Cosmetic procedures for facelift: an overview of methods

Modern "facelifts" are a whole group of cosmetic and medical procedures that reduce the signs of aging, create more defined contours, and improve the quality of the skin. This includes not only traditional surgical procedures, but also numerous non-surgical methods—injections, hardware technologies, threads, laser, and chemical rejuvenation. Patients increasingly want noticeable results with minimal recovery time, which explains the growing interest in modern minimally invasive techniques. [1]

With age, the skin and soft tissues of the face undergo natural changes: collagen and elastin levels decrease, subcutaneous fat thins in some areas and accumulates in others, and the supporting ligaments weaken. This leads to sagging tissue, deepening of nasolabial folds, creases in the cheeks and chin, and changes in the facial contour. Lifting procedures are aimed either at repositioning and fixing soft tissues or at stimulating collagen synthesis and redistributing volume. [2]

In recent decades, the number of non-surgical procedures has increased exponentially and in many countries now exceeds the number of traditional surgeries. Reviews of aesthetic medicine show that patients are increasingly opting for botulinum toxin injections, fillers, hardware-based techniques, and thread lifting, postponing or even avoiding surgical facelifts, especially before age 50. However, surgical techniques remain the "gold standard" for significant age-related changes. [3]

It's important to understand that any facelift is a medical procedure, not a "risk-free cosmetic service." Each procedure has its own indications, contraindications, potential complications, and specialist qualifications. A lack of proper diagnostics, unqualified specialists, and the use of uncertified medications directly increase the risk of serious side effects, including scarring, asymmetry, nerve damage, and infection. [4]

The choice of a specific procedure should take into account the patient's age, facial anatomy, severity of age-related changes, health status, lifestyle, and expectations. In real-life practice, the best results are often achieved not by a single procedure, but by a combination of different technologies: injections plus hardware techniques, superficial skin rejuvenation plus treatment of deep structures. This combined approach is increasingly discussed in modern guidelines and reviews on aesthetic medicine. [5]

Table 1. Main objectives of cosmetic procedures for face lifting

Task	What is the impact aimed at?	What methods are used most often?
Wrinkle reduction	Facial muscles, superficial layer of skin	Botulinum toxin, laser and light techniques
Volume restoration	Subcutaneous adipose tissue, deep tissue	Injectable fillers, lipofilling
Soft tissue tightening	Ligamentous apparatus, superficial muscular-aponeurotic system	Surgical lifting, thread lifting, ultrasound methods
Improving skin texture	Epidermis and dermis	Chemical peels, laser resurfacing
Improving the oval and contours	Subcutaneous fat, subcutaneous structures	High-intensity focused ultrasound, radiofrequency lifting

Injectable methods: botulinum toxin and fillers as a "microlift"

Botulinum toxin type A injections temporarily block nerve impulse transmission to the muscle, relaxing overactive muscle fibers. This reduces the appearance of dynamic wrinkles—creases that occur during active facial expressions, such as on the forehead, between the eyebrows, and at the outer corners of the eyes. Research and systematic reviews show that, when doses and injection sites are properly selected, botulinum toxin significantly improves appearance and is well tolerated by most patients, remaining one of the most common aesthetic procedures. [6]

The effect of botulinum toxin is temporary: on average, 3 to 6 months, depending on the specific product, area, and individual factors. This allows for gradual adjustments to the treatment plan to accommodate facial expressions and age-related changes, but requires regular treatments to maintain the results. Current consensus emphasizes the importance of a conservative approach: avoiding a completely immobile face, but gently softening the appearance of wrinkles while maintaining a natural appearance. [7]

Hyaluronic acid-based dermal fillers are used to restore volume and correct contours. They are used to contour the lips, cheekbones, and chin, smooth out nasolabial folds and marionette lines, and soften the "tired" appearance of the middle third of the face. International recommendations note that proper use of fillers not only fills wrinkles but also restores anchor points lost with age, resulting in a visual lifting effect. [8]

Combining botulinum toxin and fillers often produces more pronounced and lasting results than using either method separately. Botulinum toxin reduces muscle hyperactivity and reduces mechanical stress on the area, while fillers restore volume and support tissue. Clinical studies confirm the safety and effectiveness of combined treatments when used with appropriate technique and certified products. [9]

Injectable procedures are associated with a risk of complications: bruising, swelling, asymmetry, temporary muscle weakness, a "mask" effect, nodule formation, or vascular complications if the filler enters a vessel. A separate, major problem in recent years is the underground market for counterfeit botulinum toxin and fillers sold online and used by unqualified practitioners, which has already led to cases of severe intoxication and hospitalization. Patients are strongly advised to consult only licensed professionals and request the original packaging. [10]

