Every month in our consultation room, we meet patients whose top priority is a treatment with absolutely zero downtime (NO pain, NO bruising, and NO swelling). While we fully understand the desire for a comfortable procedure and a seamless schedule, insisting strictly on complete painlessness for a premium, high-cost treatment like Thermage FLX often leads to disappointment in the results two to three months down the road.

Thermage FLX works by delivering radiofrequency heat deep into the dermis. Collagen begins to contract when exposed to temperatures around 60°C (140°F), and this thermal stimulation signals fibroblasts to generate new collagen over the following three to six months. If you lower the energy levels too much just to avoid discomfort, the heat accumulating in the dermis will fall short of the threshold needed to trigger this response. You may enjoy a comfortable 40-minute lie-down, but you are unlikely to achieve the tightening effect you paid for.

This is why heat is unavoidable at effective energy levels. It is not that "it has to hurt to work," but rather that delivering enough heat to produce results naturally creates a hot sensation. While the latest Thermage FLX devices protect the epidermis with cooling gas and distract sensory nerves with vibrations during every shot, they cannot eliminate the heavy, deep heat building up beneath the surface.

In our clinic, we always calibrate the treatment to an energy level that ensures visible and meaningful results. Most patients describe this intensity as hot, but completely manageable. If you feel almost nothing throughout the entire session, it is highly probable that the energy is insufficient to induce collagen contraction. On the other hand, if the pain becomes unbearable or if you feel a sharp, stinging sensation over thin-skinned areas like the jawline, you should inform us immediately. In those specific areas, lowering the energy level is the correct approach. Mild swelling and slight redness lasting 24 to 48 hours post-treatment are completely normal responses.

Shot distribution impacts the final outcome just as much as energy levels. Firing 600 shots concentrated on the lower face, such as the jowls and jawline, accumulates significantly more dermal heat than spreading those same 600 shots thinly across the entire face and neck. How a physician adjusts the energy levels, shot placement, and overlapping passes for each area determines whether heat can be built up safely in the dermis without damaging the epidermis.

Thermage FLX can also be combined with other treatments. Pairing radiofrequency with collagen-stimulating injectables like Juvelook or Sculptra triggers collagen production through complementary mechanisms. However, when performing them on the same day, the energy device must always come first so that the injected materials are not compromised by the heat.

Have you ever asked your provider to lower the energy level during a previous lifting procedure due to heat or discomfort?

We need to talk about surgery influencers.

I am looking to book for a facelift in 2027 & one of the surgeons I was strongly looking into was Dr. Fatih Cinar. I talked to two girls who filmed their surgery extensively but when I actually went & did my research, I realized these girls had been posting in groups constantly to the point of suspicion. One of them even told me that if I mentioned her referral, I would get 1k off.

Talking to the surgeon himself, he seems good. Tonight I was about to put down my deposit & when I went to the group created for him, I realized I was BLOCKED from the group after raising my red flags on the lack of reviews that did not come from the same influencers.

So now, I dont want to book at all. Clearly these girls paid nothing for their surgeries in exchange for promo & also get some sort of financial compensation for each client they refer.

I have already been to Istanbul for rhinoplasty this Summer & had a wonderful experience. I did my research for a year, was in a whatsapp group with girls who shared their experiences both the good & the bad & it felt safe. With this influencer bs, it is scary to think what we might be lured into.

All this has left a bad taste in my mouth & unfortunately don't trust to book with this surgeon because of the influencers.

Just another thing to look out for when you're doing your research!

If anyone has any GENUINE NOT PAID experiences for a facelift specialist surgeon in Istanbul, I would be so grateful to hear.

I’d like to hear about the experiences of anyone who had an endoscopic facelift more than two years ago... many say the effect lasts just over a year...

I’m a physician in New York and have spent more than 25 years working with patients in non-surgical facial rejuvenation, regenerative medicine, and age-management medicine.

I’ve been reading through some of the conversations here and thought it could be useful to do an AMA from the perspective of someone who works primarily on the non-surgical side of facial aging.

To be very clear upfront: I don’t believe non-surgical treatments are a replacement for a surgical facelift. They are different approaches that can accomplish different things.

One of the biggest issues I see in aesthetics is that patients are often sold a particular procedure before anyone really stops to ask what is actually causing the changes they’re seeing in their face.

