Short Incision Vertical Facelift with Extended Neck Lift

If you look older and more tired than you feel, consider a facelift in San Diego with our board certified facial plastic surgeon Amir Karam MD.

A normal and expected part of the aging continuum is the laxity that occurs in the soft tissues of the upper face, mid–face, lower face and neck. The tissues descend in an oblique direction as the deep facial fascia, SMAS (superficial muscular aponeurotic system), begins to thin and slide downward with each passing year. This is what we all begin to fear in our 40s and beyond—the sad, sagging skin of middle age.

As a result of that signature sagging of the soft tissues of the face and neck, the face is transformed from a youthful oval shape, with a smooth, firm jawline and neck, to an aged shape that is square along the jawline and loose–appearing in the neck. These changes in facial structure can instantly give away the individuals age; they no longer retain that healthy, fresh and attractive look of their youth, replaced by a haggard, tired face.

Although many alternatives and options are available, none exist that can effectively and completely correct the lower face and neck sagging as effectually as a properly performed facelift and neck lift. This is simply the gold standard in facial rejuvenation and the positive effects can last for decades beyond the procedure. We believe it is possible to restore that youthful, attractive jawline and neck in a natural, non–operative and beautiful way.

facelift patient
Short incision vertical facelift and extended neck lift
before and after necklift
Short incision vertical facelift and extended neck lift
before and after photo
Short incision vertical facelift and extended neck lift
before and after photo
Short incision vertical facelift and extended neck lift

Our Unique Treatment Approach

The Short Incision Vertical Facelift with Extended Neck Lift: The Invisible Facelift

Not all facelifts are the same. Most common, archaic techniques pull the face horizontally toward the ears, which simply doesn’t make sense; as we described above, the face descends in a downward, vertical and oblique direction. Pulling the face horizontally is where that tell–tale stretched or wind–swept look comes from—the tight, unnatural look that generates the stigmas around plastic surgery. Unfortunately, this is how most of our facelift techniques were described and taught over the last 100 years; this unnatural look comes from outdated and simply wrong techniques. Despite the pitfalls of the practice, many surgeons still perform this approach.

The most important outcome to reach through facial plastic surgery is a naturally rejuvenated and refreshed look. Repositioning the jowls and heaviness along the jawline and neck can have a powerful effect. Most patients can take a peek at the result by simply watching their reflection as they lift their faces upward and years of aging disappear. The upward direction that the patients use to lift their own face is the same action as our Short Incision Vertical Facelift with Extended Neck Lift. The results, especially when permanently applied through our techniques, are astounding.

The key here is the vertical lift. By repositioning the SMAS (many call this the muscle) back to where it started in youth, the face looks instantly refreshed, more attractive, healthier and of course younger. The goal of a facelift is to restore a youthful facial structure by repositioning the deep facial tissues to their original position. The goal is not to pull the face or to create a tight or strained appearance. When done well, the results are extremely natural, yet dramatic. No one, including close friends and family, can detect facelift surgery. Our patients simply look fresh, rested and more youthful through our specialized techniques developed by Dr. Karam, techniques you won’t find anywhere else.

Advantages of the Short Incision Vertical Facelift with Extended Neck Lift

  • Vertical lifting results in naturally restorative results
  • Consistency and reliability
  • Simultaneous lifting of the mid–face, lower face and neck
  • Low complication rate
  • Long–lasting results (5–10+ years)
  • Removal of the chin (submental) fat pad
  • Preformed under local anesthesia with IV sedation; no need for general anesthesia
  • Two week downtime
  • Ideal balance between excellent and natural results, low risk and brief recovery

Complimentary Combinations

The SI Vertical Facelift with Extended Neck Lift is designed to lift the lower jawline laxity, remove excess fat under the chin (submental fat pad) and tighten and redrape the loose neck muscles (platysma). The procedures that are most commonly combined with the SI Vertical Facelift and Extended Neck Lift are the Lateral Brow Lift, Skin Pinch and Fat Transfer.