Table 2. Comparison of botulinum toxin and fillers in facelifts

Parameter	Botulinum toxin type A	Hyaluronic acid fillers
Main action	Relaxation of muscles, reduction of wrinkles	Volume restoration, contour modeling
Main zones	Forehead, between the eyebrows, outer corners of the eyes	Lips, cheekbones, nasolabial folds, chin
Duration of effect	On average 3-6 months	On average 6-24 months
Main risks	Asymmetry, drooping eyebrows or eyelids	Edema, nodules, vascular complications
When it gives a "lifting" effect	When the downward pull of some muscles is weakened	When restoring facial reference points

Hardware methods: ultrasound, radio frequencies and other technologies

Hardware-based facelift techniques use ultrasound, radiofrequency, or a combination of these energies to heat tissue at specific depths. High-intensity focused ultrasound, often referred to by its Latin acronym HIFU, creates heating points in the dermis and superficial musculoaponeurotic system, stimulating collagen contraction and activating new collagen synthesis. Clinical studies show improved skin tone and moderate lifting with a relatively short recovery period. [11]

Radiofrequency lifting heats tissue through the passage of a radiofrequency current, causing controlled heating of the dermis and partially subcutaneous tissue. This also stimulates collagen production and skin tightening over time. There are monopolar, bipolar, and multi-electrode systems, as well as a combination of radiofrequency energy with needle attachments for a deeper effect. Reviews note that with the right parameters, this method produces a noticeable improvement in skin quality and a subtle tightening effect. [12]

The advantage of hardware-based technologies is their relative non-invasiveness, the ability to gradually build up the effect, and a short recovery period. Patients can return to their normal activities the same day or the next day, and the results develop gradually over several months, appearing more natural to others. However, these methods cannot correct significant excess skin and severely sagging tissue; in these cases, their role is merely supportive. [13]

Hardware-based procedures are not without risks. High-intensity focused ultrasound has been associated with pain, swelling, temporary blurred vision, sensory disturbances, and, in rare cases, damage to facial nerve branches due to improper depth and energy settings. Radiofrequency techniques can cause burns, pigment changes, and scarring if technique is improper, especially in patients with darker skin tones. Therefore, proper diagnosis, area marking, and use of certified equipment are essential. [14]

Machine-assisted lifting is often combined with injectable methods. Initially, botulinum toxin and fillers are used to correct facial expressions and volume, followed by ultrasound or radiofrequency to improve skin density and contour. Reviews emphasize that combining technologies targeting different tissue levels produces a more harmonious and lasting result than attempting to address all issues with a single method. [15]

Table 3. Hardware methods of face lifting and their features

Method	Depth of impact	Main effect	Duration of the result (approximately)
High-intensity focused ultrasound	Dermis and superficial musculoaponeurotic system	Tissue tightening, oval improvement	About 12-18 months
Radiofrequency lifting	Dermis, partially subcutaneous tissue	Skin tightening, wrinkle reduction	About 6-12 months
Needle radiofrequency method	Dermis at controlled depth	Collagen stimulation, smoothing of the skin's surface	About 12 months
Low-energy light and laser devices	Superficial layers of the skin	Improving tone and microrelief	Course, then maintenance procedures
Combined programs	Different levels	Multi-component lifting and rejuvenation	Depends on the combination of methods

Thread lifting: a supporting framework from the inside

Thread lifting uses absorbable or partially absorbable threads inserted under the skin through punctures. The threads may have barbs or cones that cling to tissue and gently lift it upward, forming a new framework. Over time, the thread material dissolves, but connective tissue forms around them, which maintains the result for a short time. This is marketed as a less traumatic alternative to surgical lifting for patients with moderate age-related changes. [16]

Modern threads are typically made of polydioxanone, polycaprolactone, or a combination of the two. These materials have long been used in surgery and are well studied for their absorption and tissue response. After insertion, collagen synthesis around the threads is stimulated, gradually tightening the tissue and enhancing the effect. However, skin thickness, subcutaneous tissue density, and ligament anatomy significantly affect the result, so thread lifting is not suitable for everyone. [17]

Short-term complications of thread lifting include swelling, bruising, soreness, temporary asymmetry, and skin irregularities. Meta-analytic reviews indicate that the most common complications are swelling and minor changes in skin texture, which resolve within a few days or weeks. In most cases, these effects do not require surgical correction and are limited to observation and gentle measures. [18]

