Facelift

Dr. Zelken stands out amongst his peers who offer facelift surgery. He is neither a “facial plastic surgeon”, “cosmetic surgeon”, nor an “aesthetic surgeon”, per se. You may have been told that ENT surgeons, otolaryngologists, and specialty-focused facial plastic surgeons are the safest bet, and Dr. Zelken is none of the above.

So why consider Dr. Zelken for such a complex, intimate, and important operation?

The answer is simple: Facelift surgery is Dr. Zelken’s passion, the focus of his ongoing research, and the #1 procedure he performs.

No, he is not certified by the American Board of Otolaryngology or the American Academy of Facial Plastic and Reconstructive Surgery. Instead, Dr. Zelken is a proud diplomate of the American Board of Plastic Surgery. The ABPS is 1 of 24 specialty boards that comprise the American Board of Medical Specialties and is the most prestigious and selective of certifying organizations. Unlike other diplomates, board-certified plastic surgeons by the American Board of Plastic Surgery are trained to excel in surgery of the face, body, breasts, hands, and even nerves

But this is not why you should choose Dr. Zelken. After all, many plastic surgeons in Southern California who offer facelift surgery are ABPS board-certified diplomates. What makes Dr. Zelken stand out is his unique approach to facelift surgery, his world-class domestic and international training pedigree, and the reality that his practice is primarily fueled by word-of-mouth referrals. Perhaps this is why you have never heard of Dr. Zelken before, and certainly why you have never seen him on social media platforms like TikTok and Snapchat, which he feels are not suitable outlets for thorough patient education and acquisition. His preferred platform is YouTube because it allows for meaningful discussion, accountability, and commentary, and does not disappear the next day.

Still, being a YouTuber is not a reason to choose one plastic surgeon over the next. In fact, video production is a full-time job, and a surgeon who has enough time to post videos religiously may not be busy enough in the operating room, and that may be a subtle red flag. No, there are much better reasons to choose Dr. Zelken. And it is certainly not his before and afters, which are great, but other doctors feature hundreds of facelifts, not just a dozen or so. Any surgeon can choose his top 10 best results and feature them, after all; not to mention, it is becoming so easy to digitally manipulate photos, before and after surgery.

It is also important to recognize that most patients are hesitant to feature their faces online, as this is an important and intimate decision that is intended to go unnoticed. Although it is important to provide a showcase of his or her style, Dr. Zelken hesitates to regularly feature facial surgical results because many of his Newport Beach patients do not feel comfortable with it.

Be wary of surgeons who routinely expose patients on social media because this may be an indicator that they are putting their interests before the patients’. Videography can be distracting in the operating room and should never cause delays in, or distractions from patient care. If you are considering a plastic surgeon, it might be wise to steer clear of those who dance in the presence of, pose with, or prolong an operation on a patient who is unconscious or otherwise compromised.

In summary, Dr. Zelken is an optimally qualified, artistic, experienced plastic surgeon and amateur YouTuber with a passion for rhytidectomy surgery who will never be seen dancing on TikTok or SnapChat. If your vision aligns with Dr. Zelken’s and if you find Dr. Zelken and his staff approachable and caring, and especially if you know somebody who had a facelift by Dr. Zelken and appreciates the result then you have found your match. The other details, like his academic pedigree and qualifications, his pseudo-celebrity on YouTube, and conservative tendencies are just icing on the cake.

Dr. Zelken has a unique philosophy of facelift surgery. During your consultation, or during your discussion with our patient care coordinator, you might find that Dr. Zelken does not officially offer an upper facelift, mid facelift, or lower facelift; he offers ‘just’ a facelift. This captures the essence of his strong philosophy that the face, in the context of facelift surgery, begins at the eyes and ends at the collarbone.

Dr. Zelken recognizes that facial recognition is inextricably linked to internal features like the eyes, nose, and mouth.

Surgical procedures like blepharoplasty, brow lift, lip lift, and rhinoplasty, are therefore more likely to influence visible obvious changes than a facelift alone. Accordingly, such procedures are “higher yield” and may be considered for patients looking for more dramatic changes, or more impactful before and after photographs. But most of Dr. Zelken’s patients are looking for “natural results”, and desperately wish to avoid that pulled look that we have all seen. You might be surprised that more than half his patients seek assurance that they will not look windswept, their mouths will not be wider, and that Siri (let alone, loved ones) will still recognize them after a facelift. Still, nobody wants a result that is too natural.

