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Remove Wrinkles, Jowls, and Sagging with a Facelift

Signs of aging most often appear first on the face. Midface sagging, marionette lines, jowls, and a double chin can all make you look older. A facelift, also known as a rhytidectomy, is the most comprehensive and definitive way of treating wrinkles and facial sagging associated with aging and is performed regularly by the plastic surgeons at Hill Country Plastic Surgery. This is considered the gold standard in the treatment of facial aging.

In San Antonio, fellowship-trained plastic surgeons Dr. Scott Farber and Dr. Amita Shah are industry leaders highly experienced in facial plastic surgery, with years of extensive and intense training. Dr. Farber specializes in facial aesthetic surgery, drawing on his extensive experience and training to restore contours that look both youthful and natural. Their philosophy is not to just create a lifted neck and jowls, but also recontour the face so you look like a beautiful, younger version of yourself.

They recognize that each and every face requires an individualized approach to restore the appearance of youth and use a wide variety and combination of techniques to achieve this goal. In the end, you will have the most natural-looking results that celebrate your true beauty.

Because facelift surgery can create such dramatic results, it is important to work only with a plastic surgeon who has experience with the specific procedure and who has a thorough knowledge and understanding of facial anatomy.

What Makes me a Good Candidate for a Facelift?

  • Sagging skin in your midface, jawline, and/or neck

  • Pronounced nasolabial folds, which are creases that run from your nose to the corner of your mouth

  • Sagging, crepey skin of the neck area

  • Loss or drooping of facial volume (particularly in the cheeks)

  • Jowling, which is sagging of volume in the lower face along the jawline

  • A double chin (a result of loose skin and extra fat along the jawline and chin)

  • Marionette lines, which are creases extending from the corner of your mouth to your chin

Dr. Farber and Dr. Shah can also perform a revision facelift and/or neck lift in the San Antonio to address issues you may be experiencing from a previous procedure. They generally work with patients seeking revisions a year or longer after their initial surgery.

The extent of a facelift can vary from a “mini” facelift, to a more extensive neck lift and facelift. A facelift removes excess skin, tightens the underlying facial tissue, and elegantly redrapes the skin of the face and neck, restoring a youthful facial contour, jawline, and neck. There is some downtime associated with a facelift, and it will not create a “new” you, it will simply restore a more youthful appearance. Sometimes, a facelift will need to be redone in 10-15 years, and that is patient dependent.

Some patients are not ready for surgery and prefer nonsurgical treatments, such as dermal fillers, tightening radiofrequency, and BOTOX®, which provide a shorter-term, less dramatic rejuvenation. With these non-invasive options, you can expect to achieve about 30 percent of what you would get with a facelift.

How is a Facelift Performed?

Both Dr. Farber and Dr. Shah work with each of their patients to create a customized treatment plan that will allow achievement of the best results. The goal of a facelift is to tighten the underlying tissue but not overtighten the skin, leading to beautiful, natural-looking results and avoiding the “pulled” look. A facelift will have a lasting, powerful effect on the contour of the neck and jawline, restoring your appearance to that of 10-15 years younger.

For a full facelift, the incision is placed behind the hairline and in the natural crease around and behind the ear. For a mini facelift, the incisions are more limited and are behind the ear with some extension into the crease under the ear, depending on how much skin needs to be removed. For a lower facelift/necklift, the incisions start behind the ear, backwards along the hairline, and may extend in the natural crease in front of the ear as necessary to remove skin.

These incisions allow your plastic surgeon to remove any excess skin and fat, as well as to strategically reposition facial tissues in order to restore youthful volume. The remaining skin is lifted and sutured in place over the restored contour for a firmer facial appearance, redefining the jawline and reducing wrinkles and sagging.

What is a Mini Facelift?

A mini facelift is a less-invasive surgical option than a full facelift that is designed to address sagging skin on the lower face and jowls. By using smaller incisions, a mini facelift tightens and raises the tissues of the jawline and lower face. Depending on your needs, it can sometimes be performed under light sedation and local anesthetic. The mini facelift is less invasive and less expensive than a full facelift and requires 7 to 14 days for recovery, as opposed to two weeks of downtime. If the area bothering you is your neck, then a neck lift or mini facelift would be a better choice. Dr. Farber and Dr. Shah will review all of the options with you and create a surgical plan tailored specifically for you.

