A Facelift is an outpatient surgical procedure where excess skin is removed from the cheeks and neck and the underlying muscle tissue is tightened with sutures. Excess fat in the neck and jowls is also frequently removed at the same time with liposuction or direct excision. A Facelift does not treat the eyes, forehead or brows.
2. What type of anesthesia is typically used for a Facelift?
Depending on the patients and the surgeon’s preference, a Facelift can be done under local anesthesia with intravenous sedation or general anesthesia. This can be discussed with the anesthesiologist just prior to surgery.
3. How long is the recovery from a Facelift?
I see my Facelift patients on the first day after surgery at which time the dressing is changed, the drain, if present, is typically removed and a more comfortable garment is applied. Patients are allowed to shower on the second postoperative day. Sutures are removed in stages depending on the area, usually on days four and six or eight after surgery. Most are able to return to work about ten days after surgery. I use the tumescent technique which involves injecting fluid under the skin prior to the start of surgery. This fluid contains dilute local anesthetic to reduce pain and epinephrine which diminishes bleeding and bruising.
4. Where are the scars from a Facelift?
Most of the scars from a Facelift are hidden in the scalp above and behind the ears. The others run in the crease behind the ears, as fine lines in front of the ears and one under the chin used to approach the neck. Sometimes, they are positioned around the sideburn to avoid displacing the sideburn superiorly, however, this is mostly done in repeat facelifts.
5. Is a drain normally used in a Facelift?
Whether or not a drain is used during a Facelift depends on the surgeon’s preference. I believe that the use of a drain helps to remove excess blood and fluid, which can accumulate after surgery and, therefore, reduce bruising which can speed up recovery. A drain is not normally used with a mini-facelift.
6. Is there much risk of infection with a Facelift?
Fortunately, because of the tremendous blood supply to the face, the risk of infection is pretty small with a Facelift. To reduce the risk of infection, many surgeons will prescribe antibiotics to be taken around the time of surgery. It is important that you take them as prescribed.
7. How much pain is there after a Facelift?
Most of my patients are surprised at how little pain that they have after a Facelift. By using the tumescent technique which cuts down on bleeding and pain, many of my patients take nothing but acetaminophen (Tylenol®) after surgery. Although, we do prescribe pain medication, many find that they do not need them. Some patients will complain of tightness in the neck area from the muscle tightening, which can cause mild difficulty swallowing. This is generally minor and temporary.
8. Who is qualified to perform a Facelift?
True plastic surgeons are the only physicians who learn plastic surgery as part of their required surgical training. There are many untrained surgeons and actually many physicians who are not even surgeons trying to perform plastic surgical procedures such as Facelifts. This can be very dangerous! Most of them only do the procedures in their office or their own surgical suite because they are not trained to perform the procedure and, therefore, cannot be credentialed to perform the operation at a hospital or legitimate surgical center. In these offices is where most of the serious complications occur. Neither the internet nor the telephone book care about your safety, the truth, adequate training or credentials. If you are going to spend money on plastic surgery, do not take unnecessary chances. At least make sure that your surgeon is trained and experienced in plastic surgery and is not just dabbling in something in which they have no expertise. Dermatologists are medical doctors, not surgeons! They are not trained to perform plastic surgery and have no business doing so.
When selecting a surgeon, at least make sure that he or she has had adequate training. Your surgeon should be certified by the American Board of Plastic Surgery. It is the ONLY legitimate plastic surgery board. It is the only one that evaluates a surgeon’s prerequisite training, plastic surgery training, practice performance and requires passage of rigorous written and oral examinations. You can contact the American Board of Plastic Surgery at (215) 587-9322. Another way to find out if your surgeon is trained is to see if your surgeon is a member of the American Society of Plastic Surgeons, Inc. (ASPS). Visit their website at www.plasticsurgery.org or call 1-888-4PLASTIC. All members of the ASPS are certified by the American Board of Plastic Surgery.
I would also recommend that you go one step further. To make sure that your surgeon specializes in aesthetic surgery and, therefore, is not only well trained, but is also very experienced, make sure that he or she is also a member of the American Society for Aesthetic Plastic Surgery (ASAPS). Surgeons that are members of ASAPS are all certified by the American Board of Plastic Surgery, members of ASPS, and have a practice that is dedicated to aesthetic surgery. Their web site is www.surgery.org and phone number is 1-888-ASAPS11.
Would you let a plumber do the electrical work on your house? Would you have a mechanic do your taxes? How about letting an orthopedic surgeon operate on your heart? Then why have an untrained physician, maybe not even a surgeon perform cosmetic surgery on you? If you wind up in someone’s office that doesn’t have the above credentials, do not walk but run out of that office. And forget the consultation fee. They do not deserve to be paid for trying to deceive you.
