Online Heath Chat with James E. Zins, MD

November 6, 2009 | Reviewed on January 21, 2014 by James E. Zins, MD


Cleveland_Clinic_Host: Do you look older than you feel?  Have you considered a facelift to refresh your appearance?  As many before you have found, a facelift (also known as a rhytidectomy) can provide effective and long-lasting improvement to the aging face, eliminating sagging and wrinkles and enhancing facial fullness.  A facelift also may be performed with other aesthetic procedures such as eyelid, nose and forehead surgeries.

Cleveland Clinic plastic surgeons have been pioneers in the field of facial cosmetic and reconstructive surgery.  Each of our board-certified surgeons performs the full range of cosmetic facial procedures, with extensive expertise in alternatives to face- and neck-lift surgery, short-scar facelifts, and minimally-invasive facelift techniques.  Their skill and experience can help restore your youthful appearance and re-awaken your natural beauty.

Take advantage of this unique opportunity to chat live with a plastic surgeon in a secure, confidential online setting.  If you are considering a facelift or other facial surgery, this web chat will give you the opportunity to learn about options and to have your questions answered.

James E. Zins, MD, Chairman of Cleveland Clinic’s Department of Plastic Surgery, is board-certified by the American Board of Plastic Surgery. He specializes in a complete range of facial cosmetic surgeries including facelifts, eyelid- and brow-lifts, otoplasty, rhinoplasty and injectables. He has been listed as a life member of the National Registry’s Who’s Who, in Best Doctors in the Midwest, and in Cleveland Magazine’s "Top Doctors."

After receiving his medical degree from the University of Pennsylvania in Philadelphia, Dr. Zins completed his internship, residency in general and plastic surgery and a fellowship in craniofacial research at the Hospital of the University of Pennsylvania. He also completed a maxillofacial fellowship at Great Ormond Street Hospital in London, England, and an honorary research fellowship at University College Hospital in London.

Recognized as one of “America’s Top Docs” in plastic surgery, Dr. Zins popularized the minimally-invasive facelift at Cleveland Clinic.    

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Dr. Zins. We are thrilled to have Dr. Zins here today for this chat. Dr. Zins is the chairman of Cleveland Clinic’s Department of Plastic Surgery and specializes in a complete range of facial cosmetic surgeries including facelifts, eyelid- and brow-lifts, otoplasty, rhinoplasty and injectables. Let’s begin with some questions.

Overview: Facelifts

hattiek: Who is a good candidate for facelift surgery?

Speaker_-_Dr__James_E__Zins: Patients need to be in generally good physical health and medical problems if present should be well controlled. There are no strict age requirements. Ideal candidates have good bone structure of the face, have lost some but not all skin elasticity. They may or may not have excess fat in the neck. It is also vital that the patient have realistic expectations about what the surgery can accomplish, as well as an understanding of its limitations and of possible risks.

marykP: At what age is a person too young or too old for a facelift?

Speaker_-_Dr__James_E__Zins: Age is not the most important factor in determining if a facelift is right for you. In general, the condition of your skin and your general health are more important considerations. In relation to complications from the surgery among older patients, Cleveland Clinic has studied outcomes among elderly facelift patients and determined that chronological age does not increase the likelihood of risk.

Many patients undergoing facelift surgery are 65 and older. With regard to ‘how young is too young’, patients need to demonstrate that they have facial aging. Facelifts cannot be done before aging has occurred. Generally facelifts are not performed before the age of 40.

baby_blues: How long will the results from my facelift last?

Speaker_-_Dr__James_E__Zins: While no facelift produces permanent results, it is not uncommon for a facelift’s effects to last for 10-15 years. The face will continue to age normally after the surgery, but the patient will continue to look younger. Results can last longer depending on the condition of your skin, general health, whether you smoke or drink, general nutrition, stress levels, and how old you are when you have the surgery.

lovemetender: Will it be obvious that I’ve had a facelift?

Speaker_-_Dr__James_E__Zins: A well-done surgery should result in a refreshed, rested, younger looking patient – a rejuvenation of their former look, not a modified appearance. Often, others comment that you look well rested or that you have lost weight.

andie_359: How long does the surgery take?

Speaker_-_Dr__James_E__Zins: The length of surgery varies on the extent of the procedure and the number of additional procedures that need to be performed. The length of the surgery is not nearly important as the result and the longevity of the result and the quality of the work done.

susieQ: What can I expect in terms of recovery time?

