Excessive skin is marked prior surgery. Meticulous removal of excessive skin is accomplished either by laser, electrocautery or sharp scalpel. The excess skin is excised and removed. The deep layers are suspended by plicating, upward-lifting, the entire face and neck. This is accomplished using permanent sutures, which attach to deeper, sturdy structures like deep temporal fascia or periosteum (coverings of bones). The results is restoring the sagging, deeper structures of the facial muscles, fat and fascia to their original youthful positions. The incision is closed meticulously with dissolvable and removable sutures. At times other adjunctive procedures are performed such as autologous (from you to you) stem cell-rich fat transfer from your body to the cheeks, lips, brows and chin, resurfacing lasers, CIT needling, Botox and fillers.