“Mini facelift.” “Total facelift.” “Deep plane facelift.” “Lower facelift.” “Facelift with fat transfer.” “Neck lift.” “Forehead lift.” “Endoscopic facelift.” Patients researching facelift surgery encounter a confusing array of terms — and the confusion is not their fault. Plastic surgeons of widely varying skill levels use very different techniques to “rejuvenate” the face, and they call almost all of those techniques some version of “facelift.” A surgeon who excises and pulls facial skin calls it a facelift. A surgeon who only performs fat grafting to the face calls it a facelift. They are not the same operation, and neither, performed in isolation, would meet the standard of an effective facelifting procedure. The result is that patients arrive at consultations believing all facelifts are essentially equivalent — and that misunderstanding can lead to poor procedure selection, unnatural results, and disappointment.

Dr. John Anastasatos has built his Beverly Hills practice around a more accurate framework: the face has three distinct anatomic regions, each ages differently, and each requires its own targeted intervention. Dr. Anastasatos has been an invited lecturer at the Royal Society of Medicine in London on advanced facelift techniques including the deep plane facelift, with an invited 2026 return as featured speaker. He completed his plastic surgery training under Dr. Luis Vasconez at the University of Alabama at Birmingham, the inventor of the endoscopic brow lift and one of history’s foremost plastic surgeons, whose tutelage shaped Dr. Anastasatos’s understanding of midface architecture and the deeper structural principles that guide procedure selection. The framework that follows reflects that training applied to the question every facelift patient eventually asks: which procedure is right for me?

The Three Thirds of the Face

The face divides into three anatomic regions, each with its own aging pattern and its own corrective procedure:

• Upper Third — Forehead, Brows, and Eyes: Brow descent, forehead elongation, horizontal forehead lines, vertical glabellar frown lines, and the upper eyelid hooding that descends along with the brow.
• Middle Third — The Midface: Loss of zygomatic (cheekbone) prominence, lower eyelid lengthening and tear-trough deformity, deepening nasolabial folds, drooping mouth corners, and jowl formation.
• Lower Third — The Neck: Platysmal banding, loose neck skin, submental fullness (“double chin”), and loss of jawline definition.

A patient may have aging in only one region, in two, or in all three. The right surgical approach is determined entirely by which regions need addressing — not by the marketing terminology of any particular practice.

If Your Concerns Are Concentrated in the Upper Face

Brow descent begins around age 28 in women and around age 30 in men. As the brows descend, they drag the upper eyelid skin downward and produce the appearance of upper eyelid hooding — which inexperienced surgeons frequently misdiagnose as an upper eyelid problem requiring blepharoplasty. In many of these patients, the actual problem is brow descent. Treating the eyelids while ignoring the brow produces a partial, unsatisfying result.

The targeted procedure for the upper face is the endoscopic brow lift — a minimally invasive procedure performed through three small (~1.5 cm) incisions in the hair-bearing scalp using an endoscopic camera and fine instruments, similar to the laparoscopic approach abdominal surgeons use. The procedure raises the brows, shortens the forehead, smooths horizontal and vertical wrinkles, “opens up” the eyes by relieving the brow descent that was causing apparent eyelid hooding, and corrects mild-to-moderate cases of upper eyelid ptosis without requiring formal upper blepharoplasty surgery. There are no visible scars, the patient does not look surprised or unnatural after the procedure, and most patients are recovered within a week.

This is, in effect, the “facelift of the upper third of the face.”

If Your Concerns Are Concentrated in the Midface

The midface is where a true facelift occurs. The five most visible signs of midface aging are loss of cheekbone fullness, lower eyelid elongation and tear-trough deformity, deepening nasolabial folds, drooping mouth corners that produce a “sad” expression, and jowl formation that softens the once-defined jawline. The cornerstone of midface rejuvenation is an anatomic structure called the malar fat pad — a dense formation of fibrous tissue, muscle fibers, and fat that gives the youthful midface its volume and lifted projection. As the malar fat pad descends with age, it produces all five signs at once: it deepens the nasolabial folds, drags the corners of the mouth downward, flattens the cheekbone area, increases the visible distance between the lower eyelid and the cheek, and creates the jowls that ruin the jawline.

The arrival of jowls is the single most common reason patients seek facelift consultation. The only ethical, effective, long-term treatment for jowls is a meticulous facelift — performed through incisions in front of and behind the ears that allow the surgeon to lift not only the skin but the deeper facial tissues that produced the jowls in the first place. (This is why thread facelifts cannot honestly be classified as facelifts: they act on skin only and cannot lift the deeper tissues required for a meaningful and lasting result.)

