Comprehensive Facial Rejuvenation in Beverly Hills

Which procedures do I need?

The examination answers this, not the mirror. As a starting point, the signs patients notice most often and what they usually mean:

• The jawline has softened and jowls have appeared. Deep tissue descent and ligament laxity in the lower face. Deep plane facelift, or SMAS facelift if the midface is well preserved.

• The neck has lost its angle, or shows bands or fullness. Changes beneath the platysma, not in the skin. Deep neck lift, nearly always planned with the facelift.

• The cheeks look flat or the face looks gaunt. Deflation of the deep fat compartments and skeletal change. Fat grafting, usually alongside a facelift.

• The eyes look tired, with bags or hollows. Lower eyelid fat prominence, a tear trough, or a descended midface. Lower blepharoplasty, often with fat grafting or facelift.

• The upper eyelids feel heavy. Eyelid skin excess, a descended brow, or both. Brow lift, upper blepharoplasty, or the two together.

• The face changed quickly after weight loss. Deflation with laxity. Post–weight loss facelift and neck lift with fat grafting, once weight has been stable for three to six months.

• A previous facelift has relapsed or never looked right. Scar tissue, residual laxity, or lost volume. Revision facelift, often with fat grafting.

At consultation Dr. Ramly examines each region in turn, takes standardized photographs, and writes the plan down: what will be done, what will not, and why.

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How the face ages

Facial aging happens in four layers at once, and each layer calls for a different correction. This is why the same complaint, “I look tired,” can require a brow lift in one patient, a lower blepharoplasty in another, and fat grafting in a third.

Bone. The facial skeleton remodels with age. The orbital rims widen, the maxilla recedes, the pyriform aperture around the nose enlarges, and in many patients the mandible loses height and projection. Nothing lifted will restore skeletal projection; only volume, placed where the bone has retreated, does that.

Fat compartments. Facial fat is organized into discrete superficial and deep compartments that age differently. The deep compartments of the midface deflate, removing support beneath the cheek. The superficial compartments then descend, contributing to the nasolabial fold and the jowl. A deep plane facelift releases and repositions them; fat grafting refills what has deflated.

Ligaments. The face is tethered to the skeleton by retaining ligaments: zygomatic over the cheekbone, masseteric along the front edge of the masseter muscle, mandibular beside the chin. The tissue between them sags while the ligament holds, which is why the jowl forms just behind the mandibular ligament. A facelift that does not release these ligaments cannot move the tissue they anchor. This is the central difference between a deep plane technique and a superficial one.

Skin. Skin loses collagen, elastin, and recoil. Fine lines, pigmentation, and texture are skin problems and are treated at the skin. Laxity is mostly a problem of what lies beneath and is treated surgically. Offering skin treatment for a structural problem under-treats; offering surgery for a skin problem over-treats.

The neck is its own system. The neck ages beneath the platysma: fat accumulates below the muscle, the digastric muscles and submandibular glands become visible, and the platysma bands. Skin laxity is the last and least important part. A neck lift that only removes skin and fat above the platysma addresses the surface and leaves the structure.

Sequencing and staging

• When combining is right. Procedures in the same tissue plane with overlapping recovery: facelift with neck lift, facelift with fat grafting, brow lift with blepharoplasty. One anesthetic, one recovery, one result planned as a whole.

• When staging is right. Operations that would exceed a safe anesthetic duration, patients with medical factors that make a long procedure unwise, or plans where one result should be assessed before the next is decided. Rhinoplasty is usually its own operation. Resurfacing is sometimes deferred until swelling has settled.

• The usual order. Structure first, surface second. Weight stabilized before anything.

• After GLP-1 or major weight loss. Surgery waits until weight and medication dose have been stable for at least three to six months; the anesthesiologist advises on pausing the drug before surgery.

• Filler history. Years of filler often leave more residual product than patients realize, and it distorts the examination. Dissolving it and allowing the tissue to settle is sometimes the first step.

When the recommendation is to do less, or to wait

A surgeon who only recommends surgery is not diagnosing. Several situations call for restraint:

• Mild changes. A patient with the first signs of jowling and a well-preserved neck may be served by fat grafting alone, or by nonsurgical care for several more years. A facelift performed too soon gives a small result and brings forward the need for a second.