What Things Can be Done to Enhance my Facelift?

Facelifts are often combined with fat transfer to the cheeks, jawline, chin, or lips to volumize or augment these structures, giving your face a more natural, balanced appearance. A fat transfer refers to the process of taking fat from your abdomen or other problem areas and injecting purified fat tissue into another area of your body. The goal of the procedure is to improve the fullness of the cheeks, nasolabial folds, jawline, or lower eye area, giving extra volume to the facial structure. This procedure may also be combined with a laser or chemical peel skin resurfacing to treat the fine lines and wrinkles around the mouth.

The jawline, chin and neck areas can be targeted by liposuction to remove fatty deposits and create a more contoured and enhanced appearance. It can be done in conjunction with laser or traditional facelift procedures.

Why Should You Choose the Surgeons at Hill Country Plastic Surgery?

Both Dr. Farber and Dr. Shah were fellowship-trained at the most prestigious institutions and their techniques for delivering patient results and satisfaction set the standard for plastic surgeons in the field. They use the most advanced techniques and consistently achieve superior results. Their warm demeanor, genuine care, and dedication to their patients are second to none. Ultimately however, patients choose Dr. Farber and Dr. Shah for the results. Their patients look and feel their best, and so can you. Discover the difference here in San Antonio!

What to Expect During Your Consultation Visit

During the initial consultation with your surgeon at Hill Country Plastic Surgery, we will discuss your concerns and goals before recommending treatment options that are tailored specifically to your needs. Prior to your consultation, we recommend that you review the procedures on our website so you are familiar with the terms we will be using during our discussion.

Once we identify your concerns and surgical goals, we will discuss all of the treatment options that are available to you. Every patient is unique and we will develop a tailored surgical plan that addresses your specific goals. In addition, we will thoroughly review your medical history, surgical history, medications, allergies, family medical history, and other important details. It is very important that we obtain accurate information in all of these areas as it may impact the outcome of your surgery.

While discussing different treatment options, we will perform a physical exam and take measurements that are necessary for planning for your surgery. Pre-operative (before surgery) photos will be taken either at your initial consultation, or during your pre-operative visit.

After your consultation, you will receive access to your notes on the patient portal in addition to information about your specific surgery. If you have not activated your patient portal, this can be done at your appointment by asking any of our staff to assist you. If you have questions after your appointment, you can contact our office or message us through the patient portal. Some patients will require medical clearance from their primary care physician or a specialist or additional tests before undergoing surgery.

Once you have determined that you would like to have surgery and have completed any clearances and tests that were requested, contact our office at (210) 658-3555 to schedule a pre-operative appointment with one of our surgeons.

Pre-operative Appointment

On the day of your pre-operative appointment, we will review your procedure in detail and go over the surgical plan with you. We will also address any questions and concerns you may have. Please read over the procedure consent prior to this appointment and have any questions ready so we can discuss them.

During your pre-operative visit, we will provide you with all of the after-care instructions as well as necessary medication prescriptions. Prior to your surgery you will get lab testing and depending on your age and health, EKG and/or chest x-ray. You will also be provided with a post-operative appointment for follow up after your surgery.

Before the Day of Surgery

Please do not smoke (cigarettes, vape, or pipe) or use any nicotine products 4 weeks prior to and after your surgery. Smoking and nicotine greatly impair healing, which can cause increased risk for infection and complications, such as delayed incisional healing or wound opening which lead to worse scarring. Please stay away from second hand smoke as well, as this can also cause wound healing problems. If you use nicotine products, you will need to stop 4 weeks prior to surgery and then you will need to undergo a cotinine test prior to surgery to ensure that the nicotine is out of your system.

Please do not drink alcohol before or after your surgery (until cleared by your surgeon). In addition, please do not drink alcohol while taking pain medication, as this can have serious, and life threatening side effects.

Please leave all valuables at home. If you have body piercings, kindly remove them prior to surgery.

