Q1. Have you seen a recent increase in queries/interest in facelifts? When did this start happening, and what do you attribute the increase to?
Yes, particularly over the last five years I’ve observed in my practice an upward inflection in volume of facelift patients. This trend reflects a step-change in advanced surgical techniques that offer more nuance as a result of a much more sophisticated understanding of facial anatomy and how to manipulate it surgically. The primary surgical advancement relates to a focus on lifting and shaping deeper tissue layers, the so-called “deep plane”, and anatomical structures residing under them. In my practice, patients of all ages can enjoy naturally refreshed appearances, still looking like themselves, only better.
Coincident with the step-change in surgical techniques, the inflection of public awareness of, and interest in, facelifting came about by two primary drivers: the so-called “Zoom effect” —a prolonged video view of one’s own face — and also the realization that injectable fillers are limited in delivering natural results. During the pandemic people began seeing themselves — and their aging faces — more frequently as interactions at work shifted to video teleconferencing. This sparked greater interest in aesthetics for both men and women and initially this lead to a surge in non-surgical approaches, notably injectable fillers, to correct hollows and wrinkles. However, over-reliance on fillers, on the false premise that fillers can lift tissues (which they do not, apart from a modest amount of lifting that could be achieved through restoring volume that lends structural support), created unnatural puffy faces. As awareness strengthened that fillers are not a panacea but rather should be a bridge, rather than replacement for, facelift, the pendulum swung heavily to artistically tasteful surgical lifts.
What I see now is a more informed patient who recognizes that non-surgical measures have limits, and who understands that a deep plane facelift offers improvements that injectables simply cannot achieve, particularly when laxity in the neck, jawline, and midface begins to appear. However, non-surgical dermatologic treatments, primarily fractionated non-ablative laser, neuromodulators and radio frequency-based feedback controlled thermomodulation play a synergistic role to address surface texture, collagen content and elasticity, respectively. This is why collaboration with Dr. Noëlle Sherber, Board certified dermatologist (also my wife and practice partner), has offered our patients the best of both worlds. Overall, demand is driven by greater aesthetic literacy, visual self-scrutiny via social media and Zoom, and disillusionment with the volumetric distortion of repetitive filler use.
Q2. What kind of patients have requested this work?
While the plurality of my facelift practice is comprised of patients over 50, overall I’ve observed and contributed to a global paradigm shift from facelifts viewed solely as late-stage restorative procedures to earlier structural interventions aimed at aesthetic “face optimization” — preserving youthful features as a “preventive strategy,” enhancing features for beautification, as well as rejuvenation in the traditional sense. Patients are more savvy and recognize that subtle, well-planned surgical refinement done early can look more natural and elegant than years of overfilling or chasing trends. Surgically, this requires more of a “sculptor’s” mindset of facial shaping, rather than a tension-focused approach of pulling more taut. And my surgical techniques reflect this sculptural approach: endoscopic — i.e., video camera guided — navigation through smaller hidden incisions, shaping and repositioning of deep tissues, facial bone contouring with implants or targeted reductions, and gentle fat transfer for natural volume restoration. Combined with Dr. Sherber’s dermatologic treatments we can truly fine-tune patients’ results so that they look refreshed with plausible deniability thanks to the synergistic nuance between our specialties.
Q3. Are there any new trends or demographics that you find interesting?
The most notable trends in facial aesthetics relate to both technical advances — the “deep plane” facelift technique and “structural neck sculpting” — and also capitalizing on the synergy between dermatologic and surgical approaches.
With respect to surgical advances, “deep plane facelift” refers to separation of tissue layers beneath the platysma muscle of the neck and the fascia layer of the face called the SMAS. By lifting sagging tissues above the deep plane, more natural results can be achieved. This is because the deep plane is a natural gliding surface for facial muscle contraction and natural facial movement — lifting here restores anatomy back to where it was positioned in youth while avoiding an overly tight-appearing face, a key distinction from superficial skin lifts that can look unnatural and windswept. Additional benefits of the deep plane technique are imperceptible scars and longevity of results because the muscle/fascia layer provides additional blood flow and, when lifted, carries skin up with it, acting like belt and suspenders for the face. This eliminates tension and adds strength to the repair which optimizes scar healing and longevity of results.