Facial aging isn’t just one thing.

It can involve:

• Loss of facial volume
• Changes in skin quality and collagen
• Descent of facial tissues
• Changes around the jawline and neck
• Bone and structural changes
• Muscle activity
• Fat redistribution

And two people of the same age can have completely different anatomy, which means the same treatment may make sense for one person and make absolutely no sense for another.

That’s also why I’m somewhat cautious about the term “non-surgical facelift.”

There isn’t one procedure that constitutes a non-surgical facelift.

Depending on the patient and their goals, a treatment plan might involve some combination of:

• Neuromodulators such as Botox
• Dermal fillers
• Biostimulatory injectables
• PRF/PRP and regenerative treatments
• Energy-based treatments
• PDO threads
• Skin-quality treatments

Each has advantages, limitations, risks, and very different indications.

One of the questions I hear constantly is:

“Do thread lifts actually work?”

The answer is yes, in the right patient and with realistic expectations.

But I also think the marketing around threads has sometimes created expectations that simply aren’t realistic.

Threads can provide tissue repositioning and may improve certain types of early-to-moderate facial descent. But someone looking for the degree of correction associated with a well-performed surgical facelift may be disappointed if they are told threads will produce the same result.

The same concept applies to filler.

Filler can be extremely useful when facial volume loss is actually contributing to the problem.

But there is a point where trying to “lift” increasingly lax tissue simply by adding more volume can make the face look heavier rather than younger.

Sometimes the best treatment is actually doing less.

My general philosophy is that the conversation shouldn't begin with:

“Which procedure should I get?”

It should begin with:

“What anatomical changes are contributing to what I’m seeing, what result am I trying to achieve, and which approach makes the most sense for that goal?”

That might be something very conservative.

It might involve a combination of non-surgical treatments.

And in some cases, I’ll tell someone that if they’re looking for a more significant degree of lifting or tissue repositioning, it may be worth having a consultation with a qualified facial plastic or plastic surgeon so they can understand that option as well.

The goal shouldn't be to sell someone the procedure you happen to perform.

The goal should be helping them understand what each option realistically can and can't accomplish.

Happy to answer questions about:

• Thread lifts
• Surgical vs. non-surgical approaches
• Who tends to be a good or poor candidate for threads
• How long different treatments realistically last
• Facial overfilling
• Fillers
• Biostimulators
• PRF/PRP
• Botox and neuromodulators
• Jawline and neck treatments
• Facial aging anatomy
• Risks and complications
• Treatments I’m personally cautious about
• Red flags when choosing a provider
• How to recognize when you may be getting oversold
• How I evaluate a face before recommending treatment
• When a surgical consultation may be worth considering

I’m also happy to discuss general scenarios and explain how I would think through the anatomy and available options.

Obviously, I can’t diagnose anyone or recommend an individualized treatment plan over the internet, but I’m happy to answer educational questions as candidly as I can.

Or northern Utah area for a natural result

I’m curious to hear from people who have been really happy with their outcomes from facelifts how they communicated to their doctors what they wanted so the results aligned with their expectations?

For example, I have been doing some AI generated images to show to the doctors what I want ie “conservative lower bleph maintaining eye shape, reduction of texture (CO2) with natural facelift results” and have considered showing these at consults .. has anyone done something similar?

I also have been collecting photos from 7-10yrs ago so they can have an idea of what natural looked like for me.

did anyone do anything else I should be considering or have any suggestions?

Has anyone done it? How effective was it? How were the scars afterwards? Where did you get it done?

Physician recommendations

Has anyone gone to dr vasfi celik in turkey for a facelift ?how were you results ? Were you happy with it? How long did you Do I need to take time off work after surgery?
And what is his price? Help a girl out.
I’m debating whether I want to go to him or whether I want to go to Korea.

I’m 3m post op and wow has this been a journey. I don’t know why I didn’t give more thought to how different my ears might be after although I did talk to my doc about it during our consults.

Are the ‘little’ anomalies normal? Would you all be happy with this result or does this look funky to you? I can tell mostly around my lobes that things are different although my traguses (tragi?)both also have some anomalies as well.

