Frequently Asked Questions About Facial Plastic Surgery

Patients often arrive with thoughtful questions about their surgical options, preparation and recovery. The answers below reflect how Dr. Janet Chao Pearl approaches these decisions at Timeless Faces. Each is guided by a deep anatomical understanding, careful planning and a recognition that the individual needs of each patient may differ.

Understanding Facelift & Necklift

A facelift is a facial rejuvenation procedure designed to restore smoother contours through the midface, jawline and lower face by repositioning deeper tissues that descend with age. Rather than simply tightening skin, the procedure addresses the underlying facial structures that contribute to jowling, heaviness along the jawline and loss of definition. At Timeless Faces, the goal is not to make you look different. A facelift is planned to restore structural support in a way that respects your natural anatomy, helping you look more rested, lifted and like yourself again.
A necklift is a procedure that improves the contour beneath the chin and along the neck by addressing loose skin, muscle banding and fullness that can develop over time. It is often performed to restore a cleaner angle between the jawline and neck, especially when aging changes are concentrated below the face. For many patients, the neck is one of the first places where facial aging becomes noticeable. A necklift can create a smoother, more defined profile while maintaining harmony with the rest of the face.
A deep plane facelift is an advanced facelift technique that lifts and repositions the deeper structural layers of the face rather than relying on skin tension alone. By releasing and elevating the foundational tissues beneath the skin, this approach allows the cheeks, jawline and lower face to be restored more naturally and with less pull on the skin surface. This deeper anatomical approach aligns closely with my philosophy of longevity, restraint and structural support. The intention is to restore what has shifted over time, creating elegant improvement that ages well rather than a tight or over-operated appearance.
The difference between a facelift and a mini-lift is usually the degree of correction and the areas treated. A mini-lift generally focuses on early jowling or mild laxity in the lower face, while a full facelift can more comprehensively address the cheeks, jawline and neck. The right choice depends less on the label and more on your anatomy, tissue quality and goals. During consultation, I will evaluate where aging changes are occurring and recommend the procedure that best restores balance without over- or under-treating the face.
A facelift is typically used to address jowls, heaviness along the jawline, loss of cheek support, deepening folds around the mouth and descent through the lower face. These changes often occur as gravity down pulls on the soft tissues, fat pads shift and skin elasticity declines. By repositioning deeper tissues, facelift surgery can restore smoother contours and more defined transitions between the cheeks, jawline and neck. The goal is not to erase expression, but to soften the visual signs of tissue descent that can make the face look tired or older than it feels.
A necklift addresses loose neck skin, vertical platysmal bands, fullness beneath the chin and blurring of the jawline-neck transition. These concerns can arise from aging, genetics, weight fluctuation or a naturally heavier neck structure. For patients who feel their face still reflects them but their neck does not, a necklift can provide meaningful refinement. In other cases, combining facelift and necklift surgery creates the most balanced and natural result.
A facelift addresses structural descent by surgically repositioning the deeper tissues of the face. Fillers add volume, and non-surgical skin tightening treatments primarily target skin quality or mild laxity. While these options can be helpful in the right setting, they do not recreate the facial support that has shifted lower over time. Repeated filler can add heaviness or puffiness when the true issue is tissue descent. When the jawline and lower face need support rather than added volume, facelift surgery often provides the more elegant and durable solution.

Understanding Eyelid Surgery

Upper eyelid surgery, or upper blepharoplasty, is a procedure I use to remove excess skin that creates heaviness along the upper lids. For many women, this can make the eyes look tired, shadowed or less open than they feel. My goal is not to change the character of your eyes. Instead, I focus on restoring clarity, openness and ease while preserving the natural contours that make your expression uniquely yours.
Lower eyelid surgery addresses puffiness, under-eye bags, loose skin or contour irregularities beneath the eyes. These changes are often related to fat prominence, skin laxity or shifts in the structures that support the lower lid over time. As a facial plastic surgeon, I approach this area with restraint because even subtle refinements can have a major impact on how rested and balanced the face appears. The goal is smoother transitions beneath the eyes, not an altered or over-tightened look.
Eyelid surgery can address upper eyelid heaviness, hooding, under-eye bags, excess skin, shadowing and a persistently tired appearance. In some patients, these changes are driven by aging, while in others they are strongly influenced by genetics. In my practice at Timeless Faces, I always begin by identifying the true source of the concern. Sometimes the issue is excess eyelid skin, while in other cases brow descent, volume loss or cheek changes may be contributing to what patients notice around the eyes.
Eyelid surgery and a brow lift address different anatomical concerns, though patients sometimes confuse the two. Upper blepharoplasty removes excess upper eyelid skin, while a brow lift improves heaviness caused by a low or descended brow position. This distinction matters because removing eyelid skin alone will not fully correct heaviness that originates higher on the forehead. During consultation, I carefully evaluate whether the eyelid, brow or both are contributing, so the treatment plan restores balance rather than chasing the wrong problem.
Yes, in some patients upper eyelid surgery can improve vision when excess skin folds over the lash line and begins to obstruct the upper field of view. Patients often notice this as difficulty with reading, driving or feeling like they are constantly raising their brows to see more clearly. When functional improvement is part of the goal, I still plan the surgery with the same attention to natural appearance and long-term harmony. Improved vision and a more refreshed appearance often go hand in hand.
The answer depends entirely on where the aging changes or inherited anatomy are most visible. If the concern is heaviness, hooding or drooping skin above the eyes, upper eyelid surgery is often the better fit. If the issue is puffiness, bags or loose skin beneath the eyes, lower blepharoplasty may be more appropriate. Many patients benefit from one rather than both. My role is to help determine which procedure truly serves your anatomy and goals, and just as importantly, when surgery is not the right answer. The best outcomes come from precise correction with restraint, not doing more than the face needs.

