Published Jun 23, 2026
12 minute read
Many people know that something in their face looks different, but they’re not completely sure what they’re actually seeing. When we start seeing signs of aging, it's always something different.
Some people are more focused on their eyelids. Some think it’s their neck. Some are bothered by their jawline, but the real change may be higher in the face or tied to volume loss through the cheeks. They know they look more tired, heavier, or older. They just can’t always put their finger on why.
That’s what makes facial plastic surgery more nuanced than people expect. The face doesn’t age in one place only. The brow, eyelids, cheeks, jawline, and neck all change in different ways and at different times. A patient may come in convinced she needs eyelid surgery and turn out to be dealing with brow descent. Another may focus on the neck when the lower face and jawline are part of the same picture. Someone else may think she needs a lift when the real issue is volume loss.
A good consultation is where that gets sorted out. Once the source of the concern becomes clearer, the procedures themselves start to make more sense. But before your consultation, you should know a bit more about the common facial procedures and why we use each one. The more you know going into your consultation, the better equipped you'll be to get the outcome you want.
Most patients don’t come in asking for a facelift right away. They say their jawline looks softer. They say the lower face feels heavier than it used to. They’re noticing deeper folds around the mouth, early jowling, or a face that looks more tired even when they feel perfectly well. And they want to know what they should do about it.
A facelift may be the solution. A facelift is used to improve sagging through the lower face and jawline. It helps when the issue is descent and heaviness, not just skin texture. It can refresh the lower face in a way that fillers, skin treatments, or non-surgical procedures can’t. It won’t fix every sign of aging, and it isn’t supposed to. It’s aimed at a specific part of the face, which is why it can be so effective for the right patient and too limited for someone whose concerns sit elsewhere.
Some patients already know they’re interested in a facelift. Others have started hearing more specific terms, including deep plane facelift, and want to understand where that fits.
A deep plane facelift is still a facelift. The difference is in how the lift is performed and which deeper tissues are released and repositioned. From a patient’s point of view, the more useful question isn’t which phrase sounds more advanced. It’s which approach fits her anatomy, how much descent is present, and what kind of result she’s hoping for.
For some patients, the neck is the first place that starts to bother them. They notice loose skin, fullness under the chin, muscle banding, or a neck angle that looks softer than it used to. In those cases, the neck isn’t just part of the picture. It is the picture.
A neck lift treats those changes directly. A facelift improves the lower face and jawline. A neck lift focuses more closely on the neck itself. Some patients need one. Some need both. The answer depends on where the change is actually showing up and what’s driving it. If the jawline still looks fairly strong but the neck has become loose or heavy, the discussion may center around the neck first.
Some facial plastic surgery has nothing to do with aging at all. Rhinoplasty, or a nose job, is a good example. A patient may be bothered by the bridge, the tip, the profile, or the way the nose fits with the rest of the face, and they’ve had attention on it for years. In other cases, breathing is part of the concern too.
The nose sits in the center of the face, so even a small change can alter facial balance in a noticeable way. That’s why rhinoplasty is such a central part of facial cosmetic surgery. It’s feature-focused, but the effect reaches across the whole face. A patient may not be thinking specifically about plastic surgery, but she knows that her nose has never felt right on her face.
The upper face can be tricky because it’s easy to misread. A patient may think her eyelids are the issue because they look heavier. Then, on closer look, the brow has dropped and is pushing extra weight downward. That changes the whole conversation.
A brow lift, also called a forehead lift, is used when the brow sits lower, the upper face feels heavy, or forehead wrinkles and deeper lines between the brows have become more prominent. It treats a different area than facelift or neck surgery. That may sound obvious when you say it out loud, but it’s exactly the kind of distinction patients are trying to sort through when they look in the mirror and feel that something is off.
Some patients are bothered by a soft jawline because of loose neck skin. Others have a chin that doesn’t project enough to balance the cheeks, nose, and upper face. A chin implant can add projection to the lower face and improve the way the profile and jawline relate to the rest of the face. It may be considered on its own or with rhinoplasty, facelift, or neck lift.
The eye area is one of the first places people start to notice aging. Patients will say they look tired all the time, even when they’re sleeping well and feel fine. They may feel like their eyes look smaller, heavier, or more closed off than they used to. Others are more bothered by puffiness or bags under the eyes.
That’s where blepharoplasty, or cosmetic eyelid surgery, comes in. It treats excess upper lid skin, puffiness, and under-eye bags. Some patients need eyelid surgery. Some are dealing with brow descent. Some are seeing both at once. That’s why the eye area deserves a careful look.
Upper lid blepharoplasty primarily removes excess skin that can make the eyes look heavy. Lower lid blepharoplasty focuses more on visible fat pockets beneath the eyes. The brow also needs a close look, since a low brow can add weight above the eyelids and change what appears to be an eyelid concern.
Blepharoplasty is one of the most common facial plastic surgery procedures for a reason. The eyes change early, and they change the way the whole face reads.
Not every face looks older because it has dropped. Some faces look older because they’ve flattened out. The cheeks lose fullness, the under-eye area starts to hollow, and the face can look sharper, more tired, or a little drawn, even when the skin itself isn’t especially loose.
Facial fat transfer uses the patient’s own fat to restore volume in areas that have started to look hollow or flat. It can be placed in the cheeks, temples, under-eye area, or other parts of the face where lost fullness is changing the overall balance.