More serious complications include infection, severe inflammation, abscess formation, suture migration, thread protrusion through the skin, persistent deformation or hardening, and granulomas. Reviews and clinical series note that such problems are less common but require active intervention, sometimes with surgical removal of the sutures. Incorrect patient selection, insertion that is too superficial or too deep, and working in an inappropriate anatomical area significantly increase the risk. [19]

The results of thread lifting typically last 12 to 24 months, depending on the thread material and tissue characteristics. The method has little effect on excess skin and does not eliminate deep folds associated with severe age-related changes. Experts recommend thread lifting as an intermediate option between injection methods and surgical lifting, as well as a complement to other procedures. [20]

Table 4. Thread lifting: pros, cons and limitations

Parameter	Characteristic
Target	Soft tissue lift without incisions
Indications	Moderate tissue drooping, slight excess skin
Duration of effect	On average 12-24 months
Common complications	Swelling, bruising, temporary unevenness of the skin
Serious complications	Infection, thread protrusion, deformation, granulomas

Laser rejuvenation and chemical peels as a "superficial lift"

Laser facial rejuvenation techniques target the epidermis and dermis, improving texture, tone, and fine lines. Ablative lasers, such as carbon dioxide or erbium, vaporize the superficial layers of the skin, stimulating intense regeneration and collagen remodeling. Non-ablative and fractional technologies are gentler, creating micro-zones of damage and leaving areas of undamaged skin for rapid healing. This results in noticeable smoothing and visual tightening. [21]

Chemical peels use acid solutions with varying penetration depths. Superficial peels (such as those based on glycolic or lactic acid) target the epidermis, improving skin tone and texture. Medium and deep peels (such as those with trichloroacetic acid) penetrate deeper, affecting part of the dermis and causing more pronounced tissue renewal, resulting in smoothing of wrinkles and improved skin tone. Choosing the correct peel depth is critical to balancing effectiveness and safety. [22]

Lasers and peels are particularly useful for complex issues such as wrinkles, uneven skin tone, post-inflammatory pigmentation, and acne scars. Guidelines emphasize the importance of assessing skin type, the severity of photodamage, and the presence of a tendency toward scarring and pigmentation before the procedure, as well as thoroughly preparing the skin and limiting sun exposure before and after the procedure. Without such preparation, the risk of complications increases significantly. [23]

Common side effects include redness, swelling, peeling, a burning sensation, and temporary sensitivity. More serious complications include infections, prolonged erythema, post-inflammatory hypo- or hyperpigmentation, and scarring, especially with deep peels and ablative lasers. Patients with darker skin require particularly careful selection of the depth and type of treatment, as well as strict sun protection to reduce the risk of permanent marks. [24]

It's important to remember that lasers and peels don't replace a full soft tissue lift, but rather complement it by improving the quality of the "surface." In comprehensive facial rejuvenation schemes, such procedures are often planned after volume correction and lifting to finally even out the skin's texture and tone. In some cases, moderate changes can be corrected with superficial methods alone, especially in younger patients. [25]

Table 5. Laser and chemical peeling

Parameter	Laser rejuvenation	Chemical peeling
Type of impact	Light energy	Acid solution
Depth control	Setting up the device parameters	Concentration, exposure time, type of acid
Possible depth	From superficial to deep	From superficial to deep
Main indications	Wrinkles, texture, scars, vascular changes	Wrinkles, pigmentation, uneven texture
Recovery period	From several days to several weeks	From mild peeling to longer lasting recovery

Surgical Facelift: When Surgery Is Absolutely Necessary

A classic surgical facelift, also known as a rhytidectomy, focuses on redistributing and stabilizing soft tissue, not just tightening the skin. Modern techniques work with the superficial musculoaponeurotic system, shifting it to a higher position, after which excess skin is removed. This allows for a more pronounced and long-lasting effect compared to superficial skin tightening, which was considered the standard many years ago. [26]

A facelift is primarily indicated for severe sagging, noticeable excess skin in the lower face and neck, deep folds, and facial contour irregularities. In these cases, injections, threads, and hardware-based techniques provide only limited and short-term results. Systematic reviews confirm that properly performed rhytidectomy results in high patient satisfaction and lasting results, especially when combined with other procedures such as chin liposuction, lipofilling, or eyelid rejuvenation. [27]

Like any surgical procedure, a facelift carries a risk of complications. Common complications include hematomas, seromas, sensory disturbances, temporary weakness of individual branches of the facial nerve, hairline smoothing, and noticeable scarring. Systematic reviews in recent years show that hematomas remain the most common complication, followed by unfavorable scarring and temporary neurological impairment. Most of these complications are treatable but require monitoring and, if necessary, additional interventions. [28]

