Your Questions

Q: Dr. Eppley, can you tell based on your extensive experience as a plastic surgeon what is the deal with the Lifestyle Lift? I see their commercials all the time and it just sounds too good to be true. They say nothing about that it is surgery but no cream or laser can produce those kind of results. Is it legitimate or a scam?

A: The Lifestyle Lift is both a tradename and a company that sells a form of a facelift surgery. It is a company that spends a lot of money every year to generate business for its franchisees so to speak. Its most popular TV ad is the one that features Debbie Boone who is the daughter of Pat Boone, a teen idol of many years ago and is still alive. (I just saw him on an infomercial for a whirlpool tub for seniors just this morning)

Like anything that is highly marketed, it is going to attract its share of detractors. While I haven’t done an official poll, I feel confident to say the whole Lifestyle Lift concept is probably not thought of highly by many board-certified plastic surgeons…at the very least for competitive reasons. And there is no question the company has had its share of legal entanglements brought on by a history of aggressive marketing practices.

But all the political and emotional issues aside, the company promotes its facial rejuvenation techniques through licensed physicians who enroll to be a provider in a certain geographic territory. It is surgery and it is a form of a limited facelift. Many of the patients seen in ads clearly have had other procedures done than just the Lifestyle Lift as many facelift patients are prone to need and do.

What turns off most board-certified plastic surgeons is that the Lifestyle Lift is marketed as a new and innovative procedure (I believe ‘break through medical procedure’ is what the ads say) which it is not by any plastic surgery standards. The most novel feature of it is the name as such facelift techniques date back decades in time. Doing the procedure awake and having it done in ‘just over an hour’ is obviously very appealing to patients but that does not necessarily convey that it is a superior surgical result or one that any sustained longevity. Since no scientific study has ever been published on the Lifestyle Lift  in terms of its technique or patient outcomes in any professional plastic surgery journal or presented at any plastic surgery meeting, it is easy to understand why many board-certified plastic surgeons are taken back by its claims in its ads.

A prospective patient should view the Lifestyle Lift like having any other consultation from a plastic surgeon. Take in the information, do your research and make your own educated decision about whether it is right for you.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Can you tell me anything about the Lifestyle Lift? Their commercials look great but I am skeptical. What is it that they do, is it surgery and how long will the results last?

A: Just like hamburgers and coffee, facelifts today are also a franchise business. The Lifestyle Lift is the most well known due to their large national advertising efforts and having been around for over ten years. While it often is not obvious in their commercials and advertisements, it is surgery and it is all based on a variation of small facelift. The other thing that is not obvious for their advertising is that many of the patients have had more than just a Lifestyle Lift to get the results that are shown.

There are numerous types of what I call franchised forms of so-called quick recovery facial tuck-ups which aare well known versions of limited facelifts or jowl tuck-up procedures. There is nothing magical or necessarily unique about the underlying procedure. They are all scaled down versions of a more complete facelift or a neck-jowl lift. It can be very effective if done well and will get years of sustained improvement which will vary by a patient’s skin type and genetics. I suspect the results could last anywhere from 3 to 7 years depending upon where one starts and how well one ages. The more relevant question, however, is whether this type of facelift approach is right for you. The vast majority of unhappiness with these franchised named ‘mini-facelifts’ is that the patient wasn’t a good candidate for it. Their facial aging issues were more advanced and they should have had a fuller facelift to get the kind of result that they were expecting. Patients understandably are tempted to choose a facelift rejuvenation operation based on how it would be done (local or IV sedation), a short recovery and/or a low cost rather than choosing a facial rejuvenation procedure(s) that best suit their needs. Like all cookie-cutter approaches, it works well for some people but not for others. Like any consult with a plastic surgeon, be educated, do your homework, and get different opinions.

Q: Dr. Eppley,  Hi. I read article you wrote online.  I had a “lifestyle lift” six weeks ago.  I had a mild turkey neck. After surgery I had a significant swelling in my mid neck bilaterally.  Now much of the swelling is reduced but my previously unseen thyroid cartilage is now revealed. (I am a woman.) In your experience does this ever go away or will I need revision?  Thanks so much for any help you can offer.

A:  Unmasking of the thyroid cartilage would suggest that you had a very good midline pull and recontouring from the Lifestyle Lift procedure. I don’t know whether you had platysmal muscle plication or not (you would know if there is an incision under the chin), but the lateral pull of the skin and the defatting of a platysmal separation and its reapproximation can create a very improved cervicomental angle. These standard facelift maneuvers can occasionally make the outlines of the thyroid cartilage evident, particularly in the thin patient with little subcutaneous fat.

