Artiste Lift

This is Doctor Richard Balikian at Balikian Plastic Surgery, and I’m so excited to talk to you today about our comprehensive Artiste Lift.
For a long time, we’ve had amazing consultations with patients where I spent a good half hour, 45 minutes going over all the details of what we do, what separates us, and how we get these incredible results. Today, I’m going to expose everything I say during those consultations so you can really understand our philosophy—what an Artiste Lift requires, what it entails, whether it’s through a deep vertical neck lift combined with a deep plane facelift, temple lift, brow lift, blepharoplasty, lower blepharoplasty, or rhinoplasty. We look at it all.
We look at each patient as an individual and come up with an artistic approach to get a beautiful, natural result that looks like you, that you’re proud to see in the mirror. We wanted to call it the Artiste Lift because I realized it’s not just about engineering. It’s not about doing things just the way the surgery is supposed to be done by recipe.
Artistry is an amazing, important part of what I do, and I combine engineering and artistry to create these beautiful results that have nuance, finesse, and brightness. I take pride in that. I love what I do because, just like an artist loves producing, that’s what I love. I love being there in the operating room, being an artist, and seeing the results.
I also come from a history of studying art and artists. I was an art history major at Columbia. So, combining artistry through my training and what I do every day, we’re very happy to name our process the Artiste Lift.
Whenever I evaluate someone’s face, I’m really looking at three different categories of aging, and they each have their own treatment.
The first is gravity. Things fall. The best way to treat that is to lift them back up.
The second way we age is volume loss. We lose fat, bone, and muscle. We shrink from a grape in our 20s to a raisin as we turn 100. We start getting creases through the marionettes and the nasolabial folds that are not just about gravity but also about volume loss. That’s where we do things like fat transfer to soften those shadows.
The third way we age is texture changes to the skin. We get wrinkles, and a facelift isn’t a face pull. You can pull your skin and make the wrinkles go away, but that’s not how a properly done facelift works. Sometimes, we have to work on the texture, whether through lasers or light-based therapies. We can smooth out the texture of the skin.
So today, I’m going to go through each part of the Artiste Lift to explain how and why we do the things we do.
Starting with gravity, the first place we age is usually the neck and jowls. That’s why people come to see me—because they want to look like themselves with a sharper jawline. Usually, what we see on people’s necks are the beginning of bands that are sagging down, jowls hanging, deep marionette lines forming, and deep nasolabial folds. Sometimes, these have been filled with filler and look flatter but are still a little sunken. Often, we see the fat pads that were once high on the cheek falling to just above those nasolabial folds, creating a tired and pulled-down look due to gravity.
That’s why we developed the deep plane facelift and the deep vertical neck lift—to sharpen the neckline, enhance the jawline, soften folds, and lift the cheek pads back into their proper position.
Let’s talk a little about the anatomy of the face. When we’re doing a facelift, we’re lifting things that have fallen with gravity. But it’s not just the skin—it’s the muscle layer underneath that supports the skin. This muscle layer starts in our temples, extends under our skin through the cheeks, past the jawline, into the neck, and connects in the center of our neck, forming a U-shaped hammock of muscle holding everything up.
As we age, gravity takes over. That hammock starts sliding down, bringing the loose skin with it, creating jowls. In the center of our neck, the hammock splits, and the two sheets of muscle separate. They start to sag, and their inside edges show up as platysmal bands.
So what we want to do is fix that hammock. But as a hammock falls, its contents sag down too. Not only do we need to fix the hammock, but we also need to take some weight off it so it holds stronger and lasts longer.
Traditional facelifts, or sub-SMAS (under the muscle) facelifts, would treat just the hammock. Surgeons would make a small incision under the chin, go underneath, and tie the hammock muscles back together with stitches. Then, they would make incisions around the ears, lift the skin until they saw the muscle hammock underneath, go under it, lift it up, stitch it into place, and remove excess skin.
The problem with these facelifts was that they didn’t account for the fact that the hammock of muscle is also tethered down by Velcro-like attachments in the cheek, along the jawbone, near the jowls, and in the neck. Even though surgeons would go under the muscle, when they tried to lift it, it was still held down by these attachments.
