The Facelift much like nasal reshaping is a common procedure done today that addresses the facial changes of aging and is usually done on men and women in their late 40’s and on into their late 60’s. The surgical procedure primarily addresses the aging face that includes the jowls and the aging neck. The jowls are formed from gravity which pulls down the buccal fat pad area and cheek fat, and descends downward and hangs over the jawline creating an aging face. The goal of the facelift is to tighten the jowls and re-suspend them up into the facial buccal fat pad space so as to give a natural look. The neck is addressed by removing fat above and below the platysma muscle and this is performed with a combination of liposuction, sculpting and surgical removal of the fat underneath the muscle. The platysma muscle is then tightened in the front part of the neck above the Adam’s apple to give a new defined jawline and the anterior platysma bands are transected down low to remove the two cords in the front portion of the neck. The excess skin is then tightened from behind the ears to allow the skin to re-drape into a rejuvenated new neckline. The incisions are placed in front and behind the ears and are done in such a fashion that they are minimally detectable once they are healed and the hairline doesn’t shift, keeping a natural look. There is also a small incision underneath the chin for access to the neck. The facial muscles including the SMAS (Superficial Muscular Aponeurotic System) are tightened to give a rejuvenated look. Post operatively, there are no ‘mummy wraps’ placed around the face, only two small drains that are inserted underneath the skin in the neck which remain in place for two days after surgery. General anesthesia is used for this surgery and administered by a board certified physician anesthesiologist from Swedish Medical Center. The facial procedure takes approximately 3 hours to perform and then patients will go to the recovery room for an additional two hours or so to recover from the anesthetic before being discharged to home. Out of town patients must spend at least a week to ten days in Seattle prior to going back home and there are four hotels within one block of the office that are used for many of our out of town patients. Please review our before and after photos which show the extent of Dr. Portuese’s skill and the natural results of his surgery.