Facelift by by Dr. BCK Patel MD, FRCS in Salt Lake City and St. George, Utah

Hyaluronic acid (more accurately called hyaluronan since the polysaccharide synthesized by mammalian cells is a salt and not an acid) is an important component of the body: it is found in synovial fluid in joints where it increases viscosity of the fluid. Hyaluronic acid is a major component of skin: production of hyaluronic acid decreases with age and with sun damage.

Restylane is one of several hyaluronic acid fillers available for augmenting tissues.

(Restylane,4 Restylane Lyft,5 Restylane Refyne,2 Restylane Defyne3), providing subtle lip enhancement and smoothing the lines around them (Restylane Silk6), and adding lift and volume to the cheeks (Restylane Lyft5).

Restylane fillers to treat nasolabial folds in a female

What are formulations?

Finer particles allow for the filling of fine wrinkles and for shaping, medium-sized particles are for moderate to severe wrinkles and folds and larger particles are for severe wrinkles and volume augmentation:

What are possible side effects?

The most commonly observed side effects are swelling, redness, pain, bruising, headache, tenderness, lump formation, and itching at the injection site. These are typically mild in severity and typically resolve in less than 7 days in nasolabial folds and less than 14 days in lips. Serious but rare side effects include delayed onset infections, recurrence of herpetic eruptions, and superficial necrosis at the injection site.

One of the risks with using this product is unintentional injection into a blood vessel. The chances of this happening are very small, but if it does happen, the complications can be serious, and may be permanent. These complications, which have been reported for facial injections, can include vision abnormalities, blindness, stroke, temporary scabs, or permanent scarring of the skin.

As with all skin injection procedures, there is a risk of infection.

“Well, the last time I had a picture taken I could hardly see my eyes because of the weight of heavy eyelid. Then I paid attention to how I was actually using my eyes and I really noticed when I was looking at anything especially the computer I was straining my forehead to see better. Since I have had it done I no longer have to lift the forehead and tilt my head to see. It is amazing! I love…” D. Rock 63 Yrs Old with Fat Droopy Eyes – Salt Lake City, UT


Volume loss of the cheeks occurs because of loss of fat as well as ptosis of tissues. This can result in flattening of the cheek prominence, indentations and wrinkles. Further ptosis of the tissues results in further flattening of the cheek eminence. The overlying skin will descend (or sag!). Loss of hyaluronic acid and collagen also results in static lines on the face. These are seen around the nose and the mouth. Similarly, volume is lost in lips as well. ​

Restylane fillers to treat nasolabial folds in a female

“I had a excellent eye lift done by Dr. Patel. He knows what he is doing and is very pleasant. Dr.Patel was easy to get an appointment and he works with you. The office staff was very pleasant and made you feel calm.” D. Gull Highly recommended for eye lift surgery – Salt Lake City, UT

Restylane fillers to treat nasolabial folds and lips in a female

The commonest sites are:

  1. Cheeks
  2. Nasolabial folds 
  3. Lips
  4. Mid-forehead
  5. frown lines

Other sites include:

  1. Chin
  2. Brows
  3. Lower eyelid grooves

Remember that the face is full of vessels. We use cooling of the skin to reduce the risk of bruising. Some areas are more likely to bruise than others: for example, the lower eyelids and peri-oral tissues are very vascular and may bruise more easily than the forehead or the frown muscle injections. After the injections, use of ice can reduce bruising. ​

Restylane fillers to treat nasolabial folds and lips in a female

“I had a excellent eye lift done by Dr. Patel. He knows what he is doing and is very pleasant. Dr.Patel was easy to get an appointment and he works with you. The office staff was very pleasant and made you feel calm.” D. Gull Highly recommended for eye lift surgery – Salt Lake City, UT

Restylane fillers to treat nasolabial folds and lips in a female

​We apply an anesthetic cream when patients want it. Our regular patients have an anesthetic cream prescribed which they apply before they leave home: this reduces the sensitivity of the skin sufficiently to make the injections almost pleasant! We also apply ice and we have a Zimmer cooling device which is very helpful in reducing ​bruising as well as discomfort.


Different hyaluronic acid fillers have different compositions and will have varying degrees of survival. Furthermore, areas where there is a lot of movement, like lips, the fillers get digested and absorbed by the body more quickly than more static areas like the forehead and cheeks. In general, fillers in the lips and nasolabial folds will last about six months, fillers in the frown lines last longer than a year, and, using the correct materials, cheek fillers will last one to two years.

