DR. FICHMAN | FACIAL PLASTIC SURGERY

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Facelift

Facial aging does not occur in a single layer, nor can it be addressed with a single procedure. It is a three-dimensional process involving changes in the deep tissue planes, fat distribution, weakening of the support system, and cumulative effects from previous treatments. A facelift is designed to address these changes in a controlled, precise, and long-lasting manner.

Current understanding emphasizes that the primary descent occurs in the deep facial layers—particularly in the SMAS layer and the musculofascial system of the face and neck. The skin reacts to the underlying tissues, but it is not the main driver of aging. Accordingly, modern facelifts focus on deep plane work, rather than mere skin tightening.

An important but sometimes overlooked consideration is prior filler treatments. Many patients have residual hyaluronic acid or other materials injected over the years, sometimes in deep layers. These can affect local anatomy, tissue response, postoperative swelling, and the precision of final results. In appropriate cases, controlled removal of fillers before surgery allows for cleaner, more predictable, and precise surgical work, improving both recovery and outcome quality.

The Deep Plane Facelift approach restores and lifts the deep support structures of the face and neck while preserving blood supply and minimizing tension on the skin. When performed with full anatomical understanding, it achieves significant improvement—not by stretching, but by repositioning tissues to their natural location.

Based on these principles, Dr. Pikman developed the FRAME LIFT™ technique, which combines deep-plane work with reconstruction of the facial framework—cheekbones, jawline, and the transition from chin to neck.

The goal is not to create a new appearance but to restore the face to its previous balanced state, as it was before sagging and aging. Emphasis is on restoration, not over-design, resulting in a natural look that is familiar to others and does not reveal surgical intervention or create a sense of unfamiliarity.

For men, special attention is given to preserving masculine features, structural stability, and avoiding overdone results. Proper planning may include neck lift, jawline enhancement, eyelid surgery, and complementary procedures, all considered systemically rather than in isolation.

A successful facelift results from a sequence of correct decisions: accurate diagnosis, understanding of prior treatments, responsible surgical planning, and meticulous execution. It is a procedure that rewards experience and penalizes shortcuts.

Periorbital Area

Upper eyelid surgery is not just about removing “excess skin.” In most cases, a heavy or tired appearance results from a combination of factors: excess skin, eyelid ptosis, eyebrow descent, protrusion or loss of orbital fat, and sometimes reduced skin quality and elasticity. Focusing solely on the eyelid can lead to incomplete or inaccurate results.

The procedure is suitable not only for older patients. Many younger patients, sometimes in their 30s, have a genetic tendency for excess upper eyelid skin or a naturally heavy eyelid structure. This is an anatomical characteristic, not premature aging, and surgery can significantly improve appearance and comfort, even at a young age.

A common mistake is confusing eyelid ptosis with eyebrow ptosis. In men, the brow often descends with age, and addressing only the eyelid can result in a heavy or closed look. In women, maintaining the eyelid opening (distance between lash line and brow) is crucial for a soft, balanced aesthetic. Ignoring this can compromise natural proportions, even if the skin is treated correctly.

During consultation, surgeons evaluate excess skin, eyelid function, brow position, symmetry, tissue quality, and the relationship between the eyes and the rest of the face. Depending on findings, the plan may include upper eyelid surgery alone, or combined with brow lift or functional eyelid muscle correction.

Upper eyelid surgery is both aesthetic and functional. Significant excess skin may reduce the superior visual field, causing eye fatigue, heaviness, and unconscious brow elevation during the day. Removing excess skin and restoring anatomical balance improves not only the appearance but also daily comfort and function.

When planned and executed with complete anatomical understanding, the result is not a “surgically operated look” but a precisely opened gaze—restoring sharpness, lightness, and presence while maintaining natural expression and the patient’s character.

The lower eyelid area is one of the most delicate and complex regions of the face. Small changes significantly affect overall appearance, requiring careful diagnosis and precise planning.

Typical signs of fatigue in this area are caused by: protruding fat pads, tear trough hollows, excess skin, and sometimes poor skin quality. Even young, healthy patients may appear permanently tired, especially in the morning.

A common mistake is attempting to correct the problem with fillers alone. While hyaluronic acid injections may be suitable in skilled hands, in many patients—especially those with fat pads—fillers can worsen puffiness, create heaviness, and accentuate the problem over time. In such cases, surgical intervention is more precise and stable.

