When it comes to the aging face, wrinkles are among the first and most obvious features. And rather than embrace this badge of longevity, many women seek ways to erase these telltale signs.

Fortunately, a bounty of options exists, and modern women find that when it comes to facial plastic surgery, this is not their mother’s facelift. “There is no longer a ‘traditional’ facelift,” says Dr. Michele Koo, a board-certified plastic surgeon. “Facelifts are separated by the areas of the face to be addressed so the outcome is one of being refreshed and rested with removal of excess skin and lines caused by extra skin.”

Koo notes that facelifts are not recommended to address wrinkles alone. “When one has a ‘turkey neck,’ jowls, loss of the jawline due to hanging skin, a sunken tired face, etc., that is when a lower or midface lift is the perfect answer to facial rejuvenation,” she says. “I rarely perform a ‘complete facelift’ any more. I most often perform a mid- or lower facelift with fat transfer to fill in the valleys (deep wrinkles) and reposition the skin to its natural position for the rested, refreshed face.”

Dr. Greg Branham, chief of the Division of Facial Plastic and Reconstructive Surgery with Washington University Physicians, agrees that surgery is often part of a multidimensional approach to restoring a more youthful appearance. “If you try to do what a facelift is supposed to do with filler, for instance, then you look like a balloon,” he says. “You see this in Beverly Hills, where everybody wants to have a ‘nonsurgical facelift.’ We’re seeing more and more filler being used, but it makes you look distorted, just like a bad facelift does when you actually need volume.”

Branham’s point is that patients need to be openminded and consult an experienced, knowledgeable plastic surgeon to determine which type of procedure best addresses their concern. Dr. Brock Ridenour, one of Branham’s predecessors at Washington University and a plastic surgeon in private practice since 2003, agrees that the best results often include surgery.

“Surgery works best when there is sagging or downward shifting of the soft tissues of the face over time due to gravity and the simultaneous atrophy of the deep supporting structures (bone and deep fat),” Ridenour says. “As bone mass diminishes and deep fat atrophies, the superficial soft tissues become poorly supported and shift downward. This results in bunching or wrinkling of the skin in the lower face and neck. For this problem, surgery is by far the most effective solution. No nonsurgical filler, laser or device can achieve anything close to the outcome possible with surgery.”

One advantage of surgery is longer-lasting results. Branham notes that no facelift lasts forever because tissues continue to change over time, but most people are happy with the results for several years. “In general, the surgical approach gives a more dramatic and long-lasting result,” confirms Dr. Bruce White, a board-certified plastic surgeon with St. Louis Cosmetic Surgery. “The non-surgical procedures avoid incisions, but the results are both more subtle and temporary, lasting only six to 12 months.”

New surgical and nonsurgical techniques and tools continue to be developed and perfected. Branham notes that “there are lots of new things on the horizon, and we learn more about the aging process as we go along—so stay tuned.”