A facelift works on the lower half of the face. The operation, which surgeons call a rhytidectomy, lifts deeper tissue, tightens the support layer beneath the skin and removes excess skin, with the goal of restoring contour through the cheeks, jawline and neck.
That definition comes from a Houston practice’s overview of facelift surgery, and the practice gives real space to what the surgery leaves alone. Leo Lapuerta, MD, FACS, a triple board-certified plastic surgeon with more than 30 years of experience, treats those limits as the first step of planning. His practice puts it plainly: good surgical planning starts with honest limits.
The territory a facelift covers
The practice lists the concerns a facelift may treat. Most of them trace back to one change: skin and deeper tissue sliding downward as the face ages.
- Sagging skin along the jawline, including jowls
- Loose skin in the lower cheeks
- Deep facial folds, among them the nasolabial folds that run from the nose to the corners of the mouth
- Excess skin beneath the chin
- Laxity in the lower face from sagging muscles and declining skin elasticity
The common thread is structure. Tissue that has descended can be put back, and a lift reaches it because the surgeon works below the surface, repositioning support layers before trimming the skin that remains.
Neck laxity sits at the border. If aging extends into the neck, the practice may recommend a neck lift with the facelift so the jaw and neck match.
The concerns a lift leaves behind
The list of exclusions is short and specific. A facelift will not replace skincare, and it does not erase pigment changes left by sun exposure. On its own, it may not correct poor skin quality, etched lines or lost volume.
Those exclusions share a theme. Texture, color and fine creasing live in the skin itself, and moving skin to a better position does not change its surface. Lost volume is a separate problem from descent: a lift repositions tissue, but it does not add any.
The brow sits outside the list as well. The practice names the cheeks, jawline and neck as the focus of a facelift and points to eyelid surgery as a separate procedure that can be paired with the lift.
Recovery belongs on this side of the ledger too. A facelift carries social downtime, activity restrictions and the risks that come with any operation, and the practice states that the aging process continues afterward.
Drawing the line at consultation
The practice’s candidate guidance turns these limits into a screening tool. A facelift may not be the right fit when the main concern is skin texture rather than laxity, or when someone wants an option with zero downtime.
Skin condition counts. The practice notes that skin poor enough to affect healing can work against surgery, and that a mini facelift may suit a person whose aging is still mild.
Dr. Lapuerta’s consultation reviews facial structure, skin elasticity, the degree of loose skin and the pattern of aging across the cheeks, jawline and neck. Medical history enters the plan, along with the patient’s concerns about scars, anesthesia and recovery.
That review is where the limits earn their place. A patient bothered by both jowls and fine lines needs to hear which half of that complaint the lift will reach, and which half needs a different tool.
Filling the gaps with other procedures
For a concern outside the lift, the practice pairs it with a treatment aimed at that problem. Fat transfer addresses volume loss and skin resurfacing addresses skin quality. A neck lift handles laxity below the jaw, and eyelid surgery handles the area around the eyes.
Non-surgical options have a narrower role. The practice describes fillers, skin tightening and energy-based treatments as helpful for selected patients with mild laxity, and as no replacement for surgery once excess skin and deeper descent are present.
The practice cautions that each added element should be chosen for a reason rather than added by default. Experience shapes those calls. Dr. Lapuerta has performed more than 30,000 surgical and non-surgical procedures and holds certification from the American Board of Plastic Surgery, the American Board of Surgery and in Surgery of the Hand.
In his view, a surgeon’s experience with a procedure, counted in cases and in years, together with board certification, is the best determinant of an outcome patients judge as good. His practice keeps more than 3,000 before-and-after images for patients to review, and studying faces that started where yours is now shows what a lift changed for them and what it left for another procedure to handle.
This article is for general information only and is not medical advice. Results vary from patient to patient. Consult a board-certified plastic surgeon or your physician about your own situation. Written in partnership with Joseph Lambert, a publicist working with Leo Lapuerta, MD Plastic Surgery.