The Lateral Brow Lift is an extension of the SI Vertical Facelift. As the soft tissue of the lower face is lifted vertically, the descending lateral brow and temple will become bunched if the outer brow and temple are not simultaneously raised. In order to create a balanced and seamless lift, the Lateral Brow Lift is combined in nearly all cases.

The Lower Eyelid Skin Pinch is commonly performed simultaneously with the SI Vertical Facelift, for the same reasons as the Lateral Brow Lift. When the mid–face and upper cheeks are lifted, the excess skin under the eyes become bunched as a result of the vertical lifting vector. This can make the lower eyelid skin look even worse than before the facelift. The Lower Eyelid Skin Pinch is performed to remove the excessive skin and create a soft, youthful transition between the lower eyelid and upper cheek.

Replacing the lost volume with Fat Transfer is an essential part of looking youthful and refreshed. Adding volume to the cheeks, under the eyes and around the mouth works synergistically to achieve a natural rejuvenation of the face. The Fat Transfer creates smooth, three–dimensional contours that compliment and enhance the lift. Without volume augmentation, the face can sometimes appear flat and maintain that aged tiredness.

Secondary Facelifts

With people living healthier and significantly longer lives, many want to continue to look their best and have a face that matches the way they feel inside. More and more people are returning for second or even third facelifts to maintain the youthful shape of their faces. There is no specific age restriction to limit these procedures, but the patient must pass the standard health criteria. These facelift procedures are preformed in a similar fashion to the previously mentioned facelifts. For individuals who have had a facelift that had a more horizontal vector or did not combine lifting of the neck or upper face, the Short Incision Vertical Facelift with Extended Neck Lift, combined with other complimentary treatments, can not only rejuvenate the appearance but also make the face appear more natural than with the initial lift.

Sometimes a second facelift is preformed to correct inadequate lifting from a previous procedure, even when it was recently preformed, or if the initial lift left an unnatural look. These are termed “revision facelifts.” Our practice in San Diego, has significant experience performing these procedures with very high success.


The advantage of the Short Incision Vertical Facelift and Neck Lift is that the incision is significantly shorter than with a standard facelift and neck lift. For the Extended Neck Lift, an incision is made in the submental crease (which is under the chin). Next, the submental fat pad is directly removed; this is essential for creating a smooth contour in the neck. This fat pad cannot be removed with liposuction because it’s between and beneath the neck muscles. The direct removal means a sculpted and youthful contour can be established and that the fullness will never come back. For the Short Incision Facelift, the incision begins along the temple hairline, then extends down and hides either within the natural creases of the ear or goes behind the tragal cartilage, ending behind the earlobe. Next, the skin is lifted off the fascia, and the SMAS and platysma muscle is lifted in an upward direction toward the temple, which tightens the neck, jawline and mid–face. The muscles and SMAS are fully tightened and secured with sutures. Next, the excess skin is removed and meticulously sutured. No drains are used during this procedure.

In cases where a Lateral Brow Lift is performed, the incision is extended toward the top of the temporal hairline and the skin is lifted off the superficial temporal fascia. Next, this loose fascia is lifted and tightened. Just like the facelift, the excess skin is then re-moved. This gives a subtle lift of the corner of the brow, improves the hooding on the corner of the eyes, and allows for a smooth transition toward the upper face.

Procedures and Anesthesia

Procedures are preformed in our accredited and certified (JCAHO and Medicare) surgical center, Carmel Valley Surgical Center, located within the suite in San Diego Ca. The center offers the highest level of safety and state regulations for outpatient surgery. Highly–trained and experienced surgical techs, medical assistants, nurses and a Board Certified Anesthesiologist all work together to create the safest and most comfortable experience possible. Carmel Valley Surgical Center in San Diego hosts two state–of–the–art surgical suites and a recovery center. The rooms are equipped with only the best equipment and instruments, and the center also has a separate entrance and exit from the main office, which allows our patients to undergo procedures in privacy. Your comfort is always our priority during these surgical procedures.

