When it comes to outstanding figures in the international world of plastic and aesthetic surgery, one name stands out immediately and without a doubt: Priv.-Doz. Dr. med. Dr. h.c. Klaus Exner. He enjoys an unrivaled reputation that is second to none in his field. This recognition is based not only on his impressive experience spanning more than four decades in clinical practice, research, and teaching, but also on his groundbreaking innovations, which have contributed significantly to the global advancement of high-performance medicine. Furthermore, his numerous scientific publications have repeatedly led to the establishment of innovative surgical procedures. Practicing in Frankfurt am Main and Oberursel, PD Dr. med. Dr. h.c. Klaus Exner is a renowned specialist in aesthetic surgery and eyelid surgery. With his extensive experience and excellent expertise, he has earned a first-class reputation in the world of plastic surgery. A particular focus of his work is facelifts, an aesthetic treatment method aimed at rejuvenating the appearance of the face and mitigating the natural aging process. With his professional expertise and tireless commitment to outstanding aesthetic results, he has helped countless patients achieve a fresher and more youthful appearance. In this article, we take a closer look at PD Dr. med. Dr. h.c. Klaus Exner and his significant role in the field of aesthetic surgery, particularly with regard to facelift procedures.
A facelift is a surgical procedure designed to rejuvenate the appearance of the face. The goal is to restore facial features to their original, youthful position. The skin, along with the underlying fatty tissue, is lifted and then repositioned higher up. Excess tissue can be removed or redistributed. The result is a fresher, more youthful appearance that accentuates the patient’s natural beauty. “The term ‘facelift’ literally means lifting sagging facial features. After all, soft tissues are subject to the force of gravity. ‘Lift’ is therefore an apt term because a natural appearance is best achieved through lifting. In older people, wrinkles can even be excised, since scars on the face are less noticeable in this age group. For the eyelids, the incision is largely invisible, as it is made within the eyelid crease,” Dr. Exner begins our conversation.
The motivation for a facelift varies widely.
“A person might stand in front of the mirror and simply not be satisfied with their reflection. Others, on the other hand, think of their own mother or father and realize that they don’t want to look like that as they age. They tend to view a facelift more as a preventive measure. Eyelid surgery is usually the first procedure they request. It’s important for the cosmetic surgeon to communicate with the patient on an equal footing. You have to recognize and understand the patient’s wishes. The patient’s lifestyle must be assessed, and their mental stability must be ensured. This is also important for the subsequent healing process, since a mentally unstable patient would likely have difficulty coping with potential complications,” explains Dr. Exner, adding: “It’s also important to consider the wound-healing process in heavy smokers, which will inevitably take longer. There are also colleagues who refuse to perform facelifts on smokers.”
Before the surgery, a detailed consultation takes place between the surgeon and the patient. During this consultation, the patient’s expectations are discussed, and the surgeon creates a personalized treatment plan.
In the past, facelifts were always performed under general anesthesia. “Modern anesthesia practices now include the option of administering only light sedation. This means the patient is in a twilight sleep—which I personally prefer—and music plays during the approximately 3–4-hour surgery. The light anesthesia definitely helps prevent potential postoperative bleeding,” explains Dr. Exner. “Before the surgery, I ask the patient which area is most important—whether it’s the forehead, the lower jaw area, the nasolabial folds (which, by the way, should never be completely smoothed out), or the neck area,” Dr. Exner elaborates, adding: “I always take the middle ground and don’t perform ‘extreme’ surgeries. Unfortunately, patients are often given poor advice and end up getting fillers injected instead of having a facelift.”
How is a facelift performed?
The surgeon typically makes incisions in front of or behind the ears, along the hairline. These incisions are placed so that they are barely visible afterward. The skin is gently lifted away from the underlying tissues and then repositioned upward. Excess fat tissue can be removed or redistributed to improve contours. The skin is repositioned, and any excess skin is removed if necessary. The skin is carefully sutured, with care taken to minimize scarring.
