When Marc Jacobs underwent a face-lift this summer, he took a selfie the very next day—gauze head wrap, plastic drains coming out from either side—and posted it to Instagram with the caption “#f*ckgravity.” The fashion world did a collective double take: someone of Jacobs’s stature actually being honest that self-care could go beyond yogic breathing and a gratitude journal? But also, Marc Jacobs got a face-lift? Unlike Botox or plumping fillers, face-lifts just haven’t received the same widespread acceptance in recent years, which is why many people’s perception of the procedure is frozen in time. One of the last major celebs to be so open about having a face-lift was Joan Rivers. (“I fart through my ears,” she said back in 2013.) The reality is that results lately have gotten better and more natural, says Andrew Jacono of the New York Center for Facial Plastic Surgery, Jacobs’s surgeon and a medi-celebrity in his own right thanks to his pioneering techniques. “Marc made people realize that you can have a face-lift and still emerge looking like yourself.”

A new approach

Even in this era of transparency, there are limits. When an actress over 50 is asked why she looks so great, it’s not unusual to hear about a commitment to olive oil, drinking a lot of water, a serum from her own line. “So many celebs are lying, and it makes people feel less than,” says Jacono. They can do it because “good work flies under the radar,” he says. Bad work announces itself 25 paces away. “My patients’ single highest anxiety is that they’re going to look like that person walking down Madison Avenue in New York or Worth Avenue in Palm Beach: pulled and unnatural,” says David Rosenberg, a Manhattan-based facial plastic surgeon. To help ease patients’ fears, many doctors rely on the Vectra M3, a 3D imaging technology that allows patients to visualize how they would look post-procedure. Jacono has this device but prefers a low-fi method: He uses photos of patients in their younger years and hangs them in the operating room as a reference.

The gold standard

The most popular kind of face-lift is known as the SMAS, which stands for subcutaneous muscular aponeurosis system. Gerald Imber, a plastic surgeon on New York’s Upper East Side who has performed in excess of 3,000 of them, describes the procedure as the skin being “tightened over the cheek, and sometimes all the way down to the jawline or to the platysma on the neck.” An SMAS lift smooths the jowls, nasolabial folds, and neck area. How much laxity you have determines how much skin the surgeon removes. Imber prefers this approach because, he says, “it’s all done superficially, without putting an instrument underneath the deep tissue and taking the risk of injuring a facial nerve.” The forehead, however, isn’t addressed; for that, a minimal temporal lift is needed, but Imber says that Botox can often do the job better. Scars are hidden in the ear and sideburn and behind the earlobe. Recovery time, Imber adds, is about a week.

Critics of SMAS face-lifts feel that all that stretching is exactly what gives someone a frozen look, but Imber believes that aesthetic largely lives in the past. “A pulled look is the surgeon’s fault, not a result of SMAS,” he says. Imber does not put any incisions in the hairline. (“It pulls the sideburns up and gives people that tight, shiny face. It’s unacceptable.”) His face-lifts last “at least a decade, and touch-ups are rarely as extensive as the original procedure.”

The cutting edge

Marc Jacobs got what’s called an extended deep-plane face-lift, a technique that now has some brand awareness thanks to surgeons like Jacono, whose Instagram (377,000 followers) is full of jaw-dropping before-and-afters. Unlike SMAS, extended deep-plane face-lifts don’t involve any pulling at all. Jacono makes a short incision to minimize trauma to the face, then lifts the deep facial tissue and neck muscles simultaneously and repositions the fat and muscle tissues vertically, to where they used to be. “I’m sculpting,” he says. “This technique allows me to re-create that sort of appley full cheek without injections.” Recovery is about 10 days, accelerated by hyperbaric oxygen therapy and Vbeam laser treatment for skin healing. The face-lift lasts for 12 to 15 years, and at that point, “you’re going to look even better than when you came in for surgery,” he says.

Doctors’ allegiance to extended deep-plane face-lifts is “almost religious,” says Rosenberg, who has been doing them for over 20 years. But the downside is that they’re potentially more dangerous, he says. “The technique is hard to learn, and you have to have immense surgical judgment, exceedingly good hands and eyes, and it’s perfected only with a lot of practice. There are only a small number who are going to master it.” Jacono has become like a missionary in this respect: He’s training doctors on this surgery, and he published a 500-plus-page textbook on it this past summer. “I want every doctor to be doing a better job,” he says. “If they were, people wouldn’t be scared of getting a face-lift.”

Julius Few, a Chicago-based plastic surgeon, believes in a middle ground. “I take the best elements of each technique,” he says. Few does an SMAS for the mid and lower face because it preserves the “delicate nuances” there, but he loves the extended deep plane for the jawline and neck because he finds it’s more effective for that area. Still, “at the end of the day, any technique is only as good as the experience of the surgeon.”

Can you cheat a face-lift?

There’s been so much progress in dermatology, it’s easy to understand why one wouldn’t rush to go under the knife. Still, there are limits. “For years, I’ve smiled as I’ve listened to people talk about radio frequency, microneedling, Ultherapy, or Thermage. These things will never compare to a face-lift,” says Rosenberg, referring to non- and minimally invasive cosmetic treatments. The same goes for filler. “You reach a point of diminishing returns,” says Paul Jarrod Frank, a New York–based cosmetic derm. “When a doctor says they can accomplish everything for you, that’s when you know this doctor is no longer for you.” Work with a derm who knows when to refer you to a trusted surgeon for a fresh opinion. Also, realize that a face-lift may not be the final word on your aesthetic journey. Many people still elect to use injectables afterward. “A face-lift doesn’t help skin quality or wrinkles around the mouth,” says Frank.