Is a subtle result easier to achieve, and less costly than something more drastic? In short, no.

Steven Tyler, the front man for the band Aerosmith, once said “You have no idea how expensive it is to look this cheap.” This unflattering quotation has surprising parallels to Dr. Zelken’s philosophy on rhytidectomy surgery. Like Steven Tyler’s wardrobe, it sometimes takes more to generate a signature look (in the case of Mr. Tyler) or durable, beautiful, and natural results (in the case of Dr. Zelken). Therefore skin-only facelifts fell out of favor in the 1970s and may have contributed to the downfall of abbreviated, “lunchtime” facelifts such as the Lifestyle Lift. Although he offers less invasive, skin-only facelifts, patients must be carefully selected and educated about the limitations of these procedures.

Accordingly, shortcuts in facelift surgery may reduce downtime and short-term risk but are more likely to generate less durable and natural results. But what does this have to do with not offering lower facelifts and mid-facelifts as standalone procedures? The answer to this question further clarifies Dr. Zelken’s unique vision and philosophy.

The face, as he sees it, demands harmony and respect for the critical interplay of its subunits. Where does the midface begin? Where does the lower face end?

Although surgeons may define anatomic descriptors for facial subunits, the fact is, these are not defined as anatomic structures. Dr. Zelken understands that the public sees a face as eyes, nose, mouth, and periphery. He also recognizes more subtle features that contribute to a subconscious perception of beauty. Distinct shadows for example, where they look good, explain why jowls are unappealing. And soft or nonexistent shadows, where shadows are bad, explain the popularity and importance of lower blepharoplasty surgery.

Indeed, Dr. Zelken judges facelifts on the basis of jawline definition, shadow effacement elsewhere, and volume optimization. Not on drastic changes or the “wow factor”.

When the face and neck are approached as distinct units, it is easy to neglect the reality that tightening only one of these features is less likely to be impactful in the context of jawline definition. If you pull one side of a simplistic “ridge” tent without addressing the other side, you can’t pull it tight and create a ridge.

There is so much that goes into facial aging, and each aspect must be addressed and tailored to each patient’s unique anatomic features, goals, and desires. Aging of the face involves generalized subcutaneous volume loss and migration of mobile downward and inward.

You may have heard the term “radial expansion” to describe this. As the skin becomes thinner, underlying features such as neck muscles, bony landmarks, and even blood vessels become more visible. Muscles of the face become stretched and lax, the skin may become irreversibly pleated, and even bony changes and erosion can occur.

When we think of a rhytidectomy, most of us probably think about cutting skin and pulling it tight. As you might imagine, this may only address one of many age-related facial changes. However, another treatable age-related change that is too often overlooked is volumetric fat loss. These inevitable changes afflict patients of all age groups, genders, and body types.

Sometimes called the “lift and fill facelift”, Dr. Zelken employs autologous fat grafting in 95% of facelifts he performs. He is hesitant to change this aspect of his facelift practice because it just makes sense; he is happy with the consistently satisfactory results he achieves with conservative and artistic fat transfer.

In his opinion, the only reasons not to perform facelift and fat grafting together are:

a) when young patients are being treated for the previous over-voluminization with filler or fat, and

b) when patients simply do not want it after thoughtful discussion and education.

This procedure adds up to 1 hour to the surgery, and the most common fat donor site is the abdomen. But do not get too excited, as only enough fat is taken to enhance the facelift result, which is seldom enough to see visible change at the donor site.

The most common recipient sites for fat are between the eyebrows, at the base of the nose, the tear troughs, and the lateral borders of the chin. Other areas include the cheeks and jaw angle when these areas are inherently deficient. Adding fat to the face is not intended to, and typically won’t make you look fatter.

The word “scar” is the enemy of plastic surgeons. It is the fundamental tradeoff for everything that we do to enhance somebody’s beauty or restore a normal appearance after reconstruction. Plastic surgeons are known amongst specialists for being ‘good’ at making scars relatively invisible, and at the very least, caring the most about scar appearance. Not only do we ask to make sure that scars are as acceptable as possible, but we also have a lot of strategies to minimize them after the fact (i.e., with silicone sheeting, gels, tapes, lasers, micro-needling, sunscreens, and other measures).

