Current concepts of surgical facial rejuvenation are based on recent discoveries and insights about mechanisms of facial aging. It combines broad array of individualized surgical techniques, based on detailed preoperative evaluation. Advanced methods of facial rejuvenation involve redistribution of soft tissues to restore facial shape and contour to a more balanced youthful state and unoperated look.

With increasing age, there is progressive loss of skin contractile capacity, facial muscle tone and soft tissue volume. The facial volume gradually descends downwards and the skin folds from the nostrils, towards the corners of the mouth (nasolabial folds) deepen, the corners of the mouth droop and the jaw line sags. The eyebrows droop and the skin of the eye lids gathers in loose folds. Excess fat and skin accumulate under the chin, and the former youthful contour of the neck and jaw line is lost. Increase in fine lines, as well as thinning of the skin tissues, also lead to an aged appearance. The rate at which the aging process affects the face varies from one person to another and is also determined by our genes. The appearance of the face does not necessarily reflect the rate at which the rest of our body and mind is ageing. The new concept of facial rejuvenation is based on recent scientific evidence suggesting that selective fat compartment deflation, and alterations in the associated support ligaments contribute more to the aged appearance than long believed reduced skin elasticity and effects of gravity.

The ideal facial rejuvenation algorithm is comprised of an appropriate combination of procedures, thoughtfully chosen from an array of proven alternatives that when skillfully performed provide both short and long-term enhancement to the undesirable conditions of aging. Current concepts of surgical facial rejuvenation include facial soft tissue augmentation by structural fat replacement, removal of excess skin, three dimensional lifting, tightening and redraping of underlying tissues. For obtaining consistently reliable, natural and long-lasting results, with lowest potential risk, an individualized plan to address unique features of aging is devised for each patient. Several of the following procedures are usually combined in surgical facial rejuvenation:

- Facelift reduces saggy skin and repositions the tissues on the lower half of the face and especially around the jaw line and neck.

- Mid facelift restores youthful fullness to the cheeks without visible scaring.

- Brow (forehead) lift is designed to reposition sagging eyebrows and remove wrinkles of the forehead to refresh upper eye region.

- Blepharoplasty is used to refresh and rejuvenate the eyes and remove excess, baggy eyelid skin.

- Neck liftrejuvenates the neck, lifts the jowls, removes excess wrinkled skin and recreates a well-defined jaw line.

- Facial implants can improve the appearance of reduced bone structure in an aging face.

- Neck and chin liposuction remove fatty deposits from the neck and under the chin to better define the jaw line.

- Resurfacing techniques reduce surface wrinkles and uneven pigmentations by removing damaged outer layers of the skin. Options include chemical peels, pulsed light, laser resurfacing, dermabrasion.

-Injectable fillers plump out deep wrinkles and shallow contours with injections of hyaluronic acid, collagen or other types of filler. Depending on the type of filler used treatment needs to be repeated every six to nine months.

- Botulinum toxin (Botox) injections temporarily flatten out wrinkles by reducing the muscular contractions that cause them. It won’t help with wrinkles caused by sagging of your facial tissue or tiny surface wrinkles caused by sun damage.

- Earlobe correction balances the face and rejuvenates or repairs aged or stretched-out earlobes.

Some procedures commonly performed for facial rejuvenation are performed even in younger people for correction of genetically predisposed imperfections. (e.g. removal of excess fat under the chin with liposuction, correction of sunken cheek pads, chin augmentation). We all know that we age differently and when considering rejuvenation, biologic not chronologic age is essential. Even different parts of the face, in the same individual, age with different pace. Therefore, depending on the details of the facial anatomy and the unique features of the aging process, a procedure or combination of procedures, that will achieve the best results regarding the outcome patient wish to achieve, is recommended.

Younger and younger patients are now opting for minimally invasive procedures to retard the aging process. Generally the first signs of aging appear on our faces in thirties. We notice increasing surplus skin around the eyes, the outer part of the eyebrow lowers and some fine wrinkles form at the corners of the eye. The crease running from the nose to the corners of the mouth (nasolabial fold) becomes more visible. Injections of fillers and neurotoxins can usually correct them. When we reach our forties, all signs of aging, become more apparent. Creases and excess skin between the eyebrows and on the forehead become increasingly apparent. Some fullness of the cheeks is lost. Modified short scar facelifts or isolated midface or neck liftsmay be appropriate for these patients with less pronounced signs of aging. In the fifties,  the skin of the neck begins to sag and wrinkle. A typical bulge appears in the jaw line, eyes are becoming hollow with a lot of excess skin around them. Wide variety of surgical techniques that remove excess skin, lift underlying soft tissues and add volume to specific compartments can be employed to address these changes. At that stage injectable treatments cannot replace more invasive procedures, but are frequently used to touch up the results of surgery. In sixties the skin of the face and the subcutaneous fat become much thinner and wrinkles on the cheek become obvious. The distance between the nose and mouth increases visibly lengthening the upper lip. Lips become thinner. The tip of the nose, earlobes and chin descend. A comprehensive approach with a combination of surgical and adjuvant procedures is recommended. Most commonly the combination of lifts (face, midface, neck, brow, forehead) is done together with correction of eyelids (blepharoplasty) and skin resurfacing. Age is not a limit for surgical rejuvenation, as long as the patient is healthy in good physical condition.