1. How long will a facelift last?
The rejuvenation a face attains from a facelift lasts forever. The aging of the face continues and at some point you may choose to have a second facelift. However, with the first facelift you have make sure you look 15 years younger; you will always look 15 years younger than you would have had you not had the facelift. Aging never catches up to the reversal that occurs when a facelift is properly performed. The key to having the best facelift results is to find a surgeon who has many years of experience performing the procedure and can show you before and after pictures of other patients demonstrating the lasting effects of their facial rejuvenation surgery. This means you need to see photographs taken years after the procedure and not just photos taken soon after surgery.
2. How long will the bruising and swelling from a facelift last and when will I be able to wear make-up and go out in public?
A properly performed facelift is a gentle procedure that follows the precise anatomic planes of an individual’s face. Therefore, there should not be a dramatic amount of bruising and swelling. However, minimal bruising and/or swelling should be expected and planned for. In my hands bruising is rare but when it occurs it can be expected to last as long as 7 to 10 days. The use of pre-surgical nutritional supplements such as trace minerals vitamins and Arnica combined with the avoidance of aspirin, Advil, antihistamines and other over-the-counter or prescription medications that predispose a patient to have bruising are helpful adjuncts to prevent bruising and swelling. The timeline for wearing make up for my patients is as follows:
- 6 days after the procedure sutures along the ear are removed and 24 hours following the removal of the sutures make-up can be worn.
-10 days after surgery the sutures behind the ear are removed and 24 hours after those sutures were removed the patient may return to their normal make and hair care routine.
There is always some degree of swelling following a facelift most of my patients tell me that 10 days after surgery they feel confident in going out in public without concern for their appearance.
3. How much pain is to be expected following facelift surgery?
There should never be pain following a facelift surgery. If you do have pain that can be a sign of something wrong and you should contact your physician. My technique for facelift surgery follows precise anatomic planes of the face and repositions these in such a way as to provide a rejuvenated or youthful facial appearance. The way the tissues are moved or manipulated really should not cause any major degree of pain. The first night following your facelift will be spent in the hospital. You will wear a very firm dressing that applies pressure underneath your chin along your cheeks and your neck. Many people find this dressing to be somewhat cumbersome but it should never be painful. There will be drains designed to remove any potential fluid buildup that may occur in your face following the surgery. These drains are painlessly removed the day after your procedure. The initial dressing will be changed and a new much more comfortable dressing will be applied using an elastic Velcro band.
This dressing will need to be changed by you or your family each day following surgery. We asked that the patient wear this 24 hours a day for 6 days following their discharge to allow any tension on the sutures to be prevented which aids in re-draping of the skin to the deeper structures in their new location.
10 days after your surgery all of your sutures will have been removed and most people note that their neck feels "tight" but not restricted. Many patients report that their face "feels more relaxed"
4. Where are the incisions for a facelift located and will those incisions be visible?
The incisions for a facelift may have some small variation based on the individuals facial anatomy and skin type but are always located in a hidden crease just in front of the ear curving around the earlobe then along the back of the ear and then straight back to the hairline at the point in which the ear crosses the hairline. Once the incision reaches the hairline it may either extend back straight into the hair or it may follow the junction of the hair bearing scalp and the neck. In either situation all the incisions are designed, carried out, and closed in such a way to make the incisions as invisible as possible with minimal development of scar tissue. Visible scars, widened scars, or unacceptable appearance of incision lines are usually the result of tension on the skin. This requires the surgeon to have experience and knowledge to move the deeper tissues of the face in such a manner that the tension is placed on these deeper tissues below the skin. This results in a more youthful facial appearance that appears well rested and demonstrates the fullness of youth. We never want a face to look tight or stretched. Therefore if you put all the tension of tightening the face on the skin the result is an operated look that can many times result in widened unacceptable scars to go with the tight windblown look. Modern facelift surgery should never have a visible scar and should never make the patient look “different” only better.