This does not change the fact that minimally invasive surgical options such as radiofrequency lifting and tightening, fillers, neurotoxins, and threads are gaining popularity. And while these nonsurgical and minimally invasive approaches thrive, it does not change the fact that they may not be as effective as their traditional surgical counterparts.

Dr. Zelken has gained a lot of popularity for the FaceTite procedure in Newport Beach, CA. This is often marketed as a “scarless” facelift, and at the very least, a means of slimming the lower face. While it is not truly scarless and is a surgery, it works well; the majority of patients are very satisfied with the changes they see. But it is not for everybody. Older patients, and especially older patients who are very thin, may not get adequate tightening of relatively inelastic skin with a device that only addresses the skin of the lower third of the face and neck, and not the underlying framework of the face.

Many people discover Dr. Zelken through researching FaceTite, so he is accustomed to informing borderline and poor candidates for the procedure that they may not achieve the results they desire. Minimally invasive surgical procedures are great, in other words, for enhancing liposuction and liposculpture results. However, as a standalone procedure to enact skin and muscle tightening, especially when little or no fat is involved, it can fall short.

And so, a facelift is discussed. The idea of a facelift may lead to hesitation. It seems scary, for some, and the thought of scars is unacceptable to others. Some even leave disappointed knowing that they let themselves get to a point where a facelift is warranted, or even necessary.

A lot of the facelift hesitation usually stems from three possibilities:

• Patients may feel that they are not old enough to require a facelift. Dr. Zelken’s philosophy includes the notion that rhytidectomy is a more powerful beautification tool than a rejuvenation tool, and this often helps patients to recognize the benefits of traditional facelift surgery.
• Patients consider the downtime and risk associated with facelift surgery. This is a valid concern and warrants an open and honest discussion about the limitations of minimally invasive surgery in suboptimal candidates (for example, those with thin faces, thin skin, sun-damaged skin, deep wrinkles, and visible neck bands). These patients are often open to a facelift but may choose to undergo no surgery at all.
• The scars that ensue. People do not want others to know that they have had something done. This is another benefit of minimally invasive procedures.But how bad is the scar, really? After all, a bad scar is one of the telltale signs of a facelift (others are pixie ear deformity, that windswept look, and nerve injury).

A well-designed and well-placed scar is not only intended to be inconspicuous but in many cases, even unrecognizable. Through a relatively short incision, it is amazing how much can be accessed all the way from the corner of the eyes down to the collar bone.

Do note that different patients heal differently, and younger patients with thicker skin and more pigmentation may have darker scars that last longer. It is frustrating that individual scar healing tendencies are as important, if not more, to scar appearance as surgical technique.

Fortunately, with time, all scars do fade and mature even further and are expected to become relatively inconspicuous, and in some cases, nearly invisible.

A well-healed facelift scar: Can you find it? Dr. Zelken has many tricks up his sleeve: from adjusting the angle of his knife blade to tension-free multi-layer closure and sophisticated suture methods; he obsesses over atraumatic skin handling to ensure that scar minimization occurs. Scars cannot disappear, but the Jonathan Zelken, MD offers lasers and light therapies to enhance recovery and reinforce protocols designed to make scars less noticeable. All these strategies, in addition to a well-placed incision, are truly intended to make this process as enjoyable and cosmetically acceptable as possible. Because truth is, nothing beats a facelift in most cases. Having said that, if you are a good candidate for less invasive alternatives like FaceTite, Morpheus 8, laser, liposuction, buccal fat pad removal, or any combination of those, Dr. Zelken will recommend these options as the first line of treatment against facial aging.

Facelift, in the context of plastic surgery, is . . . surgery. Many people discover Dr. Zelken by researching minimally invasive facelift methods. But nobody, including Dr. Zelken, can perform a facelift without surgery. A facelift without surgery is like cheesecake without calories: there are low-calorie and nonfat options, and healthy alternatives, but if something seems to be too good to be true, it probably is. That is because facelift remains the gold standard, the benchmark for rejuvenation, beautification, and optimization of facial harmony.

