What the research shows
A facelift moves loose tissue; a laser or peel treats wrinkles, texture and sun damage in the skin itself. Doing both in one operation was long a concern because the laser heats skin that has just been lifted off the tissue beneath it (Wen 2026). An early study found that lasered facelift flaps healed slowly, and its authors advised against the combination (Guyuron 1998).
Later work showed it can be done safely with adjusted settings. A pooled review of combined facelift and CO2 laser found the complication rate no higher than a facelift alone (Koch 2002), and patients given fractional CO2 laser over the lifted skin all healed within a week with no skin loss (Wright 2015). The 2026 meta-analysis found high satisfaction and skin slough in about 1 in 500. Slough was more likely when the lifted skin was lasered at the same energy as the rest of the face (Wen 2026).
A deep phenol-croton oil peel around the mouth at the time of a facelift reduced lip lines and made patients look younger to outside raters (Ozturk 2013). It also shortened the skin between the nose and the upper lip, which lengthens with age (Janssen 2026).
Devices tighten skin less than surgery. In a blinded comparison, one fractional radiofrequency treatment gave about a third of the laxity improvement of a surgical facelift (Alexiades-Armenakas 2010). Microfocused ultrasound improved most patients in the eyes of their doctors, but fewer patients called themselves satisfied when they could answer neutral, and treatment is moderately painful (Amiri 2025). It works best on mild to moderate laxity; results fall off with looser skin and higher body weight (Contini 2023).
Resurfacing can wake up the cold sore virus. Antiviral pills prevented outbreaks whether started the day before or the day of treatment (Gilbert 2000). Even with antivirals, about 1 in 3 people with a history of cold sores had an outbreak, and the authors advise a higher dose for them (Alster 1999).
Where surgeons disagree
- Lasering the lifted skin. One view holds that it delays healing and should be avoided or done at very low settings (Guyuron 1998). Series of fractional laser over the lifted skin report no skin loss (Wright 2015), and the 2026 review found lasting color change more often after SMAS and biplanar lifts than after endoscopic lifts done under the bone lining (Wen 2026).
- Devices before a facelift. A review of published cases and FDA device reports found one report of a compromised facelift after microfocused ultrasound and found no published evidence of harm beyond unverified reports (Humphrey 2025). A deep-layer facelift surgeon's review describes changes in the soft tissue after ultrasound and radiofrequency treatment that alter how the operation is planned (Chadab 2026).
- How to use radiofrequency. An early study of the lower face and neck left two in three patients unsatisfied and linked better results to higher energy per pulse and younger age (Hsu 2003). A later survey found that many low-energy passes, guided by the patient's sense of heat, gave lasting tightening far more often than single high-energy passes (Dover 2007).
What is new
- Exosome gel applied after deep plasma resurfacing with a facelift cut healing time from about 15 days to about 10 (Lacerna Kimbrell 2026).
- Hybrid fractional laser delivered deeper than usual during a facelift did not raise the complication rate in skin types I to IV (Sirmans 2025).
- The 2026 meta-analysis named the changes that lower risk: less laser energy on lifted skin and one consistent laser technique (Wen 2026).
What is still unknown
- Whether earlier ultrasound or radiofrequency treatment makes a later facelift harder or less durable. The evidence so far is case reports and surgeon experience (Humphrey 2025, Chadab 2026).
- Results in men and in darker skin. The ultrasound studies treated women (Contini 2023), and the deeper laser series reported on skin types I to IV (Sirmans 2025).
Key papers
- Guyuron 1998: showed delayed healing in lasered facelift flaps and set the caution that followed.
- Koch 2002: pooled early cases and found facelift plus CO2 laser no riskier than a facelift alone.
- Alexiades-Armenakas 2010: measured one radiofrequency treatment against a surgical facelift; the device gave about a third of the result.
- Ozturk 2013: facelift with a perioral phenol peel reduced lip lines and apparent age.
- Wright 2015: fractional CO2 laser over the lifted skin healed within a week.
- Amiri 2025: pooled microfocused ultrasound results; satisfaction lower when patients could answer neutral.
- Humphrey 2025: searched for harm to later facelifts after ultrasound and found one report.
- Wen 2026: meta-analysis of resurfacing during a facelift; safe with lower energy on lifted skin.
- Janssen 2026: perioral peel at facelift shortened the upper lip.