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An unfortunate side effect of getting older is a dramatic change in the appearance of the face. What was once smooth, tight, soft and youthful skin is replaced by wrinkled, loose and leathery skin. For those looking for the fountain of youth, one of the best ways to eliminate fine lines and wrinkles on the face is by having a facelift. Facelifts are among the top 5 most common cosmetic surgery procedures in the United States, helping patients get a refreshed and rejuvenated appearance. Dr. Leo Lapuerta is a triple-board-certified certified plastic surgeon who specializes in facial cosmetic surgery procedures in the greater Houston, Katy and Pearland areas, providing patients with facelifts that restore their youthful appearance in a manner that is soft and appears natural.

  • Review from A.B.
  • Source: Rate MDs
  • May 30, 2019
I had visited other Drs, but none provided as much time and knowledge to sit with me as Dr LaPuerta and his staff did. His care and attention throughout the process is genuinely commendable. I have always felt that I've been more than just a patient. I have recommended him to others and will continue to do so.


A facelift, also known as a rhytidectomy, is a surgical procedure designed to remove or reduce visible signs of aging on the face. Many patients have misconceptions about what a facelift involves and frequently associate a facelift with a total face, unnatural, “wind blown” appearance. The reality is that a facelift addresses the mid and lower face and neck area. If aging of the upper face is of concern, then the area from the cheekbone and above can be addressed with brow lift surgery and eyelid surgery as well as injectable products. Common signs of aging that the surgery can treat include wrinkles, sagging skin, facial muscle laxity, jowls and loose skin in the mid to lower face and neck.

The goal of a facelift is to reset the clock on the aging face in a manner that is soft and natural. Many patients consult with Dr. Lapuerta regarding a sagging neck or jowls and have never even considered a facelift. In reality, these patients are the perfect candidates for a facelift and are the very patients for whom a facelift was created. The facelift is one of the less invasive cosmetic procedures but it addresses the problems with both the changes in the skin and muscle associated with aging and the results are effective. Unlike non-invasive techniques, lasers or surface treatments which produce variable to minimal results or improvements, patients will be assured that a facelift will produce tangible results.


Dr. Lapuerta’s goal during any facelift surgery is to improve the patient’s appearance in a way that provides natural-looking results. The ideal facelift surgery candidate is an individual in good overall health who is interested in improving the appearance of the mid to lower face and/or, neck area. Patients who are the best candidates for a facelift are those wanting to address issues that include:

    • – loose and sagging skin
    • – visible jowls
    • – a loss of volume in the face
    • – wrinkles and fine lines
    • – excess fat throughout the face and neck area


The candidate should also be a non-smoker and have an understanding of what the expected outcome of the procedure will result in. Prior to any surgical procedure, Dr. Lapuerta will sit down with the patient to make sure they fully comprehend each step of the surgery, as well as what they can expect the surgery to accomplish.


There are various techniques used today to perform a facelift. Facial anatomy, skin laxity and the overall aesthetic goal of the patient will determine the best approach. Each procedure will be unique to the patient and will vary based on the type and location of the incision, the number of tissue layers affected, the plane of elevation and the level of invasiveness. During a consultation, Dr. Lapuerta will examine the patient’s face and discuss the patient’s goals and review their medical history in order to determine which technique will deliver the best results. Below are some of the most commonly used facelift surgery techniques.


A mini facelift is geared toward patients who only have minimal skin laxity.  With a mini facelift, a smaller scar is used and only skin is removed. A mini facelift will not address any of the underlying tissue layers below the skin.  Most patients considering a facelift have moderate to severe skin and tissue laxity and are better served by other facelift techniques. Patients with minimal skin and/or tissue laxity or volume loss, may be good candidates for a combination of botox, facial fillers and fat injections.  The use of injectables can achieve both a minimal degree of lift as well as help to restore loss of volume. For patients with minimal skin and/or tissue laxity, Dr. Lapuerta can help determine if a mini facelift or a combination of botox and injectables will be able to achieve the improvements a patient is seeking.


