Gravity and longevity are a formidable combination, leaving their mark on the face. The skin shrinks here and sags there, thins out, and becomes increasingly susceptible to the damage caused by exposure to the sun. With aging we lose the fat, muscle and bone of our face giving us the inward (concave) curves of the cheeks instead of the outward (convex) curves seen in the full face of children. 

Sad to say, our faces begin to rearrange much earlier than most of us would like to admit. "Crow's feet," those short straight lines radiating from the outer edge of the eyes, can appear any time after the age of 30. Skin in the upper eyelids loosens as well. Creases in the forehead, between the eyebrows, and around the nose and mouth suddenly seem more noticeable when a woman reaches her 40s. By the age of 50, the neck starts to wrinkle, the jaw-line seems to blur, and the tip of the nose may look a bit droopy. The nose grows by 20% of its origin due to skin sagging.

The ears also migrate downward and grow longer. The white of the upper lip becomes longer and the red of the lips narrower due to bone and fat loss. 

Although signs of age appear at different times in different people, facial wrinkling and sagging become hard to ignore by the fifth decade of life.

Facelifts became very popular ten years ago as they were the only game in town. Today they have to compete with neck liposuction, Acculift non invasive lasers, fat transfer and chemical peels. Today, a facelift is reserved for cases of severe skin sagging especially of the neck or the development of a deep nasolabial fold. According to US statistics, more than 150,000 facelifts were performed in 2010. 

Facelifts are very individualized procedures. In your initial consultation the surgeon will evaluate your face, including the skin and underlying bone, and discuss your goals for the surgery. Careful questioning during the first appointment helps doctors identify people who expect the impossible. If you have trouble describing exactly what you want to change or seem distraught about a relatively minor "deformity," you are not a good candidate for a facelift, and probably won't receive one. 

Your surgeon should check for medical conditions that could cause problems during or after surgery, such as uncontrolled high blood pressure, blood clotting problems, or the tendency to form excessive scars. Be sure to tell your surgeon if you smoke or are taking any drugs or medications, especially aspirin or other drugs that affect clotting such as garlic supplements or vitamin E.