Facelift

Introduction

As we age, the effects of gravity, sun exposure and the stress of everyday life become visible on our face. Deep creases form between the nose and mouth, the cheeks fall, fat deposits and wrinkles appear around the neck. A cervicofacial facelift cannot stop this aging process; however, the only thing we can is to “set back the clock”, improving the most visible signs of aging, by tightening the facial muscles, removing excess fat and redraping the skin of your face and neck. The facelift can be performed alone or in conjunction with other procedures such as blepharoplasty or rhinoplasty. The forehead lift corrects saggy eyebrows and the wrinkles.

If you're considering having a facelift, this information will give you a basic understanding of the procedure-when it can help, how it is performed, and what are the results to expect. It can't answer all of your questions, since a lot depends on the individual patient and the surgeon`s preferences. Please ask your surgeon about anything you don't understand.

Who is the best candidate for facelift?

The ideal candidates for a facelift are those men or women whose face and neck have begun to sag, but whose skin still has some elasticity. Most patients are in their forties or sixties, but a facelift can also be successfully performed on patients in their seventies or eighties as well. A facelift can make you look younger and it may enhance your self-confidence, but it will not give you a completely different look, nor can it restore the health or vitality of your youth. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

Facelift: preoperative appearance.

Planning your surgery

Good communication between you and your plastic surgeon is essential. In your initial consultation the surgeon will evaluate your face, including the skin and underlying bone, and discuss the surgical options. Your surgeon should check for medical conditions that could cause problems during or after surgery, such as uncontrolled high blood pressure, blood clotting problems, or the tendency to form excessive scars. Be sure to tell your surgeon if you smoke or are taking any drugs or medications, especially aspirin or other drugs that affect clotting.

If you decide to have a facelift, your surgeon will explain the techniques and anesthesia he or she will use, the type of facility where the surgery will be performed, and the risks and costs involved. Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results.

Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, taking or avoiding certain vitamins and medications and on how to wash your face. If you smoke, it is important to stop at least a week or two before and after surgery. If your hair is very short, you might want to let it grow out before surgery, so that it's long enough to hide the scars while they heal. Carefully following these instructions will help your surgery go more smoothly. Also, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two if needed.

The surgery

The facelift is always performed in the operating room, within a clinic or hospital. Normally, the patient remains in the hospital the night after surgery, being discharged the next day.

The facelift can be performed under local anesthesia along with sedatives or, more frequently, under general anesthesia, depending on the extent of the procedure and on the surgeon`s preferences. If the surgery is being performed under local anesthesia with sedation, you'll be awake during the surgery, but relaxed and insensitive to pain. If general anesthesia is used, you'll be sleeping through the entire operation.

A cervicofacial lift usually lasts for several hours, or more when performed in conjunction with other interventions. The exact placement of incisions and the sequence of events depend on your facial structure and your surgeon's technique. Incisions usually begin above hairline at the temples, they extend in a natural line just in front of the ears, and continue behind the earlobe to the lower scalp. If the neck needs work, a small incision may also be made under the chin.

In general, the surgeon separates the skin from the fat and muscle below. Fat may be trimmed or suctioned from around the neck and chin to improve the contour. The surgeon then tightens the underlying muscle and membrane, pulls the skin back, and removes the excess. Following surgery, a small, thin tube may be temporarily placed under the skin behind your ear to drain any blood that might collect there. You might also wrap your head in a loose bandage.

In forehead lift, the incision is placed in the forehead, hidden behind the hair, or in some cases, on the border between hair and forehead. The skin of this area is separated from the underlying structures, resection of the muscles responsible for wrinkles and the excess skin.

 Incisions are usually placed in the hair in front of the ear and behind it. The tissue of the face, neck and the muscles are separated to achieve an adequate stretch.

 

The excess skin is removed. Resulting incisions

Getting back to normality

There is usually little discomfort after surgery; if there is, it can be relieved with pain medication prescribed by your surgeon (if you have severe or persistent pain you should immediately report it to your surgeon.) Some numbness of the skin is quite normal; it will disappear in a few weeks or months. You must keep your head elevated for a couple of days after surgery, to keep the swelling down. If you've had a drainage tube inserted, it will be removed one or two days after surgery; bandages are usually removed after one to five days. Don't be surprised at the pale, bruised, and puffy face you see. Just keep in mind that in a few weeks you'll be looking normal. 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.

