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The Facial Aging
Process, Explained

Facial aging is a natural process in both men and women, typically becoming noticeable in the mid to late 40s and advancing over the following decades. It leads to distinct changes in the face and neck, often resulting in an older, more tired appearance. While many people remain physically and mentally active, this aging appearance can conflict with how they feel internally, prompting a desire for rejuvenation while maintaining a natural look.

Double Chin & Neck Contour Issues

One of the earliest signs of aging in the face is the development of fullness and excess fat in the neck area, often described as a “double chin” or, as it progresses, a “turkey gobbler neck.” This is characterized by increased neck fat and a loosening of the skin and neck muscles. This results in a less defined jawline and a fuller neck appearance.

Sagging of the Jawline and Midface

As aging continues, many individuals notice sagging or pouching along the jawline, known as “jowls.” This is primarily due to the loss of skin elasticity and weakening of the underlying muscles. Additionally, there is often a downward shift in the midface and cheeks, deepening the nasolabial folds (lines from the nose to the sides of the mouth).

Skin Texture Issues

The skin’s texture also changes with age, influenced by skin type and sun exposure. These changes include deep wrinkles, more superficial lines and etchings, dark sun spots, dry-looking skin, and a generally sallow appearance. These textural changes and progressive changes in facial features add to the overall aged look of the face.

The Primary Facelift: An Overview

The primary facelift, or rhytidectomy, is a surgical procedure to rejuvenate the face by addressing signs of aging. It involves removing excess facial skin, tightening underlying tissues, and reshaping the face’s contour. This procedure focuses on areas like the jowls, neck, and lower face to smooth out wrinkles and restore a youthful appearance. Often sought by individuals in their 40s, 50s, 60s, or beyond, the primary facelift offers significant and lasting aesthetic improvements with a natural, refreshed look.

Primary Facelift Treats:

  • Sagging in the midface
  • Deep creases below the lower eyelids
  • Deep creases along the nose extending to the corner of the mouth
  • Facial fat that has fallen or is displaced
  • Loss of muscle tone in the lower face, creating jowls
  • Loose skin and excess fatty deposits under the chin and jaw
  • Wrinkled or sun-damaged facial skin
  • Uneven skin tone or texture
  • Slackened skin and decreased elasticity
  • Overall tired or aged facial appearance

Why The Traditional Facelift Isn’t Enough

While effective in addressing sagging skin and deep wrinkles, the traditional facelift often falls short in treating all the signs of facial aging. It primarily tightens the lower face and neck but doesn’t address aging signs in the upper face, such as drooping eyelids or brows or excess fat deposits in the neck (double chin). Additionally, it does not improve skin texture, tone, or sun damage. Dr. Guida offers modern facelift techniques, known as a deep plane facelift, for more complete facial rejuvenation.

Dr. Robert Guida’s Approach: 3-in-1 Facelift

Dr. Guida takes a personalized, comprehensive approach to facial rejuvenation through the deep plane facelift technique, also known as the 3-in-1 Facelift. This method addresses the three primary signs of aging: sagging skin, loss of volume, and changes in skin texture. Unlike traditional facelifts that primarily tighten skin, this method works on a deeper level, repositioning underlying muscle and tissue for a more natural, youthful appearance.

Advantages of 3-in-1 Facelift:

  • Addresses multiple aging signs: sagging skin, loss of volume, and skin texture
  • Provides a more natural, youthful appearance
  • Targets deeper structural layers for longer-lasting results
  • Combines surgical lifting, liposuction, and lasers for comprehensive rejuvenation
  • Minimizes scarring and achieves a more subtle look
  • Effective for significant sagging and extensive aging signs
  • Reduces tension on the skin, leading to natural-looking outcomes
  • Suitable for a wide range of ages and skin types
  • Reduces recovery time compared to multiple separate procedures

The Elements of the 3-in-1 Facelift


Traditional liposuction is a cosmetic procedure for fat removal. It involves the mechanical removal of fat. After making small incisions, a thin tube called a cannula is inserted to suction out the fat. This technique is effective for removing larger volumes of fat. For patients with mild to moderate signs of aging and facial fullness, liposuction can be performed to remove excess fat deposits, correct a double chin, and tighten sagging skin.

CO2 Laser Resurfacing

CO2 laser resurfacing is a cosmetic procedure that uses focused, pulsed light beams to treat skin irregularities. The UltraPulse device and the MiXto SX laser are two popular CO2 lasers used in this procedure. The UltraPulse device is known for its precision and ability to deliver high-energy, short-duration pulses, effectively targeting and vaporizing the outer layers of damaged skin. This promotes the regeneration of a new, smoother skin layer while minimizing heat damage to the surrounding tissues.

The MiXto SX laser combines high power with a unique micro pattern to provide effective skin resurfacing with reduced downtime. Its fractional approach creates tiny microchannels in the skin while leaving surrounding areas intact. This stimulates natural healing processes and collagen production, resulting in rejuvenated skin with improved texture, tone, and elasticity. Both devices effectively treat wrinkles, scars, sun damage, and other skin irregularities, offering a more youthful and refreshed skin appearance.

Deep Plane Facelift

The deep plane facelift is an advanced surgical technique that goes beyond the superficial layers of the face to reposition deeper facial structures. Unlike traditional facelifts that primarily tighten skin, this method targets the deeper muscular layer known as the SMAS (Superficial Musculoaponeurotic System). By working underneath this layer, the surgeon can lift and reposition sagging muscles and fat, resulting in a more natural rejuvenation. This approach reduces tension on the skin, leading to more natural-looking results and minimized scarring.

This technique specifically addresses the mid to lower regions of the face, including the jowls and neck area. By repositioning the deeper layers of the face, it restores youthful contours and improves the overall appearance of aging skin. The deep plane facelift is particularly effective for individuals with significant sagging and who require more extensive rejuvenation than what less invasive procedures offer. The results are typically more dramatic and enduring, providing a refreshed and youthful appearance that aligns with the patient’s natural facial structure.

Consult Dr. Guida, Facelift
& Eyelid Surgery Specialist

Dr. Guida is a distinguished plastic and rhinoplasty surgeon based in Manhattan with over 25 years of recognition as one of the Best Doctors by the Castle Connolly Guide. He is double board-certified in facial plastic and reconstructive surgery and otolaryngology, and he takes the time to understand each patients’ unique goals and concerns. He receives multi-generational clients who trust him to deliver safe, consistent, and natural-looking results. Schedule a consultation with Dr. Guida today to explore your personalized facial rejuvenation options.

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