This led to a tug-of-war, which caused many surgeons to pull too tightly to achieve a result. But all this did was put excessive tension on the face, creating pleats and unnatural looks. If they pulled the skin more, it put stress on the stitches, leading to thick scars and short-lived results, as the attachments would pull the face down again within a year.
That’s why the deep plane facelift was invented. The idea was to go deeper into the face, release those Velcro-like attachments in the cheek, jawbone, jowls, and neck, and lift from a deeper plane. Now, without those restrictions, we can lift the muscle properly—just a centimeter and a half—just like you do in front of the mirror.
When we lift from the right spot, without anything holding it down, we can reposition the fat pad, restore the jowl, and achieve a soft, supple, and natural-looking result. Because the jowl moves with the deep plane lift, there’s no need to pull on the skin. The stitch lines heal paper-thin, and no one will ever see your incisions. The success of the surgery comes not just from good stitching but from the entire procedure being done correctly.
Now, let’s talk about the incisions for our Artiste facelift. We start with a small incision under the chin. Unlike most surgeons who make a straight incision—which can lead to a noticeable “double bubble” or distinct scar—we take extra care. We create a small, curved incision that heals exceptionally well.
Through this incision, we access the muscle layers that have sagged. But instead of just tying them together like in a traditional facelift, we go deeper to find all the structures that have descended over time. This is where the sculptor in me comes out. I trim those down appropriately to take some of the load off, to make a smoother surface here. Once we do that, then we can tie the hammock of muscle back together, and then we do this very cool move. We release the hammock from everything that’s pulling it down. So instead of pulling up and back, we can really get a vertical deep neck lift. That’s how we get necklines that are super sharp, elongated, elegant, and beautiful. That’s why our patients come in and say, “I love my neck.”
Now, incisions around the ears. They start along the hairline here, completely hidden. They heal very well. It’s not going to change your hairline. It’ll follow the natural curve of your ear here and go on the inside edge of the ear cartilage there, along the earlobe to the back of the ear, completely hidden in that crease. We don’t make an incision behind your hairline where you can see it. We go all the way up to the top of the back of your ear, where no one will see it, where your earlobe overlaps with your hairline, and slightly down the hairline. They heal exceptionally well. We don’t get pulled ears, and we don’t get ear cartilages that pull forward because we have no tension on our facelift.
Now, this is where we’re really proud of our version of a preservation facelift. A traditional facelift has to lift the skin from in front of the ears all the way to the front of the cheeks and from behind the ears all the way into the neck. And as we said before, that skin is attached to that muscle very strongly. So every time a surgeon takes that skin off the muscle, they’re causing trauma, excess bruising, excess swelling, a longer recovery, and the need for drains. But we’ve eliminated that from our recovery. You don’t need drains anymore. We can really eliminate and decrease the recovery time.
So what do we do differently? We do a three-pocket preservation facelift. What does that mean? That means we only have to lift the skin a little bit around each ear. We only have to lift the skin a little bit under the chin. We never connect all those together. So we’re leaving all this skin through the cheeks and the neck intact to the muscle. That means less trauma, less bruising, less swelling, no need for drains, quicker recovery, and incision lines that look spectacular.
Another thing 99% of surgeons do when they’re doing a facelift is put stitches under the deep layers of skin to help support it. But because we haven’t peeled that skin off a lot, and because there isn’t a lot of tension on that skin, we don’t need those stitches. And when we remove those stitches from right under the skin, amazing things happen. There’s less irritation, less inflammation, and the stitch lines heal much faster.
So how do we get the skin to reattach? It’s very cool. We use something called fibrin glue so that we can just glue your skin right back onto the position it’s supposed to be. We still put stitches in the skin, but now the skin isn’t being supported by just a few stitches. It’s being supported by the whole surface area of that skin. So what does that lead to? Less bruising, less swelling, less risk of hematoma, and much better stitch lines.
