How Do I Achieve a Natural Facelift?

Many patients are concerned that they will receive an unnatural facelift result. This fear is not unwarranted because many of us have seen people who have had work done on their face that appears obviously pulled and unnatural.

The key to achieving a natural-looking result is to avoid a procedure that simply pulls the face up. The best, most natural facelift results are achieved with a procedure that repositions the face.

So what causes that pulled-face appearance? In a rhytidectomy (the technical name for a facelift) the soft tissue of the face is lifted. The soft tissue layer is specifically called the SMAS layer. In a SMAS facelift, the layer is dissected and repositioned to the desired area. However, if the SMAS layer is not fully released, then adequate cheek lifting and lift of the lower face is not achieved, which leads to a pulled or tightened appearance. The opposite of fully releasing the SMAS is known as thread facelift surgery, which is not effective in lifting and maintaining a naturally lifted look.

So why is it that some plastic surgeons release all the attached tissue of the SMAS layer while other plastic surgeons do not?

The key is visibility.

What enables a plastic surgeon to see and ultimately avoid damaging vital structures is the amount of bleeding during surgery. If there is excessive bleeding during surgery, the plastic surgeon cannot distinguish between the structures that can be cut and those, such as nerves, that should be avoided. When the surgery is performed cleanly, in that there is no bleeding, the face is easier to fully release, and a cheek lift and a lower facelift can adequately be achieved without looking pulled or obviously lifted. This is the key to achieving a natural-appearing rejuvenation. This procedure is internally minimally-invasive. Patients may think that small incisions are the same as minimally invasive, but what is more important is that the soft tissue inside the body is not traumatized.


People may think that a facelift is painful. However, a facelift surgery performed well is not painful at all. The key differences between the results of a facelift often come down to the experience and training quality of the surgeon. As a matter of fact, after well-performed facelift surgery, patients typically take only Tylenol during the first 24 hours. The reason for such minimal pain is that there is no bleeding during facelift surgery. The key to not bleeding is carefully lifting a layer of tissue called the “SMAS layer” without damaging the blood vessels. Whether your surgeon will be performing mid-facelift or cheek lift, by avoiding vessel damage, they will minimize bleeding and therefore minimize pain after surgery.

This type of facelift is also sometimes called a SMAS facelift. Another key aspect of minimizing pain after SMAS facelift is to operate precisely under the SMAS. Because the surgery is ultra-precise, facelift surgery can be performed while the patient is awake under local anesthesia only. When the patient does not experience pain during facelift surgery, the pain after a facelift is minimal. This is the key to avoiding pain after any surgery. Typically, patients are put under general anesthesia for facelift surgery. The problem with this typical method of anesthesia is that the patient wakes up with pain. And then the pain has to be chased or controlled with heavy narcotic pain medication.


Dr. Kenneth Kim is a board-certified plastic surgeon that performs all his facelift surgery under local anesthesia. The advantage of this method of anesthesia for a facelift is that the patient will experience little pain. As mentioned, Dr. Kenneth Kim’s patients typically only take Tylenol for less than 24 hours after facelift or rhytidectomy. Compared to non-surgical facelift, Dr. Kenneth Kim’s facelift surgery is less painful. And when compared to thread lift, again, Dr. Kenneth Kim’s facelift surgery is less painful. This is because Dr. Kenneth Kim specializes in non-bleeding ultra-precise facelift surgery and lower facelift surgery.

Dr. Kenneth Kim’s office is located in Los Angeles and Beverly Hills area. During your consultation with him, Dr. Kim will explain whether you will need a lower facelift, a cheek lift, or a mid-facelift to achieve the most natural result. And of course, Dr. Kenneth Kim will explain in detail why the facelift will not be painful.


A facelift can definitely be performed with only local anesthesia. As a matter of fact, performing the facelift or mid-facelift surgery under local anesthesia is not only safer but it also leads to a better result.  First of all, general anesthesia for rhytidectomy has inherent risks. The patient who desires a natural facelift is typically past 40 years of age.