Facelifts originally involved only removing excess skin and pulling that skin under tension back towards the ears.  Beginning in the 1980s through the mid 1990s, surgeons recognized the importance of the underlying tissue known as the SMAS (superficial musculoaponeurotic system).  The facelift technique was altered to address skin laxity and tissue laxity by now including both removal of excess skin as well as addressing the underlying tissue layers.  This became known as the SMAS facelift and was considered the gold standard for many years.

This surgery, while more complicated, produces results that are more dramatic and longer-lasting. The technique involves manipulating a group of muscles beneath the skin known as the superficial musculo-aponeurotic system (SMAS). This section of muscles controls facial expression. An incision is made along the hairline from the temple to just behind the earlobe. The skin is then separated and lifted. The underlying muscles and tissues are tightened and secured so they maintain their new position. While this technique was an improvement over prior facelift techniques, it can be associated with an unnatural look that appears “windblown”.  It also has a greater risk of damage to the facial nerves.


In the mid to late 90s, a new approach for facelift surgery was introduced.  The MACS lift or Minimal Access Cranial Suspension facelift, offered several advantages over the traditional SMAS or Deep Plan SMAS facelift that was commonly performed.  

The MACS lift is an excellent facelift option for patients with moderate skin and tissue laxity.  The MACS lift is also sometimes called a “short scar” facelift as it is less invasive and leaves a shorter scar than the SMAS or Deep Plan SMAS.  This technique, which uses an incision in front of the ear instead of behind it, allows for the correction of sagging facial features using a minimal incision. Another benefit of the MACS technique is that the surgery requires less operation and recovery times than other techniques.


Developed in Europe, the Modified MACS removes excess skin, suspends the underlying tissue layers (involving the SMAS) in a vertical direction, includes liposuction to the neck area and below the chin, pulls the neck muscles beneath the chin area together and uses a suture technique to lift and support the neck and jaw to provide a smooth jaw line.

Small incisions are made just below the chin, around the front of the ear and behind the ear.  The modified MACS works well for patients with moderate amounts of skin and tissue laxity. There is less risks to the underlying facial nerves and it produces a long lasting, natural appearance.  The procedure takes only about 3-4 hours and patients experience a quicker recovery.

The Modified MACS Facelift is Dr. Lapuerta’s preferred technique for the majority of his patients.  For patients with more severe skin and tissue laxity, Dr. Lapuerta incorporates aspects of the Traditional SMAS facelift to provide patients the best aspects of all techniques available.  Dr. Lapuerta creates an individualized approach for all of his facelift patients and may recommend additional options. These options include Botox, facial fillers, fat injections to nasolabial folds or marionette lines (the drooping lines from the outer corners of the mouth) and chemical peel applications to the forehead, chin, crows feet or mouth to improve deep wrinkles and skin damage.

Frequently, patients will also elect to include upper or lower eyelid surgery (blepharoplasty) or a forehead lift.  This allows patients to reset the clock on all aspects of facial aging with one surgery and one recovery.


Depending on the type of facelift planned and the patient’s medical history, a facelift can be performed under oral sedation with local anesthesia, deep I.V. sedation with local anesthesia or under general anesthesia with local anesthesia.  The length of the surgery will vary, depending on the planned approach, from 3 to 6 hours.  

Regardless of the method of anesthesia planned, Dr. Lapuerta only works in fully accredited surgical facilities.  Some surgeons will perform a facelift surgery in an office exam room or procedure room with only oral sedation and local anesthesia.  This option is usually promoted by the surgeon as a way to lower cost for the patient and allows the surgeon to avoid the expense, maintenance and oversight associated with becoming an accredited surgical facility.  Patient’s should be aware that when this option is chosen, there is no one other than the surgeon and his assistant to observe the patient’s vital signs and comfort level. The surgeon assumes the role of both the anesthesiologist and the surgeon as well as providing oversight to his assistant.  Most facelift patients are in their 50s or older and often have some health issues and may be uncomfortable lying flat and still for several hours during surgery. Patient’s should carefully consider their own health history and the potential disadvantages concerning their comfort, health and safety when considering a facelift in an office only vs. an accredited surgical facility environment.

