Facial Rejuvenation: Surgical and Non-Surgical Approaches
- Dr. Naheed Ali, MD, PhD
- Jul 27
- 11 min read
Updated: Jul 28
Facial enhancement involves a set of cosmetic procedures that treat visible signs of aging to improve skin health and appearance. Common concerns include wrinkles, sagging skin, and volume loss, prompting individuals to seek treatments that provide a refreshed look. Both surgical and non-surgical options are available, tailored to patient needs [1]. Facial enhancement costs vary based on treatment goals, selected services, and geographic location, highlighting the importance of individualized planning [2].
Recognizing the Signs of an Aging Face
With age, the skin goes through tremendous changes that result in altered skin condition. While genetics plays a large role, environmental factors, such as UV exposure, sun damage, smoking, and stress, also contribute to these visible signs [1]. The aging face may show the following signs:
Facial Wrinkles: Fine lines and deeper wrinkles around the eyes, mouth, and forehead form as the skin becomes less elastic as a result of decreased collagen and elastin production [1].
Sagging Skin: With the loss of collagen and fat under the skin, the face starts to sag in areas like the jawline, cheeks, and eyelids [1].
Eye Bags: Puffiness under the eyes, usually due to fluid retention or compromised tissue, can add to a tired or old appearance [1][3].
These alterations tend to compel patients to look for interventions that can reverse or reduce their observable effects.
Causes of Bags Under Eyes: Why Puffiness Develops
Bags under the eyes are a common concern, particularly as people age, prompting many to explore various skin treatments and common procedures. This condition arises when the structures that support the eyelids weaken over time, contributing to skin laxity in the area. As a result, the skin around the eyes starts to sag, and fat that is typically found around the eye area can shift downward. In some cases, fluid may accumulate under the eyes, making the area appear swollen or puffy [3].
Several factors contribute to the development of under-eye bags, including:
Aging [1][3]
Genetics [3]
Lifestyle factors [3]
Fluid retention [3]
How Does the Skin Age?
The process of skin aging is complex and involves both intrinsic and extrinsic factors that affect new collagen production [4].
Intrinsic Aging
Intrinsic aging refers to the natural aging process that occurs due to genetic factors. Over time, the skin loses its ability to produce collagen and elastin, which are responsible for maintaining the skin’s strength and elasticity [4]. This leads to:
Wrinkling [1][4]
Thinning skin [1]
Loss of volume [1][4]
Extrinsic Aging
Extrinsic aging refers to factors outside of genetics that accelerate the skin's aging process [4]. These factors include:
UV exposure [4]
Pollution [4]
Lifestyle factors [1][4]
Minimally Invasive Facial Treatments: Options and Benefits
Patients seeking solutions for aging, pigmentation, or acne scars often turn to less invasive procedures and treatments. Non-surgical facial enhancement treatments include chemical peels, laser skin treatments, and injectables such as neuromodulators and dermal fillers. These options offer effective results with less downtime, lower risk, and greater affordability than surgery [5].
Anti Aging Treatments in Cosmetic Dermatology
Cosmetic dermatology provides various treatments designed to enhance facial aesthetics and address common aging concerns. These treatments can improve skin quality, reduce wrinkles, and contribute to healthier skin [5].
Laser-Based Skin Resurfacing Treatments
Laser skin resurfacing treatments utilize ablative and non-ablative laser technologies to induce controlled dermal injury, triggering neocollagenesis and extracellular matrix remodeling [6]. It helps minimize wrinkles and improve skin irregularities, resulting in less scarring and bruising than other treatments.
Ablative Lasers: Carbon dioxide (CO₂) and erbium (Er:YAG) lasers vaporize the epidermis and coagulate dermal tissue, improving deep facial wrinkles and skin texture [6]. These lasers are FDA-approved for skin resurfacing treatments aimed at improving skin texture, reducing wrinkles, and treating photodamage. They are not FDA-approved for face-lifting or under-eye bags.
Non-Ablative Lasers: Fractional lasers and intense pulsed light (IPL) systems deliver thermal energy to the dermis without damaging the epidermis, targeting mild-to-moderate wrinkles and pigmentation with minimal downtime [6][7]. These devices are FDA-cleared for skin resurfacing treatments but not for face-lifting or removal of deep eye bags.
Laser treatments can have shorter recovery times and achieve subtle improvements that look natural compared to traditional surgical methods [6].
Lasers are FDA-cleared for skin resurfacing. Use for lifting or treating under-eye bags is off-label. Known risks include burns, pigmentation changes, and scarring. Risks include post-inflammatory hyperpigmentation, erythema, infection, and scarring [6][7]. For complete FDA labeling, visit this guide.