Understanding Rhinoplasty

Rhinoplasty is surgery to reshape the nose in a way that improves facial balance, proportion and, in some cases, breathing. Because the nose sits at the center of the face, even small refinements can create meaningful change when they are thoughtfully planned. In my practice at Timeless Faces, rhinoplasty is never about chasing perfection or creating a one-size-fits-all look. My focus is on harmony, structural support and shaping a nose that feels aligned with the rest of your face.
Cosmetic rhinoplasty focuses on the visible shape and proportion of the nose, such as a hump, tip shape, width or asymmetry. Functional rhinoplasty addresses breathing concerns caused by internal structural issues, such as collapse, deviation or narrowed airflow. In many patients, these goals overlap. As a facial plastic surgeon, I often plan rhinoplasty to improve both appearance and function, so the nose not only looks balanced, but also works well over time.
Asian rhinoplasty is a highly individualized form of nose surgery that accounts for anatomical features commonly seen in Asian patients. While the overall goals remain facial harmony and long-term function, the surgical plan often places special emphasis on bridge augmentation, tip definition and structural support. In my practice at Timeless Faces, this may involve carefully using cartilage grafts to build height through the bridge, strengthen support and refine tip shape in a way that feels elegant and natural. Just as importantly, the goal is always to preserve ethnic identity and ensure the nose remains in harmony with the patient’s broader facial features rather than imposing a generic aesthetic ideal. Asian rhinoplasty is about refining structure, proportion and definition while honoring the individuality and heritage of the face it belongs to.
Rhinoplasty changes the outer shape, support and visible balance of the nose. Septoplasty specifically corrects a deviated septum inside the nose to improve airflow and breathing. Although they address different concerns, the two procedures are often performed together when patients want both aesthetic refinement and functional improvement. During consultation, I determine whether the surgical plan should address the visible concern, the breathing concern or both.
Rhinoplasty can address a dorsal hump, tip asymmetry, nasal width, projection, crookedness, nostril shape and overall proportion relative to the chin, cheeks and eyes. It can also improve structural issues that affect breathing. What matters most is not the nose in isolation, but how it relates to the entire face. In my practice, I evaluate rhinoplasty through the lens of facial balance, so the result supports harmony rather than drawing new attention to the nose.
Yes. When breathing issues are caused by structural problems such as septal deviation, internal valve narrowing or collapse, rhinoplasty can often be combined with functional correction to improve airflow. Because long-term support is central to my approach, I plan breathing improvements with the same emphasis on structural integrity that guides the cosmetic result. A beautiful rhinoplasty should also remain stable and functional for years to come.

Understanding Buccal Fat Removal

Buccal fat removal is a procedure I use to selectively reduce fullness in the lower cheeks by removing a carefully measured portion of the buccal fat pad. In the right patient, this can create more definition through the mid-to-lower face and improve the transition between the cheeks and jawline. In my practice at Timeless Faces, this is never about chasing a hollow or overly sculpted look. My focus is subtle refinement, structural balance and ensuring the face will continue to age well over time.
Buccal fat removal changes the appearance of persistent lower-cheek fullness. Patients often notice improved contour, less facial roundness and more visible definition through the cheek-jawline transition. The most important point is that the change should feel integrated with the rest of the face. I only recommend this procedure when the underlying bone structure and soft tissue support can carry that refinement naturally.
Because the buccal fat pad sits deep within the lower cheek, even small reductions can change how light and shadow move across the face. When performed selectively, buccal fat removal can create more elegant contour beneath the cheekbones and a cleaner transition toward the jawline. As a facial plastic surgeon, I approach this area with significant restraint. Over-removal can lead to premature hollowing, which is why my technique prioritizes selective reduction rather than aggressive excision.
Because the buccal fat pad is surgically removed, the procedure itself is not truly reversible. Volume can sometimes be restored later through fat grafting or other facial balancing techniques, but that is different from replacing the original buccal fat exactly as it was. This is why candidacy matters so much. A major part of my role is helping patients decide whether this contour change will still feel right years from now, not just in the short term.

