Question 1

What is the most advanced Facelift technique?

Accepted Answer

The procedure considered by most internationally renowned facelift surgeons to be the most advanced and effective is the Extended Non-Delaminating Deep Plane Face and Neck Lift, performed according to the technique developed by Dr. Neil Gordon.
For me, this method represents the gold standard in facial rejuvenation. It was designed to achieve especially natural-looking, non-operated results with long-lasting effects.

Question 2

How does the face change with time?

Accepted Answer

Common age-related changes perceived as bothersome include nasolabial folds, jowls, sagging of the neck, loss of jawline definition, and skin laxity. It is important to understand that the face does not primarily lose volume with age. Rather, fat and connective tissue shift downward while the skin loses elasticity.
As a result, the lower third of the face becomes fuller and wider, while the cheeks lose youthful projection. The nasolabial fold is therefore not a true wrinkle—it appears because the skin around the mouth remains relatively fixed while tissue bulges from the side and above.
Fillers cannot lift tissue or reduce excess volume. Beyond a certain point, repeated filler treatments—especially of the nasolabial fold and tissues around the mouth—often lead to unnatural, overfilled appearances.

Question 3

How are age-related changes best corrected?

Accepted Answer

Facial aging is driven by two primary processes:

Downward and forward displacement of fat and connective tissue
Laxity of the skin

Effective rejuvenation requires addressing both processes. Key principles include:

Restoration of youthful facial contours
Even lifting across the neck, face, and forehead
Anterior extension of the lift to address jowls, nasolabial folds, and double chin
Recontouring in the deep tissue plane, rather than tightening skin alone

These principles lead to results that appear youthful, natural, and long-lasting—without a tightened or operated look.

Question 4

What are the alternatives to a Facelift?

Accepted Answer

I perform all established facial rejuvenation treatments with many years of experience. These include:

Wrinkle treatment with botulinum toxin (Vistabel®, Bocouture®, Azzalure®)
Fillers (Hyaluronic acid: Restylane®, Juvederm®; PLLA: Sculptra®) and autologous fat
Skin treatments such as deep microneedling, PRP, and CO₂ Fraxel laser
Surgical procedures including endoscopic brow lift, upper and lower eyelid surgery, and advanced facelift techniques

Question 5

When are volume treatments and fillers appropriate?

Accepted Answer

In younger patients, volume treatments can be effective in maintaining youthful contours. Subtle injections in the cheeks, tear troughs, and—very conservatively—the lips can achieve natural results. I prefer repeated treatments in small steps to maintain discretion.
Once nasolabial folds and marionette lines deepen, the neck becomes lax, and jowls develop, volume treatments are generally no longer effective or advisable.

Question 6

Are energy-based treatments an alternative?

Accepted Answer

Energy-based treatments (e.g., Morpheus®, Thermage®, Exilis®) aim to induce tissue contraction through heat. Like many experienced colleagues in the United States, I approach these methods with caution.
During facelift surgery, the tissue effects of such treatments can be clearly observed: scar-like tissue changes are visible, while the tightening effect is often unsatisfactory. For these reasons, I do not recommend these treatments as a true or good alternative to surgical lifting.

Question 7

Are laser treatments an alternative to a Facelift?

Accepted Answer

CO₂ and Erbium:YAG laser treatments allow controlled removal of superficial skin layers and can improve pigmentation, texture, and fine wrinkles. I perform laser treatments with extensive experience.
However, laser treatments achieve different effects than a facelift. True contour corrections—such as improvement of under-eye bags, jowls, or a double chin—cannot, in my experience, be achieved satisfactorily with laser treatment alone.

Question 8

Non-Delaminating Extended Deep Plane Facelift – The Advanced Facelift of Hollywood Stars

Accepted Answer

This technique was developed and first described by my esteemed colleague Dr. Neil Gordon (New York City), whose patients include many internationally known models and Academy Award-winning actresses.
I have collaborated closely with Dr. Gordon for many years. He regularly lectures at the European Facelift Course in Regensburg, demonstrates his techniques in anatomical dissections, and performs live surgical demonstrations. I have studied these techniques in great detail and continue to refine them through ongoing academic exchange.

Question 9

How are particularly natural and harmonious results achieved?

Accepted Answer

Achieving truly natural results requires more precision and effort—not less. Harmonious rejuvenation must include all relevant facial regions.
It is often beneficial to combine additional procedures—such as upper or lower eyelid surgery or endoscopic brow lifting—with an Extended Non-Delaminating Deep Plane Facelift during the same operation.

Question 10

What Facelift techniques exist?

Accepted Answer

A wide variety of techniques exist, including mini lifts and thread lifts. In my experience, these methods are often associated with less natural results, limited durability, and may require extensive secondary corrections.
Other techniques such as MACS lifts or variations of SMAS lifts involve separate elevation of the skin and SMAS layers. I have seen, assisted, and performed all major techniques. I am happy to advise you individually on the most suitable approach.
From my perspective, avoiding separate skin elevation—the non-delaminating principle according to the Gordon technique—offers a decisive advantage over other facelift methods.