A related and crucial element of my deep plane lifts is “deep neck sculpting,” a surgical philosophy centered on reducing oversized tissue structures contained within the platysma neck muscle. While many patients are lead to believe that a “double chin” is due to excess subcutaneous fat, for the majority of patients this is caused by enlarged deep structures, specifically submandibular salivary glands, deep (under platysma) fat and “strap muscles”, a collection of small muscles under the chin. I commonly see this as an age-related change to patients’ necks though it can also occur in younger patients with a small jawbone which cannot contain the volume of tissues within it. Except for patients with conditions that predispose them to dry mouth, deep neck sculpting is safe in expert hands and has become my go-to method to give patients beautifully defined and sculpted necks and jawlines. While rarely offered by surgeons due to concerns around risk, this is more often than not due to unfamiliarity with deep neck anatomy rather than objective risk.
Third, Dr. Noëlle Sherber and I often collaborate in 3 primary ways to give our patients optimal results. One, scientific evidence supports pre-facelift skin resurfacing with fractionated non-ablative laser to reduce scarring. Scheduling treatments in the days leading up to a deep plane facelift will “kick start” cytokines into a pro-healing state which improves scar healing. Second, strategic use of neuromodulators (eg. Botox, Daxxify, etc.) can help to offload tension from healing facelift scars, further optimizing their healing. Third, antioxidant-rich skincare reduces the inflammatory response during post-surgical healing, nourishing and calming skin while delivering peptides and other results-oriented ingredients to recovering skin. Finally, Thermage FLX, a feedback-controlled RF platform reliably tightens the collagen layer without excess heat that can damage facial fat or nerves, helping patients to maintain their results. In total, these evidence-based, science backed modalities optimize skin health, texture and tone which surgery cannot do.
Q4. What impact do peers have on getting someone to consider a facelift, vs social media?
Peer influence is ever more crucial in the modern world of social media connectivity. While I use Instagram to educate my followers about complex aesthetic concepts and my science-based surgical approaches, generally speaking social media can propagate inaccurate or unreliable information. For example, too often I see claims of a taut jaw and neckline with barely any recovery which can be temporary due to “stress relaxation” — a property of skin where recurrent laxity and wrinkling occur over weeks and months — if the structural foundation is not well supported. I focus my facelift methods with the long term result in mind: establishing proper structural support means both longevity of results but also more time for swelling to abate and tissues to settle, a process that takes weeks and months, not just days. So it’s important to normalize the idea that natural, long-lasting results take time which is why real patient experiences, paired with scientifically focused education through social media, are more influential than before/after images that represent single snapshots in time. Like anything in life, “you get out what you put in” and I spend lot of time consulting with patients about how we can achieve beautifully natural refreshes that have real longevity, a process that takes time, consistency and patience. Oftentimes we’ll tap into our vast network of happy patients to speak about their own experiences so that patients can gain realistic insights that corroborate what they’ve ready about our practice and results. Over the last decade, Dr. Sherber’s and my practice has been built on word of mouth, natural results with science-driven procedures and safety at top of mind.
Q5. What are the reasons younger people (30 – 49) want to get facelifts, based on your practice?
My facelift demographic hasn’t shifted so much as it has expanded, now encompassing a younger cohort, like a bell curve that is has widened. The average age of my facelift patient now is 49, with a range from 35 to 75, as compared with 55 in prior years. Younger patients are increasingly seeking contour enhancement and proportion correction to correct early signs of aging — neck and jawline laxity, nasolabial folds, under eye hollows and brow droop — and I’m often blending both rejuvenation and optimization strategies, focusing on deep plane lifts, microfat grafting to restore volume, subtle brow and eye shape improvements with endoscopic lifts, lower blepharoplasty and rhinoplasty. Patients often seek endoscopic or minimal scar techniques since skin laxity may be subtle and may not warrant long scars. However, I’ve found that, even with mild surface skin laxity, deep plane lifts with skin removal, done well, can give the most optimal results without worry for problematic scars. This is especially true in the setting of significant weight loss, as we’re seeing commonly with GLP-1RAs, or connective tissue disorders such as cutis laxa or Ehlers-Danlos where skin laxity is more pronounced at earlier ages.
The term “facelift” is a misnomer in face optimization since it conjures the notion of lifting back up that which has fallen — an aging concept. Face optimization may or may not employ a facelift, but more accurately it is a sculptural approach. Since aging changes are more subtle, or their bone structure may not be optimal thus requiring skeletal architectural modification, aesthetic targets are often smaller which requires exceptional attention to detail and microscopic changes so as not to overshoot and create unnatural distortions which we often see on social media, especially overseas where extreme appearances are common (to be clear this is not my aesthetic). In a broader context of ethics and patient safety, proper patient selection is crucial. I turn away those whose goals are unrealistic or dangerous or who have evidence of body dysmorphia. Social media has distorted the perception of beauty to extremes and so I must always weigh carefully patients’ expectations and the highest safety and ethical standards to which I adhere.
Q6. How has social media and the surging popularity of these facelifts changed the education process at your practice? What misunderstandings or misinformation do you typically encounter?