Patients who are in their 40s, 50s, 60s, 70s, and 80s are at a higher risk of blood clot formation.

A typical mid-facelift and lower facelift would take at least four hours to perform.  This is because the SMAS layer is elevated with the platysma muscle. This is known as a SMAS facelift or deep plane facelift. These techniques are labor-intensive and require time to produce a natural result. Therefore, performing surgery for an extended time on the facelift patient age group increases the risks associated with general anesthesia.

Local anesthesia is applied to the midface and lower face in order to perform the facelift procedure.

The local anesthetic is delivered to the face without pain. Once the local anesthesia is injected, the patient does not experience any pain.  The advantage is that the SMAS, mid-face, lower face, and the platysma is fully numbed and bathed in fluid. Thus, the tissue is easily dissected to produce an effective cheek lift and lower facelift.  Because the tissue is bathed in fluid, the tissue undergoes minimal strain. This means that after the facelift surgery, the patient will experience minimal pain. Most patients only experience discomfort and will only require Tylenol the evening of surgery.

Facelift Using Local Anesthesia

One of the main advantages of using only local anesthesia is avoiding the complications that occur with general anesthesia and deep sedation in facelift surgery. What are the risks of awake facelift? There are DVT (Deep Vein Thrombosis), VTE (Venous Thromboembolism) and malignant hyperthermia. Both VTE and malignant hyperthermia are life-threatening complications. IV sedation used with facelift has risks as well, which can cause a patient to breathe inadequately due to over-sedation. As a matter of fact, death and severe complications from anesthesia can occur from over-sedation with deep IV sedation.

When using only local anesthesia to perform facelift surgery the advantage is that we take away the risks that come with general anesthesia.

In surgery there are two types of risks: one is the surgical risk and second is the anesthetic risk. By removing the anesthetic risk in facelift surgery, the patient can safely receive the procedure without additional complications. Local anesthesia works by numbing only the nerves around the face, making the facelift procedure as safe as possible. Another recent development of general anesthesia and IV sedation risks is that it can kill nerve cells in the brain with prolonged exposure. A facelift procedure can take anywhere from three to six hours. Therefore, being under anesthesia for this long period of time increases the risk of brain cell damage that can affect cognition and memory.

Facelift Specialist – Dr. Kenneth Kim

Dr. Kenneth Kim is a specialist in local anesthesia facelifts.

Dr. Kim’s facelift technique is unique in that no general anesthesia and no IV sedation are used. Strict use of only local anesthesia is used to perform the SMAS facelift and lower facelift. Dr. Kenneth Kim has presented his innovative facelift technique to the American Society of Plastic Surgeons and the Korean Society of Plastic and Reconstructive Surgery.

Dr. Kenneth Kim is a Korean plastic surgeon in Los Angeles, California with extensive experience operating on all types of faces to create a natural facelift result. He is known to produce natural results in difficult patients with heavy soft tissue.

Although Dr. Kenneth Kim specializes in Asian facelift, he also performs facelift surgeries for all ethnicities.

Asian facelift is known to be the most difficult procedure due to Asian faces being heavy and  prone to scarring. In order to perform facelift surgery using local anesthesia, the surgeon must meticulously perform the dissection using the ultra-precision method, which is a technique pioneered by Dr. Kenneth Kim. Facelift surgery is an elective procedure to enhance and improve the quality of life of the patient. It is unnecessary to take on additional anesthetic risk by undergoing general anesthesia or deep IV sedation.

Dr. Kim can perform cheek lift, lower facelift, and neck lift. His rhytidectomy and SMAS facelift techniques are state-of-the-art.

Those interested in learning more about no-bleed facelifts and how Dr. Kim will help them achieve facial rejuvenation can schedule a consultation with him at his office in Los Angeles.