The Art of Turning Back Time: A Surgeon's Journey with the Vertical Restore
Imagine standing in front of the mirror, lifting the skin of your face and neck with your hands, and seeing a younger version of yourself appear for just a moment. That fleeting glimpse is often the first sign that you are ready for something more permanent. For nearly two decades, I have dedicated my practice to one specific goal: helping people look as young as they feel. This journey led to the development of the Vertical Restore, a deep plane facelift that is fundamentally different from traditional approaches. It is a procedure born from the belief that we can rewrite the aging process by restoring the face to its original position—not by pulling things tight, but by lifting them back to where they once were.
Let me walk you through the most common questions I receive, because understanding the "why" behind every detail is what transforms a surgical decision into a confident choice.
The Core Philosophy: Sagging, Volume, and Skin
Aging is not a single event; it is a three-part process. There is sagging of the soft tissues, volume loss in the face, and changes in the skin itself. The Vertical Restore directly addresses the sagging by lifting the deep plane—the layer of tissue beneath the skin that provides the longest-lasting, most natural result. But this lift is not isolated. It incorporates a neck lift, a midface lift, and a lateral brow lift in every single case. The vector of lift is different from traditional deep plane lifts; it is less of a sideways pull and more of a vertical restoration. This is why it looks so natural.
But remember, sagging is only one piece. To fully reverse time, we must also address the volume loss that makes a face look tired and hollow. That is why the most powerful combination I have found is the Vertical Restore paired with fat transfer. We take your own fat, harvest it gently, and place it back into areas like the temples, under the eyes, around the mouth, and the lips. The goal is not to make you look fuller or different; it is to refill what time has taken away so you look like a younger version of yourself. I have been performing fat transfer since my fellowship, and in my hands, it has been an incredibly reliable and safe way to add that final, beautiful touch.
Skin quality is the third pillar. While the lift repositions and the fat refills, the skin itself still needs care. After surgery, we put all patients on the Care MD Trifecta—a topical system that stimulates collagen. But if the skin requires it, we also use a laser, specifically the Sciton Contour TRL, an erbium YAG resurfacing laser. The recovery from this laser is about two weeks, which syncs perfectly with the recovery from surgery itself. So yes, I treat the skin in every single case, either topically or with a laser, to ensure the result is as refined as possible.
Who Is the Right Candidate?
This is the question I hear most often, and the answer might surprise you. Age has nothing to do with it. I have performed Vertical Restores on people in their late thirties and early forties, and I have performed them on people in their sixties and beyond. The real deciding factor is facial laxity. If you catch yourself lifting your face in the mirror and thinking, "Oh, that looks so good," that is the clearest sign that you are technically ready. Some individuals are genetically predisposed to sag earlier, and for them, waiting only allows the gap between their chronological age and their facial age to widen. The typical patient, however, is entering perimenopause or menopause in their late forties or early fifties, when the soft tissues of the lower face, midface, and neck begin to descend. The moment you notice heaviness in the jawline, or the corner of your brow dropping, or the neck starting to sag—and you feel emotionally and physically ready to address it—you are likely a good candidate.
Anesthesia: Safer by Design
Another unique aspect of how I perform the Vertical Restore is the use of local anesthesia with IV sedation. This is our default in 99% of cases. Why? Because eliminating the risks associated with general anesthesia—such as drug reactions, airway complications, or hospitalizations—makes the procedure significantly safer. While our facility is fully equipped to provide general anesthesia if a patient requests it, almost everyone prefers the IV sedation route once they understand the safety benefits. It allows for a controlled, comfortable experience with a much lower risk profile.
The Neck, the Eyes, and the Weight Factor
One common concern is crepiness of the neck skin. The Vertical Restore's neck lift component dramatically tightens the deep fascia and removes all loose skin, so the neck appears much smoother. But if your skin is naturally thin or crepey, some of that texture may remain. This is where collagen stimulation becomes essential—through sun protection, topical retinol, vitamin C, growth factors, and in-office treatments like microneedling. The lift does the heavy repositioning; the skin care does the finishing.
As for the lower eyelids, I often use the term skin pinch to describe the removal of excess skin without touching the fat pads. When there are puffy bags under the eyes, I perform a lower blepharoplasty, which involves removing the fat through the inside of the eyelid and then pinching the excess skin on the outside. Both approaches are tailored to the specific anatomy of the patient.
On the topic of weight: it is ideal to be at your stable, natural weight before surgery. But I have seen many patients achieve tremendous results even if they are not at their "perfect" weight, especially if their face does not carry excess weight. Reasonable weight shifts of ten to twenty pounds after surgery are fine, and because the fascia is tightened, the face will shrink down without sagging. I simply do not want you to drastically lose or gain weight just for surgery, as that can lead to hollowness or unexpected changes.
Risks, Recovery, and Reality
No procedure on the planet is risk-free. The potential complications of facelift surgery include infection, hematoma, seroma, scarring, and the rare possibility of nerve damage. However, with a surgeon who performs this surgery day in and day out—sometimes twice a day, four times a week—the risk profile is extremely low. Experience with the anatomy makes a profound difference. We also mitigate risks by putting patients on specific vitamins and herbs before and after surgery to reduce inflammation and improve clotting. If a complication like a hypertrophic scar does occur, it can be treated effectively.
Recovery is a journey. The first week is rough—swelling, bruising, and the feeling that you have been through an ordeal. But by the end of the second week, most patients are "restaurant ready." They can return to work and social situations without looking alarming. The result continues to improve over the following weeks and months. Our pre-operative preparation is extensive, ensuring that you are mentally and physically ready to manage those ups and downs.
The Secret to Looking Like Yourself
The question I treasure most is: How do you preserve facial identity? The answer is a combination of technique, vector, procedure selection, and a certain artistic talent. My goal has always been to make people look like a younger version of themselves—not like a different person who had surgery. When you look at our outcomes, you would never know that any procedure was done unless you see the before photo next to it. That naturalness comes from using the correct vectors, combining the right procedures (fat transfer, upper and lower blepharoplasty, lip lift) to create balance and harmony, and a deep understanding of each individual face. From my very first facelift to the one I performed yesterday, every single outcome has looked natural and unoperated. That is the secret.
When to Do It, and How Many Times
If you are bothered by your facial aging now, you will be even more bothered ten years from now. Why wait? Earlier lifts actually last longer, and they are easier to recover from. But I also see patients who waited until their sixties, and they still achieve beautiful results. The best age is simply when your anatomy and your desire align.
As for how many times you can have it done: if it is done right the first time, you may only need two or three in a lifetime. I have a patient who had her first lift at 45, and when I saw her at 67, she looked incredible. We did a minor touch-up, and she may never need another. The key is to choose a surgeon who uses a durable technique like the deep plane and who understands natural aesthetics. If you have had a lift that was not effective, you can always get it redone—just be sure to pick the right surgeon this time.
Final Thoughts: The Trust You Place in a Surgeon
Board certification is a necessary starting point—it ensures the surgeon has the proper training and qualifications. But true expertise comes from doing this day after day, year after year. Look for a surgeon whose practice is focused on what you need, who performs facelifts frequently, and who has a consistent track record of natural results. Prepare your body with good nutrition, stop smoking, and arm yourself with knowledge. The more you know, the more confident you will be.
The Vertical Restore is not just a procedure; it is a philosophy of restoration. It is about taking the face back in time, not to a different version of yourself, but to the one you remember. If you have more questions, drop them below. I listen, and I answer. Because this journey is yours, and I am here to guide you through it.