Your complete guide to facial rejuvenation surgery with Dr. Susan Tan — from consultation through your final result. This resource is provided to surgical patients of Hawaii Facial Plastic Surgery. It covers the face and neck lift as the foundational procedure, with guidance on adjunct procedures that may be part of your individual surgical plan.
Facial aging is driven by structural change beneath the skin — not by the skin itself. Fat pads that once provided volume shift downward, creating hollows above the cheekbones and heaviness below. The ligaments that once held the face in its youthful position relax over time, allowing the SMAS — the structural muscular layer beneath the skin — to descend from where it once naturally lived.
Non-surgical treatments — fillers, energy devices, injectables — address these changes up to a point. They restore volume, tighten the surface, and refresh the appearance. But at a certain stage of structural descent, restoration means returning tissue to where it once was — not adding to it or treating the surface above it.
That is what surgery does. And when performed correctly, at the right depth, the result is not transformation — it is recognition. You look like yourself again.
Restore volume beautifully. Cannot reposition tissue that has shifted structurally downward.
Tighten and resurface. Cannot lift anatomy that has descended from its natural position.
Relax and refresh. Cannot address the structural descent that drives advanced facial aging.
At a certain stage, restoration requires returning tissue to where it once naturally lived — not adding to it or treating the surface above it.
Tissue is returned to where it once naturally lived — not pulled, not tightened. The ligaments anchoring tissue in its descended position are released, and the SMAS and deeper layers are lifted as a single unit.
The natural contours of the jawline, lower face, and neck are re-established. The skin follows the lifted structure — completely tension-free. This is why the result looks natural, not operated on.
The face and neck are treated as one continuous aging unit — not as isolated zones. The result is harmonious and proportionate across the full face.
Every incision is placed within a natural fold — designed to disappear into your own anatomy. Modern technique is built around concealment from the first incision.
Hidden within the hairline above the ear. Preserves your natural hairline shape and contour.
Follows the natural crease in front of the ear. Designed to blend and become invisible once healed.
Tucks neatly behind the ear and into the hairline — completely hidden when facing forward.
"Will I look unnatural?" — The goal is restoration, not transformation. You should look like yourself — rested and renewed. "Will people know I had surgery?" — With the deep plane technique, results are subtle enough that people notice you look well, not different. "Will I still look like me?" — Yes. That is the only acceptable outcome. Recognition with refinement.
The face and neck lift is the foundation of your surgical plan. Adjunct procedures — blepharoplasty, brow lift, facial fat grafting, and TCA peel — address specific concerns that the lift alone does not treat. Your individual plan was determined at consultation based on your specific anatomy and goals. Not every adjunct listed here applies to every patient.
The deep plane facelift is the most comprehensive surgical approach to facial rejuvenation — addressing the face and neck as a single aging unit at the structural level. Dr. Tan releases the retaining ligaments that anchor tissue in its descended position and lifts the SMAS with the overlying tissue as a composite unit. The skin follows tension-free. The result looks natural because the cause of the problem — not the surface expression of it — has been addressed.
The neck lift is performed simultaneously — addressing platysmal banding, excess skin, and subplatysmal fat for a clean, natural chin-to-neck transition. For most patients, facelift and neck lift together produce the most harmonious result — because the face and neck age as one system.
4–6 hours
General anesthesia
10–15 years
Blepharoplasty removes excess upper eyelid skin that causes heaviness and visual obstruction, and/or addresses lower eyelid puffiness from herniated orbital fat. Performed at the same session as the facelift, it addresses the full picture of facial aging — the eyelids and the lower face together — for a result that is cohesive and harmonious. Incisions are placed precisely within the natural eyelid crease and become essentially invisible once healed.
Important: Many patients with heavy upper eyelids have a combination of true eyelid excess and brow descent (ptosis). Dr. Tan assessed both at your consultation to ensure the correct procedure — or combination — is addressing the actual cause of the concern.
The brow lift addresses descent of the brow from its youthful position — restoring the natural, open appearance of the upper face without altering expression. Performed via tiny incisions hidden within the hairline (endoscopic) or at the temporal hairline (limited incision). When combined with the facelift and blepharoplasty, it creates a seamless rejuvenation from brow to neck — each procedure building on the last rather than addressing isolated zones independently.
Structural lifting addresses descent. But facial aging also involves volume loss — the gradual deflation of fat compartments that once provided the fullness and projection of youth. Fat grafting addresses this dimension directly, using your own fat harvested from another area of the body, processed, and precisely reinjected into areas of hollowing — cheeks, temples, tear troughs, and the perioral area.
Dr. Tan uses both microfat (for structural volumizing) and nanofat (for superficial skin quality improvement) as appropriate. A facelift combined with fat grafting addresses both structural descent and volume loss in a single surgical session — producing a more complete and naturally youthful result than either procedure alone.
The TCA (trichloroacetic acid) peel is a medium-depth resurfacing treatment applied at the conclusion of your surgical procedure — once all incisions are closed. It addresses the surface of the skin that structural surgery does not treat: texture irregularities, sun damage, fine lines, and uneven pigmentation. Performing it at the end of surgery means you begin healing from both the structural and surface dimensions simultaneously — in a single recovery.
The TCA peel is applied to the facial skin with precision — avoiding incision lines entirely. Your skin will peel over the days following surgery as part of the normal healing response. The peeling process is how the peel works: old, sun-damaged skin sheds to reveal the smoother, more even skin beneath. The post-peel care protocol is distinct from your surgical incision care and is described in detail in the Aftercare section below.
Preparation before surgery directly affects your safety and the quality of your healing. Please complete every item on this checklist. Contact our office if you have any questions.
