Many patients, particularly Caucasians, have both saggy skin and wrinkles. They can benefit from both the facelift and laser skin resurfacing procedures, so it makes sense to combine these procedures. Most of my facelift patients have at least some degree of laser skin resurfacing simultaneously at the time of their facelift. This includes almost all women. This is because women have thinner skin than men, tend to develop more wrinkles and are usually more concerned than men about facial lines. There is some truth to the old observation that wrinkles give men a distinguished look, but women just look old. Most men are more concerned about saggy jowls and necklines; treatment of wrinkles is secondary. Also, women can hide the redness that occurs after laser skin resurfacing more easily with makeup, which men are not yet as accustomed to using (this is changing).

For younger patients, it is best to start gradually, often with Botox^®, eyelid surgery, laser skin resurfacing or fat injection. These are popular procedures often done in a patient's thirties or forties and help to maintain a youthful appearance and prevent or at least delay the appearance of aging.

In the past, combined procedures were not done so much simply because there were few tools at the surgeon's disposal. As recently as the 1980's, when I was trained, endoscopic surgery, laser skin resurfacing and fat injection were not yet part of the plastic surgeon's armamentarium. At that time, combined procedures meant combining eyelid surgery with a facelift, which has been a common practice for decades.

Most patients over 45 elect to have combined procedures. Plastic surgical procedures may be likened to paints on an artist's palate. The more we have to choose from, the more lush the result. With many paints on the palate, we can achieve beautiful and dramatic results, outcomes which truly do take off years. Doing procedures together can give a congruous, top-to-bottom facial rejuvenation and actually produce a more natural look than a partial rejuvenation that rejuvenates one area of the face but not the other. The common disharmony of a tight neck and loose mid-face is avoidable.

However, combined procedures are not for all surgeons and not for the novice. To be an expert in combined procedures, one has to be expert in each procedure individually. The surgeon needs to be efficient to avoid excessively long operations. In my own practice, combined procedures rarely exceed six hours of operating time.

Typically, once patients elect to have laser skin resurfacing and a facelift, which has a substantial recovery phase, other techniques can be added on without significantly extending recovery time. These include an endoscopic forehead lift, eyelid surgery and fat injection. These additional procedures cause very little additional blood loss or tissue trauma and can be performed expeditiously by a skilled and experienced surgeon. In such a situation, the difference between recovering from a facelift and laser skin resurfacing and recovering from facelift, laser, forehead lift, eyelids and fat injection is negligible. The results are better and the recovery is essentially the same.