2, surgery was never going to help you in the first place, and anybody who is telling you that has something to sell. I'm Dr. Shereene Idriss. I hope you guys enjoyed this video, and I hope you have a beautiful Saturday.