Social media has dramatically expanded awareness of facial procedures, but it has also compressed complex surgical concepts into oversimplified terminology. As a result, my consultation process is more in-depth today than ever. Patients are often well versed in sophisticated lingo such as “deep plane,” “vertical lift,” or “SMAS,” yet their understanding is incomplete because these terms are frequently used inaccurately online.
Many misconceptions abound. For example, patients are often lead to believe that a heavy appearing neck and double chin is just excess fat that liposuction or Kybella can fix. On the contrary, for patients who are at a normal weight, a heavy appearing neck is due to bulging deep tissue structures that require deep neck sculpting.
Also, CO2 laser, a decades-old technology, has been reinvigorated by facelift surgeons who feel the need to offer laser resurfacing and these devices are relatively inexpensive. While showing surface skin contraction can be misconstrued for “tightening”, the scientific literature has demonstrated that these lasers can be overly aggressive and cause damage to collagen as much as they might stimulate its production. Like smart phones having replaced simple flip phones of decades prior, fractionated non-ablative laser technologies have largely replaced CO2 due to their ability to delivery of energy gently thus stimulating collagen without destroying it and because of their excellent safety profile.
The FDA recently released a patient safety advisory about radiofrequency microneedle tissue heating devices. While radiofrequency technology is scientifically sound, RFMN devices place heat mechanically into the skin and can damage deeper structures. They also lack “negative feedback control” mechanisms, meaning that heat energy delivered to tissues can progress beyond safety thresholds resulting in microscopic scarring, reduced blood flow and, at worst, burns. I’ve witnessed the after effects of such devices firsthand in facelift patients whose tissues have lost elasticity due to sub-surface scarring, making surgery more challenging and healing potentially riskier.
Another misunderstanding stems from before-and-after images that suggest dramatic changes can be achieved without scars or downtime. While I often rely on endoscopic approaches to minimize external scars, this does not mean that downtime is always minimal as these techniques involve equally extensive dissection as “open” (i.e. long incision) methods to achieve optimal results. For me, careful patient selection to maintain safety and optimize results are always paramount.
My role is to re-ground the conversation in anatomy, safety, and individualized planning. I find that once patients understand my rationale behind each maneuver they appreciate that Dr. Sherber and I focus solely on scientifically backed, results-oriented treatments and procedures.
Q7. When people are seeking facelifts, what kind of language/vocabulary do they use? What kind of language do you use?
Patients often use intuitive language such as wanting to look “refreshed,” “less tired,” “sharper jawline,” “ more awake,” etc. They often describe their features as appearing heavy or weighed down by lax tissues. Some will even say they “don’t recognize themselves,” especially after weight loss, stress, or accelerated aging.
In my consultations, I translate those subjective impressions into anatomic terms so patients can understand the origin of what they are seeing. I speak about ligament descent, skeletal support, midface ptosis, loss of periorbital framing, or deep neck bulk. I also introduce the concept of aesthetic fine-tuning—the idea that the same deep plane principles apply across ages, but the degree of correction is calibrated to the individual’s anatomy, stage of aging, and desired degree of optimization.
Language is important because clarity ensures alignment. When a patient tells me they “want to look like themselves,” my response is to explain how subtlety is achieved—through millimeter-level adjustments, preservation of facial character, and a surgical plan that respects the architecture of their bone structure and soft tissues.
Q8. Have you had patients express that they want to get a facelift to help further their career prospects? How diverse are facelift patients in terms of their careers or occupations? Any specific patients/stories that jump out at you?
Yes, patients occasionally reference career motivations, though not in a superficial or performative way. What I hear more commonly is a desire to align their external appearance with the energy and capability they feel internally. Patients in high-visibility roles—executives, attorneys, diplomats, physicians, and those frequently on camera—are very aware that subtle facial cues can influence how others perceive vitality, attentiveness, and confidence. Descended eyelids, brows, necks and mouth corners can deliver unintentional messaging of waning energy, lackluster performance or declining relevance in their professional circles. As such, my practice draws a wide range of professions — attorneys, judges, CEOs, politicians, physicians, and those who simply want to look their best — unifying factors are not prestige or social pressure but a desire for authenticity and longevity in one’s appearance. Many have demanding schedules and seek solutions that are predictable, safe, and long-lasting rather than short-lived, limited interventions.
One memory that stands out is a patient who had reached a major leadership milestone in his political career. He felt that the heaviness of his neck and jawline made him look perpetually fatigued, which conflicted with his sense of authority. After a deep plane facelift with deep neck sculpting, he told me that his confidence — and sense of relevance on The Hill — was restored. What mattered most to him was that people reacted to his presence, not the procedures—precisely the outcome I aim for.
