Everybody dreads getting a "tell-tale" facelift. Whether it's the infamous wind-tunnel look, the lower-eyelid droop that reveals the whites of the eyes, an unnatural-looking smile or some other surgical faux pas, clumsy surgery is a nightmare for the person who has to live with it.

Such outcomes are becoming less frequent as time goes on. Techniques and materials are getting more sophisticated every year, and surgeons are at pains to learn from each other quickly so as to avoid the common errors associated with this complex, delicate and challenging operation.

You Can Avoid It
Still, bad facelifts do happen. Here are the five most common mistakes I see among those who seek me out for facelift "revision." These mistakes are usually committed by surgeons who lack experience, and they can be avoided by knowing what to look for when you do your due diligence in consulting rooms, prior to making your commitment.

The most obvious problem associated with the traditional facelift is a "swept-back" look or "lateral sweep" of the lower face. This happens when a simplistic approach is used, removing slack skin in the neck area and repositioning it behind the ear, without taking into account the need to restore volume throughout the face.

As time goes by, the lower face stays "up" but the un-lifted deep structures of the upper cheek continue to fall, thus creating a sweep toward the ear that gets progressively worse.

I can correct this imbalance by reversing the progressive movement of the cheek, fat, and muscle. Repositioning this anatomy to its original position eliminates the sweep and restores youthful contours to the midface. But it's best to avoid this outcome in the first place, by finding a doctor who understands the more sophisticated approaches to facial rejuvenation circulating today.

For years surgeons performed the "face and eyes" facelift without appreciating the role of a forehead lift in total facial restoration. A rejuvenated lower face combined with an aging forehead can result in facial imbalance.

To achieve a balanced natural look, I always evaluate a patient's forehead and eyes during consultation, demonstrating in a mirror how the imbalance of upper and lower face can distort their results. I will recommend a forehead lift in cases where I feel it's essential.

The malar crescent is a subtle yet distinctly telling characteristic impossible to correct with a traditional facelift. This crescent-shaped fullness corresponds to the lower-eyelid muscle (orbicularis muscle) and occurs along the upper cheek area. Women who have a lower-eyelid lift as part of their traditional facelift often end up with this feature appearing more pronounced next to the hollowness created by the traditional lower-eyelid lift.

To avoid this error I will move the complete orbicularis muscle toward the eye and replenish the fat under the eye during a facelift, thus maintaining a youthful smooth contour in this important area of the face.

Frequently following traditional facelift surgery, the earlobes are pulled down too far (pixie ears) or pulled too far forward. This is an unacceptable outcome. Surgeons with the proper training, skill and experience never allow this to happen, but there are inexperienced surgeons who still commit this faux pas. Luckily the error can be addressed with further surgery.

Since 1924, lower-eyelid fat has been removed during lower-eyelid rejuvenation procedures. This is especially true today with the advent of laser blepharoplasty, where surgeons often remove eyelid fat by using a hidden incision inside the eyelid and then lasering the surface of the skin. Whether traditional or laser, the results are the same when the fat is removed - an abrupt transition is created between the soft under-eye tissue and the cheekbone. The area beneath the eye will then appear more concave, or hollow, than before. From the front, the eye socket is more pronounced.

The youthful appearance of the eye depends on a smooth, soft transition, and informed surgeons have found ways to utilize orbital fat to correct this phenomenon during the facelift procedure.

How can you make sure you don't end up with any of these outcomes? When evaluating a plastic surgeon, ask for references to patients he or she has worked on before. Meet with these patients personally, don't just look at their photographs (photographs can be angled to hide these problems). When you meet with these patients, examine their faces closely for the five most common problems. If you see evidence of even one of them, keep shopping.