Speaker_-_Dr__James_E__Zins: This depends primarily on the extent of the surgical procedures that would be necessary to give you your desired outcome.  Minimally invasive facelifts require a shorter recovery period, approximately one week. Traditional facelift recovery generally requires two weeks.

chitchat: What is a facelift able to fix, not fix?

Speaker_-_Dr__James_E__Zins: A facelift can enhance your appearance by improving visible signs of aging in your face and neck, It tightens the skin, removes excess fat, improves the jawline and neckline and reduces wrinkles.

helpme: What is the cost of facelift surgery?

Speaker_-_Dr__James_E__Zins: The cost of surgery depends on the specific procedure(s), and the extent of the work that will be done. Specific costs are available at the time of consultation.

desi111: Are facelift, eyelid or neck lift procedures ever covered by health insurance?

Speaker_-_Dr__James_E__Zins: Eyelid surgery, when the skin excess interferes with vision, may be covered by insurance. Neck lift and facelift surgeries are rarely covered. The only time facelift surgery would be covered would be in the case of facial paralysis.

vparker568: Sometimes, in the jowls and under my eyes forehead, I have been taking care of my skin with skin care products since I was a teenager, and it shows when you look at me and then look at my sister who is years younger than me because I stayed out of the sun all my life and she stayed in it, I also use SPF30, but I'm still not satisfied, and I don't understand why? I also lost pounds and I have the junk hanging here and there that needs liposuction.

Speaker_-_Dr__James_E__Zins: Weight loss in middle age or later will have a bad effect on the skin appearance because it will create extra skin. This is most apparent usually in the neck and in the creases between the nose and the mouth. The only solution once this has occurred is surgical correction.

From your description, a surgical consultation is necessary. Liposuction would not help such a situation as it would just add more skin excess to the situation. What you describe needs skin removal i.e. facelift or other less invasive procedures.

Daisy: When you speak of the condition of the skin, does prior sun damage affect a face lift?

Speaker_-_Dr__James_E__Zins: Yes. If the skin quality or skin elasticity is poor the facelift results will not be as long lasting. This would mean that instead of perhaps 10 years the patient would have correction for perhaps 5 years and you would need a revision sooner than someone with better quality skin.

LilBoPeep: What can be done to build collagen and elasticity? My facial skin is in good shape but has had no elasticity since I was 35! Now I have dreaded turkey neck but it looks like I have lost a lot of weight b/c my face is small and neck is long. I have NOT lost a lot of weight although I am thin. Thank you!!

Speaker_-_Dr__James_E__Zins: If you have a 'turkey neck,' or extra skin hanging in the neck area - surgery is the only answer. Some type of neck lift or direct skin removal is the best option. Sometimes procedures that are less invasive than the traditional neck lift surgery can correct the problem. A consultation with a board certified plastic surgeon would be your best option.

Improvement in skin quality can be accomplished by a variety of peels and skin care products such as retin-A. However, once extra skin is present as you have described, these are not the best options.

Facelift Surgical Techniques

wmrobin: What is the most popular facelift procedure?

Speaker_-_Dr__James_E__Zins: There are a wide variety of facelift techniques from simple minimally invasive approaches through incisions in front of the ear to the more extensive face and neck lift procedures. Most modern facelift techniques address not only the skin but also tighten the underlying soft tissue in some fashion. This underlying tissue is called the SMAS. It can be excised and closed; it can be advanced or sewn together without removal. Each has its advocates.

johnsok: For the facelift. I would like to know the difference, pro and con between a "regular" facelift, and those newer miracle lifts that are advertised on TV. Also will they be offered at the Cleveland Clinic?

Speaker_-_Dr__James_E__Zins: There are no miracle facelifts. Be very careful about infomercials and advertisements on television. Be circumspect about your surgeon and facelift procedure.

I perform over 100 facelifts per year and would be happy to discuss all issues including minimally invasive facelifts and traditional facelifts as well as the pros and cons of each.

Daisy: What are the differences between a deep plane and a SMAS lift, and a mid facelift and lower facelift? Thank you.

Speaker_-_Dr__James_E__Zins: The deep plane face lift is an operation which proceeds at a level below the skin to enhance the blood supply to the face. It works closer to the facial nerve than other similar facelift operations. Therefore the pro is that blood supply is improved. However, the risk of facial nerve injury might be greater.

There are a large number of SMAS operations - all doing various maneuvers to the SMAS layer. The SMAS is a tissue plane deep to the skin that encompasses the muscle of facial expression.

