Typically, people become candidates for a facelift in their 40’s. The aging process varies from person to person and being ready for a facelift depends not only on your genetic makeup but also on environmental factors like sun exposure, smoking, and skin care. So, if you are mindful of your skin, you can help ward off some of the effects of aging. Unfortunately, we can’t do anything about genetics (yet), but what we CAN control are the environmental factors. That being said, take care of your skin!
If you see the following changes in your face, you may be a candidate for a facelift:
–Droopy or “saggy” eyebrows
–Excess skin or ”bags” in your upper or lower eyelids, giving a tired look
–Flattening of your cheekbones (not as full and round as they used to be)
–Deep creases or smile lines (that look like parentheses around your mouth)
–Extra or loose skin of your jawline and neck
The only way to be certain is to meet with your plastic surgeon, discuss your wishes and concerns, and have them properly assess you.
A facelift, which we often perform in combination with forehead and/or eyelid surgery, can improve the following areas:
–Raise eyebrows to correct droopiness (forehead lift)
–Improves appearance of “bags” or excess skin in upper or lower eyelids (eyelid surgery)
–Restores youthful, round appearance of cheekbones
–Smoothes out wrinkles and re-drapes excess skin in cheeks and lower face
–Improves smile lines (parentheses) around the mouth
–Improves or eliminates jowls, restoring a well-defined jawline
–Re-drapes and smoothes out neck skin, greatly improving the contour of one’s neck
Injectables, otherwise referred to as fillers (such as Restylane, Perlane, Juvederm, Radiesse, and Sculptra), and Botox are great tools that we often use to rejuvenate the face. They are VERY effective alone or in combination with a facelift. However, if someone has a lot of excess facial or neck skin, there is no amount of Botox or filler that will improve one’s face and neck contour as nicely as a facelift. So, we often use fillers and Botox to prevent or improve signs of aging until a certain point is reached, when one becomes a good candidate for a facelift.
A facelift is a two to four hour-long procedure. We perform it through a fine incision that begins in the subtle crease just in front of one’s ear and ends in the hairline behind the ear. (Once healed, these scars are typically imperceptible at a conversational distance.)
There are three layers of soft tissue in one’s face that should be addressed during a facelift. The deepest one is called the “SMAS”, which is a thin but tough layer of tissue that covers one’s muscles of facial expression. Like skin, this layer becomes loose and saggy with time, and should be tightened. We use absorbable sutures to re-drape and tighten this deep layer, giving a better and longer-lasting result. The skin, the most superficial layer, is tightened and re-draped over the SMAS layer, essentially re-contouring the face from the deepest to most superficial layer.
The middle layer, which is the fatty tissue in between the other two layers, is not only prone to sagging but also tends to atrophy (or decrease in volume) with age. Using fat injections (liposuctioned from somewhere else in one’s body), we can restore volume and achieve a more youthful facial shape in those patients who are good candidates.
A forehead lift and/or eyelid surgery is often done at the same time as a facelift, with little increase in recovery time.
Once all of the above steps are complete, the incisions are sewn up using absorbable suture (and small, surgical staples in the hair-bearing regions). A cotton dressing is then placed over the incisions and gauzed wrapped around the head to keep it in place. The patient is then taken to the recovery room, where they are closely monitored until they are awake and comfortable enough to go home safely. A family member or friend picks the patient up and takes them home after the surgery.
In an effort to shorten the length of scars, different facelift techniques have been developed over the last decades. “Mini-lifts” or “short scar facelifts” are best used in patients who have a mild to moderate excess and sagging of facial skin. The advantage is that the final scars are shorter and recovery is a bit shorter. Beware, though, of surgeons who offer these techniques to ALL patients. Candidates must be carefully chosen because if someone who should get the traditional “full facelift” gets a “mini-lift,” the result will not be as nice. Like all plastic surgery procedures, facelift techniques must be tailored to the individual.
A facelift can safely be performed either under general anesthesia (where the patient is completely asleep) or local anesthesia with sedation (medication given through an IV that puts the patient in a twilight state). We routinely perform facelifts under both types of anesthesia. Patient comfort is ensured with both techniques and patients can choose which one suits them best.
We send all patients home with prescription pain medication to keep them comfortable. Swelling and some bruising is expected during the first 48 hours, and patients are instructed to sleep with their heads elevated on 3-4 pillows for the first week. The first postoperative appointment is 48 hours after the surgery. The head dressing is removed and a light, removable elastic compression garment is placed around the head for one week. A shower is permitted at this time and patients can gently wash their hair with normal shampoo. All surgical staples are removed 7 days after the surgery, at which point much of the swelling has resolved. Visits are scheduled two weeks and then 3 months later, to make sure that the patient is healing well. If patients have any questions or concerns, they can call the clinic 24 hours a day, 7 days a week and there is always someone available to help.
Most people wait several days before venturing out in public after a facelift. During the first few days, while one’s face is still swollen, most people will wrap a scarf around their heads while out in public. After the first week, though much of the swelling has resolved, most patients will not feel comfortable enough with their appearance to be seen out in public. Two weeks after the surgery, most of the swelling and bruising are no longer evident and patients will begin venturing out. A full three weeks of recovery is recommended (for patients who wish to keep their surgery private) before encountering their friends/acquaintances in social settings. Remember, our goal is NOT to make you look different, but better. Close friends and family members, though, may comment on how a patient looks “so well rested” or “looks great,” without knowing why…
A facelift can make a patient appear 10 to 15 years younger. Of course, this varies from person to person. How long the result of a facelift lasts depends on both genetics and environmental factors (sun exposure, smoking, skin care). The average patient, however, can expect the result to last approximately 10 years. Patients often choose to have a second one at that time (recovery is easier the second time around).
While undergoing a facelift is a very safe procedure, there is a small risk of having complications. These include bleeding, infection, nerve injury, disruption of the parotid gland, unfavorable scars, skin necrosis, numbness, asymmetries, and irregularities. Most of the complications can be treated without surgery, with little effect on the final result. Rarely, a return to the operating room is necessary to address the problem. It is important that patients discuss all potential risks and complications with their surgeon prior to undergoing any type of surgery.