The technical core of the facelift is elevating the malar fat pad. Most facelift surgeons attempt to do this by elevating, undermining, and lifting a fibromuscular layer beneath the facial skin called the SMAS (Subcutaneous MusculoAponeurotic System). When the undermining of this layer is deeper and more extensive, the procedure is called a deep plane facelift. Most facelifts performed worldwide are conventional SMAS facelifts with limited SMAS undermining.

The variability in outcomes from SMAS facelifts is significant, however, because the SMAS layer can be weak and thin in many patients. A weak SMAS cannot effectively lift the midface. More effective techniques exist in which the malar fat pad and other key structures are repositioned directly. Regardless of the technique, the only meaningful measure of success is whether all five signs of midface aging have been addressed. A properly performed facelift takes approximately three to four hours because the work is delicate. Surgeons who claim to perform a facelift in an hour or less are not addressing the deeper structures — they are pulling and removing skin, which stretches again within a year and leaves the patient looking the same as before, or worse.

A Specialized Option: Minimally Invasive Midface Suspension (MIMS)

For appropriately selected patients, an exciting recent advance allows the midface to be addressed percutaneously — without the classic incisions in front of and around the ears. Dr. Anastasatos developed and named this technique MIMS — Minimally Invasive Midface Suspension — and it is closely related to his percutaneous facelift offering. The procedure uses specialized microsurgical equipment and a single 3 cm incision in the hair-bearing temporal scalp. Because no facial skin is cut or lifted, recovery is exceptionally fast — usually within three days.

The ideal MIMS candidate is a patient in their forties without significant face or neck skin laxity who has begun to show early signs of midface aging — particularly jowl formation and midface flattening — but is not yet ready for a comprehensive facelift. For older patients with established skin laxity, MIMS will not produce sufficient lift, and a traditional facelift remains the appropriate procedure.

If Your Concerns Are Concentrated in the Neck

Neck laxity is largely the product of changes in a broad paired muscle called the platysma — two halves of muscle extending from the undersurface of the jaws down to the collarbones. As the platysma relaxes and stretches with age, it pulls and stretches the overlying skin. Because the neck is often the first area to reveal aging visibly, patients tend to be especially sensitive to its appearance.

The targeted procedure for the neck is the neck lift — performed through a discreet incision behind the ear, sometimes combined with a small incision under the chin. The most effective neck lift technique creates a tight “corset” of the platysma muscle, which restores the sharp jawline definition of youth and the smooth neck contour that no non-surgical treatment can produce. For patients with submental fat fullness, chin liposuction is often combined with the neck lift in the same operative session.

A facelift is not a neck lift. A neck lift is not a facelift. They address different anatomy, use different techniques, and produce different results. A surgeon who performs a facelift but ignores the neck creates an unbalanced, unnatural result. The face and neck age together, and in most patients they should be addressed together for a truly harmonious outcome.

Matching the Procedure to Your Anatomy

A Note on Volume Loss

Aging produces both skin laxity and volume loss — and the right approach is rarely just to remove skin. Restoring the volume that has been lost, often through fat transfer, is frequently as important as lifting the tissues that have descended. Many of Dr. Anastasatos’s facelift patients benefit from fat transfer performed in the same operative session, restoring the cheek volume, temple fullness, and lip projection that surgical lifting alone cannot deliver.

What Actually Determines Your Result

The most important variable in a facelift outcome is not the procedure name. It is the surgeon’s understanding of facial anatomy, the depth of their technical training, and the aesthetic judgment they bring to each individual patient’s anatomy. The face and neck are among the most complex regions in plastic surgery — small differences in technique produce visibly different results, and the difference between a natural outcome and an obvious one comes down to surgical skill more than to any other factor. A surgeon who genuinely understands the underlying causes of facial aging — and who can offer ethical, effective, lasting solutions — will produce harmonious results that age gracefully. A surgeon who simply pulls skin will produce results that fail within a year.

Schedule a Consultation to Determine the Right Approach

The framework above is a starting point. The specific procedure that is right for your face requires an in-person evaluation of your anatomy, your stage of facial aging, your skin quality, your goals, and your tolerance for recovery. Dr. Anastasatos welcomes patients to his Beverly Hills office at 436 North Bedford Drive, Suite 202, Beverly Hills, CA 90210, for a private consultation that addresses these questions specifically and outlines the best surgical or non-surgical approach for your individual situation. Contact our office in Beverly Hills to schedule your facial rejuvenation consultation with Dr. Anastasatos.