What is actually happening
Most of what people call aging skin is accumulated sun exposure. Over decades, ultraviolet light breaks down the collagen and elastin in the dermis and disrupts the cells that produce pigment. The results are roughness, fine lines that sit independently of expression, enlarged pores, broken vessels and uneven pigment.
Separately, and more slowly, the skin thins and its ability to recoil declines. Thin skin shows everything beneath it more readily, which is why the same underlying structure looks different at 40 and at 65.
A facelift repositions the tissue. It hands the same skin back to you, in a new position.
What is worth ruling out first
The useful question is which layer your complaint lives in.
Genuine surface change is texture, pore size, pigment and sun damage. It responds to resurfacing and to treatments that work in the dermis, and it responds to protecting the skin from further exposure.
Structural change wearing thin skin is different. If the jawline has broken up or the neck has lost its angle, treating the surface will improve the quality of the skin and leave the shape exactly as it was.
Dynamic lines are a third thing again. Lines made by movement, mostly in the upper face, come from muscle activity rather than surface damage, and resurfacing is not the tool for them.
Skin tone belongs in this assessment too. Treatments that remove the surface carry a higher risk of pigment change in darker skin, and that shifts which option is sensible before anything else is considered.
What treats it
Results
BeforeAfter
Individual results may vary. The photographs shown are of actual patients of Dr. Keni who have consented to their use.
Common questions
- Will a facelift improve my skin?
- It will not. A lift repositions tissue and the same skin arrives in the new position. Texture, fine lines, pigment and pore size are a separate problem needing a separate tool, which is why plenty of facelift patients also have their skin treated.
- Laser or microneedling?
- Fractional CO2 resurfaces the surface and gives the larger change in texture and pigment, with real downtime. Radiofrequency microneedling works deeper without removing the surface, so recovery is far shorter and the change is more gradual. Skin tone matters to the choice as well.
- Is resurfacing safe in darker skin?
- It calls for more caution. Removing the surface carries a higher risk of pigment change in darker skin tones, and treatments that spare the surface are usually more predictable. This is a conversation to have specifically rather than generically.
- Do I need a procedure at all?
- Sometimes not. Some people arrive asking for a device and leave with a skin care plan and nothing else. If that is the honest answer for your skin, it is the one you will get.
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