For example, Radiofrequency skin tightening is often measured as a percentage of a facelift result. You may notice advertisements and ubiquitous promotions for “liquid facelifts”, “thread facelifts”, and “scarless facelifts” that rely on energy-based technologies or otherwise promote collagenases. If the creams, lights, pills, oils, needles, or exercises offered meaningful efficacy, facelift surgery would probably not exist.

There are adhesive tapes, digital filters, and innumerable lasers, devices, masks, and garments to help you enjoy a facelift without surgery. Despite misleading advertising, these nonsurgical strategies are intended to achieve facelift-like results but may never achieve rhytidectomy results. The closest thing Dr. Zelken had discovered, and offers, utilizes radiofrequency assisted lipolysis (RFAL, or FaceTite), liposculpture, and sometimes, muscle tightening.

Although we do not advertise prices, which are apt to change often, Dr. Zelken and his staff are very transparent at the time of your consultation. The cost of a facelift depends on several variables.

Dr. Zelken’s fee does not include the cost of your anesthesiologist or the surgery center fee, which may exceed $5000-$6000 in combination. Inflation and a historic imbalance of supply and demand of medical supplies have recently driven prices higher. Revision facelifts typically cost more than primary (first-time) facelifts. Adjunctive procedures like lasers, eyelid surgery, and brow lift will influence the price of a facelift.

Although Dr. Zelken does not charge $200,000 for a facelift, his fees may be higher than the local average, and certainly the national average, and this reflects the demand for his services, top-notch training, and the concierge care you can expect at the Our clinic for Aesthetic Medicine.

The term “wide awake” facelift is intended to distinguish procedures that warranted a visit to the ambulatory surgery center from those that can be done in the comfort of Dr. Zelken’s office. Unlike procedures requiring an anesthesiologist, with or without a tube that goes in your mouth, “wide awake” procedures rely on local anesthetic and oral sedation.

The prospect of awake surgery is financially advantageous and reduces many logistical hurdles and “grogginess” often associated with general anesthesia and a third-party surgical center. Mini- or skin-only facelifts are very suitable for awake surgery, and so are full facelifts.

Dr. Zelken is very selective when it comes to candidacy for awake surgery and does not offer it to all patients. Patients with a strong history of anxiety, panic attack, and “needing more anesthesia than usual at the dentist’s office” may not do well with awake surgery despite its many benefits.

In short, a facelift is a serious operation, and if Dr. Zelken has any concern that a wide-awake procedure will compromise your health or cosmetic procedure result, he will not offer it to you.

Dr. Zelken offers the deep plane facelift. But is it really the best option? Not universally, despite what you may read about Marc Jacobs, and hear from many vocal facial plastic surgeons.

The modern facelift must reflect a patient’s unique anatomic features and goals. The earliest facelifts were skin-only (subcutaneous) lifts that looked good initially but did not last long due to the weak mechanics of the skin (the weakest organ). Scar widening was caused because the tension was placed along the incision, not deeper tissues.

Torg and Skoog revolutionized facelift surgery in the 70s by exploiting the “SMAS”. This is a dense connective tissue layer that intertwines with muscles of facial expression and exists between the subcutaneous fat and skin above, and the so-called deep plane below. The “classic” facelift relies on modulation and manipulation of the SMAS. By raising the “hood” (skin and fat) and exposing the SMAS, tightening and rotating these deeper tissues not only softens the nasolabial and melolabial folds (marionette lines) but recruits facial skin with it, offloading tension on the skin closure, making incisions fainter and results more long-lasting.

Although it has gained widespread demand and appreciation more recently, the deep plane facelift was also described in the late 1970s but did not gain general acceptance until the 1990s.

The biggest difference between the deep plane and “classic” facelift is that dissection occurs more in the deep plane than in the subcutaneous plane, and the SMAS (dissected free from underlying attachments) can be manipulated and tensioned as a composite flap inclusive of the subcutaneous fat and skin. This reduces subcutaneous swelling and bruising, and theoretically maximizes blood supply to the skin.