Lower eyelid surgery allows direct treatment of fat—removal, reshaping, or repositioning—along with skin and supportive tissue adjustment. Often, the approach focuses on preservation and proper repositioning to avoid a hollow or sunken look. In suitable cases, surgery can be performed through a hidden incision with no visible external scar.

When treated properly, the lower eyelid area appears balanced and attractive, with no signs of surgical intervention and without altering natural gaze expression.

Brow lift can cause anxiety due to fear of a surprised or unnatural appearance. In skilled hands, it is an aesthetic procedure with excellent results.

Brow lift restores the eyebrow to its correct position relative to the eye and facial frame. In many cases, heaviness in the upper eye area is caused not by excess eyelid skin but by gradual brow descent—a natural age-related or congenital structural feature.

Correct brow positioning is a critical step in treatment planning. Attempting to correct brow descent with upper eyelid surgery alone may produce unsatisfactory results or worsen brow ptosis. Brow lifts are sought not only by older patients; young women may also undergo the procedure to refine brow and eye aesthetics.

The procedure is planned according to anatomical data and treatment goals, whether to correct ptosis or to subtly modify brow shape. The emphasis is on brow positioning, its relationship with the eyes, and achieving predictable, stable results.

Chin and Neck

The chin is a central anchor in facial structure. Its position, size, and relationship with the nose and lower jaw directly affect facial profile, jawline definition, and separation of the face and neck. A recessed chin can make otherwise proportionate faces appear unbalanced.

Most cases of chin deficiency are structural rather than isolated, so diagnosis should consider interactions between the chin, nose, lips, jaw, and bite. Decisions not based on this comprehensive evaluation may create new imbalances.

A chin implant provides a precise and stable structural correction. Unlike fillers, which are not long-term solutions in this active area, implants allow better control of proportions and contour, unaffected by daily muscle activity. Proper planning ensures the result integrates naturally into the facial structure.

Chin enhancement can significantly improve the overall appearance, sometimes even more than rhinoplasty. It sharpens the jawline, enhances the facial profile, and clarifies the face-neck transition. It is a minor structural intervention with broad impact on overall facial balance.

Excess fat in the neck and chin area is not always related to weight. It can be genetic or structural, even in slim, young patients, and may blur the jawline despite good skin quality.

Neck liposuction is suitable for patients with localized fat accumulation and sufficient skin elasticity, allowing clear jawline definition without extensive intervention. When skin elasticity is poor or tissue sagging is significant, liposuction alone may be insufficient, and a neck lift or complementary procedure should be considered.

The procedure is relatively short, performed through tiny hidden incisions, with generally fast recovery. Liposuction can be done alone or as part of a comprehensive facial rejuvenation plan, sometimes combined with chin implant or jawline enhancement.

Many patients seek consultation after repeated lip injections without achieving desired results. Often, the issue is structural rather than volumetric: with age, the upper lip elongates, descends, and folds inward. Fillers cannot restore proper proportion and may accentuate imbalance.

An upper lip lift provides precise structural correction. A fine, hidden incision along the base of the nose and nostrils shortens the distance from nose to lip and gently elevates the upper lip. The result is a shorter, defined, natural-looking lip.

The procedure can be performed independently or combined with facelift and other rejuvenation procedures. In appropriate cases, it can be combined with removal of previous silicone injections, and, after recovery (usually ~3 months), precise hyaluronic acid injections may be considered to add volume if desired.

FAQs

Who is suitable for a facelift?

Patients seeking treatment for facial and neck aging while maintaining a natural and harmonious appearance. Criteria include age, medical status, skin and tissue laxity, subcutaneous fat depletion, excess fat in the neck and chin, and realistic expectations.

45–55, when skin elasticity is still good and recovery is faster. Effective results are achievable up to age 80.

Typically 3–4 hours, depending on complexity and combined procedures.

Usually minimal; patients report mild stretching or discomfort that resolves with recovery

Varies with extent of surgery; typically 2–3 weeks to return to normal activity.

Restores appearance approximately 10 years younger; long-term maintenance depends on additional treatments, sun exposure, and lifestyle.

Present but hidden; they fade over time. Skilled surgeons can further minimize visibility.

Bleeding, infection, nerve injury, asymmetry, skin necrosis. Risk depends on surgical skill and patient health but is never zero.

Post-facelift treatments to improve skin quality such as Botox, Skinboosters, Radiesse, Tixel, and CO₂ laser.

Threads, fillers, Botox. These enhance results but cannot replace surgical facelift.