• A problem that is not surgical. Dark circles from thin skin or pigmentation, texture, and dynamic lines are treated at the skin.

• Unstable weight. Surgery waits until weight has settled.

• Unrealistic goals. A patient who wants a different face rather than a restored one will not be satisfied by restoration.

• Medical factors. Smoking, uncontrolled blood pressure, certain medications, and some conditions change the risk profile enough to defer or decline.

Declining to operate is a recommendation, not a refusal of care. It is written into the plan with the reasoning, and the patient leaves knowing what would change the answer.

Recovery when procedures are combined

Combined surgery is planned so that recovery overlaps rather than stacks. For a facelift with deep neck lift and fat grafting:

• Days 1–3. Swelling and bruising peak. Head elevated, light activity, soft diet. A light dressing; drains are used selectively rather than routinely.

• Days 4–7. Bruising begins to fade. Sutures around the ear are removed during the first week. Most patients are comfortable without prescription pain medication.

• Week 2. Presentable with makeup for many patients. Return to desk work and social settings that do not involve close scrutiny.

• Weeks 3–4. Most visible swelling resolved. Return to exercise, beginning with light cardio. On-camera or public-facing work is realistic for many patients.

• Months 2–3. Residual firmness and subtle swelling settle. Incisions mature from pink toward skin tone.

• Months 6–12. Final result. Grafted fat has stabilized; scars have faded to their final appearance.

Adding blepharoplasty or a brow lift does not materially extend this course. Resurfacing adds its own healing period. Patients who travel for surgery remain in Los Angeles for seven to ten days; see information for out-of-town patients.

Risks, stated plainly

Every operation carries risk, and combined surgery carries the risks of each component. For a facelift and neck lift, the ones that matter most: hematoma (bleeding beneath the skin, the most common complication in the first twenty-four hours, managed promptly); numbness of the cheek and ear, which usually resolves over months, though a small area near the ear can remain; infection and delayed healing or skin loss, both more likely in smokers; temporary weakness of a facial nerve branch, uncommon and almost always resolving; visible scarring, hairline distortion, or earlobe change, which are technique-dependent; hair loss along incisions; prolonged swelling or firmness; asymmetry; the possibility of a revision; blood clots; and the general risks of anesthesia. Blepharoplasty carries dry eye, lid malposition, and, very rarely, vision-threatening bleeding. Fat grafting carries under- or over-correction and, rarely, firm areas of fat necrosis or cysts.

These are listed because a patient who understands them makes a better decision and recovers with less anxiety. Each is discussed at consultation with reference to the specific plan.

Anesthesia, facility, and incision design

Surgery is performed in an accredited surgical facility under general anesthesia or deep sedation with local anesthetic, chosen with the anesthesiologist according to the plan and the patient’s health. Patients who prefer to avoid general anesthesia may be candidates for the awake facelift; the operation itself is not reduced.

Incision design is decided for each patient. In front of the ear, the incision follows the edge of the tragus or sits just inside it, depending on skin thickness and ear shape. At the temple, it is placed along the hairline rather than within it when the sideburn would otherwise be lifted. Behind the ear, it runs in the crease and into the hairline at an angle that keeps the hairline continuous. These choices are what make a scar inconspicuous and a hairline unchanged, and they are worth asking any surgeon about.

Follow-up visits, from the first week through the first year, are with Dr. Ramly.

How cost is structured

Comprehensive surgery is quoted as a single plan, not a sum of menu prices: the surgeon’s fee, reflecting scope and duration; the anesthesia fee; and the accredited facility fee. Combining procedures in one operation costs less than performing them separately because anesthesia and facility time overlap. A written, itemized quote is provided at consultation once the plan is set. Elective aesthetic surgery is not covered by insurance; functional components, such as a brow lift or upper blepharoplasty correcting a documented visual field obstruction, are occasionally eligible and assessed case by case.

Frequently asked questions

How do I know whether I need a facelift, a neck lift, or both?

