Botox vs. Facelift – Which is the Right Choice for You?

Let’s face it, we all want to stay looking young and beautiful! This motivates us to try new products and experiment with different treatments, and we usually want immediate results.

Mother Nature is rarely kind and we are all destined to show some telltale signs of facial aging at some point. Years of exposure to the sun, smoking, pollutants, the stresses of our daily lives, and that nasty thing called gravity will take their toll. Some of us will suffer from skin wrinkles, some from deep creases or folds, and others from sagging extra skin along our jaw lines and neck.

None of us really loves the idea of invasive traditional facelift surgery, also called rhytidectomy surgery, and the difficult recovery process we’ve heard about. We understand that facelifts are surgical procedures and Botox injections are not. But do we know which one is right for us? Which one is best to treat the specific problems we have?

There is no fountain of youth but, fortunately, plastic surgeons have been working for decades to improve upon techniques that can help restore a more youthful appearance to our faces.

Non-surgical rejuvenation techniques such as Botox can never achieve the same results as facelift surgery, but may be just the treatment you need. In fact, both treatments complement each other! Let’s discuss both options.

Botox & Facelifts – The Differences

The most important thing to understand is that facelifts and Botox injections really serve two completely different purposes and will never produce the same results.


The main purpose of a facelift is to reshape deep facial structures and remove some extra skin tissue to bring us back to a more youthful appearance. These lax, saggy tissues are most often found in the lower half of the face (neck and jowls). If you have a lot of sagging skin, nothing can be done to shrink it significantly; it has to be repositioned, removed and repaired. Facelift surgery may also include eyelid surgery, a forehead lift or a neck lift to further improve the look of the face.

Some issues that are nicely resolved with facelift surgery are:

  • Deep under-eye creases
  • Deep forehead creases
  • Drooping eyebrows
  • Deep folds or creases along the nose
  • Lowered cheek pad
  • Saggy skin along chin or jaw line
  • Double chin
  • Jowls and “turkey gobble” neck


Botox, on the other hand, is a brand of botulinum toxin that is directed at overactive muscles to alleviate the wrinkles, laugh/ frown lines, and crow’s feet that they cause. It is used most often in the upper part of the face (wrinkles radiating from the corners of the eyes, forehead creases, creases between the eyebrows). Botox is absorbed by the muscles and helps them relax. The injections have no real impact on the skin itself. This treatment may be called a “non-surgical facelift” but is not a facelift at all. There is no skin removal and no lifting, but the result of the injections can give the skin a smoother, softer and more youthful look.

Some issues that are nicely resolved by Botox injections are:

  • Fine facial wrinkles
  • Crow’s feet
  • Laugh lines and frown lines
  • Furrows between eyebrows
  • Fine forehead wrinkles
  • Neck (platysmal) bands

Who is NOT a candidate for these procedures?


The best candidates for facelifts have supple, elastic skin and are at their ideal weight. If your skin has excessive sun damage you may take longer to heal and more scar tissue may form. As with any invasive surgical procedure, you should in satisfactory health. If you have any questions whether or not your health, medical condition or a medication you take may preclude you from having a facelift, be sure to discuss it with a qualified plastic surgeon.


There are some conditions that will preclude you from having Botox injections. You should avoid Botox if you are pregnant or nursing or have a neuromuscular disease like ALS or Myasthenia Gravis. Your risk of complications can also be increased if you have a skin inflammatory disease (e.g., eczema, dermatitis, psoriasis) where you intend to have the injections.

How long do the results usually last?


An important factor to consider is that we all age at different rates based on genetics, health, sun exposure, smoking and stress. No doctor can predict this for you because there are too many variables. A well-performed facelift can knock 10 years off the age of your face but you won’t stop aging. However, the results you gain from a well-done facelift can last 6 to 10 years on average.

Some modified surgical facelift techniques (e.g. “mini facelift, “S-lift”) make minimal changes and the results may not last as long as with the more involved “complete” facelift. Another factor is the patient’s age; younger patients have less elasticity in their skin so facelift improvements usually last longer than those of an older patient with looser skin. Other factors depend on the patient’s lifestyle. If you return to smoking after surgery, resume exposure to the sun, or lose/gain a substantial amount of weight, you may not achieve long-lasting improvements.