A recent anecdote on career-minded drivers for facial aesthetic surgery is that, during the recent government shutdown, there was an uptick of patients seeking surgery because they unexpectedly had the time to recover out of view.
Q9. Is there anything about the rising interest in facelifts that you find concerning?
What concerns me is not the interest itself, but rather the potentially dangerous misconception that a facelift is a product or commodity that, like shopping from vendors on Amazon, can be purchased from any surgeon who offers it. In reality, deep plane facelifting is technically and artistically demanding, and results vary as they are reflections of a surgeon’s experience, skill, aesthetic sensibilities, artistic nuance, technical ability and focus on patient safety. Despite the overuse of the term, not all facelifts are created equal: a true deep plane lift requires complete dissection to the nasolabial fold, which many surgeons avoid due to purported risk of facial nerve injury (though expert navigation in this area is notably safe in skilled hands). Also, deep neck sculpting also is often avoided for fear of bleeding complications, which are minimal in expert hands. The degree to which restraining ligaments are released, vectors of tissue elevation, tension-free incisions, delicate tissue handling and above all, how and where safety is optimized, all factor into results. In skilled hands a true deep plane lift offers wonderfully transformative results whereas in others’ it is a risky endeavor. Especially in this modern age of digital promotion, patients are behooved to do due diligence more than ever.
I also have concerns about the social media environment that encourages patients to pursue extreme or unrealistic aesthetic goals. The proliferation of exaggerated results, especially those emphasizing sharp angles or unusual eye shapes, can distort a patient’s self-perception and sense of what is natural. This is where ethical patient selection becomes essential. I decline surgery when I believe expectations cannot be met safely or when motivations are driven by transient online trends.
As interest grows, my priority remains patient safety: ensuring surgery is performed in properly equipped medical centers with board-certified anesthesia teams, and maintaining a pace that allows me to give each case the rigorous attention it deserves.
Q10. The blurriness around age—positive, negative, or both? How might this affect how we interact with each other?
I view the blurring of age as a nuanced development. On one hand, modern surgical and nonsurgical techniques allow individuals to look in harmony with how they feel, without focusing on specific time points of life. When executed thoughtfully, a deep plane facelift does not erase age but restores structural relationships—lifting tissues back to where they once belonged and enhancing facial balance in a way that feels justified.
On the other hand, the societal shift toward indistinct age ranges can create new pressures, particularly when people interpret youthfulness as an expectation rather than an option. My goal is never to make someone appear ambiguous or artificially preserved. Instead, I aim to create results that look timeless because the underlying anatomic relationships are corrected, not stretched or stylized.
This blurriness can also encourage healthier interactions. Without immediate assumptions about age, people often focus more on presence, expression, and capability rather than superficial markers of aging. When aesthetic changes are natural and identity-preserving, they support confidence rather than concealment, and that often enhances interpersonal dynamics rather than complicating them.
Q11. Have you ever done facelifts on a mother-daughter pairing? What were those experiences like?
I have performed mother-daughter facelifts, though these are less common than people might imagine. More frequently, I treat couples—partners who choose to undergo surgery in close succession, with coordinated aftercare from a private duty nurse—so they can recover together and experience their facial rejuvenation in parallel. This shared process often strengthens their commitment to long-term maintenance and allows them to move through the recovery phase with mutual understanding.
Regardless of individual or pair experiences, my patient care approach is shaped by the same principles that guide all my surgical planning: individualized analysis, respect for unique anatomy, and fine-tuning my surgical approaches based on each person’s stage of aging and desired degree of optimization. Even when genetics create similarities, the surgical approach is not necessarily the same: a mother may need different vectors of lift and more extensive neck work, while a daughter may benefit from subtler adjustments via endoscopic methods, yet both approaches unified by calibrated, millimeter-scale refinements.
What is most meaningful is observing their reactions—each sees the other looking refreshed yet entirely like themselves.
48 year old woman 6 months after endoscopic brow lift, deep plane face lift, deep structural neck lift, lower blepharoplasty, microfat grafti
43 year old woman 6 months after endoscopic brow lift, deep plane face lift, deep structural neck lift, lower blepharoplasty, microfat grafting, chin augmentation.
A 70 year old man 1 year after deep plane face lift, deep structural neck lift, endoscopic brow lift, microfat grafting, upper and lower blepharoplasty, porous polyethylene orbital rim implants [2 stages].
38 year old woman 2 months after endoscopic brow lift, canthoplasty (outer eye corner lift), deep plane face lift, deep structural neck lift, porous polyethylene orbital rim implants, lower blepharoplasty, microfat grafting.