A mid-face lift addresses the eye area and the cheek area and has little effect on the lower face and neck.

A lower facelift addresses the neck, jowls and the cheeks.

pianonut: I have heard a lot about the “Lunchtime Lift” and other similar procedures. Are they safe?

Speaker_-_Dr__James_E__Zins: The lunch time lift is a consumer term for a minimally invasive face lift. Various techniques have been used to try to accomplish what traditional face-lift surgery can.

Minimally invasive techniques are most effective for younger patients and most effective in the cheek area. They are less effective in the neck and jowl region.

Undergoing lunchtime surgery, expecting immediate recovery and spectacular results is not realistic. Having an in-depth consultation with a board certified plastic surgeon, who does a significant amount of facelift surgery, is your best bet for happiness.

wmrobin: Can one have a 'neck lift' independent of a facelift?

Speaker_-_Dr__James_E__Zins: Definitely yes. There are a number of approaches to neck lift without facelift surgery, including an operation that is done through an incision under the chin.

wmrobin: Do you provide the 'quick lift' that has been advertised recently?

Speaker_-_Dr__James_E__Zins: We provide all types of minimally invasive and traditional facelift procedures, including minimally invasive facelifts. The reality of surgical results needs to be discussed honestly and the benefits from minimally invasive surgery clearly understood.

The quick lift advertisements are often misleading and over promise. A clear discussion regarding expectations should be part of any surgical procedure.

What to Expect After a Facelift

Daisy: If I came to Cleveland from another state for a face lift, how long would I need to stay? What would the recovery be like as far as swelling, bruises, and scars? Thank you.

Speaker_-_Dr__James_E__Zins: If you came to Cleveland for the facelift, you would have an appointment the day prior to the surgery to review plans, expectations, risks and complications. The surgery would be the next day. I would like you to stay in Cleveland for one week.

The recovery: in two weeks you should be able to return to normal activities with some camouflage. In 3 weeks you should feel comfortable in all situations.

scarychick: How much scarring is there after a facelift?

Speaker_-_Dr__James_E__Zins: Usually scarring is minimal because experienced surgeons will position the incisions strategically, concealed in unobtrusive places or, whenever possible, use small incisions in areas that generally heal well.

Selecting a Surgeon

helpme: What factors should I consider when selecting my surgeon?

Speaker_-_Dr__James_E__Zins: Having your procedure performed by a board certified plastic surgeon is critical. You should make certain that your surgeon is well trained, has completed a fellowship at a reputable institution, and will perform the procedure in an accredited medical facility.

Also, you should check that your surgeon stays on top of the latest developments in the field. This information should all be readily available and the surgeon should be happy to provide it for you. A good rapport between doctor and patient, and the trust and confidence resulting from that communication, is key to achieving a superior outcome.

helpme: What questions should I ask my surgeon?

Speaker_-_Dr__James_E__Zins: Ask about the surgeon’s training, experience, and board certification, and if the medical facility where the procedure will be performed is accredited. Get information about treatment options and a recommendation of the option(s) that can best achieve your goals. Request the opportunity to review before and after photos for the procedure, and discuss what results you can reasonably expect. Inquire about medical outcomes and possible risks and complications. Ask what steps you can take to achieve and maintain positive, long-lasting results, from preparing for the surgery, to your recovery period, to lifestyle choices after surgery.

lincolncenter: How can I prepare for my facelift surgery?

Speaker_-_Dr__James_E__Zins: The most important thing is identifying the appropriate surgeon for your surgery. Important questions to ask would be:


1. Are you board certified by the American Board of Plastic Surgery?

2. How many facelifts do you perform in a year? Someone who does a significant amount  of facelifts is more likely to perform them well.

3.Have an in depth discussion with your surgeon regarding advisability and appropriateness of the operation for you, risks and complications, and expected results.

4.You should see photographs of other patients that the doctor has operated on and you should be comfortable with the answers that he or she provides.

5. The reputation of the doctor in the community -do you know any patients that the doctor has operated on and how happy were they with the outcome?

6.Health issues and medication also need to be reviewed by your doctor prior to surgery.

7.A second opinion is always worthwhile.


Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. James Zins is now over. Thank you again Dr. Zins for taking the time to answer our questions about facelifts.

Speaker_-_Dr__James_E__Zins: Thank you for having me here today.

More Information

This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician's independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians. ©Copyright 1995-2014. The Cleveland Clinic Foundation. All rights reserved.