The success of the surgery directly depends on the plastic surgeon's qualifications, careful preoperative planning, and adherence to recommendations during the recovery period. Prior to the procedure, the patient's overall health, risk factors (smoking, hypertension, coagulation disorders, severe endocrine disorders), and psychological expectations are assessed. Adherence to restrictions in the early postoperative period reduces the risk of complications and improves the quality of scarring. [29]

Surgical facelifts are increasingly being combined with less invasive methods: botulinum toxin and filler injections are used after the main recovery for fine-tuning, while lasers and peels are used to improve skin quality. This approach not only lifts the tissue but also makes the skin appear smoother and fresher, which is perceived by others as harmonious rejuvenation, rather than simply a "tight" appearance. [30]

Table 6. Surgical facelift: key points

Parameter	Peculiarities
The main goal	Deep tissue movement and fixation
Indications	Severe excess skin, severe sagging
Duration of effect	Several years, longer with a good lifestyle
Common complications	Hematomas, scars, temporary nerve weakness
Requirements for a doctor	Specialization in facial plastic surgery

How to choose a procedure and specialist: practical guidelines

Choosing the right facelift procedure begins with an objective assessment of the skin and soft tissue condition. For young patients with early signs of gravitational ptosis, injections and hardware-based methods are often sufficient. For those with moderate changes, threading techniques and more pronounced hardware programs are suitable. For severe deformations of the face and neck contour, surgical lifting is considered. Modern reviews emphasize the need for a personalized plan rather than a standardized age-specific approach. [31]

It's critically important to choose a qualified specialist and a reputable clinic. In most countries, serious injection and device procedures must be performed by doctors trained in aesthetic medicine or plastic surgery. Reports of counterfeit botulinum toxin products, illegal clinics, and serious complications after "home" procedures demonstrate the dangers of skimping on specialists and products. Patients are advised to check the licenses, certificates, and reputation of the clinic. [32]

Equally important is an honest discussion about risks and expectations. The doctor must explain that no procedure "freezes" age, but only delays the visible signs of aging, and that the result is always limited by the patient's anatomy and tissue condition. Guidelines for aesthetic medicine emphasize that informed consent is not a formality, but rather part of safe practice that helps reduce the risk of disappointment and unnecessary repeat procedures. [33]

Before major procedures, including threads, high-energy hardware programs, and especially surgical lifting, it is necessary to collect and evaluate your medical history. Certain medications, smoking, untreated chronic diseases, bleeding disorders, and a tendency to keloid scars may require postponing or changing the type of procedure. Some sources recommend involving a physician or other specialist in the evaluation, if necessary. [34]

It's also worth planning the recovery period in advance. Even relatively gentle procedures can be accompanied by swelling, bruising, temporary asymmetry, and restrictions on skin care and physical activity. Scheduling interventions around work, important meetings, and travel helps avoid unnecessary stress and gives the skin time to recover, which directly impacts the quality of the final result. [35]

Table 7. How to roughly select a tightening strategy based on the degree of change

The degree of age-related changes	Possible approaches
Slight changes, first wrinkles	Botulinum toxin, light peels, gentle hardware methods
Moderate tissue drooping	Fillers, thread lifting, more intensive hardware programs
Significant excess skin, disrupted oval shape	Surgical lifting with the addition of injections and laser techniques
Combination of wrinkles and pigmentation	A combination of injections and superficial skin rejuvenation
Presence of common diseases	Minimally invasive techniques, after consultation with doctors

Conclusion

Today, cosmetic facelift procedures offer a wide range of options, from injections and hardware technologies to complex surgical procedures. The main difference between the modern approach and previous years is its focus not only on skin tightening, but also on restoring volume, improving the quality of the dermis, and preserving natural facial expressions. A combination of methods working at different tissue levels allows for a gentler and more harmonious rejuvenation when planning and execution are in the hands of trained specialists. [36]

When choosing a specific procedure, it's important to soberly assess the initial data, be mindful of the potential risks, and avoid chasing "instant youth without consequences." Injections, threads, hardware techniques, and surgeries vary in the depth of impact and duration of effect, but all require a competent diagnosis, high-quality materials, and adherence to safety protocols. A conscious attitude toward your own health, choosing a licensed specialist, and a commitment to realistic, not fanciful, results are essential to ensuring that a facelift isn't a source of problems, but rather part of a well-thought-out strategy for maintaining your appearance for years to come. [37]