There is no way to undo the lift to camouflage the thyroid cartilage again. Continued aging will eventually cover up the thyroid cartilage again bit that is obviously going to take time and there is no guarantee that it will do so. An alternative suggestion is to do a simple thyroid cartilage reduction (tracheal shave). This is a common procedure to reduce the jutting and prominent thyroid cartilage.

Dr. Barry Eppley

Indianapolis, Indiana

Without explanation, everyone seems to know what a neck wattle is. While not seen as an endearing neck ornament as one gets older,  this sagging piece of skin and fat is often a source of considerable anguish of one’s appearance.

The good news is that neck wattles can be successfully eliminated and usually much easier than one thinks. The trick is matching the proper solution for the size of the neck wattle. Some wattles are small, others are quite large. Different wattles need different approaches.

The two things that we know about neck contouring is what doesn’t work. There has yet to be a cream that has a real ‘neck rejuvenation’ effect. The winner in that transaction is always the seller of the magical potion. If there was a cream that could really change your neck, we would all know about it and it would cost thousands of dollars per jar. The other scam is that of neck exercises. If a neck wattle was really due to loose muscles, this approach might have some benefit. But it is loose skin and fat for which the ‘neck gym’ remains no better than those creams in a jar.

Getting rid of that neck wattle requires a necklift, also known as a facelift. There are different varieties of  these lower facial lifting procedures depending upon how the size of the wattle. Smaller or more limited versions are popularly known as Lifestyle Lifts. They are great for jowling but not for the bigger neck wattle. For a neck that hangs more, a full facelift is what is needed. It has a powerful change effect on making that neck more shapely and tucked up again.The difference between the two is the location and extent of the incisions around the ears and the time of recovery.

 To really change the neck in more significant wattles and sagging, the facelift must have an incision that goes up behind the ear and back into the scalp. It is the pull from behind the ear that draws up and tightens the loose skin in the middle of the neck. When needed, the extra recovery is worth the investment.

The other neck wattle surgery that few people have ever heard of is the direct necklift. It is the real wattle reducer and is the simplest of procedures to go through with but a few days of recovery. By cutting out the wattle directly, it is gone forever and creates a neck shape that will last for decades. The tradeoff for this simple wattle eliminator men is a fine line scar down the center of the neck. For men who have beard skin, this scar heals beautifully and may be the procedure of choice in the older male. For women, this potential scar must be considered very carefully.

Q: Dr. Eppley, I am interested in getting rid of my sagging jowls and neck. Do you think Thermage or radiofrequency treatments would work? If not, would you recommend a lifestyle lift or a mini lift? What about laser tightening for face & neck vs these lifts?

A: While I have never seen what you look like, I can only speculate about your neck and jowl concerns. However, almost any patient that I have ever seen with a sagging jawline and neck rarely would benefit significantly by any non-surgical or non-invasive treatment method. By and large, the use of non-surgical methods of neck and jowl improvement produce very minimal benefits and most patients would consider them unsatisfactory. They are best used when the patient has a very minimal problem or when the patient is fairly young with just the very beginning of any sagging. Most certainly, what often is paid for the hope of some of these non-surgical methods would have been better invested in a surgical solution. In short, any non-surgical method of jowl and neck tightening does not compare to the results achieved by more conventional surgical techniques.

There is no difference between a Lifestyle Lift, minilift or any other branded and marketing name for an operation that has been around for decades…a reduced version of a facelift. 

It is understandable why patients seek anything but surgery for their aging concerns of their lower face, but they often end up chasing a solution that does not exist…and waste money along the way.

Dr. Barry Eppley

Indianapolis, Indiana

Catching a glance in the mirror or looking at a picture and seeing those sagging jowls and a droopy neck can be a troubling finding. It often seems like it came out of nowhere. I have yet to see a person find this discovery charming. While hope lies in that some magic cream or laser treatment will make it all go away, deep down inside we all know it isn’t true. (but we can dream can’t we?)

When it comes to that loose jowl and neck skin, everyone wants to avoid the dreaded word…facelift. While most people are unaware that a facelift is really just a necklift, everyone would agree that they would like as little surgery as possible. While the fears and recovery surrounding a necklift are largely overstated, one really hopes that they can get by with a ‘minimal’ procedure. This understandable apprehension has led to the nationwide branded selling of facelift surgery.

