A facelift may be the star of the show, but it's rarely a solo act.
Dr. Lawrence Bass and Dr. Kylie Edinger break down the "facelift friends" — the add-on procedures and treatments that enhance results, restore balance, and address areas the lift alone can't fix.
The key is harmony. A lifted mid and lower face can still look "off" if the eyes, brows, skin, or lips tell a different age story.
By tailoring combinations of surgical and non-surgical treatments to your needs, you can walk away with results that look complete, natural, and last longer without having to come back months later for the "next worst thing."
Learn more about facelift surgery
About Dr. Kylie Edinger
Dr. Kylie Edinger is a plastic surgeon practicing in Bozeman, Montana. During the creation of this facelift series, she was training as an aesthetic plastic surgery fellow with Dr. Bass and a host of other world class plastic surgeons at Manhattan Eye, Ear, and Throat Hospital in New York City. Part of the prestigious Northwell Health program, this is one of the top aesthetic plastic surgery fellowships in the country. Dr. Edinger completed her plastic surgery residency at the University of Wisconsin.
Follow Dr. Edinger on Instagram @kylieedinger
About Dr. Lawrence Bass
Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond.
To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc
Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass.
Transcript
Summer Hardy (00:01):
Welcome to Park Avenue Plastic Surgery Class, the podcast where we explore controversies and breaking issues in plastic surgery. I'm your co-host, Summer Hardy, a clinical assistant at Bass Plastic Surgery in New York City. I'm excited to be here with Dr. Lawrence Bass, Park Avenue plastic surgeon, educator and technology innovator. The title of this episode is Facelift Friends. Illuminate this title for me, Dr. Bass. What are we talking about today?
Dr. Lawrence Bass (00:28):
We're talking about treatments and procedures that are often done in conjunction with the facelift. Our main focus is procedures that are done at the same time, but there are also treatments that may be taking place in a series before or after the facelift. All of these associated procedures or friends are intended to address other features that the facelift doesn't address or to amplify the degree of correction that the facelift can produce. Some of these features the facelift doesn't address are in the zone of the tissues the facelift works on, other features are aging changes in parts of the face that the facelift does not modify, but are subject to aging changes along with the rest of the face.
Summer Hardy (01:22):
Okay, let's get right into it. What are some examples of procedures that address areas of the face that facelift doesn't?
Dr. Kylie Edinger (01:29):
Some examples include blepharoplasty, brow lift, lip lift, and earlobe reduction, which are the more common procedures that are done in concert with a facelift. A blepharoplasty is a surgery to remove excess skin and fat of the upper and lower eyelids. This is a very nice surgery with nearly imperceptible scarring that removes redundant overhanging skin of the upper eyelids and eye bags of the lower lids, leaving patients looking more refreshed and well rested. A brow lift surgery is a surgery that is exactly what it says. It lifts the brows. The lift can be customized to create the brow shape the patient desires, and there are many different types of brow lift surgery. There are coronal brow lifts, minimally invasive endoscopic brow lifts, gliding brow lifts, temporal brow lifts, direct brow lifts, and many other variations to these techniques that each use their own incision placement and fixation techniques to create a lifted, youthful brow shape, which brow lift is best for you will be a discussion to have with your plastic surgeon.
(02:26):
A lip lift is a surgery that places a scar that's hidden within the contours at the base of your nose, and it's used to shorten the length of the upper lip. As we age, the distance between the nasal tip and the upper lip increases, and our columella lengthens. This surgery shortens this distance to create a more youthful upper lip. Earlobe reductions help to restore a younger looking earlobe that is not as stretched and elongated. Patients often overlook how impactful an earlobe reduction can be to giving an overall refreshed and younger look to the face. All of these surgeries are great adjuncts to add on during a facelift surgery so that all areas of the face are addressed to maintain a natural balance after surgery. We have mentioned this a few times already in this series, but a facelift is a surgery that primarily focuses on the midface and the lower face. It corrects chowing, repositions cheek fat softens nasolabial folds, and helps correct loose skin and platysmal banding of the neck. When you address the lower and the midface alone with a facelift and fail to address aging of the eyes, brows and other areas mentioned that are a telltale sign of aging, you can be left with an unnatural appearance as the harmony of the face is disrupted.