Most patients who undergo a facelift are up and about in a day or two, but you must rest during week after surgery. Be especially gentle with your face and hair, since your skin will be more sensible for a while. Even though your surgeon will give you specific guidelines, include these suggestions: avoid strenuous activity for at least two weeks, avoid steam baths and saunas for several weeks and also avoid exposing yourself to the sun for a few months. Above all, get plenty of rest and allow your body to spend its energy on healing. At the beginning, your face may look and feel rather strange due to inflammation and your facial movements may seem somewhat slow. Some bruising may persist for two or three weeks, and you may tire easily. By the third week, you'll look and feel much better. Most patients are back at work about ten days to two weeks after surgery. If you need it, special camouflage makeup can mask most bruising that remains.

Are there risks? Are there any guarantees?

When a facelift is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable. Complications that can occur include hematoma, injury to the nerves that control facial muscles (usually temporary), infection, and reactions to the anesthesia. Poor healing of the skin is most likely to affect smokers. You can reduce your risks by closely following your surgeon's advice both before and after surgery.

The results

The results are very satisfactory and you will be happy, provided you understand that the result is not immediately apparent. Even after the swelling and bruises are gone, the hair around your temples may be thin and your skin may feel dry and rough for several months. The scars from your facelift will remain hidden by your hair or in the natural creases of your face; in any case, they will fade within time and should be scarcely visible.

Having a facelift doesn't stop the clock; your face will continue to age with time, and you may want to repeat the procedure five or ten years later. However, the effects of facelift are lasting; years later, you'll continue to look younger.

 

 Postoperative appearance

Facial rejuvenation surgery: summary

The facelift is a procedure designed to tighten facial and neck skin in order to reduce the creases or wrinkles. The bone structure of the face, the muscles and skin texture go through an involutional process over the years. There might also be other factors, such as heredity, poor diet, stress, prolonged exposure to sun etc. that substantially alter the signs of facial aging.

Rhytidectomy is usually treats the skin of the neck and cheek, but sometimes it is used to corrected the wrinkles of the forehead and sagging eyebrows. Eyelid surgery it is quite often performed in association with rhytidectomy.
The operation can be performed under general anesthesia or local anesthesia and sedation, depending on each individual case (more or less extensive surgery, the patient's personal wishes, etc.).

Incisions for this surgery are made in the scalp in the frontal and temporal regions, around the ears and ending in the area near the neck. Through these incisions, the surgeon separates a larger of a smaller part of the skin, in order to tighten it. Through the same incision, the surgeon may reduce fat accumulation or tighten muscles that have become flaccid, giving a firmer appearance to your face.

The intervention usually takes 2 to 4 hours, depending on the extent of the procedure and of other interventions such as eyelid surgery, liposuction, etc. After the surgery, small, thin tubes may be temporarily placed to decrease the chance of bruising and to reduce inflammation.

After surgery, patients notice a variable degree of swelling of the face and neck, swelling or bruises and feel their skin a bit tight and numb. This discomfort is temporary and may disappear spontaneously or with analgesics.

Most of the scars are hidden by your hair or in the natural creases of your face and ears. During the first weeks after surgery, only the scars placed in the area around the ear might be noticed, but they also can easily be concealed with your hair.

After 5 or 6 days from your surgery your stitches start to be removed, a process to be finished after 8 to 10 days. Usually, in the third postoperative week you can live a normal life and even go back to work.

Facelift interventions not only achieve a remarkable rejuvenation but also you will appear much younger years later. If, over time, wrinkles and folds reappear, you can repeat the procedure.

Possible complications of rhytidectomy are scarce and, in most cases, temporary; hematomas, defective wound healing, hair loss in scalp scar, abnormal mobility of the eyebrows or lips, etc. Only in very rare situations additional surgery is needed to treat these complications in the immediate or late postoperative period.

The information contained on this page cannot, and does not replace the information provided individually by your plastic surgeon. In case of doubt, your plastic surgeon will provide appropriate clarifications. If you are planning to undergo an intervention or Aesthetic Plastic Surgery, see a specialist in Plastic, Reconstructive and Aesthetic Surgery.