Surgical facelift techniques have greatly improved and the results gained from facelifts are much more natural now. You may need facelift surgery “touch-ups” only once or twice more in your lifetime.


Botox injections don’t last forever. The muscles under the skin will start to move again after 3 to 6 months and the wrinkles will slowly return. This means you will need re-treatments every 3 to 4 months if you want to maintain the results.

You can (if you can afford it) have Botox injections throughout your life. Plastic surgeons will often advise patients in their 30s and 40s to begin with Botox and, after 10 years or so of treatment, elect a facelift if they begin seeing less improvement from the injections.

Many facelift patients also benefit from periodic Botox injections in spot areas like crow’s feet.

What is recovery like and are there any side effects?


Recovery time after facelift surgery is faster than it used to be and very much depends on the individual patient. Most patients have only one or two days of mild pain after surgery. There will be swelling and bruising that should begin to subside after about one week. Some patients can be out and about in 5 or 6 days if they are not overly self-conscious about their bruises. Others need up to 2 weeks to feel comfortable enough to be seen in public.

You should be able to return to work in about one to two weeks. Exercise and heavy lifting should be limited for the first 3 weeks. You may experience temporary facial numbness for up to 9 months.

Possible side effects of facelift surgery can range from allergic reactions to anesthesia, swelling and scarring, hematoma (blood clot under the skin), and damage to the facial nerves (particularly true for patients who smoke).


There is virtually no recovery time after Botox injections. The treatment can be done at lunchtime and you can return to work immediately! Your doctor may tell you not to rub the injection sites for the first few days or take any kind of blood thinning medications (such as aspirin and NSAIDs) to avoid bruising.

Common side effects of Botox injections include nausea, flu-like symptoms, respiratory infection, forehead and eyelid drooping, and headache. Less common are symptoms that are associated with the injection, including redness, pain, swelling, numbness, bruising, muscle weakness and bleeding. Normally, these symptoms will subside within a week after your Botox injections.

How do the costs compare?


More extensive facelifts will be more expensive. Less invasive or modified facelifts that don’t require as much surgical time will be less expensive. In general, however, you can expect to pay somewhere between $12,000 and $35,000 for a full facelift. Major urban areas like New York and Los Angeles will probably be on the higher end.

Keep in mind that higher prices do not guarantee better results. While cost is important, you should pay close attention to the qualifications and experience of your surgeon!


What makes Botox work is the number of units needed to properly treat the area. The standard appears to be 10 units per muscle. For most areas (forehead, crow’s feet lines, frown lines), 15 to 20 units would be the typical quantity. This may change depending on how deep the injection must go, the severity of the wrinkling and possibly whether you are male or female. Most women need 20-25 units for the treatment of frown lines but men may need 35 units because the amount of muscle is greater.

Botox prices nationwide average between $10 and $15 per unit. If it takes 25 units of Botox to weaken or paralyze your laugh muscles, you could expect to pay $250 to $375 per treatment. If it takes 75 units of Botox to weaken your forehead muscles, you could expect to pay $750 to $1,125 for treatment. The cost may also vary based on the technique of injection and geography. Always ask how many units of Botox you will be getting and you will be able to calculate the approximate cost.


The bottom line is that you only have one face and it’s visible to everyone. You should do extensive research to make sure you will get the best, most natural-looking results from the best possible doctor. If you are contemplating a very involved surgical procedure like a facelift, the training and expertise of the plastic surgeon you select is especially critical.

Carefully check the doctor’s credentials. Is the surgeon certified by the American Board of Plastic Surgery ( Botox should only be injected by a licensed physician, or a registered nurse under the direct supervision of a doctor who has examined you personally. Contact the medical board in your particular state to learn what training and supervision is required to perform Botox injections.

The most expensive procedures are those that cause you to go elsewhere afterward to get them fixed. Whether you are contemplating a facelift or Botox injections, do your research, talk to your doctor about the procedure and what you can expect, and choose a doctor that makes you feel comfortable and is willing to answer every question. If you’ve made the decision to rejuvenate your aging face, you will want to make sure that you’ll get to enjoy it!

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