Perhaps one of the biggest advantages from a safety standpoint is that these facelift procedures can be performed under local anesthesia with IV sedation. With this technique, patients are comfortable, moderately sedated and without any discomfort. Most patients in San Diego choose this method to avoid any of the risks associated with general anesthesia. For those patients who do prefer general anesthesia, our facility is fully–equipped for general anesthesia.

Post–Procedure Care

Following facelift surgery, a head wrap gauze dressing is applied and patients return to the com-fort of their home or hotel room. Patients come back for an in–office check where the dressings are removed and the face is examined. Antibiotic ointment is used on the incisions for one week. A lighter dressing is used for a minimum of four days and recommended to be used at nights for one week. At one week, sutures are removed in the office. At this point, swelling is starting to resolve rapidly. Follow–up appointments are made at one month, three months, six months and one year to monitor healing and make sure all questions are answered.


Recovery is primarily related to swelling. Bruising is not commonly seen in our patients, although it is a possibility. The typical recovery takes between 10–14 days. We recommend planning two weeks off of work or social engagements to allow sufficient time to heal. Although healing is not completely finished by two weeks, most patients are sufficiently healed and can return to work and other occasions. Incisions, numbness and minor swelling continue to improve steadily for up to one year following the procedure. Exercise is resumed between three to four weeks following facelift surgery, depending on the nature of the activity and the degree of swelling involved.

Why Choose San Diego Facial Plastic Surgeon Dr. Karam for your Face and Neck Lift

An average Board Certified Plastic Surgeon performs 10–20 facelifts annually. Dr. Karam, on the other hand, preforms over 250 every year. Extensive experience translates to more natural results, more consistency and less variability, plus a distinct knowledge of different ethnicities and facial types and how to change the techniques to best suit the particular facial structure. Dr. Karam personally developed his innovative technique, Short Incision Vertical Facelift with Extended Neck Lift, based on new, modern techniques and with the natural course of face lifting in mind. Dr. Karam’s careful and intentional approach ensures that no one changes their identity, but simply looks refreshed and youthful.

Dr. Karam’s comprehensive approach, which involves combining these procedures with others, results in synergistic effects. The entire face looks naturally and vibrantly youthful, rather than hosting a single, unnatural element. In his his text book, Rejuvenation of the Aging Face, Dr. Karam describes his approach to facial rejuvenation and facelifting in order to teach the ingenious technique to other surgeons and colleagues. Dr. Karam’s expertise in the subject has also prompted him to write a number of book chapters and scientific articles on facial plastic surgery topics, including Short Incision Vertical Facelift with Extended Neck Lift.

And perhaps most importantly, Dr. Karam’s caring demeanor, good patient communication skills and responsive and knowledgable staff ensure you’re always comfortable and informed. It’s these particular skills that have earned Dr. Karam the trust to perform these procedures on his medical colleagues and their families.

Planning Your Consultation

During the facelift consultation, your expectations will be discussed and a personalized treatment plan will be proposed after careful examination and discussion of your goals. The basic criteria for timing of this procedure is dependent on two factors: first, whether there is enough laxity to justify lifting. This is evaluated by manually lifting the face in an upward direction and assessing whether the change results in a more youthful appearance. The second criteria is a patient’s readiness. Everyone has a different tolerance of the changes that occur as a result of aging. The average patient defines the changes seen in the mid–to–late 40s as the point when lifting would make a positive difference. The combination of their desire and the presence of mild to moderate face and neck laxity is used to determine when the time is right. In general, the earlier the better. The advantages of performing the surgery sooner are that the changes are less dramatic and more subtle, and the results last longer. More and more patients are utilizing these procedures as a way to maintain their appearance and prevent aging.

To discuss arranging your own consultation for a facelift, please call 858–259–3223 or send an email inquiry to San Diego facial plastic surgeon Amir Karam MD.

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