Facial Surgery
The 4D Facelift is my multi-vector, multi-planar (including the “deep plane”) facelift technique, refined over 25 years to restore the face in four dimensions.
Albert Carlotti, MD, FAACS · Fellowship-trained cosmetic surgeon
4.9 / 5 · 59 Google reviewsFacelift surgery, also called rhytidectomy, addresses sagging facial tissue, jowls and changes in the lower face and neck. At BellaNova Cosmetic Surgery in West Palm Beach, Dr. Albert Carlotti uses his 4D Facelift approach to evaluate skeletal support, muscle and fascia, skin, and surface quality before recommending your surgical plan.
Albert Carlotti, MD, FAACS is a fellowship-trained cosmetic surgeon with 25 years of experience and more than 30,000 procedures across facial, breast and body surgery. Your consultation is with Dr. Carlotti at 1261 S Congress Ave, West Palm Beach; surgery is performed in BellaNova’s state-registered Level III surgical facility.
Explore facelift before-and-after results, the recovery timeline, and what your facelift quote includes.
The four layers can age differently. Your plan may include repositioning deeper tissue, redraping skin, and evaluating whether additional skeletal support or resurfacing is appropriate. For a closer explanation of the approach, read 4D Facelift: from skeleton to skin.
Explore three cases from Dr. Carlotti's patient gallery. Each caption identifies the combined procedures and the time after surgery.
This 63-year-old woman desired facial rejuvenation. These photographs show her before surgery and 3 months after an endoscopic brow lift, upper and lower blepharoplasty (eyelid surgery), 4D Facelift, and CO₂ laser resurfacing of the face, neck and chest. Individual results vary.
This 59-year-old woman desired total facial rejuvenation. These photographs show her before surgery and 3 months after an endoscopic brow lift, upper and lower blepharoplasty (eyelid surgery), 4D Facelift, and CO₂ laser resurfacing of the face, neck and chest. Individual results vary.
This 66-year-old woman desired total facial rejuvenation. These photographs show her before surgery and 3 months after an endoscopic brow lift, upper and lower blepharoplasty (eyelid surgery), a 4D Facelift, and CO₂ laser resurfacing of the face, neck and chest. Individual results vary.
"Most importantly, my results look natural, refreshed, and lifted — not tight or overdone."
A good 4D facelift candidate has facial descent, jawline softness, neck change, or surface aging that cannot be corrected by injectables or laser alone.
Surgery does not erase pigment, etched wrinkles or sun damage. Those surface problems may respond to resurfacing, and are often planned alongside a lift rather than instead of it.
1. Skeleton. Dr. Carlotti starts with the bony platform: chin projection, mandibular angle, jawline continuity and midface support. A lift can reposition soft tissue, but it cannot make a deficient foundation support that tissue. When the skeleton is part of the problem, implants or skeletal correction may be discussed.
2. Muscle and fascia. The SMAS and platysma are the load-bearing layer of the lower face and neck. A deep plane release may be used here as a technical component, because releasing tethered tissue allows a vertical repositioning vector rather than a pulled lateral vector.
3. Skin. Skin is redraped after the deeper support has been corrected. It should not be the structure holding the lift. That is how Dr. Carlotti avoids the swept, tight signs around the ear and mouth that patients fear.
4. Surface. Fine lines, pigment, texture and sun damage are surface problems. CO₂ resurfacing or other skin treatment may be planned with the lift when appropriate, but surface treatment is not a substitute for structural surgery.
The result is a surgical plan rather than a branded gadget: skeleton, muscle and fascia, skin, and surface evaluated together so the face reads refreshed rather than operated on.
| Neck lift and platysmaplasty | The neck and the lower face are one anatomical unit. Addressing the face without the platysma leaves an obvious mismatch. |
|---|---|
| Eyelid surgery | A facelift does not change the upper third. If the eyes read tired, they will still read tired. |
| CO₂ resurfacing | Addresses the surface dimension — fine lines, pigment, texture — that a lift cannot. |
| Facial implants | Restores skeletal projection where bone has resorbed or was never adequately projected. |
Educational video
Dr. Carlotti explains what he means by a surgical 4D Facelift: skeleton, muscle and fascia, skin, and surface planned together.
