At the time of a facelift, much of the skin on the cheeks is undermined in order to access the underlying muscles to lift the cheeks and jowls and to stretch out the redundant skin so that the excess can be removed. In the process of elevating the skin, much of the blood supply to it has been removed. As a result, we are then relying on much smaller blood vessels in the skin to keep it alive and allow the incisions to heal normally. Any further trauma to the skin or those blood vessels can result in skin loss, worse scars or delayed healing.
This is the reason that a facelift should not be performed on a current smoker. The nicotine from a single cigarette can cause those remaining blood vessels to constrict; leaving the skin with no blood supply causing some of the skin to die. Obviously, this can be a disaster and leave severe scarring as well as a very delayed recovery. This can also happen with secondary smoke, which must be avoided for at least 3-4 weeks before and after a facelift.
Lasers and Peels
For the same reason, this limited blood supply to the skin is why laser skin resurfacing, dermabrasion and chemical peels cannot be performed on the skin that is elevated during a facelift procedure. These types of treatments, however, can be done to treat wrinkles on other areas of the face at the same time as a facelift, such as around the mouth or on the nose and forehead. The most common area is the skin on the lips and chin to treat “smokers lines.” As this skin is not raised with a facelift, it has normal blood supply and should heal normally.
Lasers after Surgery
After a facelift has healed, the majority of the blood supply grows back so that skin-resurfacing procedures can be safely performed on the face. Lower level peels and fractional resurfacing, such as with a Fraxel® Laser, can generally be done within a month of a facelift. More aggressive chemical peels, dermabrasion and laser treatments would have to be postponed for about three months after a facelift has been performed if they are to be done on areas where the skin was elevated. If you are considering both laser treatments and a facelift, it is generally preferable to have the facelift done first as the result if usually better than performing the laser procedure of a chemical peel first.
When looking for a surgeon to perform a facelift, make sure that you find one that is certified by the American Board of Plastic Surgery (ABPS). In face, it is best to go one step further and make sure that your surgeon is experienced in cosmetic plastic surgery. To do that, make sure that he/she is a member of the American Society for Aesthetic Plastic Surgery (ASAPS). Dr. McMahan is certified by the ABPS and is a member of ASAPS as well as the American Society of Plastic Surgeons.