The best example is that of the Lifestyle Lift. Through their national magazine and television ads, this is a franchise approach to getting a facelift…or some version of it. I have seen many patients who know the name, but don’t really know what it is. Promising to turn the clock back at least ten years and look recovered in just a few days, its catchy name seeks to assure patients that it will fit into their ‘lifestyle’. Interestingly, and perhaps not an oversight, nowhere in their advertising does it even suggest that it is real surgery. Many prospective patients only become aware that it is surgery when they actually visit a company facility.

What is a Lifestyle Lift? While sounding new, it is really quite old and has been practiced by plastic surgeons for decades. It is a scaled-down version of a facelift, a ‘mini-facelift’ if you will.  Sometimes called a tuck-up facelift, a secondary facelift, or a jowl lift, it is a limited operation that best improves those sagging jowls with a little tightening of the neck. The operative word here is a ‘little tightening of the neck’. If you have a neck wattle or turkey neck, this is not the right procedure for you.

Because it has an appealing name, the Lifestyle Lift has created a number of name knock-offs, including the Swiftlift and even the Lunchtime Lift to name just a few. Most of these are surgeons who have jumped on the naming and marketing bandwagon and have given their version of a limited facelift its own name. There is no real difference in the procedure or in whom it is or is not most beneficial.

Because it is heavily marketed and the internet exists, the Lifestyle Lift has its share of critics.  Much of this has to do with trying to make an individualized custom operation into a factory line retail product. As an operation, however, limited types of facelifts do have a valuable role in facial rejuvenation. Not every patient needs or wants a full facelift.

Facelifting is not an operation that should performed the same on everyone. Nor does having a catchy name mean it leads to better results or a quicker recovery. Many plastic surgeons offer similar limited types of  facelifts that just don’t have a branded name, but that doesn’t make them any less effective or useful.

Dr. Barry Eppley

Indianapolis

Q: I am interested in what a limited facelift or lifestyle lift might do for me or if I can get away with fillers or something like that. What is the comparative recovery time? Costs? How long do they last?

A: One of the common misconceptions in management of the aging face is that injectable fillers and some form of a facelift treat the same problems. They do not and, as a result, are not comparable treatments. They are often companions (done together or in separate stages) but are never substitutes for each other. Injectable treatment are for the central part of the face and do things that surgery generally can not either achieve or do very well. These include Botox for forehead and eye wrinkles and fillers for nasolabial fold depth reduction and lip wrinkle reduction and lip size increase. Any form of a facelift deals only with the sagging skin and excess fat in the neck and jowls, lower third of the face sagging.

There are procedures touted as ‘liquid facelifts’ but these are a bit (or maybe a lot) misleading and are associated, in my opinion, with a relatively poor value. By using injectable fillers, the sides of the face and cheeks can be puffed up which does create a mild temporary lifting effect due to the expansion of the tissues. The operative word is temporary (six months or less) and, when one compares the cost of numerous syringes of injectable fillers, one could already be more than halfway to one of the variations of a facelift. This injectable approach will also do nothing for the neck area which is the primary target of facelift surgery.

For the patient with lesser amounts of facial aging, the combination of a limited facelift (aka Lifestyle Lift) and injectable fillers can create a very dynamic effect by being able to treat the entire face more effectively. There is a very definite role and benefit to injectable fillers but their results are not comparable to facelift surgery.

Dr. Barry Eppley

Indianapolis, Indiana

For those who don’t know, the “wattle” is that fleshy fold of skin hanging down from the neck or throat. While not seen as an endearing piece of anatomy as one gets older, it is quite common in birds be it the pelican, common rooster or a Thanksgiving turkey. While it may be cute in a bird and makes it identifiable as a species, I have found no human yet that finds it flattering. Common amongst men and women alike as they get older, this sagging piece of skin and fat is often what bothers them the most about their aging face.

The wonderful world of digital cameras and cell phones have helped some people discover their neck wattles by seeing themselves in  side view in a picture. Men make the discovery when wearing certain shirts and often feel it ‘flopping’ around when they move their heads. (swinging a golf club seems to bring on this sensation)

The good news is that neck wattles can be successfully eliminated and usually much easier than one thinks. The trick is matching the proper solution for the size of the neck wattle. Some wattles are small, others are quite large. Different wattles need different approaches.