Dr. Lawrence Bass (03:36):
And these areas that are not treated by the facelift, again, are centered in the perioral area, the area around the mouth, the periorbital area or periocular area, the area around the eyes and the upper face or forehead area. So they're not action areas for the facelift. But when you think about it, when people interact with you, they spend most of their time looking at your eye area. About 70% of the time studies show. So working on periorbital changes along with face changes as well as some of these other areas like lip contour, earlobes, but particularly that area around the eyes is really important to project the kind of image you're trying to project, that useful restored image and nod your aging looking a little bit worn out kind of image.
Summer Hardy (04:39):
Okay, so we discussed examples of procedures that address areas of the face the facelift doesn't, are there any procedures done in the area of the facelift to amplify the correction?
Dr. Lawrence Bass (04:50):
There are indeed, and this has become a really big thing. In fact, a central thing in facelifting in 2025 and beyond. Fat grafting to add volume back to the face to enhance the restoration of a youthful facial shape has become really central to facelift surgery because we lose not only a loosening of the skin as we age, but we lose volume in the face and repositioning the reduced volume moves us back towards a youthful shape. But adding back some of the lost volume using fat grafting moves us a lot closer back to that youthful shape. And there are other advantages besides. Sometimes instead of using fat grafting, this is done with chin and cheek implants, which have a more predictable volume and shape. And overall fat grafting will enhance skin re-draping and overall harmony of facial shape because the more projecting the underlying scaffolding, the better, more completely the skin will re-drape.
Summer Hardy (06:11):
Okay, so finally, we're ready to talk about procedures that do other things besides what the facelift does.
Dr. Lawrence Bass (06:18):
These are things the facelift doesn't do at all or maybe only does minimally. So for example, wrinkles and other features of skin quality.
Summer Hardy (06:29):
Dr. Edinger, what are the main approaches here?
Dr. Kylie Edinger (06:32):
Some of the main ones are laser resurfacing, chemical peels, dermabrasion, and other energy treatments of the skin, like radiofrequency microneedling are basically some examples of the modalities that we use to enhance skin quality by improving its texture, coloring and wrinkling. These modalities can be tailored and how aggressive they are depending on the patient need and their tolerability of downtime. They all come with similar risks including hyperpigmentation or darkening of the skin, hypopigmentation or lightening of the skin, and scarring. Which modality is best for each patient really depends on several factors, including their degree of wrinkling, their texture, their patient's skin color, and ethnicity. There are other modalities you'll possibly have heard about including skin rejuvenating treatments like platelet-rich plasma or PRP and exosomes. Platelet rich plasma is a concentration of platelets and growth factors that are actually derived in the patient's own blood. Exosomes, on the other hand, are a bottled version of platelet derived growth factors and signaling molecules with proteins that are harvested from stem cells and manufactured into a topical product. The platelets, growth factors and signaling proteins from PRP and exosomes are often used in combination with microneedling or injections to deliver their regenerative molecules to the target tissue more directly. They're used to reduce inflammation, stimulate collagen production, and enhance skin tone quality and texture.
Dr. Lawrence Bass (07:53):
And I alluded to this before, but fat grafting itself for certain forms of fat grafting like nanofat, in addition to adding back volume, also signal a lot of the biological youthful skin responses that things like PRP and exosomes can signal. So part of the interest in fat grafting is restoring that facial volume, but part of it is also about trying to modulate the biology of the skin in a favorable way to get new blood supply, new collagen, better healing and a more vibrant, youthful looking skin.
Summer Hardy (08:36):
It sounds like there's a lot of different options. How do you decide when other procedures are needed?
Dr. Kylie Edinger (08:42):
Deciding which procedures to apply really depends on what the specific patient needs. We do not want to treat one isolated part of the face, leaving the face unbalanced and unnatural after surgery. So we approach each patient holistically and come up with a treatment plan to meet their unique goals and their needs. Not every patient is going to need a blepharoplasty or a brow lift in concert with a facelift to maintain that facial harmony. Some patients will need more aggressive skin rejuvenation efforts to improve their texture and wrinkling, while other patients may need more of a focus on volume restoration. Each treatment is thoughtfully considered and applied to each patient based on what they need and what they're hoping to get out of the surgery, all while ensuring that at the end of the day they're left with a natural, youthful, balance result.
Dr. Lawrence Bass (09:23):
I think that's so important. You said that beautifully. It's extremely common. In other words, not every facelift, but most of them, almost all of them that some other procedures included at the same time and often multiple additional procedures. But this is always based on careful physical exam by the plastic surgeon to identify features that need to be addressed and that mated with the individual patient's aesthetic concerns. So it's that customization that Dr. Edinger was talking about that creates an individual plan for that patient.
Summer Hardy (10:08):
Are there downsides to adding procedures? How does it impact recovery?