Please have someone available to drive you home. Due to the lasting effects of the general anesthesia, you will be unable to operate a car after surgery. A taxi or car service is not adequate either. You will need a family member or friend who can assist you.

You may have been asked to obtain pre-operative tests at a lab facility or your primary care physician. Your pre-operative tests (labs, X-rays, EKG, etc) need to be completed at least three days before your surgery. If you have them done at your doctor’s office, the results will need to be faxed to (210) 362-1582.

The surgery facility will call you the day before your surgery to let you know what time and where you should arrive.

Shower the morning of or the night before your surgery with your normal soap and water. Do not use deodorant, lotion, cream, perfume, aftershave, oils, or makeup after bathing.
Do not take Advil, Aleve, Naproxen, Fish Oil, Garlic, CoQ10, Omega 3,6, Motrin, Excedrin, Ibuprofen, Aspirin, medications for arthritis or any medication that contains these medications for ten days prior to your surgery and two weeks after.
Do not eat or drink anything after midnight the night before your surgery.

Please call our office if you have an infection of any kind prior to your surgery.

Day of Surgery

On the day of surgery do not take the following blood pressure medications with generic names that end in “-pril”, “-sartan” before your surgery. If you are on metformin, you will be asked to not take it on the day of surgery.

On the day of surgery, your plastic surgeon will meet you in the pre-operative area to go over any last minute questions or concerns you may have. Your plastic surgeon may make some preoperative markings and will perform extensive checks with careful attention to detail, ensuring high quality care and safety. You will meet the anesthesiologist and their team, as well as the members of our plastic surgery operative team.

During the plastic surgery procedure, our plastic surgeons pay meticulous attention to detail and work as a highly experienced team to ensure a great result. Your family will be updated of your status periodically and will be able to talk with the plastic surgeon in person after the procedure is completed. The incisions will be placed in a dressing or a compression bandage. Instructions for care on these will be given to you in your preoperative paperwork.


In order to make your recovery faster and more comfortable, we recommend that you prepare before your surgery. Things you can do are:

●      Prepare a sleeping area that is easy to get to. For example, set up a couch downstairs instead having to walk up to an upstairs bedroom. Keep your toiletries close by and prepare food ahead of time. Arrange for someone to be with you the first night after surgery.

●      You may receive your post-operative medications at your pre-operative appointment. You should pick up these medications prior to your surgery.

●      If you’re having an outpatient same-day procedure you will be released to go home the same day and will need someone to drive you home.

●      Review your post-surgery instructions given to you at your pre-operative appointment

If you have a history of nausea or vomiting after anesthesia, please let us and your anesthesia provider know. We can prescribe anti-nausea medications and take extra steps to prevent nausea and vomiting after surgery.

When undergoing general anesthesia, you will need to have someone drive you home. You will not be allowed to undergo surgery if there is no confirmed designated driver.


After surgery you will have discomfort and the goal of pain medications is to reduce pain, but it will not completely remove all pain. A good measure for if you need more pain control is that you should be able to take a deep breath without severe pain. Do not wait until your pain is unbearable to take the next dose of pain medication because it will take longer to get your pain under control again.

You may resume your home medications after surgery except blood thinners and as determined by your surgeon. We will give you a prescription for a pain medication. If you are prescribed medications that contain acetaminophen (tylenol) it is important that you not exceed 3500 milligrams of acetaminophen (tylenol) per day.. Do not drive, operate heavy machinery or make important decisions while taking narcotic pain medications.

Narcotic medications may cause constipation. Ensure you have adequate (>25 grams/day) of fiber in your diet and drink at least 64 oz. of water daily. You may also wish to take an over the counter stool softener such as Miralax or Colace once or twice daily.

You can alternate your narcotic medication with Ibuprofen 600mg every 6 hours and/or Gabapentin 300mg three times a day.   Take ibuprofen with food to protect your stomach from irritation.

If you have a history of nausea or vomiting after anesthesia, you may be prescribed an anti-nausea medication (Ondansetron) which can be taken as needed.