The examination answers this. If the jowl and nasolabial fold are the main changes and the neck is still well defined, a facelift alone may be right. If there is banding, fullness beneath the chin, or a loss of the angle between chin and neck, the neck needs its own operation. In most patients over fifty the two are performed together.

Can a facelift be combined with eyelid surgery?

Yes, and it often should be. The lower eyelid and cheek form one unit; correcting one while leaving the other produces a visible mismatch. Upper blepharoplasty and brow lift are also commonly added. The combined operation is longer, but recovery is not materially extended.

Where are the scars placed?

In front of the ear along or just inside the tragus, around the earlobe, behind the ear in the crease, and into the hairline at an angle that keeps the hairline continuous. Eyelid incisions sit in the upper lid crease and just beneath the lower lash line or inside the lid. Brow lift incisions are hidden in the hairline or, for an endoscopic approach, behind it. Incision design is discussed before surgery.

What makes Dr. Ramly’s approach different?

The diagnosis comes before the procedure. Every region of the face and neck is examined and the plan is written down with its reasoning, including what will not be done. Surgery is performed by Dr. Ramly personally, follow-up is not delegated, and the practice is small enough that it stays that way.

Is it safer to do everything at once or to stage procedures?

It depends on total operating time and the patient’s health. Procedures in the same tissue plane with overlapping recovery are usually safer and more predictable combined. Procedures that would push anesthetic time beyond a safe threshold, or where one result should be assessed before the next is decided, are staged.

Do I need fat grafting with my facelift?

If the examination shows deflation of the deep cheek, temple, or tear trough, yes. Lifting restores position, not volume. If volume is well preserved, fat grafting is omitted.

What is the right order if I want several things done over time?

Structure before surface. Repositioning and volume first; skin resurfacing afterward. Weight stabilization before any of it. Rhinoplasty is usually its own operation.

I have had a lot of filler. Does that change the plan?

Often. Residual filler can persist for years and distort both the examination and the result. It may need to be dissolved before surgery so that the plan is based on your actual anatomy.

I lost significant weight on a GLP-1 medication. When can I have surgery?

Once weight and medication dose have been stable for at least three to six months; the anesthesiologist advises on pausing the drug before surgery. The plan nearly always includes fat grafting alongside repositioning.

Will I look like a different person?

No. The goal is restoration of your own face as it was some years ago, not a new one. Results that look like surgery come from skin tension, over-resection, over-filling, or treating one feature in isolation.

How long do the results last?

A deep plane facelift and neck lift are long-lasting, often a decade or more, varying with skin quality, genetics, weight stability, and sun exposure. Fat that has survived at about six months is considered durable. Blepharoplasty results are usually lasting. Skin treatments require maintenance.

Can nonsurgical treatments replace surgery?

For skin texture, pigmentation, dynamic lines, and mild volume loss, yes. For descended tissue and a structurally aged neck, no; energy devices and threads tighten skin modestly and temporarily but cannot reposition deep tissue or address what lies beneath the platysma.

What is the recovery for combined surgery?

Most patients are presentable with makeup at two weeks and comfortable in public-facing or on-camera settings at three to four weeks. Final results are judged at six to twelve months.

Does Dr. Ramly perform the entire operation?

Yes. Dr. Ramly performs the surgery personally from first incision to final suture, and follow-up visits are with him.

How is the cost of a comprehensive plan determined?

As a single written quote covering surgeon, anesthesia, and facility fees, provided once the plan is set at consultation.

I live outside Los Angeles. Is that practical?

Yes. Consultations can begin virtually, with the in-person examination the day before surgery. Patients stay in Los Angeles for seven to ten days afterward. Information for out-of-town patients.

About Dr. Ramly

Dr. Elie Ramly trained in plastic and reconstructive surgery at Harvard, with a foundation in complex facial reconstruction before focusing his practice on aesthetic surgery of the face and neck. He is the author of 89 peer-reviewed publications and remains active in the surgical literature. A meaningful share of his facial practice is revision and complex work, including patients whose results must withstand close scrutiny on camera. The practice is deliberately small: consultations are unhurried, surgery is performed personally from first incision to last suture, and follow-up is not delegated.

Ramly Plastic Surgery · 414 N. Camden Drive, Suite 800, Beverly Hills

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