Dr. Balikian breaks facial aging down into three primary changes: gravity, volume loss and the skin.
Gravity causes tissues to descend. The cheeks begin to fall, jowls develop and the jawline becomes less defined. Volume loss is different. The face gradually loses some of the fullness it had when it was younger, creating hollows and shadows. The skin itself also changes, developing wrinkles, sun damage and changes in texture.
These are different problems, and Dr. Balikian believes they should be treated differently.
When tissues have fallen, the goal is to reposition them rather than add enough volume to make them appear lifted or pull the skin tighter to compensate for what has changed underneath.
That distinction is fundamental to Dr. Balikian’s approach to facelift surgery.
Dr. Balikian brings you inside an Artiste Lift™ consultation to show how he evaluates facial aging, discusses a patient’s concerns, and determines which areas should be restored and which should be left alone.
Although the name suggests otherwise, Dr. Balikian does not think of a facelift as simply pulling the face tighter.
The skin is the covering of the face. Beneath it are deeper tissues that provide support, shape and youthful contour. As these tissues descend over time, they remain connected to deeper structures by retaining ligaments. Dr. Balikian sometimes describes these attachments as being like Velcro. If the deeper tissues are still tethered, simply pulling harder from the side does not necessarily put them back where they belong.
A deep plane facelift allows Dr. Balikian to work beneath the skin, release those attachments where necessary and allow the descended tissues to move more freely. Once they are released, the cheek and lower face can be repositioned rather than pulled against resistance.
The important work in a deep plane facelift happens underneath the skin. Dr. Balikian works with the deeper tissues of the cheek and lower face, including the SMAS, rather than asking the skin to create the result.
After the appropriate retaining structures are released, those deeper tissues become mobile enough to be repositioned. The direction of that movement is determined by the patient’s anatomy and the way the face has aged.
Dr. Balikian generally uses a strong vertical component because facial aging occurs largely through downward descent. But he does not believe every structure should simply be pulled in one direction.
The vector has to make sense for the anatomy being restored.
This allows the cheek to return toward a more youthful position, softens the jowls and restores definition through the lower face and jawline.
The difference comes down to where the lifting force is placed.
If the skin is being asked to hold the face up, tension has to be placed on the skin to create the result.
Dr. Balikian instead places the structural support deeper within the face. Once those deeper tissues have been released, repositioned and secured, the skin does not have to hold the lift. It can simply redrape over the restored structure underneath.
This is central to Dr. Balikian’s philosophy of Younger, Not Different. The goal is not to stretch the face into a new shape or erase every sign of aging. It is to restore tissues that have changed position while preserving the features, proportions and expressions that still belong to the patient.
Dr. Balikian does not want someone sitting across the table thinking, “Who did your facelift?”
He wants them to simply think, “You look great.”
Before and After
These before and after photos reflect Dr. Balikian’s focus on restoring facial structure and youthful contours while keeping each patient naturally recognizable..
Facial aging is complex and highly individual, which is why there’s no one-size-fits-all solution. Dr. Richard Balikian offers a range of advanced facelift techniques, each tailored to the patient’s anatomy, aging pattern, and goals.
Whether you’re concerned with midface sagging, deep folds, or a loose neck, Dr. Balikian customizes every surgical plan for natural, long-lasting results.
Signature Full-Face Rejuvenation with Natural Precision
The Artiste Lift™ is Dr. Balikian’s signature facelift technique. It combines a preservation deep plane facelift with a deep vertical neck lift to restore youthful definition to the cheeks, jawline, and neck, all while preserving your natural facial expressions.
The Comprehensive Artiste Lift™ extends the procedure to include eyelid and brow rejuvenation, creating harmony across the entire face.
Hear directly from Dr. Balikian’s patients as they share why they chose facial rejuvenation, what recovery was really like, and how they feel about their results.
What sets the Artiste Lift™ apart is not just the result, but the recovery. Patients typically experience less swelling, no drains, no narcotics, and a smoother healing process, thanks to Dr. Balikian’s meticulous technique and innovative protocols.
Advanced Correction for Midface, Jowls, and Folds
For patients with deeper facial aging, the deep plane facelift offers a more comprehensive lift. This advanced technique lifts the skin and underlying muscular structures as a single unit, allowing for dramatic yet natural improvement in the cheeks, jowls, marionette lines, and nasolabial folds.
Unlike traditional SMAS facelifts that tighten tissue at the surface, the deep plane method releases key ligaments and repositions the midface at its foundation. This results in a softer, more youthful look that avoids the tight or overdone appearance.
The deep plane facelift is considered the gold standard for facial rejuvenation and is performed by only a select group of surgeons with advanced anatomical expertise, including Dr. Balikian.
Targeted Refinement for a Sculpted Neckline
A neck lift is ideal for patients primarily concerned with sagging or fullness beneath the chin. This procedure tightens the platysma muscles, removes excess fat, and eliminates loose, hanging skin, resulting in a longer, smoother, more youthful neckline.
Neck lifts can be performed on their own or in combination with a facelift for a more comprehensive outcome. While effective on its own, an isolated neck lift does not address jowling or facial sagging and is typically best suited for patients whose concerns are limited to the neck area.
Facial aging occurs in three primary ways: gravity, volume loss, and surface texture changes. While a facelift addresses sagging tissues caused by gravity, it does not restore lost volume or smooth deep wrinkles.