A major proponent for this method was Dr. Sam Hamra, a Dallas plastic surgeon, who appreciated the inherent maximization of blood supply to the skin and capacity to the face and the nasolabial fold (smile line). Since the skin and the SMAS are elevated together as a single composite unit, the surgeon may undermine the nasolabial fold. Hamra’s results were good, probably because he was good, but the operation was quickly challenged for the greater risk of injury to the facial nerve branches.

Dr. Zelken believes that there are important benefits of deep plane dissection, but these come at the expense of increased risk and a relative inability to tailor the skin and SMAS layers in different directions. For example, pulling skin more vertically and deeper structures more posteriorly. This is where a traditional SMAS lift shines. A SMAS lift raises the skin and SMAS layers separately. This allows better control and customization to individuals’ anatomies and goals.

The deep plane method tends to be limited to one direction of tightening which is fine in many, but not all cases. Additionally, the SMAS can be tightened, trimmed, removed, and repaired in different ways to address different goals and choices. In short, the deep plane technique is more regimented and less customizable. A SMAS lift is safer in many ways, is time-honored, and allows for deep fat injection to the sub-SMAS space to volumize the malar and nasolabial region more dependably.

Many patients request a deep plane rhytidectomy because they have heard it is better. Others ask for a breakdown comparing the two, and to shed some light on the controversy over which technique is superior. There actually is no controversy.

Dr. Zelken believes there are fewer surgeons who routinely perform deep plane facelifts, and this is an opportunity to market a “premium” product in a competitive market. The best facelifts I’ve seen and executed are “classic” facelifts that involve some combination of fat transfer, SMASectomy or SMASplication.

More recently, the most famous facelift patients (i.e., Marc Jacobs, Paul Nassif) and celebrity facelift surgeons tout the deep plane technique. That’s not to say the results are superlative, or even superior, to the results of more traditional methods. But social and mainstream media are effective marketing tools. We have yet to learn whether these celebrity facelift results will stand the test of time.

Because the deep plane facelift is endorsed by celebrities and is associated with higher costs, there is certainly some perception of superiority.

Dr. Zelken prefers the deep plane technique when it is warranted, particularly in revision surgeries with significant jowling, in patients with very thin skin, and because it allows for easy access to the buccal space. For this reason, Dr. Zelken typically approaches the face with a hybrid technique that incorporates elements of both the deep plane and traditional facelift.

The deep plane facelift and traditional facelift (involving SMAS) tend to overlap at the anatomic level of the jawline, where it is common with both techniques to undermine and/or divide the neck muscle (platysma) and resuspend it to accentuate the jaw angle. But there is something called a deep plane neck lift as well. Dr. Zelken offers the deep plane neck lift and is happy to discuss it with properly selected patients who appreciate the increased risk profile and longer recovery.

Deep plane neck lift candidates typically have fullness attributable to things other than fat. For example, strong neck muscles, enlarged or drooping salivary glands called submandibular glands, and a short, wide neck will improve with less invasive neck lift approaches. For patients who are bothered by the fullness of the neck, who do not have particularly fat necks, and who understand the nuances and risks of the submandibular gland and digastric muscle resection, the transformation can be stunning.

Risks of the deep plane neck lift include prolonged downtime and swelling, the need for a temporary drain, potential for injury to muscles that control your voice and tongue, bleeding, salivary fluid collections, and dry mouth.

The term “wide awake” facelift is intended to distinguish procedures that warranted a visit to the ambulatory surgery center from those that can be done in the comfort of Dr. Zelken’s office. Unlike procedures requiring an anesthesiologist, with or without a tube that goes in your mouth, “wide awake” procedures rely on local anesthetic and oral sedation.

The prospect of awake surgery is financially advantageous and reduces many logistical hurdles and “grogginess” often associated with general anesthesia and a third-party surgical center. Mini- or skin-only facelifts are very suitable for awake surgery, and so are full facelifts.

Dr. Zelken is very selective when it comes to candidacy for awake surgery and does not offer it to all patients. Patients with a strong history of anxiety, panic attack, and “needing more anesthesia than usual at the dentist’s office” may not do well with awake surgery despite its many benefits.

In short, a facelift is a serious operation, and if Dr. Zelken has any concern that a wide-awake procedure will compromise your health or cosmetic procedure result, he will not offer it to you.