The two things that we know about neck contouring is what doesn’t work. There has yet to be a cream that has a real ‘neck rejuvenation’ effect. The winner in that transaction is always the manufacturer and seller of the magical potion. If there was a cream that could really change your neck, we would all know about it and it would cost hundred to thousands of dollars per jar. (wrinkles are one thing, wattles are quite different) The other hopeful but unsuccessful effort is that of neck exercises. If the loose neck was primarily due to muscle looseness, this approach might have some benefit. But for the skin and fat that has become loose and is sliding off the face into your neck, the ‘neck gym’ remains more theoretical than useful. Neck exercising will have about the same benefit as it would for lifting the sagging breast or those eyebrows that just keep getting lower.

While many people would consider having a necklift, they wouldn’t dare undergo a facelift.This comes from a misunderstanding of the two procedures, not realizing that they are largely one and the same.  I have found only a handful of patients who have ever actually known what a facelift really was. A facelift is really a necklift. But facelifting comes in two varieties which differ based on how much improvement in the neck is needed. A limited facelift (popularly known as a  Lifestyle Lift or jowl lift) is great for jowling but not so much for the neck wattle. For small neck wattles, a Liftstyle Lift combined with liposuction in the neck may just do the trick. For a neck that hangs more, a full facelift is what is needed. It has a powerful change effect on making that neck more shapely and tucked up again.The difference between the two is the location and extent of the incisions around the ears. To really change the neck in more significant wattles and sagging, the facelift must have an incision that goes up behind the ear and back into the scalp. It is the pull from behind the ear that draws up and tightens the loose skin in the middle of the neck.

The other neck wattle surgery that few people have ever heard of is the direct necklift. It is the real wattle reducer and is the simplest of procedures to go through with but a few days of recovery. By cutting out the wattle directly, it is gone forever and creates a neck shape that hasn’t been seen for decades. The price for this most effective and simplest of wattle solutions is a fine line scar down the center of the neck. For the beard skin of men, this scar heals beautifully and may be the procedure of choice in the older male. For women, the location of this scar must be thought about carefully to determine if this is a good trade-off.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I am interested in having a jawline tuck procedure. The only part of my face that bothers me as I have aged is along the jowls. That is the only place where I have some excess skin that affects my appearance. Please tell me where the incisions area and what part of the face this operation does, and does not, affect. Thank you!

A: Basically, a jawline tuck is a simple modification of a limited or mini-facelift. It is similar to the advertised and marketed ‘Lifestyle Lift’ which is a franchise approach that offers a very similar procedure. As the name would imply, it is a facial rejuvenation procedure that has very little downtime hence the branded name. The fine line incision starts at the top of the front of the ear, goes inside the ear behind the tragus, and then around the back of the earlobe. Through this hidden incision, any loose skin along the jawline (jowls) is lifted smoothing this area out. There is some benefit in the neck area but not as significant as that of the jowls. This procedure is as described….a tuck for the jawline or jowls. It does not affect any other part of your face.

Many times other facial procedures are done with this ‘little’ facelift such as neck liposuction, laser resurfacing or chemical peels, and eyelid tuck procedures. But when done alone, there is less than a week of any visible swelling and bruising so recovery is quite rapid.

The key concept to grasp is that a facelift is an isolated jowl and neck procedure. A limited facelift or jawline tuck is just a smaller version of it.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I am tired of looking older. My jowls are getting bigger and my neck is starting to really sag. I hate to consider the thought of a plastic surgery procedure like a necklift but I am going to have to do something in the near future. I don’t mind getting old per se, I just don’t want to look old! I have read that there are different types of facelifting procedures. How do I know which one will work for me?

A: A facelift is a plastic surgery operation that changes the lower third of the face, the neck and jowls only. So it is a good match for the jowl and neck issues which bother you. Like many plastic surgery procedures, there are different ways to do them and they come in different ‘varieties’. No one type of facelift is right for everyone. Your plastic surgeon must ‘match the solution to the problem.’

Fundamentally, a full facelift changes both the neck and jowls and is best for someone whose primary problem is their neck. The jowls get improved as well and get swept alone in the changes that occur far away in the neck. The mini-facelift, aka Lifestyle Lift as called by some, changes the jowls primarily and a little bit of the neck. Any limited improvement in the neck is the result of the changes that have occurred in the jowls. The mini- or limited facelift is best for someone whose primary concern is in their jowls. Since jowling proceeds any significant changes in the neck, one can appreciate why a limited facelift is for younger people who have less signs of facial aging.