To achieve the most harmonious and natural-looking results, Dr. Balikian may recommend combining your facelift with one or more of the following procedures:
Dr. Balikian explains how the upper lip changes with age and demonstrates how a subnasal lip lift can shorten an elongated lip, improve dental show, and restore youthful balance around the mouth.
Aging often elongates the upper lip, causing it to sag and roll inward. In some cases, filler alone isn’t enough.
A lip lift shortens the upper lip and subtly rolls it outward, restoring a youthful balance to the mouth. Dr. Balikian calls this procedure the “icing on the cake” for facial rejuvenation.
As we age, facial volume diminishes, much like a grape becoming a raisin. While a facelift repositions tissue, fat transfer restores fullness to hollow or sunken areas.
Using fat harvested from another part of your body, Dr. Balikian artistically sculpts a more youthful contour. As he often says, “A facelift rejuvenates, but the fat adds beauty.”
While a facelift improves structure, deeper wrinkles often require additional treatment. CO2 laser resurfacing removes the outer layer of damaged skin and stimulates collagen in the deeper layers.
This process helps improve stubborn lines and enhances the overall skin texture, giving your refreshed look an added glow.
The length of your recovery and what to expect during it will depend on the type of facelift performed and other factors.
When patients wake up after the facelift surgery, some of them will likely not remember anything from the procedure. The dressing will not be removed until 24 hours or once advised by the surgeon. Swelling, bruising, and discomfort are to be expected. Medication can help to manage pain during your recovery period.
Dr. Balikian discusses the use of ELIXIR MD photobiomodulation as part of his postoperative recovery protocol and how it is incorporated into the healing process after facial surgery.
During the initial days, you may experience tightness in the neck and notice more swelling on one side of the face than the other, this is completely normal. Adequate rest is essential during this time.
Light walking is encouraged, as it promotes circulation and healing.
By the end of the first week, most patients no longer need pain medication. Gentle walks and light daily activities are usually well tolerated, though visible improvements are still in progress.
Patience is key as your body continues to heal.
At this stage, most patients are ready to return to non-strenuous work.
Minor swelling and bruising may still be present, and a tingling sensation is common as the tissues continue to settle and heal.
About a month after your facelift, you can typically resume moderate lifting and more strenuous activities. By this time, most swelling and bruising will have subsided, though subtle residual effects may take a couple of months to fully resolve.
To support your recovery, you’ll receive detailed post-operative instructions tailored to each phase, from the first week through the months that follow. These may include:
Following these guidelines carefully can significantly improve your healing experience and help ensure a smooth, successful outcome.
How is a deep plane facelift different from a SMAS facelift?
Deep plane surgery lifts under the SMAS instead of pulling on top of it. The result is a softer, natural look with improved midface support and a refined jawline, often with less skin tension.
What areas does it improve most?
The deep plane approach targets the cheek, nasolabial fold, jowls, and neck. Releasing retaining ligaments allows real elevation instead of surface tightening alone.
Is the neck addressed at the same time?
Yes in most patients. A deep plane facelift commonly includes neck contouring, platysma management, and selective fat reduction for a clean angle of the neck.
Where are the incisions and what about scars?
Incisions are hidden around the ear and within the hairline. Careful design and tension-free closure help scars mature to fine lines over time.
How long do results last?
Results are designed to be long-lasting. You will continue to age naturally, but the structural lift typically maintains a more youthful contour for many years.
How uncomfortable is recovery?
Most patients report pressure and tightness more than pain. Discomfort is usually well controlled with medication and detailed aftercare.
What anesthesia is used and how long is surgery?
General anesthesia or deep sedation is typical. Operative time varies with the plan and any combined procedures.
Are drains or dressings used?
No routine drains. Dr. Balikian manages swelling and fluid with meticulous technique and a light compression wrap, not surgical drains. The wrap is used briefly after surgery and adjusted at the first postoperative visit.
Can fat grafting be added for volume?
Yes when appropriate. Micro-fat to the cheeks, temples, or jawline can restore youthful contours that a lift alone does not replace.
Can eyelid surgery or laser resurfacing be combined?
Yes, combination plans are common. Upper or lower blepharoplasty and targeted laser can refine skin quality and complete the result safely when planned together.
How do you prevent a pulled mouth or pixie ear look?
Support is placed deep and the skin is closed without tension. This protects natural earlobe position and avoids a stretched appearance.
What age range is typical?
There is no strict age. Most patients are in their 40s to 70s, depending on anatomy, skin quality, and goals.
How soon can I be event-ready?
Most patients feel camera-ready by three to four weeks. Residual swelling tapers for several months and continues to refine.
What maintenance helps results last?
Sun protection, medical-grade skincare, neuromodulators, and targeted lasers can maintain tone and texture. Healthy habits support long-term quality.
Dr. Richard Balikian is a renowned facial plastic surgeon known for his dedication to patients throughout Southern California.
With more than two decades of experience and double board certification in Facial Plastic and Reconstructive Surgery and Otolaryngology – Head and Neck Surgery, he brings together surgical precision and an artist’s eye.
Dr. Balikian is among a select group of specialists whose advanced training is devoted entirely to procedures of the face and neck.
Patients choose Dr. Richard Balikian for precision facial procedures, personalized care and results that look naturally you.
