Dr. Bashar Bizrah Explains Facial Aging and the “Three-Story” Approach to Advanced Face and Neck Lifting
Why Does the Face Change So Much With Age?
Facial aging is not simply a problem of loose skin. As the years pass, changes occur across multiple anatomical layers and regions of the face. The eyebrows may descend, the lower eyelids may become fuller, facial folds deepen, the jawline loses definition, and tissues of the neck begin to descend.
This is why advanced facial rejuvenation cannot always be achieved simply by pulling or removing skin.
In this educational video, Dr. Bashar Bizrah, FRCS (England), explains facial aging decade by decade and discusses his approach to advanced deep SMAS face and neck lifting.
His central concept is simple: Aging moves facial tissues downward. Facial rejuvenation aims to reposition descended tissues upward—“taking everything north.”
The objective is not to create a different face. It is to restore more youthful anatomical relationships while maintaining a natural appearance and the patient’s individual facial identity.
Facial Aging in Your 30s: The Youthful Baseline
During the 30s, many people continue to demonstrate relatively youthful facial architecture. Typical characteristics may include:
- A well-defined jawline
- Firm facial contours
- Good cheek support
- Relatively smooth transition between the lower eyelid and cheek
- Limited skin laxity
- A more defined neck
- Naturally elevated facial tissues
This represents an important concept in facial rejuvenation. The goal of facelift surgery should not be to create an artificially tight face. Instead, the surgeon attempts to understand where the patient’s facial structures were positioned before significant aging occurred and restore more youthful proportions without changing identity.
Facial Aging in the 40s and 50s: The Early Descent Begins
During the 40s and early 50s, the effects of aging may become increasingly apparent. Common changes can include:
- Mild descent of the eyebrows
- Early hooding around the upper eyelids
- Lower eyelid puffiness
- Deepening nasolabial folds
- Early jowling
- Reduced jawline definition
- Early neck laxity
- Changes in cheek position and volume distribution
These changes do not occur independently. The eyebrow, temple, cheek, jawline, and neck are anatomically interconnected. For this reason, treating only one isolated area may not always provide balanced rejuvenation.
Facial Aging in the 50s and 60s: When Multiple Levels of the Face Begin to Sag
With further aging, the changes can become more pronounced. Patients may develop:
- Hooded upper eyelids
- Prominent lower eyelid bags
- Deeper nasolabial folds
- Marionette lines
- Jowls
- Loss of mandibular definition
- Excess skin around the chin
- Significant neck laxity
- Reduced definition of the cervicomental angle
- A generally tired or aged appearance
At this stage, facial aging often involves much more than superficial skin. The deeper support system of the face has also changed. This is one reason why Dr. Bizrah emphasizes addressing the deeper anatomical layers, rather than relying solely on skin tension.
What Is the “Three-Story” Face and Neck Lift?
Dr. Bashar Bizrah describes advanced facial rejuvenation as addressing three anatomical stories:
Story 1: Temporal Region
The upper level addresses age-related descent around the temple and lateral brow. The objective is to restore a more youthful position while avoiding an exaggerated or unnatural appearance.
Story 2: Cheek and Midface
The second level addresses descent through the cheek and lower face. This may help improve:
- Cheek position
- Nasolabial folds
- Jowling
- Lower facial contour
- Jawline definition
Story 3: Neck
The third level extends rejuvenation into the neck. The aim is to address descended tissues, excess skin, and loss of definition beneath the jaw and chin.
When these three levels are assessed together, the face can be rejuvenated as a single anatomical unit rather than as unrelated individual areas.
What Is a Deep SMAS Facelift?
The SMAS — Superficial Musculoaponeurotic System — is an important fibromuscular layer beneath the skin of the face.
In advanced facelift surgery, the objective is not simply to pull the skin tighter. Instead, deeper facial tissues can be repositioned and supported while excess skin is managed separately.
This distinction is important. Skin should not be responsible for carrying the entire lift. By repositioning the deeper support structures, the surgeon aims to restore facial contours while allowing the skin to lie naturally rather than under excessive tension.
“Taking Everything North”: What Does It Mean?
Dr. Bizrah uses the phrase “taking everything north” to describe the direction of facial rejuvenation.
Aging and gravity contribute to downward displacement of tissues. This can produce:
Brow descent → cheek descent → deeper folds → jowls → loss of jawline → neck sagging
Advanced lifting surgery aims to reposition appropriately selected descended structures toward a more youthful anatomical position.
However, the goal is not simply to pull everything vertically upward. Different areas of the face require carefully planned vectors based on anatomy.
The desired result is: Lifted, supported and refreshed—not stretched or operated-looking.
Why the Jawline Is So Important in Facial Rejuvenation
One of the most visible signs of aging is loss of a clean mandibular border. As tissues descend, jowling can obscure the transition between the face and neck.
A well-planned face and neck lift therefore evaluates the cheek, jowl, jawline, submental region, and neck together.
Restoring jawline definition can significantly influence the overall perception of facial youthfulness. The objective should be a naturally defined transition from the face to the neck—not an excessively tight appearance.
Why a Face and Neck Lift Should Be Planned Together
A rejuvenated face above an untreated aging neck can produce an imbalance. Similarly, tightening the neck without addressing significant jowling and facial descent may leave other aging features untreated.
For patients with changes affecting both areas, a comprehensive assessment can determine whether the face and neck should be treated as one continuous anatomical unit.
This is especially relevant when aging involves:
- Jowls
- Loose jawline
- Submental laxity
- Neck skin redundancy
- Deep facial folds
- Significant lower-face descent
Does a Deep Plane Facelift Make You Look Different?
