Living develops character in the face, reflecting the experience, accomplishments and wisdom gained over the years. But the face also shows the effects of gravity, exposure to the sun and the stresses of daily life – creasing between nose and mouth, a slackened jawline and folds and fat deposits around the neck. Another source of the dramatic increase in facial wrinkles is facial fat redistribution. This leads to ptosis, or drooping of the facial skin.
A facelift can leave your unique character intact, but significantly improve the most visible signs of aging by elevating facial fat, tightening underlying muscles, removing excess fat, replacing upper facial fat and redraping the skin of your face and neck. This procedure can’t stop the aging process, but it can turn it back a few years.
Facelifts are sometimes performed in conjunction with other procedures, such as a forehead lift or eyelid surgery. The best candidate for a facelift is a man or woman whose face and neck have begun to sag, but whose skin still has some elasticity and whose bone structure is strong and well-defined. Most patients are in their forties to sixties, but facelifts can be done successfully on people in their seventies or eighties as well. We use a combination of techniques including the Deep Plane or SubSMAS facelift, or the less invasive MAC facelift, also referred to as the short-scar facelift.
In / Outpatient, Anesthesia, Length of Procedure
We typically performs facelifts in our private, out-patient surgical center, although some patients with certain conditions may require a short inpatient stay at the hospital. This procedure, which takes several hours, is generally done under general anesthesia, along with a sedative to make you drowsy and relaxed.
During and After
We will discuss this procedure with you thoroughly beforehand and explain in detail what to expect during the surgery and recovery period, as well as the anticipated ultimate outcome. The facelift / necklift procedure will take several hours to complete, particularly if you are having more than one procedure. The exact placement of incisions and the sequence of events depends on your facial structure, but incisions usually begin above the hairline at the temples, extend in a natural line in front of the ear (or just inside the cartilage at the front of the ear) and continue behind the earlobe to the lower scalp. If the neck needs work, your surgeon may also make a small incision under the chin. He separates the skin from the fat and muscle below, trimming or suctioning fat from around the neck and chin to improve the contour. He then tightens the underlying muscle and membrane, pulls the skin back and removes the excess. Stitches secure the layers of tissue and close the incisions; metal clips may be used on the scalp. Following surgery, he may temporarily place a small, thin tube under the skin behind your ear to drain any blood that might collect there.
There isn't usually significant discomfort after surgery; if there is, it can be lessened with the pain medication we prescribe for you. Some numbness of the skin is quite normal; it will disappear in a few weeks or months. You should keep your head elevated and as still as possible for a couple of days after surgery to keep the swelling down. If the doctor has inserted a drainage tube, he will remove it a day or two after surgery. Bandages, when used, are usually removed after one to five days and most of your stitches will be removed after about five days. Your scalp may take longer to heal and the stitches or metal clips in your hairline could be left in a few days longer.
Side Effects and Risks
Common side effects from this procedure include temporary bruising, swelling, numbness and tenderness of skin. Men having the facelift procedure now will need to shave behind the ears, where beard-growing skin is repositioned.
Complications that can occur include hematoma (a collection of blood under the skin that must be removed by the surgeon), injury to the nerves that control facial muscles (usually temporary but may be permanent), infection, bleeding and reactions to the anesthesia. Poor healing of the skin is most likely to affect smokers. Excessive scarring is possible, as is asymmetry or a change in the hairline.
You should be up and about in a day or two, but plan on taking it easy for the first week after surgery. Be especially gentle with your face and hair, since your skin will be both tender and numb and may not respond normally at first. Get plenty of rest and allow your body to heal. You should be back to work in 10 to 14 days, but should avoid strenuous activity for at least two weeks. Bruising should disappear within two to three weeks. Avoid alcohol, steam baths and saunas for several months and limit your exposure to the sun for several months.
At the beginning, your face may look and feel rather strange. Your features may be distorted from the swelling, your facial movements may be slightly stiff and you'll probably be self-conscious about your scars. By the third week, you'll look and feel much better, though the hair around your temples may be thin and your skin may feel dry and rough for several months. You'll have some scars from your facelift, but they're usually hidden by your hair or in the natural creases of your face and ears. In any case, they'll fade with time and should be scarcely visible.
Duration of Results
While this procedure does not stop the clock and you will continue to age normally, the effects of a facelift are long-lasting – usually five to 10 years. Even many years after a facelift, you will continue to look better than if you'd never had a facelift at all.