Microneedling (Percutaneous Collagen Induction Therapy)
Microneedling creates micro-wounds in the skin that trigger the body's healing response, stimulating collagen and elastin production [4][8].
Microneedling is often combined with platelet-rich plasma (PRP) or radiofrequency to enhance results. [8][10].
Microneedling devices are FDA-cleared for facial acne scars in adults 22+. Use for general facial enhancement or with PRP is off-label. Effectiveness and safety are unestablished. Risks include erythema, infection, and hyperpigmentation. See this guide for complete FDA labelling.
Chemical Peeling Agents and Protocols
Chemical peels, using agents like glycolic acid and trichloroacetic acid (TCA), can resurface the skin, lighten pigment, reduce acne, promote collagen production, and involve skin peeling [5][9].
Chemical peels may be used in combination with other procedures for more dramatic effects [9], but their safety and efficacy for off-label uses have not been established.
Chemical peel products are not FDA-approved for general use. Consumers should only use these products under the supervision of a licensed practitioner. The safety and effectiveness of off-label uses have not been established. Risks include erythema, irritation, and infection
Injectable Fillers and Botox for Facial Wrinkles Treatment
Injectable treatments, such as dermal fillers and neuromodulators, are non-surgical options that address volume loss and expression lines with minimal downtime, improving facial contours [5].
Dermal Fillers for Facial Volume Restoration
Dermal fillers (soft tissue fillers), such as hyaluronic acid (HA), poly-L-lactic acid (PLLA), and calcium hydroxylapatite (CaHA), are used to restore facial volume and improve wrinkles [11].
Hyaluronic Acid (HA) Fillers: Hydrate and volumize tissue, lasting 6-12 months and reversible with hyaluronidase [11].
Calcium Hydroxylapatite (CaHA) Fillers: Provide immediate volume and stimulate collagen, lasting 12-18 months [11].
Poly-L-lactic Acid (PLLA) Fillers: Gradually stimulate collagen for improved skin thickness, lasting up to 24 months [11].
These skin resurfacing treatments complement other non-invasive procedures for facial wrinkle treatment and overall skin quality improvement [5]. Studies show that filler injections combined with BTX-A can improve the longevity of the results compared to using either alone [1][11]. However, the safe use of dermal fillers in combination with other treatments has not been evaluated by the FDA.
Most dermal fillers are FDA-approved for midface and nasolabial folds, not the under-eye area. Use in this region is off-label and carries risks such as bruising, swelling, and vascular complications. See FDA labeling for approved uses, contraindications, and risks.
Botulinum Toxin (Botox) for Dynamic Wrinkles
Botulinum toxin (Botox) is used to reduce muscle movement and soften lines and wrinkles by temporarily blocking neurotransmission to the muscle [5].
Common Treatment Areas: Glabellar lines, forehead creases, crow’s feet, and bunny lines [12].
Onset and Duration: Effects appear in 2–6 days [13], peak at 2 weeks, and last 3–6 months [12].
Benefits: Softens fine lines from repetitive movement, creating a more relaxed facial appearance [5][12].
A combination approach is popular among patients who seek non-invasive facial enhancement options. Botulinum toxin type A (BTX-A) is often combined with fillers for better results [1][11][12].
Botox is FDA-approved for glabellar lines, forehead lines, and crow’s feet. Use elsewhere (e.g., lower face) is off-label. Potential risks include unintended muscle weakness and asymmetry. See FDA labelling for complete details.
Eye Bags Treatment: Solutions to Reduce Eye Puffiness
For mild under-eye bags, several simple remedies can help reduce puffiness:
Cool Compress: Applying cold compresses helps constrict blood vessels and reduce swelling [3].
Fluid Management: Reducing fluid intake before bed and cutting back on salt can decrease fluid retention around the eyes [3].
Adequate Sleep: Getting sufficient rest is key to minimizing under-eye puffiness [3].
Sleeping Position: Elevating the head during sleep can prevent fluid buildup around the eyes [3].
Injectable Autologous Biologics: PRP and PRFM
Autologous injectables such as platelet-rich plasma (PRP) and platelet-rich fibrin matrix (PRFM) are widely used in aesthetic dermatology for improving dermal quality and soft tissue structure [14]. PRFM, unlike conventional PRP, forms a fibrin scaffold that enables sustained cytokine release and dermal remodeling [15]. SELPHYL®, a standardized PRFM system, generates leukocyte-poor fibrin matrices for biocompatible volumization with minimal inflammation [16].