That’s the Artiste Lift. It’s a preservation facelift that has minimal disruption to the skin. So now that we’ve talked about lifting the neckline, the jawline, getting our Artiste Lift off the ground and looking beautiful, the next thing we have to look at is what happens to the skin when we lift it up. You can see when we lift the skin here, it wants to bunch up. And if you have aging in your brow, it looks even worse.
Most people over the age of 45 need a little help to smooth that skin out there too. A lot of surgeons will make a cut right along the hairline there to smooth out the skin. But I hate that. I think it looks terrible. So we do something called a temple lift. Instead of cutting the skin, we’re going to cut behind your hairline, about a centimeter behind your hairline. We don’t have to shave your hair. We don’t have to cut your hair. You don’t lose any hair. But from that little one-centimeter access incision, I can go underneath and release all this area that wants to bunch up and lift it up.
And it does two things. It smooths out that skin that wants to bunch, and it lifts the tail of your eyebrow back up. Not like a crazy brow lift or anything like that, but just enough that you look like you did 15 years ago. Sometimes, we do have people whose brows are drooping down too, and then we have to consider a brow lift in addition to the temple lift.
So how do we decide that? Well, we look at where your eyebrow is, what its shape is, and where the position of the bones are. And this is where artistry comes out. For years, people would publish articles like engineers, saying, “This is the ideal brow lift. This is the way it should look.” But that’s not how people work. People have a look. People have different brows. People have different structures. So it’s not about hitting an ideal. It’s about creating an artistic beauty that matches that person so that their friends sit across from them at the dinner table and say, “That looks like my friend.” That’s what we want to do.
So it’s not always about lifting the brows straight up. It’s not about lifting them as high as we can. It’s not about cutting muscles and stopping Botox. It’s about repositioning the brows to be where they were beforehand. Sometimes, that’s the tail of the brow. Sometimes, it’s the outer two-thirds of the brow. And that’s where we do something called a minimal access four-point brow lift.
When we lift this way, we can really unravel the brow and treat it as aggressively as we want to put it in the position that looks most pleasing. And that’s the idea of a brow lift. A brow should be about brightness, friendliness, and no tension. It should not be about how high we can make the brows.
So now we’ve talked about the base platform of our Artiste Lift. It’s a preservation deep plane facelift. It includes the deep vertical neck lift with recontouring, a deep plane facelift done the proper way, and brow recontouring as needed to look like yourself. And that is the most important part of our facial rejuvenation.
But there are other parts of gravity that we need to add on to make sure things look harmonious and balanced throughout. So let’s talk about the eyes. The eyes are the window to the soul, right? We have to get those looking right. We have to get them balanced. It’s not about making big surprised eyes. It’s about having youthful, pleasant eyes.
Let’s start with the upper eyelid. The upper eyelid skin can age by becoming excess, and for that, we do an upper blepharoplasty. Now, every plastic surgeon can do an upper blepharoplasty, but there’s nuance and detail in it. The placement of the incision right where the skin folds over itself is critical. How far we go past the corner of the eye to get some of the excess skin can be minimized and look beautiful and hidden—not just straight across, but by going up into the crow’s feet.
For us, we take out the proper amount of skin, making sure we leave enough behind so your eyes close very well. You can rest assured that you’re going to be safe with that. A lot of surgeons remove the excess muscle right underneath the skin because it hollows it out more and can show a more dramatic result. But I don’t believe in that. I think if we remove that muscle, there could be long-term problems with function down the road. And we want to make sure you’re safe for 10, 15, 20 years—forever—after our surgery. So I don’t really take that muscle ever.
Sometimes we have fat, and a lot of surgeons are aggressive about taking fat in the eyes because it hollows them out. But as you continue to age, it’ll look even hollower, and we don’t like that skeletonized look, so we leave most of the fat behind. Sometimes, there’s a little bulge of fat right near the nose, right over the eyelid, that wants to pop out. And sometimes, we go and pluck that little bit of fat out so you have a nice concavity there. And that looks really, really pretty.
These are the little details that go into creating an upper blepharoplasty that isn’t hollow, that looks youthful, and that gets rid of the excess skin. Whenever we do the eyelids, whether it’s the upper or the lower, we generally have to do them together because we want things to look harmonious and balanced. That’s what looks pretty on a face—harmony and balance.
