What is facial aesthetic surgery?
Facial aesthetic surgery is the umbrella term for surgical and complementary procedures that address sagging, volume loss and proportion changes in the forehead, brows, eyelids, mid-face, lower face and neck. Rather than describing each operation in depth, this page offers a road map: which approach may suit which concern.
The face is made up of layers lying on top of one another: skin, the fat beneath it, a connective tissue layer around the facial muscles called the SMAS, deeper fat pads and, underneath everything, the bony skeleton. Ageing affects each of these layers at a different pace. A good plan starts with identifying correctly which layer the problem sits in.
As an ENT and head and neck surgeon, Op. Dr. Özlem Yüksel Coşar works with the anatomy of the face every day. This allows us to plan appearance while keeping functional structures in mind, such as the facial nerve branches, eyelid function and nasal breathing.
How does the face age?
Facial ageing is more than "loose skin". Several processes usually progress at the same time:
- Descent of tissues: the brows drop, the cheek fat pads slide downwards and jowls appear along the jawline.
- Loss of volume: the under-eye area, temples and cheeks lose fullness, making the face look tired or hollow.
- Changes in skin quality: skin loses elasticity, fine lines and pigmentation become more visible.
- Changes in the bony structure: the eye sockets and jaw change subtly over time, reducing support for the tissues above.
- Neck laxity: the neck muscle (platysma) forms visible bands and the angle between chin and neck becomes less defined.
Genetics, sun exposure, smoking and weight fluctuations strongly influence how fast these changes happen, which is why two people of the same age can need very different things.
Facial analysis: what do we look at?
At the first consultation we start by listening to what bothers you most. We then examine your face both at rest and while you talk and smile. The main points we assess are:
- The balance between the upper, middle and lower thirds of the face, and left–right symmetry
- Brow position, and whether upper eyelid heaviness really comes from the eyelid or from a descended brow
- Under-eye bags, the tear trough and the transition between cheek and lower eyelid
- The degree of sagging in the cheeks and jawline, and the nasolabial folds
- Neck skin, fat and platysma bands
- How the nose and lips relate to the rest of the face
- Skin thickness, elasticity and any previous treatments
Standardised photographs are taken from several angles and we discuss the plan using them. Your medical history, medication and smoking status are part of the plan too. If you are travelling from abroad, you can send photographs in advance for a preliminary assessment; the final decision is always made after an in-person examination.
Which procedure for which concern?
The table below gives a general idea of common concerns and the procedures that may be considered for them. The definitive plan is always made after examination.
| Area | Common concern | Possible approach |
|---|---|---|
| Forehead and brows | Low brows, tired or stern look | Brow lift |
| Eyelids | Excess upper lid skin, lower lid bags | Blepharoplasty |
| Upper and mid-face | Early descent of brows and cheeks, hollow under-eye area | Endoscopic facelift |
| Lower face and neck | Jowls, deep nasolabial folds, loose neck | Deep plane facelift |
| Upper lip | Long upper lip, little tooth show | Lip lift |
| Nose | Nose out of proportion, breathing problems | Rhinoplasty |
| Under the chin | Localised fat, double chin | Neck liposuction, neck lift |
| Whole face | Volume loss, hollow look | Fat grafting |
Most concerns are not confined to a single area. Heavy upper eyelids, for example, may actually be the result of a descended brow; removing eyelid skin alone can then make the look harsher. Please treat the table as a starting point rather than a menu.
Neck lift and chin liposuction
The neck can age independently of the face. In patients, often younger, who have fat under the chin but still-elastic skin, neck liposuction through a small incision under the chin may be sufficient.
When skin laxity and platysma bands are prominent, a neck lift is needed. Through a small incision under the chin the neck muscle is tightened in the midline, and excess skin is redraped through incisions behind the ears. A neck lift is usually performed together with a lower face lift, because the jawline and neck are one continuous unit.
Fat grafting and complementary non-surgical options
Volume lost with age can be restored using your own fat. In fat grafting, a small amount of fat is usually taken from the abdomen or thigh, processed and placed with fine cannulas into areas such as the temples, cheeks and the lid–cheek junction. Part of the transferred fat may be reabsorbed, so results vary between individuals and a further session is sometimes needed. Fat grafting can be done alone or together with a facelift.
Non-surgical treatments such as botulinum toxin and hyaluronic acid fillers can help with expression lines and mild volume loss. We see them not as a substitute for surgery but as complementary options that can support the result before or after an operation when appropriate. Trying to "lift" sagging tissue by filling it tends to look unnatural in the long run.
Can procedures be combined?
Because the face works as a whole, planning procedures together often gives a more balanced result. Common combinations include:
- Lower face and neck lift with upper eyelid surgery
- Endoscopic forehead and mid-face lift with lower eyelid surgery
- Facelift with fat grafting
- Lip lift with rhinoplasty
For international patients, combining procedures means one trip, one anaesthetic and one recovery period. On the other hand, operating time increases, and for some patients a staged approach is safer. We make this decision together, taking into account your general health, the anaesthetic assessment and your priorities.
When is the right time for facial surgery?
The right time is when the changes start to bother you and can be meaningfully improved with surgery. Procedures done at an earlier stage are usually more limited, with a shorter recovery and a subtler change. Later on, a more comprehensive plan may be needed.
When planning the date, we also take your work and social calendar into account. Having surgery at least a few months before an important event allows swelling and scars to settle. A stable weight, having stopped smoking and well-controlled chronic conditions all support healing.
Recovery and risks
Recovery depends on the procedure. After limited procedures such as eyelid surgery most patients return to social life within 7–10 days, whereas after a face and neck lift this usually takes 2–3 weeks. Subtle swelling can take several months to resolve completely. Consultations and follow-up are available in English, and patients who have returned home can continue their check-ups by video call.
As with any surgery, facial aesthetic procedures carry risks. These include bleeding and haematoma (a collection of blood), infection, prolonged swelling, more visible scarring than expected, temporary numbness, asymmetry and, rarely, temporary or permanent weakness of facial nerve branches. Smoking, uncontrolled blood pressure and certain medications can increase these risks.
A thorough examination, a realistic plan and careful adherence to aftercare advice are the most effective ways to reduce risk. Before surgery, we go through the risks that apply to you in detail as part of the written consent process.
The information on this page is for general guidance only and does not replace diagnosis or treatment. The right treatment for you can only be decided after an examination, and results vary from person to person.