Good vs Great Facelift Results: What I Look for in Austin
We’re in an era of amazing facelift results, and I feel lucky to be a facial plastic surgeon in Austin right now. Still, when I look at results, mine and other surgeons’, some make me say “wow” and some make me say “that looks good, but something’s missing.”
I listen to a lot of business podcasts and read a lot of business books. One of them is Good to Great by Jim Collins, which looks at how good companies become great ones. I think about surgery the same way. Here are the five things I believe make the difference.
1. The Facelift Technique
When I was in training, most surgeons weren’t doing deep plane facelifts. The technique has been around since roughly the 1980s, but it fell out of favor because many considered it too risky.
Since then, a number of surgeons have spent years teaching courses and showing other surgeons how to perform it safely and predictably. Today, most surgeons who do a high volume of facelifts perform deep plane facelifts. I think that’s been the biggest single change in how good results can be, how long they last, and how much lift is possible. Even the direction of lift has changed in the last ten years.
Longevity data is starting to catch up. A 2026 study titled Thirty Years of Deep Plane Facelifts looked at how long patients waited before having a revision after a deep plane lift. This study found an average longevity of 10-12 years depending on the age at the time of their first facelift.
With some exceptions, I’m a little underwhelmed now when I see results from a traditional SMAS facelift. My post on deep plane vs SMAS facelifts explains why.
2. Skin Quality and Texture
A facelift repositions tissue. It doesn’t repair the skin itself. If someone waits until their 60s or 70s, has a lot of sun damage and deep wrinkles, and does nothing for their skin before or after surgery, it takes away from the result.
You can sometimes see the stretch in the skin, because the wrinkles change direction depending on where you look. The skin doesn’t redrape naturally. It absorbs light instead of reflecting it, so it looks dull. And the result doesn’t last as long, because the skin has lost its structure.
Prepping the Canvas
Before a facelift, I talk to patients about prepping the canvas. Think of a painter applying gesso before starting a portrait, or priming a wall before you paint it. Skin works the same way.
I treat the skin with radiofrequency microneedling, which in my experience can thicken the dermis, and with deep erbium laser resurfacing, either full field or fractional. A small histology study in the Journal of Cosmetic Dermatology found increased collagen and elastin four months after a single microneedle radiofrequency treatment.
Some surgeons resurface at the time of the facelift. A 2026 systematic review and meta-analysis in Aesthetic Surgery Journal found combined facelift and laser resurfacing to be safe with high satisfaction when the technique is adjusted, including lowering laser energy over skin that was lifted during surgery.
Whether skin treatments are done before/after surgery or at the same time as surgery, addressing the overall quality of the skin can elevate results and create a stronger foundation for long-lasting results.
You can read more about Morpheus8 and laser skin resurfacing on my site.
3. How the Neck Is Treated
Some people have favorable neck anatomy. Their muscles and glands are small, the jawline is smooth, and the skin is simply hanging a bit. For them, a traditional platysmaplasty with a deep plane facelift is enough.
Others have larger structures under the chin that need to be addressed. When I see a post-op photo where that wasn’t done, it jumps out at me immediately.
In those cases, I do a deep structural neck lift. Depending on the anatomy, I may trim the digastric muscles, stitch them together, or divide them. Sometimes the submandibular glands need to be trimmed too. In both situations, I turn the platysma muscle into a sling. I suture it in the middle and tuck it back behind the jawline for a smooth contour.
A review in Facial Plastic Surgery makes the case that many obtuse necks are driven by structures beneath the platysma, which a skin-and-fat approach won’t fix. If your surgeon isn’t comfortable with deep neck work and your anatomy needs it, the result will fall short.
4. The Forehead
Aging doesn’t stop at the jawline. Starting in our early 20s, we lose collagen and elastin in the skin every year. That happens in the forehead and around the lip too.
A true full face rejuvenation includes the forehead. That means looking at brow position, the brow ridge, and the hairline as one unit, rather than just doing a brow lift.
I usually use a pretrichial approach for the brow lift, because I think of the forehead the same way I think of a deep plane facelift. To get the best brow lift, I release ligaments along the side of the forehead and around the orbit, so the brows can lift naturally. I don’t use permanent plates, Endotines, or similar implants. I want the brows to move freely, and I don’t want anyone to have long-term pain or irritation from hardware.
The pretrichial incision also gives me access to the brow ridge. Some people have hooding from the bone itself, beyond a low brow or extra skin. If the brow ridge isn’t addressed, it still casts a shadow over the eyes and can make the face look older and more masculine. When needed, I include brow bone reduction in the forehead portion of the surgery. Many surgeons don’t, and I notice it right away.
My post on temporal vs pretrichial brow lifts goes deeper on this.
5. A Lip Lift
The mouth ages along with everything else. If a long upper lip isn’t addressed during a facelift, it can look more noticeable afterward than it did before.
A lip lift is almost like a small facelift for the mouth. I make a small incision at the base of the nose and remove a strip of skin to shorten the distance between the nose and lip.
The facelift itself lifts the corners of the mouth slightly. Some people still need a corner lip lift through a tiny incision at the edge of the mouth to balance the shape. Some need a little volume too. I’m not aiming for big, plump lips. I just want them to look fuller and more hydrated, since lips lose volume with age.
Why It All Adds Up
Each of these details makes a difference on its own. When I can combine them in a full face rejuvenation, the result is consistently better than when someone comes in for a face and neck lift only and doesn’t want anything else.
Frequently Asked Questions
Do I need skin treatments before a facelift?
Not everyone does, but most people with sun damage or thin skin benefit. I usually plan them in the months before surgery.
Should I have a brow lift with my facelift?
If your brows have dropped or your forehead contributes to a tired look, adding the forehead often makes the result look more complete.
Does everyone need a structural neck lift?
No. Some people have favorable anatomy where a standard platysmaplasty is enough. Others need the deeper structures addressed.
Is a lip lift worth adding to a facelift?
For patients with a long upper lip, I think it’s one of the details that makes the biggest visible difference.
Look Past the Facelift Label
When you compare surgeons, ask how they treat the skin, the neck, the forehead, and the lip, because that’s where good results become great ones. If you’d like to talk through which of those would make the biggest difference for your face, I’d love to meet you at my office in southwest Austin, toward Dripping Springs.
You May Also Like:
- Deep Plane vs SMAS Facelift
- How to Maintain Facelift Results
- Combining a Lower Face and Neck Lift
- The Real Reason You Have Hooded Eyes
- How Long Does a Lip Lift Last?
- Facelift Before and After Gallery
References
- Levin M, Frankel A. Thirty Years of Deep Plane Facelifts: Characterizing Outcomes and Longevity. Facial Plast Surg Aesthet Med. 2026;28(5):482-487.
- Suh DH, et al. Clinical and histological evaluation of microneedle fractional radiofrequency treatment on facial fine lines and skin laxity in Koreans. J Cosmet Dermatol. 2023;22(5):1507-1512.
- Wen YE, et al. Laser Resurfacing at the Time of Facelift Surgery: A Systematic Review and Meta-Analysis. Aesthet Surg J. 2026;46(4):441-453.
- Bogari A, Cakmak O. Deep Neck Contouring: Indications and Techniques. Facial Plast Surg. 2025;41(1):29-42.