Imagine you have a big bulge and a low trough. The distance between those two makes a big shadow. Our goal is to shorten that distance. We want to bring the bulge down and the trough up so we can get them closer together. This reduces the shadow and creates a smoother, more youthful contour.
The majority of the time, we achieve this through a scarless surgery. It’s a really fascinating approach. These bags under the eye can be accessed from inside the eyelid, meaning we don’t have to make a cut through the skin or the muscle of the eye. This significantly reduces the risk of post-blepharoplasty lower eyelid pull.
From inside the eyelid, we locate three small pockets of fat, remove any excess, and sometimes re-drape it into the trough to create a smoother transition. However, if there isn’t enough fat to fully correct the hollowing, we perform a small fat transfer. We take fat from the belly or inner thighs, process it, and place it in tiny droplets—unlike fillers, which can create an unnatural puffiness. Fat transfer uses micro-droplets layered in multiple depths, gently lifting the trough without causing bulging.
Once we have addressed the fat, we evaluate the skin. For some, excess skin needs to be removed. In these cases, we make a discreet incision right under the lash line—completely hidden—where no one will see it. This technique, called a skin pinch, involves rolling up the excess skin, carefully trimming it, and stitching it back together seamlessly. There is no risk of pulling the eyelid down.
For others, the issue is crepey skin rather than excess skin. In these cases, cutting is not the solution, as it could cause the eyelid to pull down unnaturally. Instead, we use laser treatments or chemical peels to smooth and tighten the skin.
More and more, patients are coming into consultations highly educated about these procedures, making this an exciting time for plastic surgery. One procedure that has gained significant awareness is the subnasal lip lift.
The lips, like the rest of the face, age over time. The upper lip lengthens, the pink portion rolls inward, and the teeth become less visible when speaking—creating a subtle but noticeable sign of aging. Even with a beautifully performed Artiste Lift, a long upper lip can throw off facial harmony.
Our goal is always to achieve a balanced, artistic, and natural result. This is where the subnasal lip lift comes in—not to create an exaggerated, voluptuous lip, but to restore proportion and harmony.
A traditional lip lift involves an incision under the nose, removing a small strip of skin, and stitching the area back together. However, traditional techniques often extend too far up the sides of the nose and fail to provide adequate structural support. This can lead to thick, visible scars resembling railroad tracks.
To address these concerns, we perform a deep-plane subnasal lip lift. Instead of extending the incision too far, we precisely place it where it remains inconspicuous. Once the excess skin is removed, we don’t simply stitch it back together—we release the skin from the muscle underneath, allowing it to roll up gently. This technique shortens the lip, enhances its natural shape, and creates a subtle curl without putting tension on the stitches.
The result is a seamless, well-supported lift that not only enhances symmetry but also refines the cupid’s bow. If one side of the lip is naturally lower than the other, we correct this during the procedure to achieve a balanced and natural-looking outcome.
Rhinoplasty is another crucial component of the Artiste Lift. Many people don’t initially consider rhinoplasty when thinking about facial rejuvenation, but the nose, like the rest of the face, undergoes aging changes.
As we age, the cartilages of the nose begin to separate, the connective tissues weaken, and the nose can start to droop or change shape. The goal of rhinoplasty in facial rejuvenation is not to create a universally small, overly sculpted nose, but rather to refine and restore a natural, harmonious look.
Some surgeons favor making petite, identical noses for every patient. Instead, we take a customized approach—our goal is for your nose to look like the best version of itself, as if you were simply born with it. This allows you to look refreshed while still being recognizable to friends and family.
With my background as a head and neck surgeon, I prioritize both function and aesthetics. That’s why, during consultations, we discuss not only cosmetic goals but also breathing concerns, prior treatments, and how we can enhance both appearance and nasal function. This is one of the key reasons consultations are invaluable.
While it’s great to research and gather information, an artistic eye is essential in diagnosing and planning the right approach for each patient. That’s why I love spending time with my patients—listening to their goals, reviewing old photos, and designing a bespoke surgical plan that results in a balanced, natural, and beautiful outcome.
That is the Artiste Lift.