5. How do you make a facelift look natural, and not "operated or tight"?
Making someone look naturally youthful and avoiding the “operated or tight face” appearance requires knowledge of anatomy and the artistry of how to reposition this anatomy to achieve the desired results. What follows is a rather simplistic explanation of how this is accomplished:
The face is made up of 3 distinct layers of tissue. These correspond to the deepest layer of the face being the big muscles that move your face and give you expression and allow you to speak, eat, and drink. The most superficial layer of the face is the skin and fatty tissue called the dermis. This is the layer that you do not want to be tight as it will result in visible scars and a pulled appearance. In between the deep layer and a superficial layer is the middle layer which is referred to as the SMAS which stands for the sub-muscular aponeurotic system. This is a transitional layer of thick firm tissue called fascia which is a very strong, non-stretchable and resilient placement for the sutures. By lifting this layer of the SMAS, separating it from the deeper tissues, but leaving it attached to the more superficial layer of dermis and skin, we can move manipulate and reposition the skin and dermis of the face in such a way as to provide a youthful look without putting tension on the skin itself thus avoiding the stretched or tight look. By placing the sutures in the layer of the SMAS we can apply the necessary amount of tension to move the skin without stretching it. This technique also allows us to plicate (fold over), or stack the SMAS in such a way as to add natural fullness to the area of the cheeks, and remove or reposition fat of the face to eliminate jowls along the jawbone and reduce nasolalbial folds above the corners of the mouth. The bottom line is following a facelift you will still look just like yourself only better
6. What are the major risks of a facelift?
As with any surgery in which a cut is made in the skin there is always the risks of bleeding, infection, problems with wound healing all of which can result in an unacceptable cosmetic appearance. We all know that the face has a great degree of movement and expression. Muscles of the face provide this movement and expression by receiving signals carried from the brain to the muscles by 1 of 5 branches of the facial nerve. It is possible that in the course of performing a facelift procedure 1 of these 5 branches of the facial nerve that moves the face could be injured resulting in either a temporary or permanent lack of movement of an area of the face. In my hands having performed more than 2000 facelift procedures I have never had a permanent injury to 1 of the branches of the facial nerve however I have had 5 patients with temporary changes in their facial nerve function. All of these patients recovered facial movement in appearance by 6 weeks after surgery. Properly performing a facelift requires the operating surgeon to have an intimate and complete knowledge of where the normal facial nerve is located and how to avoid injury to this nerve. Everyone who undergoes a facelift will have some change in the way they feel their face. Most people experience some form of transient numbness around the ears and the cheeks which is to be expected since we are lifting up the tissue of the face and to some degree separating it from the sensory nerves to the skin. This numbness is always short lived and normal feeling of the skin will return in 6 weeks to 6 months following the surgical procedure.
7. Do facelift techniques differ between men and women?
Technique for facial rejuvenation differs greatly between that in men and women. Far more women have facial rejuvenation surgical procedures than do men and that is just a cultural phenomenon related to all Americans. However men do still want to look to her best the key is that in performing a facelift on a man you do not want to feminize a man's face. While moving and repositioning the skin of the face you do not want to distort the sideburns or the beard line of the face. Yet at the same time we do not want to make the skin incisions visible. Modern technique for men will use similar incisions to that for women but then requires removing some of the beard hair from underneath the surface of the skin to preserve the hairless area of skin in front of the ear before the back edge of the sideburn begins. Additionally when redraping the next skin behind the ear similar removal of beard hair from beneath the skin flap is required so that the man does not have to shave behind his ears. Lifting of the deeper tissues of a man's face should be performed in a more vertical fashion to maintain the strong male facial appearance without a widening of the cheeks. In general a man's face is much more square in appearance whereas a female’s face is more oval or almond shaped. These very distinct differences must be understood, and movement of the deeper tissues must be carried out in such a way to meet the desires of the patient without changing their gender identity. Because of beard growth, a man’s skin in general is much thicker than a woman’s skin and there is much more potential for bleeding, bruising and swelling. In general drains will be left in place on a male facelift for 3 to 5 days and external dressings are usually applied for a longer amount of time in a man than a woman. Recovery from a male facelift usually takes 3 weeks rather than 2. Men need to be aware of these limitations and make plans accordingly to allow for adequate recovery before returning to their normal activities.