Dr. Lapuerta offers patient’s several options regarding location for a facelift.  Dr. Lapuerta has privileges at eight of Houston’s most prestigious hospitals as well as an on-site, office based, AAAASF fully accredited surgical facility, The Plastic Surgery Institute of SE Texas (PSI).  This surgery is considered an outpatient procedure, but some patients may be more appropriate to have surgery in a hospital setting with an overnight stay. The vast majority of patients, regardless of age, who have a stable medical history prefer to have their surgery done at the PSI.  PSI offers patients a familiar environment with friendly faces they know and recognize, privacy, ease of access, private area for family or friends to wait and usually the cost is slightly less than the cost associated with a hospital. Patients have peace of mind knowing that in addition to Dr. Lapuerta, a medical doctor trained in Anesthesiology is present as well as a Registered Nurse and a Certified Scrub Technician.  The PSI AAAASF accreditation assures patient’s that safety standards are met, maintained and evaluated by a third party in regards to equipment, physical plant and personnel.


After surgery, patients will be bruised and swollen and the face and neck will feel tight. This will gradually improve within a few days and any discomfort or pain can be managed with oral pain medication. Many patients only require over the counter Tylenol for pain control or only a couple of days of prescription pain medication.  The use of local anesthesia during surgery helps to make facelift surgery one of the least painful cosmetic surgeries with most patients reporting minimal discomfort in the post operative period. Patient’s are encouraged to keep their head elevated to assist with the resolution of swelling. Patients are usually able to return to work and their everyday routine in as little as a week, although they need to hold off on strenuous activity for at least a few more weeks. Patients who work from home are frequently able to work the first day after surgery.  During the recovery process, it is common for patients to feel anxious about how their face will appear, but it is important to remain patient and allow the face to fully heal. Patients need to understand that they will see a dramatic change in 6 weeks after their facelift and healing will continue for up to 6 months.


Each facelift surgery is unique and will be tailored to meet the needs and goals of each patient. Because of the customization required to consider the type of facelift for optimal results, it can make it difficult to come up with an accurate average cost of a facelift. A less invasive or skin-only facelift is usually somewhere between $7,000-$14,000+, while more invasive procedures, such as the SMAS facelift or the deep plane facelift, can run anywhere between $8,500-$14,000+. lists the average cost of a facelift at $11,050.

The best way to get an accurate estimate for the cost of a facelift is to visit Dr. Lapuerta for a facelift consultation. During the consultation, Dr. Lapuerta will carefully listen to the patient’s desired results, and then partner with the patient to determine the best way to make their goals a reality. To learn more or to schedule a facelift consultation, contact Dr. Lapuerta today.


  • Recovery Time
  • 2-3 Weeks
  • Average Procedure Time
  • 4-6 Hours
  • Post-op Follow-up
  • 1 Day
  • Procedure Recovery Location
  • In & Outpatient


BOTOX®, injectable fillers, microdermabrasion, and chemical peels are examples of some non-surgical procedures that can assist in smoothing out wrinkles, improving fine lines and adding facial volume. These procedures also help to even out skin tone. However, these are treatments that will only affect the skin’s surface. Patients with loose skin, drooping jowls or a sagging neck will need to consider surgery if they want these features improved.
In the days immediately following facelift surgery, patients will feel tight and pulled. These are some short-term effects, but they will subside. It’s important to find a reputable surgeon skilled in facial surgery. Surgeons who know what they are doing will make every effort to work within the confines of the patient’s bone, skin and muscle structures so a younger, more natural look can result.
Facelift surgery does require a long incision. However, in almost all cases, these scars are well hidden as they fall just along the hairline and around the ears in the natural folds of the scalp. In most cases, the scars should be barely visible to the naked eye.
The common age range for patients who undergo a facelift is between 50-70. It is safe to say most patients will look 5-10 years younger following a facelift procedure. Younger patients (40-50 years old) generally have stronger skin elasticity so their results may last longer than those of someone older. However, older patients may have results that appear more dramatic and, for them, this can be very worthwhile. Patients should think of a facelift as a process to turn back the aging clock. You will still age, but you will appear a few years younger.
Leo Lapuerta Plastic Surgery