RHYTIDECTOMY (FACELIFT)
With time, many women develop classic characteristics of the “aging face.” Any woman may develop any or all of these characteristics. They include wrinkles of the cheeks and neck, extra skin of the face, especially in the lower face and neck, or pouches on either side of the chin -- so-called “jowls.” “Naso-labial folds” or the grooves on either side of the mouth, “marionette” lines or grooves on either side of the chin, fine lines around the mouth or “lipstick” lines and “crow’s feet” may develop. In the neck, there will be an excess of skin and loss of the angle of the youthful neck. A separation of the muscles of the neck leads to “platysma bands” or cords of muscle under the neck which can be very prominent with certain facial expressions. Sometimes there can be a loss of volume or deflation in the cheeks, chin and lips as well. The brow can also droop. The list is depressingly long.
The strong points of a standard facelift are restoring the youthful appearance of the neck and lower face and improving the jowls and major wrinkles of the face. The standard facelift procedure unfortunately has little long-term impact on the naso-labial folds and has no impact whatsoever on the little lines around the mouth or the laugh lines around the eyes. There are other procedures available which can treat these problems. The fine lines of the skin of the face are best treated with laser rather than a facelift, and rejuvenation around the eyes is discussed elsewhere.
A facelift takes about 2 ½ to 3 hours and is usually done under intravenous sedation in my accredited surgery center at the office or occasionally under general anesthesia in the hospital. The incision extends from in the hairline above the ear to just in front of the ear behind the tragus (the little cartilage prominence of the front part of the ear) and then extends down and up into the groove behind the ear. The skin of the face and neck is lifted up and tightened. Suspension sutures are placed under the jawline to improve the angle of the jaw. A facelift may be combined with some fat grafting to your cheeks, lips or chin to give your face a better shape, or you may choose to enhance your eyelids or brow elevation at the same time. You may choose to laser areas of fine wrinkling so that you will have just one recovery period.
I prefer for you to go home with a nurse after a facelift, and we will help coordinate this for you. She will manage your pain, monitor your blood pressure and help to prevent and treat nausea and vomiting. She will make sure you are comfortable during the night, change your dressings and wash your hair the next day. She will call me if she has any concerns overnight. I feel that patients who have a nurse the first night have a lower complication rate and heal faster. After a facelift, you should not do any heavy lifting, stooping or any activity for several days that would allow the blood to rush to the head. Otherwise, there are no physical restrictions. A facelift is not a particularly painful operation, but it is common for patients to be somewhat bruised and swollen for several weeks. The stitches will be removed between the fifth and tenth days. Most patients can go out in public with a scarf and some makeup in about 1 week. I usually tell patients they will hide for the first week and do their errands on the other side of town the second week. If you work outside the home, count on two weeks before you feel comfortable returning to work. A radical change of your hair style can help distract from the surgery if you are not planning to tell friends and acquaintances.
Significant complications after a facelift are unusual but can include bleeding. This bleeding should not be dangerous but could be significant enough that we might need to drain a small collection of blood in the office with a needle or, at worst case, go back to the operating room to drain more.
After any operation, an infection is a possibility. The risk of this is about 1%. You will receive antibiotics just before your surgery and for several days after your surgery. This will minimize the risk. During a facelift, the skin of the face is lifted up and also stretched in order to achieve the desired degree of tightness. As a result, the skin is at some risk for necrosis or scabbing which can lead to a thickened scar. This commonly occurs behind the ear where the skin is pulled tight but is almost never seen in front of the ear. This problem is most common in smokers who have a 7 times increased risk of skin loss after a facelift compared to nonsmokers. This procedure should not be performed on smokers unless they can absolutely abstain from tobacco for 1 month before and after surgery.
A serious complication after a facelift is that of nerve damage. To actually paralyze the face or damage the main facial muscles is exceedingly rare, although it has been reported in the literature. You should know that this is almost impossible with my facelift dissection technique. More common would be to have temporary numbness of one of the ears or a minor weakness of the corner of the mouth which would also be temporary. Some numbness of the cheeks, which disappears within a few weeks, is normal. If you look in the mirror, you will realize that your face is not perfectly symmetrical, so it will not be perfectly symmetrical after a facelift either, although you should not be concerned that you would have any pronounced asymmetries. I have purchased cosmetic insurance through “CosmetAssure” for all my cosmetic surgery patients so that if in the rare occasion a patient does develop a complication, you will have some insurance coverage. Your own personal health insurance most likely will not cover medical problems after cosmetic surgery.
You may wear makeup 1-2 weeks after your surgery. I would ask that you refrain from any tinting, perms or hair treatments other than shampooing and styling for about 3 weeks after the surgery or until the incisions are completely healed. I will give you the go-ahead for this.
People often ask how long a facelift will last. There is no set time that a facelift will last. It depends entirely on the individual. People who smoke and spend a lot of time in the sun or who have a genetic predisposition to premature aging have the kind of skin that will show aging earlier after a facelift than a patient who does not have these risk factors.
Some patients with a large amount of skin or fat under the neck or very heavy jowls may feel they would like a second facelift to really give a well-defined neckline. This is because there is a limit to how much lifting or tightening a single procedure can safely do at one time without risking significant wound-healing problems or more visible scars. Most patients have only one facelift in their lives. However, some patients will have several, and this is due to a combination of their own aging process and their personal desires. A significant weight gain or loss after surgery can undo the effect of a facelift. Please be aware that if any enhancement is desired after your initial surgery, there will be surgical and anesthesia fees that will apply.
I hope that this information has not been overwhelming in that it describes all the possible complications of this procedure. Nonetheless, the vast majority of patients have successful, uncomplicated surgery and are quite pleased with their results.
It will be a pleasure to discuss facelift surgery with you. Please feel free to call my office with any questions you may have (804-320-8545).
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