The Modern Facelift: Why Natural Results Are Changing the Face of Harley Street

For decades, the facelift carried an unfortunate stereotype: tight skin, an altered expression and a result that announced itself before the person did. But modern facial rejuvenation has moved a long way from simply pulling the skin tighter.

For me, the goal of facelift surgery is almost the opposite. A good facelift shouldn’t make somebody look like they’ve had a facelift. They should still look completely like themselves. What we are trying to restore is the shape and structure the face had before ageing changed it.

At my Harley Street practice in Marylebone, I have increasingly concentrated my surgical work on deep plane facelift and neck lift surgery — an approach designed to address the deeper tissues responsible for many of the visible changes associated with facial ageing.

Ageing is about more than loose skin

One of the misconceptions surrounding facelift surgery is that facial ageing is primarily a problem of excess skin. Skin certainly becomes more lax with time, but beneath it, other changes are taking place. Facial tissues gradually descend, youthful contours become less defined, jowls develop and the transition between the jawline and neck becomes increasingly blurred. At the same time, changes in facial volume can flatten areas that once appeared naturally full and youthful.

This distinction matters because simply removing more skin cannot necessarily recreate a younger facial shape. You can make skin tighter without making a face look younger. For me, the important question is where the tissues have moved and how we can restore them without creating tension or an operated appearance.

This is one of the principles behind the deep plane facelift. Rather than relying predominantly on tension in the skin, deeper facial tissues are repositioned, allowing the overlying skin to follow more naturally. The objective is not to create a different face, but to restore some of the contours that have gradually been lost.

Why the neck matters

In my own approach to facial rejuvenation, I rarely consider the lower face in isolation from the neck. A youthful jawline depends partly on the relationship between the face and the structures beneath the chin and along the neck. With ageing, jowling, skin laxity, platysmal bands and fullness beneath the chin can progressively obscure that definition.

This is why I frequently combine a deep plane facelift with a deep neck lift, addressing the neck as part of the overall architecture of facial rejuvenation rather than treating it as an afterthought. The face and neck have to make sense together. There is little point creating a beautiful jawline if the neck immediately underneath it tells a completely different story.

The aim is definition rather than tightness: a cleaner jawline, a more youthful transition into the neck and a result that remains harmonious with the rest of the face.

When adding volume is no longer the answer

The changing role of dermal fillers has also altered the conversation around facelift surgery. Used appropriately, fillers can be extremely effective for genuine volume loss, particularly during the earlier stages of facial ageing. But I believe there is an important point at which both patients and practitioners need to recognise that volume loss is no longer the only issue.

As the deeper facial tissues begin to descend, there comes a point when adding more volume cannot recreate youthful anatomy. You are adding volume to tissues that are now in a different position. That is when patients can start looking fuller without necessarily looking younger.

It is a distinction increasingly relevant to patients who began having injectable treatments in their thirties or forties and have continued them as their facial anatomy has changed. For some, the appropriate answer may simply be to use less filler. For others, particularly where jowling and tissue descent have become established, surgery may eventually provide a more anatomical solution than continuing to add volume.

That does not mean that everyone showing the first signs of ageing needs a facelift. Quite the opposite. Patient selection and timing remain crucial, and there are consultations where my advice is simply that surgery is not yet appropriate.

The end of the “overdone” facelift

Perhaps the biggest change I have observed in facial surgery is not technical at all. It is what patients now ask for. Increasingly, they do not want to look dramatically different. They want to look fresher, less tired and more like an earlier version of themselves. They want to retain the expressions and characteristics that make their face recognisably their own.

That requires restraint. I do not see a face as a collection of individual problems that all have to be corrected. It has to work as a whole. If someone looks at one of my patients and immediately thinks “facelift”, then for me something has been lost.

This philosophy also means accepting that natural asymmetries and individual facial characteristics do not necessarily need to be erased. The aim is rejuvenation, not standardisation. It is a particularly relevant approach in the age of social media, where patients are exposed to an unprecedented number of before-and-after photographs but are also increasingly alert to faces that appear excessively filled, tightened or altered.

The modern luxury, perhaps, is not looking treated at all.

From filler to facial rejuvenation

One of my patients illustrates that evolution particularly well. After years of using fillers to compensate for facial volume loss and the early signs of ageing, she reached a point where additional volume was no longer producing the facial shape she wanted. Her fillers were dissolved before I performed a deep plane facelift, deep neck lift and carefully placed facial fat transfer.

The purpose of her surgery was not simply to tighten her face. I repositioned the deeper tissues, addressed the neck and jawline, and restored volume selectively where it contributed to a more youthful facial balance.

Her before-and-after photographs demonstrate an important distinction: rejuvenation does not necessarily require changing someone’s identity. The most successful result may be one in which the individual looks noticeably fresher and younger, yet it remains difficult for an observer to identify exactly what has changed.

For me, this is ultimately the point.

Restoring rather than reinventing

Facelift surgery will never stop the ageing process, nor should it attempt to create a face that belongs to another decade entirely. Modern facial rejuvenation is instead becoming more sophisticated in its understanding of anatomy, proportion and the relationship between the face and neck.

The shift is from simply making the skin tighter to asking a more interesting question: what has changed beneath it?

For patients considering surgery, that also makes the consultation particularly important. The decision should not begin with the name of a fashionable technique, but with an assessment of the individual face, the degree of tissue descent, the neck, facial volume and — perhaps most importantly — what the patient actually hopes to achieve.

For me, the best facelift is not the one that looks the most dramatic. It is the one where the patient still looks completely like themselves — only fresher, more rested and more youthful.

In an era when aesthetic treatments have never been more visible, the most sophisticated result may therefore be the one that attracts the least attention to the treatment itself.

ABOUT DR DIRK KREMER

Dr Dirk Kremer is a German Board-Certified Plastic Surgeon practising in London, with a particular focus on facial rejuvenation and deep plane facelift and neck lift surgery. His Harley Street practice treats patients from the UK and internationally.

He is also the author of Beauty and the City, an observational and often witty column written from the perspective a Harley Street plastic surgeon exploring beauty, ageing and the pursuit of youth in modern London — and how life in a fast-moving, image-conscious global city shapes the way we see ourselves, our relationships and growing older.