“The classic facelift has been around for over 100 years. In the 1970s and 1980s, invasive procedures came into vogue—such as those aimed at creating ‘cat-eye’ looks—but these increased the risk of long-term damage. This brought the facelift into disrepute. This is because the risk of permanent damage—such as injury to the facial nerve—increased. Fillers and thread lifts then emerged as alternatives to major surgery. For me, however, a targeted facelift is the most natural way to achieve rejuvenation. Anything injected into the body (in the 1920s and 1930s, paraffin and silicone were used!) can ultimately have undesirable consequences. Permanent fillers still carry high risks today. That’s why I prefer a tightening procedure that doesn’t involve the introduction of any additional, artificial material,” explains Dr. Exner.
Hyaluronic acid gained popularity because it was suggested that it is a natural component of connective tissue and that the body uses this component to form new tissue. Unfortunately, this idealized notion is not true—perhaps only in very young people. Unfortunately, the use of hyaluronic acid fillers always carries the risk of lymphatic congestion or the formation of lumps under the skin that do not go away right away.
In the 1970s, the method known as the SMAS facelift was developed; the abbreviation “SMAS” stands for the superficial musculoaponeurotic system—a term referring to the deeper structures, such as muscles and connective tissue, in the face and neck.
What makes the SMAS facelift unique is that it addresses not only the superficial skin but also these deeper tissue layers. This enables plastic surgeons to achieve more natural and long-lasting results. Today, the SMAS facelift is considered an established standard procedure in aesthetic surgery for tightening the face and neck. “In the cheek area, we don’t have any muscles, only layers of fascia. The layers of skin on the face vary, and their thickness must be taken into account during the operation. Anyone who has a so-called ‘fatty face’ due to excess weight should first lose weight before undergoing a facelift,” recommends Dr. Exner, explaining: “Liposuction used to be very popular, but it’s too invasive a method for the face. However, it can certainly be performed on specific areas, such as under the chin.”
A facelift that involves the SMAS can achieve an impressive rejuvenating effect that often lasts about ten years or even longer. Most patients experience lasting results for seven to ten years before new signs of sagging skin gradually reappear. For some lucky individuals, the rejuvenating effect lasts even longer. Various factors, including individual lifestyle choices (such as diet, exercise, smoking, alcohol consumption, and stress), influence the skin’s aging process and thus also the longevity of facelift results.
The Healing Process
After a three- to four-hour procedure performed under twilight sedation, the patient may stay overnight in the hospital or at the clinic. The next day, the dressing is changed, the drainage tube is removed, and the patient can go home. “Swelling does not occur until later in the healing process.” In the case of a cheek and temple lift, the patient can usually go home immediately after the procedure. Staying overnight at a hotel is also an option to remain close to the doctor. (The so-called §30 license allows us to offer overnight accommodations with nighttime monitoring.) The patient wears a cotton bandage over their head overnight to prevent possible post-operative bleeding and must not drink alcohol. The following day, the drains are removed, and a lighter head bandage may be applied. After about five days, the fine sutures can be removed. Deeper layers of sutures remain in place longer (about 3–5 weeks). The patient can wash their hair starting on the fifth day at the latest. After about two to three weeks, they can resume their normal daily activities. To support the healing process, activities such as headstands should be avoided. A follow-up appointment is important to give the doctor the opportunity to determine whether further follow-up care is necessary. “Nature takes care of the rest,” explains Dr. Exner regarding the first few weeks after surgery.
Expertise can virtually rule out any potential complications.
“The main concern on the day of surgery is potential postoperative bleeding. Fluctuations in blood pressure are also possible, for example behind the ear. In the past, patients also complained of hair loss. I prefer the so-called ‘hairline cut,’ which means making incisions directly along the hairline. There are also a few tricks to ensure that hair grows right over the suture line. Complications can also arise from improper surgical techniques. The surgeon must have a very thorough understanding of anatomy—surgical training is absolutely essential! In over 40 years, I have never once damaged a facial nerve or motor facial nerves. For me personally, a facelift carries far fewer risks than a thread lift or fillers, and I’m known for ensuring that my patients look natural after a facelift. The goal is always for the patient to have peace of mind for ten years and be able to say, “It was worth it!”—and that concludes our conversation.
Dear Dr. Exner—thank you very much for this informative discussion on facelifts!
