What a Facelift Really Fixes (and What It Doesn’t)
Plastic surgeons Dr. Sammy Sinno & Dr. Andrew Cohen explain what a facelift can (and can’t) fix — from “Ozempic face” to deep plane lifts and turkey necks.
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Search interest in facelifts has climbed alongside two very different trends. The rise of GLP-1 drugs like Ozempic, which can leave the face gaunt and deflated even as the scale drops, and a wave of social media interest in the “deep plane facelift,” a technique patients are now requesting by name. That’s left plenty of confusion about what a facelift actually does, and what it doesn’t.
Patients often have many of the same questions: What makes someone a good candidate? What should you realistically expect from surgery? And how do surgeons approach the same concerns differently?
LA Times Studios asked two board-certified plastic surgeons...Dr. Sammy Sinno, who specializes in facelift surgery and rhinoplasty in Chicago, and Dr. Andrew Cohen, a plastic surgeon based in Encino, California, the same five questions. Their responses, shared below, reflect their individual clinical perspectives and have been lightly edited for clarity and length.
Does a facelift fix the deep lines and volume loss caused by sudden GLP-1 weight loss?
“A facelift is a great treatment for patients who have lost a significant amount of weight as a result of taking GLP-1,” Dr. Sinno explains. “When patients lose weight rapidly, the most notable symptoms are loose, saggy skin around the neck, jawline, and mid-face. Sometimes when the excess skin folds over the existing tissues deep lines are formed. This can be treated by a facelift with tightening deep layers as well as skin.” For volume that has disappeared entirely rather than just shifted, he notes fat grafting, taken from elsewhere on the body and reinjected into hollowed areas, is often layered in alongside the lift.
Dr. Cohen sees the same pattern in his practice but is more emphatic that a facelift alone will not solve it. “Not by itself,” he says. “While a facelift is excellent for repositioning descended tissues and improving laxity along the jawline and neck, it does not restore the facial volume that is often lost with rapid weight loss associated with GLP-1 medications.”
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He describes “Ozempic face” as a loss of both skin elasticity and the underlying fat pad that gives a face its youthful shape, contributing to hollow cheeks, deeper nasolabial folds and marionette lines. “Simply tightening the skin without restoring volume can leave the face looking over-tightened or unnatural,” he says.
That’s the thinking behind a procedure Dr. Cohen developed called the “luminosity lift”, which combines a deep plane facelift with structural fat grafting and fractional CO2 laser resurfacing. “Rather than treating a single aspect of facial aging, the luminosity lift addresses facial position, volume restoration, and skin quality together, creating a more complete and natural rejuvenation for patients, particularly those experiencing facial aging after significant weight loss,” says Cohen.
Why doesn’t a facelift lift my eyebrows or smooth out my crow’s feet?
This is one of the most common points of confusion for first-time patients, and both surgeons say it comes down to anatomy. “A facelift is a treatment that more so targets the neck, jawline, nasolabial, and midface,” explains Dr. Sinno. “To lift the eyebrows and smooth out crow’s feet a procedure called a brow lift is needed. This is done with hidden incisions around the temporal hair.”
Dr. Cohen agrees. “A facelift is designed to address the lower two-thirds of the face and the neck. It improves jowls, defines the jawline, softens deep folds around the mouth, and restores a more youthful contour to the lower face,” he says. “However, it does not directly elevate the eyebrows or treat the muscles responsible for crow’s feet.”
He points out that the forehead, brows, and upper eyelids age on their own timeline, separate from the lower face. His approach for a brow lift for heavy brows or forehead descent would be neuromodulators like Botox or Daxxify for crow’s feet, and laser resurfacing for fine lines around the eyes. “One of the most important parts of facial rejuvenation is selecting the right combination of procedures rather than expecting one surgery to address every sign of aging,” says Cohen.
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Will a facelift erase fine surface wrinkles and sun damage, or do I need something else?
Neither surgeon considers a facelift a skin-quality treatment, though both say it sets the stage for one. “It can help but the best treatment is to add a full field resurfacing laser done around the same time as the facelift,” Dr. Sinno says, who performs what he calls a dual-plane deep plane lift. “Once the deeper tissues and skin have been comprehensively tightened, fine lines and wrinkles, as well as sun damage are on more stretch, and therefore a full resurfacing laser treatment would have optimal impact.”
Dr. Cohen makes the distinction that a facelift improves facial position, not skin quality. “It can correct loose skin and underlying tissue descent, but it does not remove fine etched lines, pigmentation, sun damage, or changes in skin texture caused by aging and ultraviolet exposure.” For patients who want both, he often pairs facelift surgery with CO2 laser resurfacing, chemical peels, medical-grade skincare or other collagen-stimulating treatments. “Addressing both facial structure and skin quality creates a more complete and natural-looking result than focusing on either one alone,” he says.
What’s the difference between a traditional facelift and a deep plane facelift when it comes to natural movement?
The “deep plane facelift” has become a social media buzzword, and both surgeons say the terminology is worth understanding before requesting it by name. Dr. Sinno breaks the face into two workable layers: the SMAS, or “deep plane,” and the skin above it, noting that the muscles controlling facial expression sit below both. “If either of the first top layers are inadequately released, overly tightened, or not harmoniously repositioned with respect to one another the result cannot only be ineffective but also unnatural,” he says. In his view, the best outcomes come from releasing, redraping, and tightening both the skin and the deep plane layer along their own independent vectors, rather than over-tethering one to compensate for the other.
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Dr. Cohen frames the difference in terms of how tissue moves as a unit. “A traditional facelift typically relies more on tightening the skin and the superficial tissue layer, while a deep plane facelift releases key retaining ligaments and repositions the deeper facial structures as a single unit,” he says. “Because the deeper tissues move together naturally, a properly performed deep plane facelift can often produce results that look softer, more harmonious, and less operated on.” Cohen also adds that patients are able to smile, laugh, and express emotion normally because the procedure restores anatomy instead of just pulling skin tighter, though he cautions that natural-looking movement ultimately depends on surgical judgment and technique, not the name of the procedure alone.
Can a facelift fix a “turkey neck” permanently, or will the results eventually slip?
Loose neck skin is one of the most requested fixes in facial plastic surgery, and both surgeons say a facelift and neck lift combination is highly effective, though “permanent” comes with an asterisk. “Absolutely. A face and neck lift treats these areas very effectively,” Dr. Sinno says. “At the year mark and surgical result will continue aging but the speed of aging in this area is greatly reduced. To preserve results long term avoiding weight fluctuations and maintaining an otherwise healthy lifestyle are key.”
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Dr. Cohen agrees the results are long-lasting rather than permanent. “A facelift combined with a neck lift can dramatically improve the appearance of loose skin, neck bands, and excess tissue beneath the chin, creating a more defined jawline and youthful neck contour,” he says. “However, no facelift can permanently stop the aging process. Patients continue to age after surgery, but they do so from a much more youthful starting point.” Cohen tells patients that stable weight, sun protection and a consistent skincare routine all extend the results. “A good facelift and neck lift should never make someone look different,” he explains. “It should simply allow them to look like a younger version of themselves for years to come.”
Dr. Sammy Sinno is a board-certified plastic surgeon in Chicago specializing in facelift and rhinoplasty surgery. Dr. Andrew Cohen is a board-certified plastic surgeon in Encino, California, and developed the Luminosity Lift.