Another way to think about it is by looking at the incisional pattern around the ears. Mini-facelifts have use an incision that runs into and around the front the ear. Pulling upward from there only impacts the jowls primarily. A full facelift uses incisions in front of and behind the ear. By moving tissue upward from behind the ear, excess neck skin can be worked out to be cut off behind the ear. 

Dr. Barry Eppley

Indianapolis Indiana

Q: As I am getting older, I don’t like my neck which is getting looser and lower. I think I may need a facelift but am scared to death to go through it and it will likely cost more than I have. I have read and seen pictures about the Lifestyle Lift and that really interests me as it doesn’t look like surgery is needed and the results are great. Do you think that will work for me?

A: As we age, the very common signs of facial aging is in the development of a saggy neck and jowling. These loose facial skin issues are exactly what a facelift treats, contrary to what many patients believe that a facelift is.

Facelifts can be done in a variety of ways but fundamentally there are two types, limited and full. For smaller neck and jowl issues, a limited facelift can be a very good rejuvenative procedure. For larger neck wattles and jowls, a full facelift is often needed to get the best result.

The Lifestyle Lift, a tradename and franchise approach to delivering cosmetic facial surgery, is a variation of a limited facelift. Many patients have commented to me that they did not think it was surgery based on the ads and the TV commercials. But a Lifestyle Lift is surgery and can be combined with a wide variety of other facial procedures and injectable treatments. Usually a combination of ‘small’ procedures can collectively create a significant facial improvement.

The limited facelift approach has been around for a long time, dating even back to the early part of the 20^th century. It has re-emerged in popularity today because younger patients are seeking facial improvements. They don’t want to wait until they need a complete facelift and have such a dramatic change. Plus, they want to maintain a more youthful appearance as they are in their prime work years. About half of the facelifts I now do are of the limited variety because it fits many patient’s age, lifestyle, and budget.

When you see a good before and after picture of a significant facial change, you should know that is not possible without some form of surgery. There is no magical cream, laser, and other ‘magic’ that can create what a facelift operation can do. We all would like there to be but it does not exist. Remember a basic plastic surgery rule…’small changes require only small procedures, big changes come from big procedures.’    

Dr. Barry Eppley

Due to the marketing and appeal of a facial rejuvenation procedure called the Lifestyle Lift, many people have at least heard of it. A scaled-down version of a facelift, the Lifestyle Lift is not unique or new but is actually a common procedure performed by many plastic surgeons. Todays trend toward less invasive plastic surgery and beginning facial rejuvenation earlier has led to the marketing of an otherwise routinue facial procedure.

Unknown to most, the Lifestyle Lift is a branded name and is a blended marketing and service approach to delivering minimally invasive facelift surgery. In essence, it is a franchise approach to selling surgery with office locations in 22 states. (the closest office to Indy is in Cincinnati)

While there is nothing wrong with that concept, the Lifestyle Lift company was recently fined $500,000 in New York where its corporate headquarters is located.. The attorney general there has settled complaints against the company as it has admitted that it used its employees to pose as satisfied customers in online ads. Apparently the company ordered employees to write positive reviews of the Lifestyle Lift on message boards and other internet forums to appear as unsolicited testimonials and endorsements, thus violating consumer protection laws. (proving once again that www. really means the wild wild west…believe at your own risk!)

While the company and the way it operates may have some deceptive marketing practices, the actual operation however is still a sound one. The limited facelift or short scar facelift (a.k.a Lifestyle Lift) is very popular and highly successful. It is a scaled down version of a more extended facelift into which many other smaller facial procedures can be added as well.

Younger patients today want to treat jowl and neck sagging early rather than wait until it looks worse. Therefore, their facial concerns are less severe and they do not need a full facelift operation. The limited facelift is often combined with other smaller procedures (e.g., Botox, injectable fillers, laser resurfacing, neck liposuction, eyelid tucks) to create an even better overall result without extending one’s recovery.  Older patients (who really do need a bigger operation but do not want it) can still get a simpler and less invasive operation that will provide some real improvement. (although less than that from a full facelift) This usually fits their financial situation and allows them to have surgery that they can afford with a recovery that fits into their work or leisure schedule.

Dr. Barry Eppley