Surgery day is an early start. Here is what the day looks like from arrival through your return home.
You and Dr. Tan review your surgical plan together. She answers any remaining questions, marks incision lines, and confirms the plan is exactly what you both discussed. This is your last chance to clarify anything — ask everything.
You are placed under general anesthesia by a board-certified anesthesiologist. You will be completely unconscious and feel nothing. The surgical team prepares the operative field.
Dr. Tan performs the surgery with meticulous attention to anatomy and aesthetics. Every incision, every layer, every suture is placed with your result in mind. You are monitored continuously throughout.
You wake in the recovery room with dressings in place. Once stable, you are discharged into the care of your designated companion. You go home the same day — not to a hospital.
Rest is your only job. Keep your head elevated. Take prescribed medications as directed. Apply cold compresses intermittently for the first 48 hours. Your companion is there — you do not need to manage anything yourself tonight.
Significant swelling, bruising, and tightness are completely normal — they are part of healing, not signs of a problem. Pain is mild to moderate and well controlled with prescribed medication. What you see immediately after surgery is swelling — not your result. Your result takes months to fully reveal itself. Be patient.
Small surgical drains may be placed beneath the skin to prevent fluid buildup. They are removed at your first post-operative visit — the day after surgery. Record drain output as instructed. Do not remove them yourself under any circumstances.
If drain output suddenly increases significantly, or if you notice signs of hematoma (rapidly expanding firmness or tightness on one side), contact our office immediately at (808) 636-9084.
What you see early is never your final result. Every week you look a little more like yourself. The most common mistake is evaluating your result too soon. Give your face time.
Dressings and drains removed at your post-operative visit. Keep head elevated at all times including while sleeping. Apply cold compresses intermittently — not ice directly on skin. Pain is manageable with prescribed medication.
Swelling and bruising are at their most significant. This is completely normal — it is your body healing. Continue cold compresses, head elevation, and rest. Do not evaluate your result at this stage.
External sutures removed at your one-week post-operative visit. Bruising is visible but beginning to fade. You will notice hints of your new contour beginning to emerge beneath the swelling. Most patients feel significantly more comfortable by day 7.
Most patients are comfortable going out cautiously — with sunglasses and a hat. Bruising can be covered with mineral makeup from day 10. Avoid sun exposure on incision lines.
Most bruising resolves. Swelling softens progressively. Contours begin to emerge clearly. Numbness and tightness are still present — this is normal and resolves over months. Most patients return to work and light social activity.
Tissue settles into its new position. The result looks and feels increasingly natural. Most patients are socially comfortable and actively enjoying their results by this point. The 3-month in-person visit is an important milestone — Dr. Tan reviews your healing and plans next steps.
Full healing is complete. The face you see now is your result — rested, lifted, and entirely you. Residual numbness, tightness, and scar redness have largely resolved. Results from the deep plane approach last 10–15 years as a conservative estimate.
Visible peeling of the treated skin occurs during this window — this is the peel working, not a complication. Keep skin continuously moist with your prescribed ointment. Do not pick, pull, or assist peeling. Follow your TCA post-peel care protocol exactly. Full peeling resolves within 7–10 days revealing smoother, more even skin beneath.
Results are best maintained with physician-directed skincare, daily sun protection, and periodic non-surgical treatments (neuromodulators, biostimulators, SkinPen). Dr. Tan integrates every surgical patient into the non-surgical continuum to protect and extend what surgery achieved.
Keep the treated skin continuously moist. Do not allow it to dry out. Do not pick, peel, or pull at skin that is shedding — no matter how tempting. Premature removal of peeling skin causes scarring and pigmentation changes. Let it shed on its own timeline.
A note on skincare products: Dr. Tan prescribes physician-directed medical-grade skincare for the recovery and maintenance phases. These are formulated specifically for post-procedure skin — at the concentration, quality, and stability required for clinical results. Your specific products will be recommended at your post-operative visits based on how your skin heals and what it needs at each stage.
Take all prescribed medications as directed — pain medication, antibiotics, and any other prescriptions from Dr. Tan
Do not resume blood-thinning medications or supplements until cleared by Dr. Tan
No alcohol during the initial recovery period — alcohol increases swelling and interacts with medications
Arnica montana (oral or topical) may help reduce bruising — ask our team if appropriate for you
Common and expected — will last several months and resolves progressively. Sensation returns as nerves recover.
Your facial muscles are literally lifted and held in a more youthful position. The tightness you feel for 3–4 weeks is the result working. It resolves completely.
Rippling or bumps along the incision line from swelling at suture sites. Resolves once sutures are removed and swelling settles — typically 2–4 weeks.
Some patients feel a stitch "poking" along the incision — a deep suture working toward the surface. Harmless. Our team can clip it easily at any visit. Sutures dissolve in 4–6 months.
Incisions look worst between weeks 2 and 6 — red, slightly raised, and more visible. This is normal and temporary. Incisions begin to mature after 6 weeks and settle over up to one year.
Rapidly increasing swelling or firmness on one side of the face or neck (possible hematoma) · Sudden significantly increased drain output · Signs of infection: increased redness, warmth, pus, or fever above 38.5°C/101.3°F · Difficulty breathing or swallowing · Any concern that feels urgent or unusual
Office: (808) 636-9084
These questions are drawn directly from our patients' most common concerns after surgery. If your question isn't here, call our office — we are always available to help.
Dr. Tan sees every patient personally at every post-operative visit. If you have a concern between visits — call us. There are no silly questions during your recovery. Your safety and peace of mind are our priority.