Explore the fourth dimension
What does the surface dimension of a 4D Facelift involve? Watch Dr. Carlotti introduce CO2 laser resurfacing and the technology behind it.
Resurfacing is considered separately from the structural lift, with its own candidacy and recovery plan.
Interactive anatomy
Follow Dr. Carlotti's sequence from the central neck repair through separate tissue planes and suspension directions to skin redraping and CO₂ resurfacing. Pause at any stage or use the slider to explore the movement.
Open the animation full screen · Download the animation video
Yes. Dr. Carlotti’s 4D Facelift incorporates deep plane work within his multi-vector, multi-planar facelift technique. Deep plane describes a level at which facial tissues are released and repositioned; 4D describes the broader plan, from skeletal support through muscle and fascia, skin, and surface quality.
The lifting directions and tissue planes are selected for your anatomy. Deeper support is addressed before the skin is redraped, with the goal of restoring contour without relying on skin tension. Skeletal support and CO₂ resurfacing are considered where appropriate, rather than added automatically. Read Dr. Carlotti’s explanation of the four dimensions.
Every 4D Facelift Dr. Carlotti performs includes his submentoplasty neck-reconstruction step. Explore the deep-plane submentoplasty explanation and animation to see how the healthy platysma edges are repaired at the midline and secured to the hyoid periosteum to help define the neck–jaw angle.
4D facelift surgery is performed at BellaNova Cosmetic Surgery's state-registered Level III surgical center at 1261 S Congress Ave in West Palm Beach, Florida, serving West Palm Beach and the Jupiter-to-Boca corridor.
Consultation, surgery, recovery, and routine follow-up occur in the same facility with the same team. That matters for privacy, continuity, and safety because the operating room, anesthesia process, recovery area, and post-operative visits are all controlled by the practice.
Yes, when the anatomy calls for it. Chin augmentation, sliding genioplasty, facial implants, or jawline implant planning may be combined with a facelift when skeletal support is part of the aging pattern.
A lift repositions descended tissue. It does not create a chin, mandibular border, or midface platform that is not present. Your consultation considers facial support and soft tissue together so the plan addresses your proportions as well as the changes that concern you.
Every recovery is individual. This is the pattern most patients follow, and you will receive a written plan specific to your procedure.
| When | What to expect |
|---|---|
| Days 1–3 | Head elevated, drains typically removed within 48 hours. Swelling and tightness peak. Discomfort is usually described as pressure rather than sharp pain. |
| Days 4–7 | Sutures at the hairline and in front of the ear begin to come out. Bruising migrates downward into the neck. Most patients are off prescription pain medication. |
| Weeks 2–3 | Presentable in most social settings with light makeup. Numbness in front of the ear is normal and resolves over months. Light walking resumed. |
| Weeks 4–6 | Return to full exercise, cleared individually. Swelling largely settled; the result begins to look like itself. |
| Months 3–6 | Residual swelling resolves, incisions continue to fade, sensation returns. Final contour is judged here, not before. |
| Year 1+ | Scars mature to fine lines hidden in the hairline and ear creases. The result continues to age with you, from a corrected starting point. |
For help planning work, exercise and important events, read Dr. Carlotti's facelift recovery timeline, week by week.
A facelift is an operation, and the honest version of the consent conversation covers real risks: bleeding or hematoma (the most common early complication, and the reason blood pressure control matters), infection, delayed wound healing, temporary or, rarely, permanent nerve weakness affecting facial movement, altered sensation, asymmetry, hair thinning near incisions, unfavorable scarring, and the possibility of revision.
Nicotine in any form — cigarettes, vaping, patches, gum — substantially increases the risk of skin loss along the incisions. Dr. Carlotti requires complete cessation before and after surgery.
Every one of these is discussed individually at consultation, in the context of your health history rather than as a generic list.
Your facelift cost depends on the agreed surgical plan, anesthesia time, facility fees, and whether additional procedures such as neck surgery, eyelid surgery, implants or CO₂ resurfacing are included. A personalized examination is needed to give you a meaningful price.
