Tag Archives: facial surgery

Looking Young with Face Lift?

Face lift surgery was first performed by a certain Madame Noel in Paris, France, in the early 1900s. Since then, face lift surgery has become a common cosmetic plastic surgery that has given thousands of men and women a younger and more attractive look. But is it true that people are looking young with face lift surgery?

There are a number of posts here in which I have written about how facelift surgery and facial rejuvenation is performed.





A recent study shows that what some cosmetic plastic surgeons have been telling their facelift patients for years may not really be true. For full disclosure, I have always been particularly careful to tell facelift patients that I cannot make them look younger, as I am not privy to fountain of youth secrets. As a plastic surgeon I have told my facelift patients that I am looking for a natural and rested look after the surgery. If a cosmetic patient wants to call that youth, so be it.

 Face lift photo

Face Lift study

A recent study took a number of subjects and showed them before and after photos of cosmetic patients who had undergone facial rejuvenation surgery and facelifts.

They were asked to rate patients on attractiveness and whether they looked younger after the facial surgery and facelifts.

The results of the study showed two interesting facts.

1. Face lift surgery does not make you more attractive

Attractiveness has more to do with basic facial anatomy and proportions than with aging or looseness of the skin. In fact, my plastic surgery professor taught me that some cosmetic patients were “BU”—basically ugly—and frankly beyond hope. One could pull skin tight, fill and remove fat and do all sorts of surgery, but the patient will ultimately remain BU.


2. Face lift patients were found on average to look three years younger

Three years is certainly not that much time, yet cosmetic patients who have facelifts do look better if they have been operated on by a skilled, board-certified cosmetic plastic surgeon. So what is going on?


After a face lift, patients do not look more attractive and barely look any younger. Yet face lifts continue to be performed at increasing rates, and patients seem to be happy with their surgical results. One answer may be that it is just removal of the signs of facial aging that give a rested look to the patients, who then sees themselves as looking “better” and feeling better and more confident; the idea is that it’s the inner youth and beauty that shines through.

How about that?


Morad Tavallali, M.D., FACS

Face lift and Facial Nerve Surgery

Face lift and facial nerve; Botox of the entire face


Face lift surgery has few serious complications, but one of them is injury to the underlying facial nerve. The facial nerve is the primary nerve for facial expressions and innervates face muscles. Plastic surgeons must know about face lift and facial nerve surgery .

Here are some articles about facelift surgery.



The facial nerve has a long and convoluted course.  It may seem boring to read this anatomy lesson, but you will need to have an idea of the subject so my next blog makes sense—that one is going to be unnerving (could not resist). Your cosmetic plastic surgeon is intimately aware of this anatomy.


First, as our facial nerve comes out of our brains, it gives off a few branches (chroda tympani) and stapedial (ear) and travels by the tragus cartilage in front of the ear to a higher level. Our facial nerve then splits into five main branches just in front of the ear but still under the facial muscles and gives a combination of sensation and movement to our faces. The nerve comes out to a superficial level past the pupil area. If a branch is damaged during facelift or facial surgery, it may take days or months before function returns.


Branches of the facial nerve

facial nerve


facial nerve photo

Deep Facial nerve branches

  • Chorda tympani – taste to front (anterior) 2/3rd of the tongue
  • Submandibular/sublingual gland
  • Stapedial branch – to middle ear stapes muscle


Superficial Facial nerve branches

  • Temporal – helps to elevate the eyebrow  
  • Zygomatic – helps the cheek to elevate

          – helps eye closure

         – reflex blinking of lids

  • Buccal – helps the corner of the mouth/cheeks to elevate
  • Marginal mandibular – depresses lower lip muscles
  • Cervical – tightens neck muscles


Facelift surgery

During facelift surgery, the skin of the face is elevated above the fat and muscles of the face. The fat and muscles are elevated and held in place with sutures. The skin is then pulled tight. All facelift surgery occurs in a level above the face muscles. The facial nerve runs below the muscles. Injury to the facial nerve during facelift surgery is hence rare if the surgeon stays above the facial muscles. The facial nerve does become more superficial, piercing the facial muscles as it gets closer to the nose. Injury can occur in the central part of the face.

More commonly there is a temporary lack of function of the facial nerve due to the local anesthesia that is placed in the skin of the face for facelift surgery. The anesthesia gives the same results as paralysis of the superficial branches of the facial nerve.


Botox and botulinum toxin and facial nerve

Botox treatments give very similar results in some cases to facial nerve injury or decreased function. The botulinum toxin will actually stop some of these facial nerve branches from working. If the botulinum toxin is put in the wrong areas, Botox can lead to serious side effects that will require therapy. This is why Botox is only recommended for specific areas of the face, such as the area between the eyebrows, the crow’s feet and the forehead.

So much for the anatomy lesson—stray tuned for the next blog, which shows someone with facial nerve paralysis!


Morad Tavallali, M.D., FACS

Cosmetic Lower Eyelid Surgery (Blepharoplasty)

Lower eye lid surgery or  blepharoplasty movie


Eyelid surgery


I recently posted a live movie depicting a cosmetic surgery of the upper lids; here is its lower eyelid surgery or blepharoplasty counterpart.

The Lower Eyelid Surgery involves removing excess skin from the eyelids. Next comes the removal of fat from three separate compartments. The surgery ends with closing the wounds. Like all video presentations of surgery, this has been edited so you don’t get bored. The real surgery takes ten times longer than the few minutes you see in the video!

Please follow the link below to view



Upper Eyelid Surgery (Blepharoplasty) Video

Cosmetic upper eyelid surgery (blepharoplasty): skin and fat removal

Eyelid surgery

Sometimes a video is worth more than words. This eyelid surgery, or blepharoplasty, is a bit gory to watch, so keep your finger on the “Stop” button! The lower eyelid surgery video comes next.





Upper eyelid surgery involves the removal of excess skin from the eyelids. Next is the removal of fat from two separate compartments. The surgery ends with the closure of the wounds. Like all video presentations of surgery, this has been edited so you don’t get bored. The real surgery takes  ten times longer than the few minutes you see!

Please follow the link below…


Morad Tavallali, M.D., FACS