Facial aging results from both intrinsic changes in the skin and gravitational changes that affect the skin and deeper tissues of the face. Intrinsic changes of the skin are largely the result of the cumulative effect of years of sun exposure, which are seen as a loss of skin elasticity, irregular or "splotchy" pigmentation, and a rough texture. Treatment focuses on sun avoidance in addition to a program of skin care that can help to reverse these changes and improve both the quality and texture of the skin. These patients often benefit from a resurfacing procedure using chemical peels or lasers to help remove layers of sun damage and help the skin to regenerate a more youthful appearance and texture. Gravitational changes are the result of relaxation of a series of retaining ligaments that normally suspend our facial soft tissues and provide a youthful appearance. As these tissues relax during the aging process, the brow position drops, eyelid fat and skin acquire multiple folds, and the eyelid area takes on a "tired" look. In the midface, the fat of the cheek prominence drops to deepen the fold between the mouth and nose. The lower face loses the smooth contours of the jawline and the angle where the neck meets the chin. Surgical correction is directed at a restoration of these soft tissues to their original anatomic configuration. The surgical goal is one of restoration, to make the patient appear "refreshed", free of abnormal distortions that can sometimes be seen with facial surgery. The upper face, brow and eyelid areas are best approached as a unit. Most patients that seek to improve the appearance of their eyelids can do so only if their brow is in the correct aesthetic position. These areas can be addressed with a combination of browlift, often performed using short incision endoscopic techniques, and traditional eyelid surgery that removes fat and skin in the combination needed for each individual patient. The midface and lower face and neck can be addressed by a facelift technique. This procedure seeks to resuspend the connective tissue layer beneath the skin to obtain more youthful midface contour, a smooth jawline, and increased definition of the angle where the chin meets the neck. This approach then allows for the skin to be redraped without tension allowing for a more natural, less "surgical" look. The goal is to help your face to return to its previous youthful configuration. A personal consultation allows for an in-depth evaluation that results in the combination of approaches that best fits your specific needs. These procedures are most often performed in combination, but some patients may have needs confined to only the eyelid and brow areas, for example. These procedures are usually performed on an outpatient basis under general anesthesia or sedation. Recovery usually involves a one to two week period of activity restriction. What follows are examples of patients who have allowed us to share their preoperative and postoperative photographs with you. These are examples of typical outcomes, but may not represent your preoperative situation or postoperative result.