The objective of modern facial rejuvenation should not be to change the patient’s identity. A well-planned facelift aims to make the patient appear like a more refreshed and youthful version of themselves.
The aim is to avoid:
- Excessively stretched skin
- Distorted facial features
- Abnormal eye shape
- Over-elevated brows
- An artificial “facelift look”
The surgical philosophy is therefore based on restoration rather than transformation.
More Than 30 Years of Facial Plastic Surgery Experience
Dr. Bashar Bizrah, FRCS (England), has practiced facial plastic surgery for more than three decades and works with patients in Dubai and London.
His educational approach to face and neck lifting emphasizes detailed anatomical knowledge, deeper tissue repositioning, appropriate surgical vectors, and preservation of natural facial characteristics.
The goal of advanced facial rejuvenation is not merely to remove excess skin. It is to understand how the face has aged anatomically and determine which structures require repositioning, support, or conservative treatment.
Frequently Asked Questions About Deep Plane Face and Neck Lift
What is a deep plane facelift?
A deep plane facelift is an advanced facial rejuvenation approach that works beneath the superficial skin layer to mobilize and reposition deeper facial tissues. The objective is to restore descended structures while allowing the skin to redrape with less reliance on skin tension alone.
What is a deep SMAS facelift?
A deep SMAS facelift involves manipulation and repositioning of the deeper SMAS support system beneath the skin. Techniques vary between surgeons, so the exact surgical plane and extent of dissection should be discussed during consultation.
What is Dr. Bizrah’s three-story facelift concept?
Dr. Bizrah describes comprehensive facial rejuvenation across three main levels: the temporal region, cheek/midface, and neck. The concept is to evaluate facial aging as a continuous process rather than treating each area in isolation.
At what age should someone consider a facelift?
There is no single ideal age for facelift surgery. Candidacy depends more on anatomy and the degree of tissue descent than chronological age. Some patients develop significant laxity earlier, while others maintain strong facial support much longer.
What happens to the face in your 40s?
Changes may include early eyebrow descent, eyelid changes, deepening nasolabial folds, early jowling, and reduced jawline definition. The degree and timing vary considerably between individuals.
What happens to the face in your 50s and 60s?
Facial descent may become more pronounced, potentially producing deeper folds, jowls, marionette lines, excess skin around the jaw and chin, neck laxity, and reduced jawline definition.
Can a facelift improve jowls?
A face and neck lift can address descended lower facial tissues contributing to jowling. The degree of improvement depends on anatomy, skin quality, surgical technique, and healing.
Can a facelift improve nasolabial folds?
Repositioning descended cheek tissues may soften the appearance of nasolabial folds, although complete elimination of natural facial folds is neither always achievable nor necessarily desirable.
Can a neck lift restore the jawline?
In appropriately selected patients, treatment of the lower face and neck can improve the definition of the jawline and the transition between the chin and neck.
Why combine a facelift with a neck lift?
Because the lower face, jawline, and neck form a continuous anatomical region. Treating both may provide better overall balance when significant aging affects both areas.
Is a deep plane facelift better than a traditional facelift?
No single technique is universally best for every patient. The appropriate operation depends on facial anatomy, aging pattern, previous procedures, skin quality, medical history, and the surgeon’s assessment.
How long do facelift results last?
Facelift surgery can produce long-lasting structural improvement, but it does not stop the biological aging process. Longevity varies according to surgical technique, tissue quality, genetics, lifestyle, and ongoing aging.
Will a facelift make the face look tight or unnatural?
That is not the intended objective. Modern facelift planning generally aims to reposition deeper tissues and redrape the skin without excessive tension, helping preserve natural facial expression and identity.
Can eyelid surgery be combined with a facelift?
In selected patients, blepharoplasty may be combined with facial rejuvenation when eyelid aging is also present. The safety and appropriateness of combined surgery require individual assessment.
Can a temporal or brow lift be combined with a face and neck lift?
Yes, in selected patients with upper facial descent. The decision depends on brow position, forehead and temporal anatomy, eyelid relationship, and the overall rejuvenation plan.
How do I know whether I need a facelift, neck lift, or both?
A facial examination should evaluate the temples, brows, eyelids, cheeks, nasolabial folds, jowls, jawline, chin, and neck. The procedure should then be tailored to the areas actually affected by aging rather than chosen solely by age.
Watch Dr. Bashar Bizrah Explain the Facial Aging Process
In this educational video, Dr. Bashar Bizrah explains how facial aging progresses from the 30s through the 40s, 50s, and 60s—and how advanced lifting techniques can address different levels of facial descent.
Deep Plane Face & Neck Lift in Dubai and London
Patients experiencing jowls, loss of jawline definition, neck sagging, deep facial folds, cheek descent, or other signs of facial aging can undergo a comprehensive assessment with Dr. Bashar Bizrah to determine the appropriate rejuvenation strategy.
Dr. Bashar Bizrah, FRCS (England)
Facial Plastic Surgery Dubai | London
Request a Face & Neck Lift Consultation
Facial rejuvenation should begin by identifying where aging has occurred and which anatomical layers are responsible.
For some patients, the problem may be limited to the eyelids or neck. For others, aging extends from the temporal region through the cheeks and jawline into the neck.
A detailed consultation can determine whether a deep SMAS facelift, neck lift, temporal lift, blepharoplasty, or a carefully planned combination is appropriate.
Learn more and request a consultation: drbasharbizrah.com
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