While several PRP preparation systems have received FDA 510(k) clearance for specific medical applications, such as mixing PRP with bone graft materials, this clearance applies to the device, not the product’s use in aesthetics.
SELPHYL® is not FDA-approved for aesthetic applications involving injections beneath the skin, mucosa, or within the dermis, and its safety and efficacy for these cosmetic indications remain unestablished. Reported risks include erythema, edema, bruising, and post-inflammatory pigmentation [17]. Refer to the full FDA labeling for device-specific indications.
Advanced Procedures for Facial Rejuvenation
For more severe aging signs or patients seeking more dramatic improvement in their appearance, reconstructive surgery options may be considered. These procedures provide longer-lasting effects and are more suitable for individuals with significant facial aging. Costs are influenced by the procedure type, the surgeon's experience, and the location of the treatment facility [18].
Recovery time can impact overall costs, as longer recovery periods may lead to additional expenses such as time off work and follow-up care. Your surgeon will outline the full cost structure during your consultation, ensuring clarity about all fees and potential costs [18].
Some surgical applications, like combining procedures with adjunct treatments, may be off-label and not FDA-reviewed for safety or efficacy.
Rhytidectomy (Facelift)
Rhytidectomy, or facelift, is a surgical procedure that corrects facial ptosis and laxity by repositioning deep tissues and removing excess skin. It involves subcutaneous dissection and manipulation of the superficial musculoaponeurotic system (SMAS) to enhance contours of the midface, jawline, and neck. Techniques such as deep plane facelift, SMAS plication, and short-scar facelift allow customization based on facial anatomy and goals. This procedure suits patients with advanced signs of aging, including loose skin and prominent jowls [19].
Patients considering surgical facial procedures should be in good overall health to qualify for surgery [19].
Devices like PRP, lasers, or radiofrequency are sometimes used off-label during facelifts. These uses are not FDA-cleared. Risks may include infection, delayed healing, and scarring. Consult FDA labeling for further information.
Benefits of Facelift Surgery
The cosmetic change of a facelift is considerable. Patients may report perceived improvements; however, results vary and should be discussed with a qualified clinician. [19].
Improved facial appearance
Enhanced confidence
Long-lasting results
Refined neck and jawline contours
Natural-looking outcomes
Risks of Facelift Surgery
Risks associated with surgical facial procedures can include infection, scarring, and anesthesia complications [19].
Scarring: Although most incisions are hidden in natural facial creases, scarring may occur.
Infection: As with any surgery, infection is a possible complication.
Anesthesia Risks: General anesthesia includes respiratory issues or allergic reactions.
Hematoma: Blood collection under the skin may occur, potentially requiring drainage.
Asymmetry: Minor differences in facial symmetry can occur, and revision surgery may be needed.
Numbness and Swelling: Temporary numbness and swelling are common but typically resolve with time.
All patients should discuss potential risks with their surgeon and obtain detailed information about the procedure and expected outcomes.
Expected Recovery Timeline Following Facelift Surgery
Recovery from surgical facial procedures typically involves swelling and bruising, with downtime lasting from several days to weeks, depending on the procedure. Postoperative recovery typically involves a convalescence period of 2 to 3 weeks, during which edema, ecchymosis, and soft tissue swelling gradually resolve. Full resolution of residual edema and scars, along with scar maturation, may extend over several months. Patients are counseled on activity modifications and diligent wound care to optimize outcomes [18][19].
Blepharoplasty
Lower eyelid blepharoplasty effectively addresses under-eye bags, puffiness, and excess skin, contributing to an improved appearance. Recovery typically involves 1-2 weeks for swelling and bruising to subside, with full healing occurring in 4-6 weeks [20].
Adjuncts such as CO₂ lasers or PRP are occasionally applied in lower eyelid surgery [20] but are not FDA-approved for this indication. Known risks include skin burns, prolonged swelling, and pigmentation changes. For more details, refer to the FDA product labeling.
Conclusion
Facial rejuvenation encompasses a spectrum of surgical and adjunctive procedures aimed at addressing structural and soft-tissue changes associated with aging. Techniques such as rhytidectomy and lower eyelid blepharoplasty remain foundational for managing facial laxity, volume descent, and periorbital contour irregularities. Adjunctive treatments can further support cutaneous quality and enhance aesthetic outcomes when appropriately selected.
Optimal results depend on individualized treatment planning, anatomical precision, and a thorough understanding of procedural risks, with the overarching goal of restoring facial balance and promoting a refreshed, healthy appearance.
About the author: Dr. Ali is a medical journalist and copywriter.
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