Because volume loss shows up in so many different ways, fat transfer can complement a wide range of facial procedures. Dr. Shermak may add this to a facelift, brow lift, neck lift, or eyelid procedure when lifting alone won’t address everything the patient is seeing. She also uses it with nearly every lower lid blepharoplasty to support the lower lid during healing and smooth the transition between the eyelid and cheek after the visible fat pockets have been addressed.
A lip lift is a smaller procedure, but it can change facial balance more than people expect. Some patients feel the upper lip has lengthened over time. Some notice less tooth show when they smile. Some feel the mouth area has flattened and want a structural change rather than temporary volume.
A lip lift changes the position of the upper lip. It’s different from injectables or dermal fillers. It’s a surgical adjustment in proportion, and for the right patient, it can make the mouth look more open and better balanced with the rest of the face.
Otoplasty belongs in this discussion because the ears affect the way the face reads as a whole. Some patients have been bothered by prominent ears since childhood. Others are more focused on asymmetry or shape. It’s not unusual for someone to feel self-conscious about their ears for years and then decide it’s finally time to address them.
It’s not an anti-aging procedure. It’s still part of facial plastic surgery because it changes proportion and balance. The same is true of a lot of facial procedures. They don’t all aim to make the face look younger. Some are there to improve appearance in a more targeted way.
Buccal fat removal is about contour. It’s used in selected patients who want less fullness through the lower cheek area. This is a different kind of conversation from facelift, neck lift, or brow lift. It’s less about looking refreshed and more about changing shape.
Some procedures are aimed at aging. Others are aimed at facial contour. Buccal fat removal falls into the second group. It’s a procedure that needs restraint and good judgment, because the goal isn’t to hollow the face out. It’s to refine fullness in a way that still suits the patient’s natural structure.
The face doesn’t age all at once, and it doesn’t age in one direction.
A patient may have lower-face heaviness, but the eyes are also starting to look tired. Another may want a sharper jawline, but the face has also lost volume through the cheeks. A third may come in focused on the eyelids, and the brow turns out to be part of the same picture.
That’s why some procedures are combined. One part of the face may need lifting. Another may need volume. Another may need skin removal. The goal isn’t to pile these procedures together. The goal is to match the treatment to what’s actually happening in each part of the face. That’s also why a consultation can change a patient’s initial assumptions. She may walk in focused on one detail and leave with a clearer sense of the full picture.
There isn’t one age when facial plastic surgery suddenly becomes appropriate. The right timing comes down to what has changed, how much it bothers you, and which procedure can address it.
Years ago, patients were more likely to wait until their 60s and address several areas at once. Surgeons sometimes referred to that approach as “TWT,” or “the whole thing.” A facelift, neck lift, eyelid surgery, and brow lift might all be performed as part of one larger plan.
Some patients are starting these conversations earlier. Someone in her 30s or 40s may want to address early jowling, a low brow, changes around the eyes, or the direction in which the facial tissues have begun to shift. She may choose one focused procedure now and consider another later. Facelift consultations among patients in their 30s and 40s have become more common, and smaller or earlier interventions may be considered when a patient’s anatomy supports them.
Men and women can both be candidates for facial surgery. Age alone doesn’t decide it. Dr. Shermak looks at the patient’s anatomy, skin quality, facial structure, health, prior procedures, and the changes that are causing concern. The face in front of her is more important than the date on your driver’s license.
When the issue is sagging in the lower face or jawline, a facelift or a deep plane facelift may come up. When a patient is bothered by looseness, fullness, or banding through the neck, a neck lift may be right. When the concern is heavy eyelids, puffiness, or droopiness around the eyes, blepharoplasty may be the better fit. When the face has hollowed, facial fat grafting or dermal fillers may help. When the concern is a specific feature, such as the nose, ears, or upper lip, we can look at rhinoplasty, otoplasty, or lip lift.
This is also where non-surgical procedures have a place. Botox, fillers, chemical peels, and other cosmetic procedures can help with early changes in the skin, fine lines, sun damage, and texture. They can do useful work. They just don’t do the same job as surgery when the issue is deeper descent, excess skin, or a structural problem.
Facial plastic surgery isn’t only cosmetic. It also includes reconstructive surgery.
A facial plastic surgeon may perform cosmetic procedures such as facelift, rhinoplasty, and blepharoplasty, while also handling reconstructive procedures after injury, prior head and neck surgery, skin cancer, or congenital conditions such as cleft lip. That side of the field focuses on restoring form or function after trauma, disease, or developmental differences.
Cosmetic surgery is about appearance. Reconstructive surgery is about correction and restoration. Some patients need facial reconstruction after an accident. Others need reconstruction after cancer removal, a scar problem, or structural damage involving skin, bone, or cartilage. Both are part of the same specialty. That’s one reason the field is broader than people think.
An initial consultation is where all of this gets more specific to you and your features. Dr. Shermak looks at the part of the face that’s bothering you, how the concern shows up at rest and in motion, what has changed over time, and what kind of result you want.
Some people need one procedure. Some need two. Some are looking for facial rejuvenation. Others are focused on one feature. From Dr. Shermak’s perspective, the point of the initial visit is to sort that out clearly and build a plan around the face in front of her.
