Why Some Facelifts Still Look Right a Decade Later

You have seen the pulled face. The cheekbones sit too high, the mouth stretches toward the ears, and the person looks startled rather than rested. That look comes from a surgical idea that dominated for decades: grab the loose skin and pull it back.

Dr. Steven R. Cohen, founder of FACES+ in San Diego, has spent his career arguing that the idea starts from the wrong diagnosis. His practice describes facial aging as four separate processes: sun damage, volume loss, laxity, and the wear that comes from years of facial movement. Tightening skin addresses laxity. The other three keep going.

Volume is the part most patients miss

Look at a photograph of yourself at 25 and one taken last year. The jawline may have softened, but the larger change often sits in the cheeks and around the eyes, where the face has thinned. Fat pads shrink and shift. Bone recedes. Skin loses the thickness that once hid the structure underneath.

A lift cannot put back what has gone. If a surgeon tightens a face that has lost volume, the result can look flat and hollow even when the skin is smooth. Patients often describe it as looking “done” without being able to say why.

Cohen’s answer is to rebuild before he lifts. FACES+ pairs a deep-plane approach with what the practice calls Injectable Tissue Replacement and Regeneration, a fat grafting method that uses the patient’s own fat to restore lost volume.

What deep plane means in practice

In a deep-plane facelift, the surgeon works beneath the muscle layer rather than just under the skin. FACES+ describes Cohen’s version as moving the underlying tissues vertically and slightly inward, reconstructing the ligaments that stretched with age. The skin moves because the structure under it moved, so it never carries the tension of the lift on its own.

That distinction decides how a face ages after surgery. Skin under tension relaxes within a few years. Repositioned deeper tissue holds longer, and FACES+ tells patients to expect results of ten years or more.

The practice reports that its regenerative fat grafting protocol retains about 80 percent of the added facial volume two years after treatment in patients under 55. It compares that with roughly 35 percent for conventional fat grafting. Those are the practice’s own figures, and they explain why Cohen treats volume as the foundation of the operation.

The neck is treated as its own problem

A refreshed face above an aged neck gives the game away. FACES+ evaluates every layer of the neck separately: skin, fat, the platysma muscle, and, where they contribute to fullness under the jaw, the submandibular glands. Some patients need a platysmaplasty to tighten muscle bands. Others need fat removed from beneath the muscle, which liposuction alone cannot reach.

Cohen’s practice calls the finished look a California facelift. The goal is a face that reads as rested and at ease, with no windswept contours and no sign of tension at the ears.

Recovery, and what to ask your surgeon

The practice’s published timeline is plain. Expect swelling, bruising and tightness for the first one to two weeks. Most patients return to light daily activity between day ten and day fourteen, can wear makeup after about two weeks, and avoid strenuous exercise for four to six weeks. Final results settle over several months as swelling resolves.

If you are weighing a facelift anywhere, three questions will tell you a lot about the surgeon’s philosophy:

• Which layer of the face do you lift, and why?
• How do you plan to address volume loss, and how much of that volume do your patients keep?
• How will you treat my neck, and which of its layers need work?

A surgeon who answers the first question with “the skin” is describing the operation that produced the pulled face.

The credentials behind the approach

Cohen trained in plastic surgery at the University of Pennsylvania and Children’s Hospital of Philadelphia, then completed a craniofacial fellowship at UCLA. He is certified by the American Board of Plastic Surgery, serves as a clinical professor at UC San Diego, and edits the fat grafting and stem cell section of the Aesthetic Surgery Journal. Newsweek has named him to its America’s Best Plastic Surgeons list each year since 2023, and its 2025 ranking placed him first for facelift surgery in Southern California.

FACES+ has operated in San Diego since 1999. Its facelift consultations include a full assessment of skin, volume and neck before any recommendation.