At consultation, you receive a single written quote covering the surgeon’s fee, anesthesia, facility fees and routine postoperative visits. Ask which procedures are included and which would add to the quote. Read Dr. Carlotti’s guide to understanding and comparing facelift quotes, or review cost and financing options.
Request your facelift consultation or call (561) 834-6682 to speak with the BellaNova team.
Explore photographs of Dr. Carlotti’s patients, published with consent. Look at the face and neck together and review the procedures listed for each case. Individual results vary. View 4D Facelift before and after photographs.
Meet one-to-one with Dr. Carlotti to discuss your goals, health history, facial anatomy, surgical options, risks and recovery. Bring your questions about the neck, eyelids, skin texture and any previous facial procedures so these can be considered in the plan.
Consultation, surgery and routine follow-up take place at BellaNova. See directions to our West Palm Beach office and information for patients traveling for surgery. To prepare, review questions to ask at your consultation.
Yes. Dr. Carlotti’s 4D Facelift is his multi-vector, multi-planar facelift technique incorporating deep plane work. The 4D approach evaluates four dimensions together: skeletal support, muscle and fascia, skin, and surface quality. The surgical plan is tailored to your anatomy.
Multi-vector describes repositioning tissue in directions chosen for the individual face. Multi-planar describes working at different tissue levels, including the deep plane. In Dr. Carlotti’s 4D Facelift, these decisions are part of a plan that considers support, facial and neck contour, skin redraping, and surface quality.
No. The 4D Facelift evaluates skeletal support and skin surface quality, but evaluation does not mean every patient needs every additional procedure. Facial implants or CO₂ laser resurfacing may be considered when appropriate. Dr. Carlotti explains which components are recommended during your consultation.
Dr. Carlotti’s 4D Facelift is a surgical technique incorporating deep plane work to reposition facial tissues. Fotona 4D is a non-surgical laser treatment. The similar names describe different treatments; a consultation helps clarify which approach fits your goals.
At BellaNova, 4D means we plan the face in four layers: skeleton, muscle, skin, then surface. Aging happens in all four. A skin-only pull ignores the ones underneath — which is why some facelifts look tight instead of natural.
Patients with jowls, neck banding, midface descent, or a prior lift that looks pulled often benefit. Good candidates are healthy enough for elective surgery and want to look like themselves — refreshed, not operated. Fillers and lasers are sometimes better first steps; we sort that out in consult.
At our own state-registered Level III surgical facility at 1261 S Congress Ave, West Palm Beach, FL 33406-5172, with two private operating rooms. We serve West Palm Beach and patients from Jupiter through Boca. You are not sent to a random hospital OR for the plan we make together.
Most patients plan social downtime in the range of about two weeks, with residual swelling that settles over the following weeks to months. Exact timing depends on what we combine (brow, eyelids, CO₂, chin/jaw work). I give you a written plan at consultation — not a one-size Instagram promise.
Sometimes yes. If the skeleton needs projection or a chin advancement, we can discuss that in the same overall plan. That is part of why dual MD/DDS training matters. Orthognathic or genioplasty cases are labeled clearly in our galleries — they are not the same as a soft-tissue-only lift.
Call (561) 834-6682, email info@bellanovasurgery.com, or use the consultation form. Consults are with me, in person, typically 45–60 minutes. Please do not put detailed medical information in the online form — we will cover history privately in the office.
The goal is the opposite. Extra skin is removed and redraped without tension. Support comes from deeper layers (and bone when needed), not from yanking the surface. Patients often say they still look like themselves — just rested.
No. Every quote is a single written figure after we examine you and agree on the plan — surgeon, anesthesia, facility, and routine post-op care. Financing options can be discussed; CareCredit is available for qualifying patients.
Reviewed by Dr. Albert Carlotti, cosmetic surgeon and founder of BellaNova Cosmetic Surgery. Last reviewed 2026-09-05. This page is educational and is not a substitute for a consultation. Individual results vary.
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Read moreDiscuss your goals and receive a personalized surgical plan and written quote. Meet Dr. Carlotti at BellaNova Cosmetic Surgery, 1261 S Congress Ave, West Palm Beach, FL 33406-5172.