Understanding Hairline Lowering

Hairline lowering surgery, also called forehead reduction, is a procedure I use to reduce the vertical height of the forehead by carefully advancing the hairline forward. In the right patient, this can restore better proportion between the upper face, eyes, nose and midface. The goal is never to create an unnaturally low hairline. In my practice at Timeless Faces, the focus is restoring balance in a way that looks soft, intentional and appropriate as the face continues to evolve.
Hairline lowering is often a strong option for women who feel their forehead appears disproportionately tall compared with the rest of their facial features. The best candidates usually have a stable hairline, good scalp flexibility and hair characteristics that support discreet healing. As with many facial balancing procedures, the decision is less about one isolated feature and more about proportion. I recommend it when advancing the hairline will improve overall facial harmony rather than simply lowering the forehead for its own sake.
Hairline lowering and brow lift surgery address very different goals. Hairline lowering changes the position of the hairline to reduce forehead height, while a brow lift elevates the brows to improve heaviness, hooding or brow descent. Although both procedures involve the upper face, they solve different proportional concerns. During consultation, I carefully assess whether the issue is forehead height, brow position or both, so the surgical plan addresses the true source of imbalance.
Yes. Hairline lowering can sometimes be combined with other facial procedures when the goal is broader upper-face or full-face balance. In carefully selected patients, combining procedures can improve harmony while minimizing separate recovery periods. That said, I only recommend combined surgery when it clearly serves the patient’s anatomy, healing profile and long-term appearance. My planning always prioritizes what will age well, not simply what can be done in one setting.
All surgery involves an incision, but the goal in hairline lowering is to place that incision so it heals discreetly within the natural hairline. I pay close attention to incision design, closure technique, hair direction and density so the result blends as naturally as possible. Scar visibility also depends on healing biology and hair characteristics, which is why candidacy and preoperative planning are so important. In most patients, the incision becomes increasingly difficult to notice as healing progresses and hair regrowth continues.

Understanding Ear Surgery

Otoplasty is a procedure I use to reshape or reposition the ears so they sit in better proportion to the head and face. Most often, this involves reducing prominence, improving symmetry or refining cartilage contour so the ears feel less visually distracting. In my practice at Timeless Faces, the goal is never to flatten or aggressively pin the ears back. I focus on creating a natural angle and contour that feels harmonious, balanced and quietly unremarkable.
Otoplasty can address ears that project more prominently than desired, asymmetry between the ears or cartilage irregularities that affect contour. For many adults, these concerns are subtle but persistent, often influencing hairstyle choices, photographs or overall facial balance. What matters most is proportion. I recommend otoplasty when refining the ear position or contour will better align the ears with the rest of the face rather than draw new attention to them.
Earlobe repair is a minor surgical procedure designed to restore the natural contour and structural integrity of the earlobe after a tear, split, stretching from gauges or elongation over time. When performed precisely, it allows the lobe to look whole again and often restores comfortable support for earrings. Even though it is considered a small procedure, technique matters profoundly. My approach emphasizes layered closure, careful scar design and long-term healing so the result simply looks natural rather than visibly repaired.
Yes. Torn, split or stretched earlobes can usually be repaired very effectively with a focused in-office procedure performed under local anesthesia. The goal is to restore the shape, contour and strength of the lobe while minimizing visible scarring. This is one of the clearest examples of how even minor details can shift facial harmony. When the repair is thoughtfully done, the earlobe should simply look restored rather than surgically altered.
That is always the goal. Whether I am performing otoplasty or earlobe repair, my approach is rooted in restoration and proportion rather than obvious change. As a facial plastic surgeon, I believe ears should never become the focal point after surgery. The best result is one that feels like it has always belonged to your face, with balance restored so nothing feels distracting.
Re-piercing is typically discussed after the earlobe has healed adequately, which is often around two to three months after the procedure, though the exact timing depends on your tissue quality, healing pattern and the specifics of the repair. I guide this decision carefully because proper timing helps protect the integrity of the repair and reduces the risk of re-injury. In my practice, aftercare and re-piercing guidance are treated with the same attention to detail as the procedure itself.

Facial Rejuvenation & Treatments

Facial rejuvenation is the process of restoring balance, support and harmony to the face as it changes over time. In my practice, this is not about making someone look like a different person or chasing a younger version of the face. It is about helping the outside reflect how you feel on the inside. That may involve addressing tissue descent, skin quality, volume changes, heaviness around the eyes or shifts in facial proportion. The right approach depends on anatomy, goals and how the face is likely to continue evolving over the years ahead.
The difference usually comes down to what is actually changing in the face. Surgical facial rejuvenation restores deeper structural support by repositioning tissue, refining contour or correcting proportion. Non-surgical options such as lasers, injectables or skin treatments are often better suited for skin quality, surface texture, mild volume loss or early changes. Neither is inherently better. The key is matching the treatment to the true anatomical issue. In my practice at Timeless Faces, I recommend surgery when structural descent is the main concern and non-surgical options when the goals can be achieved more conservatively without compromising long-term balance.
That is completely appropriate, and it is often an important part of the decision-making process. Not every concern requires surgery, and not every patient is at the right stage emotionally, practically or anatomically to move forward with an operation. A meaningful part of my role is helping patients understand what can be improved now, what may be better observed over time and when no treatment is the best choice. Sometimes that means exploring non-surgical options. Sometimes it means simply giving the face more time. Thoughtful timing is part of achieving results that continue to feel right – long after the initial decision.