Restylane fillers to treat nasolabial folds and lips in a female
Restylane fillers to treat nasolabial folds and lips in a female


This is very much a combined decision between the surgeon and the patient. As the fillers gradually wear off , there is no fixed time between fillers. Overall, photographs taken prior to any fillers being used are useful in helping decide when the next fillers may be helpful. Furthermore, a conservative volume augmentation is always better than an aggressive over-filled appearance.

Restylane fillers to treat nasolabial folds and lips in a female

By following our advice! Just as discretion is always the better part of valour, so is a conservative filling regime better than overly-aggressive injections. We will guide you and always choose the minimal filler to give you an improvement in volume, shape or position. Carefully and anatomically placed fillers can achieve wonders: it isn’t ​just a matter of shoving it in willy-nilly.


The main side effects are mild, temporary swelling, redness, an accentuation of the brown spots, crusting, and an occasional bruise or small superficial blister (like a sunburn blister).


Facelifts are performed in an operating theatre for the sake of sterility and your comfort. We have a team of anesthesiologists and nurses who are trained to specifically look after patients undergoing these procedures.
General anesthesia is best for facelifts, although in some instances, sedation anesthesia may also be used.

With a 3-D procedure, there are several layer of sutures, accurately placed to give the lifting, tightening and filling, without leaving any tell-tale pull-lines. Some are slow dissolving sutures, others are more permanent. The skin sutures are generally removed between 7 and 14 days. ​

Lasers will be used to treat peri-oral lines, “sleep lines” on the cheeks and other skin irregularities. The advantage of using all the skills and modalities available to us, rather than performing quick or weekend or one-hour facelifts is that it allows us to give you a remarkable improvement not only in the structure and appearance of the face, but also the health and smoothness of the skin as seen here:
Facelift surgery can take between 3 and 5 hours of surgery time, depending upon the planned procedures, patient’s face-type, age and other factors. ​
Bruising and swelling are de rigeur! However, significant long-lasting complications are rare.
Bleeding is not common as we pay close attention to proper hemostasis. On rare occasions, a small hematoma may collect.

Everyone will experience some numbness in the face: this resolves over weeks to months. This occurs because of the dissection of the face. This is not a complication.
Because of the dissection and repositioning of the tissues, it is common for there to be small differences in the smile between the right and left sides: this is usually only noticeable to the patient and to Dr. Patel! It recovers over a few weeks.

All faces have asymmetry and there will be some degree of asymmetry. This is to be expected.
Permanent weakness of nerves and muscles is rare.
The scars are usually very well hidden. However, some patients may have a tendency to cause hypertrophic scarring: in such cases, certain lasers and treatments will help. By-and-large, scars are rarely a problem. With Caucasian skin, pinkness of scars is to be expected for several weeks. With darker skin, some hyperpigmentation may occur. 
Bruising around the jawline and upper neck is common for the first two weeks. The face itself usually will not get much bruising, but may be pink from any laser work. Swelling is to be expected because of the extent of the surgery: the swelling abates over about two weeks. ​
Only if insurance will buy you a Rolls Royce (Phantom, of course). ​
A sensation of firmness will be there because of the swelling: this is present for the first few days. Most patients do not need prescription pain medication after the first two to three days. ​
We will provide you with a special neck dressing which you will wear as much as you can for the first couple of weeks. You will also apply a moisturizer (any brand will do) to the face as healing skin and lasered skin requires moisturizer. Icing the face also helps for the first two to three days. Many of our patients will ice the face for longer as it feels good. You may be up-and-about the day after surgery. Gentle exercise (treadmill and stationary bicycle) may be commenced by day 3. More vigorous exercise like skiing and tennis may be resumed by about day 10. ​
Ideally, you should be within about 3 – 5 pounds of your desired weight. Whereas I can create the most beautiful angles and curves in slim patients, if you are able to get close to your ideal weight, we can wonders as can be seen in this patient who lost some weight before her surgery and is absolutely chuffed at her result:

In the first few days, everyone will experience some degree of dryness and blurry vision. You will also feel that your lids look a little tight on the outer corner where you will also feel some of the deeper sutures if you put your finger there: this is of no concern. The tightness and the bumps under the skin settle over a few weeks.
More serious complications which are very rare include excessive bleeding, hemorrhage and loss of vision. 




Do you have questions or need more answers?

    Contact Info

    ​Dr. BCK Patel MD, FRCS
    ​1025E 3300S
    Salt Lake City, Utah 84106, USA

    (801) 413-3599 (phone/text)

    Dr. BCK Patel MD, FRCS
    617 E Riverside Dr Suite 101
    ​Saint George, UT 84790, USA
    (435) 215-0014