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sometimes I find patients laughing and jumping around immediately after facelift or breast surgery. They need a reminder that they just had surgery and should take it easy from an activity perspective because pain is simply not there to remind them. Patients are actually able to enjoy their recovery and a little break without pain and the confusion and drowsiness caused by typical pain medications. The introduction of Exparel - particularly in the expanded, tumescent formulation I developed - has truly transformed the way my patients experience surgery and recovery. About a decade ago, I began incorporating Exparel into the fluid I use during procedures not only to minimize bleeding and surgical trauma, but to significantly reduce or even eliminate postoperative pain. What began as an experiment quickly became standard practice across the board - for facelifts, breast and body procedures, even complex genital reconstruction surgeries. The results have been nothing short of remarkable. Most of my patients report zero postoperative pain, even after recovery from traditionally challenging surgeries like abdominoplasty. It has really reshaped what recovery can look like. This approach also allows me to perform nearly any procedure without general anesthesia, making for a seamless, pain-free experience whether the patient is awake or asleep into recovery. What’s equally rewarding is seeing how this pain-free recovery impacts patients emotionally. There’s no grogginess from narcotics, no fog of confusion, no need for addictive pain medications. Patients often describe their recovery as surprisingly peaceful—some even say it feels like a restorative pause in their daily lives rather than a disruption. Interestingly, the greatest challenge we now face isn’t managing pain - it’s reminding patients that they just had surgery. Because they feel so well, I often catch them laughing, jumping around and being expressive with their arms immediately after a facelift or breast surgery. We now have to build in gentle reminders that while they may not feel discomfort, their bodies still need time to heal. In essence, we no longer have pain to use as a guidepost during recovery and we need to be more intentional in care and communication on limitations. ML: You’ve built a reputation not just for innovation, but for revision surgery - especially facelifts gone wrong. What are the most common mistakes you see in facelifts today, and how do you approach correcting them? Dr. Maercks: Indeed, roughly half of my facelift practice is dedicated to revision surgery, with patients traveling from across the country and around the world. What brings them to me is usually the same concern: something just doesn’t look or feel right - especially when they smile, talk, or animate. These are not just subtle imperfections; they are often structural missteps that result in expressions that appear unnatural, distorted, or even unsettling. The most common issues I see involve unnatural tension, particularly around the mouth and ears. Patients often present with visible scars that distort or obscure their natural ear anatomy, or incisions that extend onto the facial plane - clear signs of poor planning in flap design and incision placement. But the more pervasive problem is a technical one: an avoidance of the deep plane, the anatomical foundation that actually supports the face. Many facelifts marketed as “deep plane” procedures are, in reality, simply lateral tension lifts - pulling the edges of the face horizontally or vertically without addressing the central architecture of aging. This often leads to an imbalance where the outer contours are tight, but the midface - the area under the eyes, around the nose, and at the corners of the mouth - remains unsupported. The result is a face that appears hollow or deflated in the center and overly taut at the periphery. One of the more distinctive deformities that arises from this is what I call the “Joker line”