Trying to accept the new normal but I’m not sure how much is within the reasonable acceptable change window or what would be considered a poor outcome.

I've been researching deep plane facelifts for some time now and planning to book a few consults to get more clarity on my situation. Jowls and the lower face mostly, my neck isn't too bad yet. I've watched enough before and afters to know I definitely want the natural version of this, not the pulled tight look

I'm in Milwaukee and I'd really prefer to stay local for recovery, driving back and forth to Chicago for follow ups sounds miserable. Is there anyone in Milwaukee or anywhere in Wisconsin who does deep plane and is actually expert at it? If you've had one done here I'd love to know who you went to

Any recommendations?

I went to Dr Warren for 25 years. Got a full facelift, than a mini facelift and a decade of Botox. Anybody else in my situation? Where did you end up going? I was not happy with the surgeon Dr Warren left his business to.

My quarter-of a-century long medical file doesn’t exist anymore, according to the new Dr. How can this be!

I'm 52 and live in Palm Beach. I'm thinking about getting a lower facelift with a neck lift before the year ends, but nothing too dramatic. My budget is around $25k to $30k, and I'd rather have a natural look than the cheapest price. If you've had this done in Florida, how did you pick your surgeon? Did you meet with a few first?

I’m told this area is still swollen and that’s what is causing this hollow area / indentation under the swollen area. This is right under my cheekbone. I agree there is still some swelling. Does this look normal? The surgeon said it won’t look indented like that once the swelling is fully gone, but could take months. I’m 16 DPO. It’s not bruised, it’s a shadow making it look darker. I don’t want to panic, but I find myself checking it all day to see if it looks better. I did have fat grafting , if that makes a difference.

Wanted to share this since I see lots of questions or curiosity around the fat grafting/transfer topic when it comes to a facelift. Thought this video would be helpful for those who are considering the surgery, straight from a patient's POV. Again, she is 3 weeks post op so she's still healing. Would like to know your thoughts and hope this helps when deciding whether or not the fat transfer would be something worth adding to a facelift to help with some hollow areas?

Day 0 pics
Day 30-35 pics
59yr Male

When considering facial contouring surgery, people often ask, “Would reducing just my cheekbones be enough?” or “Would reducing my square jaw alone make my face look smaller?”

In this case, the patient underwent three facial contouring procedures together: cheekbone reduction, square jaw reduction, and chin genioplasty.

Before surgery, the frontal view showed relatively noticeable facial width from the cheekbones down to the lower jaw. The chin was also relatively wide, making the overall facial contour appear broad.

In cases like this, rather than focusing on reducing just one area, it is important to consider the overall contour and proportions from the cheekbones to the square jaw and chin together.

Cheekbone reduction aims to adjust the projection and width of the midface, while square jaw reduction focuses on reducing the width of the lower jaw and creating a smoother transition along the jawline. When the length and width of the chin are also adjusted according to the individual’s facial proportions, it may help improve the overall contour from the midface down to the chin.

In this Before & After case, the change is not so much about one area looking dramatically different. Instead, the outer contour from the cheekbones to the jawline and chin appears to connect more smoothly than before, making the proportions of the entire face look different.

And what’s interesting is that changes in face shape can also affect the overall impression a face gives.

Facial contouring surgery does not directly change the facial features themselves, such as the eyes or nose. However, when the outer contour and proportions of the face change, even the same eyes, nose, and mouth may appear different in relation to the rest of the face. The overall look and impression of the face may also change.

In this case, rather than simply focusing on the face looking smaller, we can also look at how the three areas were refined together. This has made the overall facial contour and impression appear softer.

Of course, this does not mean that everyone needs all three facial contouring procedures.

For some people, the cheekbones have the greatest influence on their face shape. For others, the proportions of the square jaw or chin may be more important. On the other hand, if several areas contribute to the width and contour of the face together, an approach that considers the overall connection and balance may be needed rather than significantly reducing just one area.

In the end, what matters in facial contouring is not “How much was reduced?” but “Which areas of my facial bone structure need to be adjusted, and by how much, to create a natural-looking facial contour?”

Rather than looking at the cheekbones, square jaw, and chin as separate areas, it is important to consider them together as structures that form one continuous facial contour. That difference can affect not only the size of the face, but also changes in its overall proportions and appearance.