9. What are the biggest benefits from a Facelift?
The greatest benefits most patients see from a Facelift involve the lower face and neck. This makes the term “Facelift” somewhat of a misnomer. Most people think of their “face” as running from their forehead to their chin. The benefits from a Facelift, however, start below the eyes and extend down to include the neck. The biggest changes in most patients include correction of sagging jowls, reduction or elimination of excess neck skin and improving the angle between the chin and the neck. Other benefits include smoothing of wrinkled cheek skin and reduction of the folds that extend down from the sides of the nose (nasolabial folds).
10. What areas are not affected by a Facelift?
Although many people expect that the eyes, crows feet, lines around the mouth and brows will be improved with a Facelift, these areas are not affected. However, these areas can be improved with simultaneous procedures such as a brow lift, eyelid surgery, dermabrasion or laser resurfacing.
11. What other procedures can be done at the same time as a Facelift?
Common procedures that may be done at the same time as a Facelift include eyelid surgery (blepharoplasty), brow lift, dermabrasion for lines around the mouth, rhinoplasty and injection of dermal fillers such as collagen and hyaluronic acids (Restylane®, Hylaform® and Juvederm®).
12. What can be done to reduce the risks of a Facelift?
Prior to surgery, you should be given a list of medications to avoid for two weeks before surgery to reduce the risk of bleeding and bruising. This particularly includes aspirin and any aspirin containing medications. It is important that you take this list seriously. You should not smoke or be exposed to secondary smoke for one month before and after a Facelift. The nicotine in tobacco smoke constricts the blood vessels in the skin and can cause the skin to die resulting in severe scarring. If you have high blood pressure, it needs to be under good control prior to surgery. It is important to keep your head elevated for several days after surgery to reduce bleeding and bruising. To reduce the risk of blood clots forming in your legs, you should be up and around as soon as possible after surgery and you should move you feet and legs frequently while you are sitting. If you have any medical problems, it is advisable that you consult with your primary care physician prior to surgery.
13. Does a chemical peel or laser resurfacing do the same thing as a Facelift?
Chemical peels and laser resurfacing are used to treat fine to moderate depth lines in the face as well as evening out the tone and texture of the skin. They do not eliminate excess skin, correct sagging jowls or improve the neck line as is accomplished with a Facelift. Chemical peels and laser procedures are not replacements for a Facelift.
14. What is the difference between a Facelift and a neck lift?
Surprisingly, there is not a big difference between the average Facelift and a neck lift. A neck lift is actually the lower half of a facelift treating only the neck with no change in the cheeks or jowls. A facelift without the neck portion is a mini-facelift.
15. How long does the numbness in the cheeks last after a Facelift?
The cheeks may stay numb for three to four months after a Facelift. This can be particularly bothersome in men because they are unable to feel a razor blade on their face resulting in injury to the skin while shaving. Therefore, it is recommended to switch to an electric razor until the feeling in the skin returns.
16. What is a mid-face lift?
A mid-Facelift is typically done at the same time as a normal Facelift to help correct deep folds that extend downward from the sides of the nose (nasolabial folds) or deep furrows under the eyes (nasojugal folds) or both. This procedure is done through lower eyelid incisions and is generally done as a “deep plane” lift as the muscle of the cheek is elevated off of the facial bones. A normal Facelift does not help the nasojugal folds and is only mildly effective for treating the nasolabial folds.
17. What can be done to prevent the mask-like or wind-swept appearance that I have with some celebrities who have had Facelifts?
Most good plastic surgeons have progressed from the old Facelift procedure where the skin was pulled real tight resulting in the wind-swept or mask-like appearance. This technique is very out-dated. The modern day Facelift is much more of a contouring procedure where fat removal and muscle tightening are the most important elements of the surgery and there is less emphasis on skin removal. This results in a more natural, unoperated look.
18. I keep hearing about “one day recovery” Facelifts or something like a fast-lift. What are these and should I consider this over a standard Facelift?
Most of these are gimmicks and should be avoided. I have seen many patients over the years who have fallen for this attractive advertising only to wind up with minimal results, a much longer recovery than they had expected, bad scars and an empty pocketbook. I believe that most patients are much happier and get better results with a standard Facelift. In addition, you will find that most good plastic surgeons do not perform these procedures because they do not need you to fall for these gimmicks to get patients.
19. What is a 'Mini-Facelift?'
A mini-Facelift is basically a facelift without the neck portion of the procedure. It is a good procedure for someone who with loose cheek skin or sagging jowls but with a well preserved neck. Compared to a standard Facelift, a mini-procedure has shorter scars around the ears, no scar under the chin, usually no drains and generally a quicker recovery.
20. What is a 'SMAS' lift?
SMAS is an acronym for Subcutaneous Musculo-Aponeuritic System. This is the layer under the skin that envelops the facial and neck muscles. This is the layer that experienced modern day plastic surgeons suspend during a facelift procedure. Elevation and suspension of the SMAS provides a longer-lasting, natural result with better improvement of the jowls and neck.