Dr. Kylie Edinger (10:13):
The main downside to adding more procedures is increased cost in anesthesia time. The adjunct procedures we have discussed will have minimal impact on recovery time, but they may increase the overall amount of bruising and swelling after surgery.
Dr. Lawrence Bass (10:27):
Some procedures can be done exactly as you usually would as a standalone, and other procedures are modified a little bit if they're done in conjunction with a facelift. So things like laser resurfacing in particular is a good example of that, especially if it's full field and not fractional resurfacing. I have actually written a couple of discussions on this in medical journals and book chapters where we modify how we do the laser resurfacing because we're attacking the skin from the surface as well as from underneath with the facelift surgery. In order to do that safely, we need to change things up a little bit and use a different set of laser parameters, but these things can be done reliably and safely at the same time.
Summer Hardy (11:25):
Okay. And what are the most common facelift friends in your hands?
Dr. Kylie Edinger (11:30):
I most commonly perform blepharoplasty and fat transfer during the time of facelift surgery. I find that most patients need that in addition to the facelift, and I usually add in a skin resurfacing modality to improve their texture and wrinkling to the treatment plan, whether this be at the time of surgery or at some point before or after the surgery.
Dr. Lawrence Bass (11:48):
And I'm going to sound a little bit like a broken record because I have more or less the same answer. Blepharoplasty is extremely common at the same time as a facelift surgery unless the patient has done it previously. And fat grafting is associated with facelift surgery in many, many cases unless there's a particularly heavy face and not just for the faces that are strikingly hollow, but there are more subtle aging changes that are volume mediated in most faces that can benefit from fat grafting along with those biological benefits. In addition, I'm a big laser resurfacer. I think lifting a face and leaving a bunch of wrinkles is half a job or glass half full, and I'd rather have the glass all the way full. So I do this frequently with the facelift, but sometimes it's better to do it as a standalone to get a more complete treatment. But localized areas like the perioral area with those lipstick bleed lines are really, really common at the same time as a facelift,. As an alternative, you can do it as a fractionated treatment in a series starting at the facelift, but then with more treatments later on after recovery.
Summer Hardy (13:17):
That makes a lot of sense. So Dr. Edinger, do you have some takeaways for us on this topic?
Dr. Kylie Edinger (13:23):
For me, treating all aging faces with a facelift alone is a lot like repairing a weathered home's foundation without replacing the roof or updating the windows or repainting the house itself. So while the aging face may very well require a facelift to improve and reverse the signs of aging, it is not the only modality we have at our disposal to restore youth. We have to approach the face not in isolated units, but as a comprehensive entity. When we restore youth, it has to be balanced and tailored to give them that natural result.
Dr. Lawrence Bass (13:52):
So that's really important. Dr. Edinger really laid it out nicely that there are circumstances where someone has done other things and all they need at this time is a facelift or a secondary lift, but usually a few other features are really ready for treatment at the same time. And you'll notice the next worst thing if you take the worst thing away, things that are very minor, you can leave. But things that are really ready to be done are commonly performed along with the facelift. More often than not. Skin quality in particular needs other treatments. This is often done as a series or sometimes at another time. And the other aging features, again, the areas that facelift doesn't treat or that facelift doesn't fully address need additional concomitant treatments. So as I said, when you take away the worst thing, you inevitably see the next worst thing, and you don't want to turn around in three months and be back for another procedure. That's about planning.
(15:01):
Have a detailed discussion with your plastic surgeon, see what they suggest, and look at yourself in the mirror and in pictures. I usually show patients a photograph of themselves during a consultation, and if the features the surgeon points out are meaningful to you, take this chance at the same time as the facelift to chase them. If you're really convinced they don't matter to you, it's okay to leave them off. But overall facelift friends, these associated procedures are an essential part of putting together the most complete rejuvenation possible, a harmonious, beautiful face. Take advantage of them during the facelift and use them to best advantage.
Summer Hardy (15:48):
All of these add-ons make deciding what to do when having a facelift a lot more confusing, but they also promise a lot of additional rejuvenation. Thank you Dr. Bass, Dr. Edinger for schooling us on these additional options and all they can do for us. They truly are facelift and patient friends. Thank you for listening to the Park Avenue Plastic Surgery Class podcast. Follow us on Apple Podcasts, write a review and share the show with your friends. Be sure to join us next time to avoid missing all the great content that is coming your way. If you want to contact us with comments or questions, we'd love to hear from you. Send us an email at [email protected] or DM us on Instagram @drbassnyc.