Question 11

Why is the Non-Delaminating Deep Plane Facelift particularly gentle?

Accepted Answer

In this technique, the skin is not lifted or tightened as a separate layer. In other deep plane techniques, the skin is elevated independently, creating a space prone to bruising and hematoma formation.
By keeping skin and SMAS together as a composite layer, the skin stretches less over time (“less creep”), no tension is placed on the skin, and the risk of widened scars or distortion of the earlobe is reduced. Most importantly, this approach minimizes the risk of an operated or tightened appearance.

Question 12

Neck Lift – Liposuction – Fat-dissolving injections

Accepted Answer

Isolated neck correction may be appropriate in cases such as a double chin. Excess skin can only be corrected surgically, with incisions placed around the ear or under the chin.
Liposuction can be effective for reducing submental fat when skin excess is minimal and is usually performed on an outpatient basis under sedation.
So-called fat-dissolving injections are increasingly being abandoned. They contain substances that destroy fat cells, but are difficult to dose, unpredictable in effect, and may cause unintended tissue damage. For these reasons, I do not offer this treatment.

Question 13

Who performs your Facelift surgery?

Accepted Answer

I perform your surgery personally. This is a core element of my quality commitment. I am available to you before, during, and after your procedure.
As part of my center’s educational mission, I train experienced, board-certified colleagues (fellows) who spend approximately one year observing and assisting. The actual surgical procedure, however, is always performed by me.

Question 14

What should be considered before a Facelift?

Accepted Answer

The following are general guidelines and do not replace a personal consultation. Always follow the instructions provided during your individual preoperative discussion.
Blood-thinning substances should be discontinued at least two weeks prior to surgery. These include garlic, ginkgo, vitamin supplements, and certain herbal remedies, as well as medications such as aspirin®, ibuprofen®, diclofenac®, and others. Prescription medications should only be adjusted in consultation with your physician.
Nicotine impairs blood supply to the skin and should be avoided from 10 days before to 14 days after surgery. Alcohol consumption should be minimized one week before and after surgery. Direct sun exposure should be avoided for two weeks prior to surgery, with strict sun protection (SPF 50, hats).
On the evening before surgery, remove all makeup. On the morning of surgery, wash your face and do not apply makeup. Do not wear jewelry. Comfortable, front-opening clothing is recommended.

Question 15

What should be considered after a Facelift?

Accepted Answer

Postoperative care is individualized. General recommendations include:

A soft head dressing is applied and changed the morning after surgery
A supportive chin/neck bandage may be worn at night for 10 days
Incisions should be cleaned daily and covered with prescribed ointment
Incisions must not be massaged or mechanically stressed

Sauna, tanning beds, and intense sun exposure should be avoided for 2–3 months. Sun protection should be used for one year. Light exercise may be resumed after 2–3 weeks.
Camouflaging makeup is usually possible after 2–3 weeks, by which time swelling has typically subsided sufficiently.

Question 16

When will I be socially presentable again?

Accepted Answer

Most patients are socially presentable 2–3 weeks after a deep plane facelift. Fine incisions in front of the ear may still require makeup for a while. In some cases, swelling or bruising may persist longer.
For patients in the public eye, I recommend allowing 3–4 weeks of recovery.

Question 17

Before-and-after photos

Accepted Answer

Comparative images of cosmetic procedures may not be publicly displayed online in Germany due to legal regulations protecting patient privacy. If you wish to view results, please email VorherNachherGassner (at) gmail.com with your name, age, gender, and a brief description of your treatment interest. I will have a larger number of photos available during your personal consultation.

Question 18

Costs and preliminary inquiry

Accepted Answer

Facelift procedures are generally not covered by health insurance. Rare exceptions include unilateral procedures for patients with facial nerve paralysis.
Costs depend on the extent of surgery, technique used, type of anesthesia, and whether an overnight stay is required. While fees for renowned U.S. surgeons may exceed $100,000, my fees are significantly lower, while employing the same advanced techniques.
To receive a complimentary preliminary assessment, please send front and side photographs taken from approximately 2 meters against a neutral background to praxisteam.gassner (at) gmail.com, along with your name, gender, age, and treatment request.
I respond personally. By submitting your data electronically, you consent to electronic communication and acknowledge that data transmission occurs at your own risk in both directions.

Question 19

Expertise

Accepted Answer

The only U.S.-trained Facial Plastic Surgeon (ABCFPRS) practicing in Europe
Eight years of training at the Mayo Clinic, USA
Advanced subspecialty fellowship (AAFPRS) at the University of Washington, Seattle
Ten years as Head of the Section of Plastic and Reconstructive Head and Neck Surgery, University ENT Department Regensburg
Director of over 20 international conferences and courses in facial plastic surgery, particularly facelift surgery
Close collaboration with leading U.S. experts including Dr. Neil Gordon, Dr. Jonathan Sykes, and Dr. Kofi Boahene
Author of multiple scientific publications and a surgical atlas on facelift surgery
Recipient of prestigious scientific awards from the American Academy of Facial Plastic and Reconstructive Surgery

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