Before prescribing any narcotic medications, we are required to check the Texas controlled substance history database (Texas Prescription Monitoring Program). If you currently have a pain medication contract with another physician or are currently on narcotic medications, we will have to coordinate your medications with that physician.

We will prescribe pain medications for recovery after surgery, but do not prescribe long-term pain medications and do not do more than one refill for any pain medications. If you have pain that is beyond what is usually anticipated for your surgery and there is no surgical reason that can be found, we will help by referring you to one of the many pain management specialists that we work with.

Surgical Site Care:

You may shower 48 hours after your surgery. Do not scrub the incisions, just let the water run over them and gently dab them dry afterwards. Apply gauze over the surgical site daily as needed for light drainage. Do not immerse your incisions in baths or hot tubs until at least 2 weeks after surgery or when cleared by your surgeon.

Right after surgery, you will be placed in an abdominal binder or a compression garment. You should wear the compression garment at all times except when showering for the first 6 weeks.

Drain Care:

Sometimes it is necessary to place a drain after surgery. The purpose of a drain is to remove excess fluid from the surgical area. Empty the bulbs and measure the output whenever the bulbs are half full or at least twice a day. You will be given a sheet to record how much is coming out of the drains. Bring this sheet to your follow-up appointment. In general, drains remain in place until there is less than 30mL (1oz) out of the drain for two days in a row.

Please Call Immediately if:

Please call if you have the following signs/symptoms:

●      temperature greater than 100.5 F

●      bleeding or pus draining from the wound site. If you have bleeding, apply direct pressure to the area for 20 minutes

●      increasing pain that is not controlled on oral pain medications

●      increasing redness or size at the surgical site

●      your drain is not holding suction

●      if your incisions come apart

●      Any other concerns

For non-emergency questions:

During business hours (8 AM – 4:30 PM): call (210) 658-3555.

After hours and on weekends/holidays: call (210) 658-3555 and you will be forwarded to the on call surgeon.

If you are having any serious problems or symptoms such as difficulty breathing or chest pain, call 911 or proceed to your nearest emergency room.

Activity restrictions:

No vigorous activity: no pushing, pulling, bouncing, housecleaning, yoga, running, heavy lifting greater than 5 lbs until your follow up appointment. Avoid activities that raise your blood pressure or heart rate. You are encouraged to walk around and you can climb stairs after surgery. You should not lay in bed and not move.

Follow-up Clinic appointment:

Your clinic appointment will be scheduled at your pre-operative appointment before surgery. If you need to change your appointment time or date, please contact our clinic at (210) 658-3555.

Limitation, risks, complications

Risks of the procedure include risks of anesthesia, bleeding, infection, fluid collections, opening of the incision, widened scarring, numbness on the abdominal wall, skin discoloration, recurrent looseness of skin, deep fat may die (fat necrosis), deep vein thrombosis, cardiac and pulmonary complications, asymmetry, need for revisions, persistent pain.

The surgeon may adjust any of the above guidelines and instructions based on the patient and type of surgery performed.

Facelift FAQs

Most of our patients experience little to no pain the day after surgery. In the operating room, they receive a local anesthetic that helps control pain during the day of surgery. We provide specialized aftercare instructions to reduce swelling and discomfort. Our team will also recommend supplements to help reduce swelling and bruising after surgery.

Recovery time after a facelift is about 2 weeks. During the first week, patients may experience some swelling and bruising. During the second week, patients may begin to go out in public. After the second week, patients may resume typical day-to-day activities. Our two-week protocol optimizes the recovery period, making recovery last about the same length as for most nonsurgical options!

It is important to note that recovery time varies from patient to patient, depending on medical conditions, extent of surgery, and other factors. After a facelift, patients are advised to keep their head elevated while sleeping, apply a cold compress when needed, and avoid exercise and other strenuous activity.

The cost of a facelift varies from patient to patient. All faces are different, and some need more correction than others. It is recommended that you come in to see the surgeons at Hill Country Plastic Surgery to get your customized facelift consultation.


Are you interested in learning more about this procedure? To schedule a consultation, please contact us. Hill Country Plastic Surgery is the premier plastic surgery center in the San Antonio area, and our friendly team members are here to help you and will reach out promptly.

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