My thoughts on surgical mastery, mental load, and why the math just stopped working.
Facelift demand has been on the rise. So why did I decide to stop performing them? Image by Freepik.
The business of facelifts is booming. As I discussed in a recent video, viral results, modern techniques, and high demand means that some plastic surgeons are charging upwards of $300,000 per facelift. So four years into my private practice, with a full schedule and a thriving YouTube channel, why did I step off the facelift escalator?
Read on to discover what I learned from my decision and what I think it means for anyone considering cosmetic facial rejuvenation surgery today.
On Paper, It Really Looks Perfect
By late 2022, facelifts were really trending up. The fad of using nonsurgical solutions (fillers, botulinum toxins, ultrasound, and radiofrequency) for every single aging problem was waning. Pair that with an explosion of surgical advances and patients eager for natural looking results, and you can see how waiting lists were filling up everywhere.
I managed by alternating my weeks: two weeks of facial plastics, two weeks for hair. My consults were booked out for months.
From the outside, everything appeared great, but inside, something else was happening.
The only way to describe my facelift weeks was heavy. I’m methodical by nature and facelifts are long operations with real risks: bleeding, facial nerve injury, skin healing challenges. To me they felt like engineering: planes and vectoring, flap perfusion, managing hemostasis. It’s elegant, but the mental load lives differently in your body. I often felt like I was navigating a minefield, and not because the procedures were unsafe, but because the margin for error is razor-thin and the consequences are immediate.
My patients did well, but my quiet anticipation began seven days before each case. The night before I’d rehearse every move, then run the operation over in my head during my commute. Afterwards while my patients were in recovery? I’d spend the next 48 replaying every decision I’d made. And then I’d do it all over again.
As a result, I was less present at home during facelift weeks. My staff noticed a difference, too. I was paying an anxiety tax for my excellence.
Financially? Sure, the upside was obvious.
Personally? I was beginning to wonder if it was worth it.
In stark contrast, my hair transplant weeks were lighter and collaborative. Hair transplant surgeries are more of composition, where thousands of micro-decisions add up to a face-framing portrait. Hairline geometry, density gradients, curl and caliber. The joy is in the cumulative nuance.
Collaboration and the art of composition made my hair transplant focused weeks a delight. Image by Freepik.
I realized I’m happiest where millimeter decisions become a portrait. My team moved as one, and my anxiety profile was lower. The room had oxygen.
Then, a consultant shared with me a line that they’d heard from a senior surgeon:
“I stopped doing facelifts after 25 years and I’ve never felt better. I wish I’d done it sooner.”
That sentence began taking up rent space in my brain. And I couldn’t unhear it.
Ethics, Timing, and Saying “No”
Even before the current appetite for earlier facelifts, I was already saying “no”. I believe facelifts should address true facial aging, not the first hint of laxity in our 20s or early 30s. More surgeries over a lifetime means more cumulative risk. That didn’t align with my values or my counseling style.
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To be clear: modern facelift surgery has never been better. Deep-plane approaches, neck integration, thoughtful vectoring and scar management are all top tier. Leaders in the field are pushing outcomes to remarkable heights. I trained with some of them. I cheer them on. I simply chose not to be them.
Mastery Requires Focus
If you want to be world-class at anything, you need practice. In the surgical world, that means volume and immersion. I was trying to be two different surgeons at once. It might work for Clark Kent switching in the phone booth, but it was costing me the surgical depth I desperately wanted.
And my own journey with alopecia areata had already changed me. Hair wasn’t just technical, it was personal. That came through in consults, in the OR, and at follow-up. Lip surgery, too, had become a true craft obsession; the millimeters, the aesthetic math, the patient joy. Those were the lanes where my curiosity stayed switched on all day.
I chose to trade breadth for depth. I picked two lanes, lips and hair, and made the decision to own them.
Stepping Away
In late 2022, I stopped offering facelifts. I focused fully on hair and my Elelyft lip surgery. Since then, we’ve performed thousands of procedures. Patients fly in from all over the world. The team is energized.
I love the work.
Do I still respect modern facelift surgery? Absolutely. I even filmed a piece on the six principles that make today’s facelifts so good. (If you’re facelift-curious, that’s a great place to start.)
Do I regret walking away from an in-demand, high-revenue procedure?
No.
The best outcomes happen where a surgeon’s skills, values, and joy overlap.
That’s where I operate now.
What This Means If You’re Considering a Facelift
Here A few principles I still share with patients:
Facelifts are best used to treat real signs of aging, not for the first wisp of jowls. Image by prostooleh for Freepik.
Start with your goals, NOT the procedure. Do you want a sharper jawline? A deep neck component matters. If your primary concern is a long philtrum and poor tooth show, a lip lift (not filler, not a facelift) is the correct tool.
Don’t chase your youth. Good skin care, targeted injectables, and energy devices (used judiciously) can bridge years. Facelifts shine when they’re treating real aging changes, not the first whisper of laxity. Chasing 20 again is where disastrous results begin.
Expect honesty about risk. Nerve injury, bleeding, healing issues: these are real. Ask your surgeon what keeps them up the night before a facelift, and how their protocols mitigate it.
Look for immersion. Surgeons who live and breathe a procedure tend to have tighter systems, deeper pattern recognition, and calmer recoveries. Volume and focus matter.
And If You’re Not a Facelift Candidate? (Yet)
There’s a lot we can do outside the OR.
Hair restoration: Medical therapy, PRP/PRF, thoughtful microneedling, and (when indicated) hair transplant artistry can transform how your face reads.
Lips: A measured lip lift can rebalance tooth show and philtrum length in a way filler never can when done for the right reasons, on the right face.
Skin & structure: Smart routines, appropriate fillers, and realistic timelines beat “everything everywhere all at once.” Keeping fit with weightlifting also does wonders to maintain skin’s collagen and bone density.
The Quiet Question Behind Every Big Choice
Could I have kept doing facelifts and been fine?
Probably.
But “fine” is not why I went into medicine.
Never say never about the future, but for now, I’m exactly where I should be.
If you’re weighing options and considering either a lip lift or hair restoration, book a consult and bring me your goals.
And, if you want to support your hair and skin the tried-and-true, evidence-forward way, our GQ award-winning hair-care lineup is available at feelconfident.com and through our Amazon storefront.
