Facelift

Facelifts, or rhytidectomy, which is literally the removal of wrinkles, is a procedure used in cosmetic surgery to give an individual a more youthful appearance. This is usually achieved by the removal of excess skin, the tightening of the underlying muscles and a redraping of the skin around a person’s face and neck.

The aging face does not only lose elasticity, develop wrinkles and looser skin; it also loses muscle tone and fatty structures under the skin. Often, additional procedures are necessary to achieve the best results. One facelift can do wonders, but in certain circumstances more than one procedure is needed to achieve maximum results. Some of the options for cosmetic surgery in and around the face include: neck lifts, eyelifts or surgery around the eyes to repair or remove “bags” under the eyes or droopy eyelids, liposuction to remove excess fatty deposits; fat injection, to add roundness and tighten skin; removal of the cheek’s fat pad, forehead lift and brow lift. Chemical or laser peels are also available as are malar (cheek), submalar or chin implants.

As we age, gravity and exposure to the sun, wind and the day to day grind of life in general take their toll. All these external factors can be seen in the face. Creases or wrinkles form around the eyes and mouth, the cheeks droop and become jowly and fat deposits form around the neck.

A facelift cannot stop the aging process, but it can give the appearance of youthfulness by erasing the signs of aging. The loose skin is tightened up, fatty deposits are removed and wrinkles are all but erased. If you are an older person between the ages of 40 and 60, then you might be a good candidate to consider facelifts. A facelift can increase your self-confidence and make you feel better about yourself. The right kind of facelift done by a reputable surgeon can make you feel more vibrant, more confident, and help you present a better “face” to the world, both on the outside and the inside.

If you are a man or a woman and your neck has begun to sag, or your face is seeing the effects of gravity a bit too much, but your skin still has retained some of its elasticity, you may be a good candidate for a facelift. If your bone structure is strong and well defined, that helps ensure the results are good. Most facelift candidates are in their 40s or 50s, but successful facelifts can be done on people in their 70s or 80s as well.

In general, however, facelifts achieve the best results in women with thin skin and good bone structure. Facelifts are best for eliminating lose skin folds in the neck area and for smoothing out wrinkles in the cheeks. Facelifts can also help the eye area, though sometimes separate “eye lifts” are done. The areas that are often not corrected well by a facelift are the creases that people develop around the nose and mouth, the so-called "marionette lines".

A facelift can make you look younger, sometimes dramatically so. It can make you feel fresher, with more vitality and youth, but it cannot actually turn back the clock. It cannot give you a totally different look or restore your health. It is purely a cosmetic procedure. Before you decide to have this type of surgery done, it is wise to think very carefully about what it is you expect from a facelift and weigh the benefits and risks of the procedure. It is also always a good idea to talk about these factors with your surgeon beforehand.

A person who has continual or persistent health issues would not be a good candidate for a facelift, mainly due to the fact that, even though it is a fairly routine procedure these days, it is still surgery, and complications can arise with all surgeries. The risk of complications is multiplied in patients with health problems. If you have health issues associated with your heart or if you have hypertension or diabetes, then perhaps facelift surgery is not the best choice for you. The risk of complications is also higher for smokers as well. Though facelift surgery is often done on those with multiple birth defects that affect not only the face but the general health of the person, these surgeries are complicated and tedious, and can only be done by the most skilled surgeons.

All surgeries carry a certain degree of risk. When a facelift is performed by an experienced and qualified plastic surgeon, the incidences of complications are less frequent and minor. With this in mind, each individual is different and their anatomy can vary from patient to patient. Individual physical reactions and healing abilities vary as well and the outcome of any surgery is never completely predictable.

Complications can include hematoma, which is a collection of blood under the skin. This must be removed by the surgeon. Injury to the nerves controlling facial muscles is a possibility as well. These are often temporary when they do occur but can be permanent. Infections associated with the surgery or complications and reactions to the anesthesia occur as well. Smokers can experience poor healing of the skin.

The most common complication associated with facelift surgery is bleeding. This may require a return additional surgery to repair. Less common complications include the aforementioned nerve damage which can leave part of the face paralyzed. Necrosis of the skin flaps can also occur. The edges of the skin where it is reattached after the surgery fail to heal and the cells die. A return to the operating room is likely in this instance.

Although infrequent, other risks associated with surgery include bruising which may take longer to fade. Infection is a complication associated with virtually any surgery. This includes facelift surgery, even though it is usually fairly risk-reduced. Scarring that is widened or thickened is another complication that can occur. In some individuals who scar easily, scars develop that are thicker and wider than normal. Loss of hair around the incision site can occur. Another possible complication is asymmetry. Sometimes due to the healing process or the type of procedure performed, there remains an unevenness between the two sides of your face.

Every person is different. Facial structure, muscle density, skin elasticity, all these factors vary from patient to patient. Facelifts, therefore, are very individualized procedures. Your surgeon will have to evaluate your face and features, including your underlying bone structure and determine the best course of action to take in conjunction with your goals for the facelift surgery.

A complete check on your medical history will be performed to check for medical conditions that could cause complications during surgery or afterwards during recovery. Uncontrolled high blood pressure, scarring problems or blood clotting issues all factor in. Make sure that your surgeon knows whether you are a smoker or if you are taking any drugs or medications. Make sure your surgeon knows if you are taking aspirin or any type of blood thinning medications or any other drug that can affect clotting. It is very important that your surgeon be aware of anything that could cause problems.

Your surgeon should discuss with you beforehand all that the procedure will entail, including the techniques used and the type of anesthesia he or she will employ. Your surgeon should also discuss with you all of the associated risks and costs of the procedure. You should not hesitate to ask the doctor any questions you may have regarding your expectations and concerns about the procedure and the results.

Your surgeon should give you specific instructions on how to prepare for your surgery. Preparation for facelift surgery is usually fairly simple, but even though it’s simple, it is still necessary if you want the surgery to be as safe and effective as possible. These should include guidelines on eating and drinking prior to your surgery. He or she should also explain about smoking beforehand or taking vitamins or other supplements or medications. Be sure to follow their instructions very carefully. The chances of complications will be greatly reduced if you do. If you do smoke, it is important that you stop smoking at least a week or two prior to surgery and after surgery as well. Smoking inhibits the blood flow to the skin and could cause complications in surgery or inhibit healing after surgery.

Since the scars associated with facelifts are hidden up behind the hairline, it is a good idea to let your hair grow out a little prior to the surgery so that it's long enough to hide the scars while they heal.

Whether your facelift surgery is done as an inpatient or outpatient procedure, you should make arrangements for someone to drive you to and from your surgery. It is also a good idea to have someone stay with you for a couple of days to help you out.

Facelift surgery may be performed in a surgeon's office or an outpatient surgery facility. It can also be done in a hospital as well. It is usually done on an outpatient basis, but some surgeons may decide to have patients remain in the hospital for a day when they are using general anesthesia. If you have certain conditions such as high blood pressure or diabetes, the surgeon may require you to spend a day or two in the hospital, for observation.

Facelifts are most often performed under local anesthesia and a sedative to make you sleepy. In these instances you will be awake but relaxed and you will not be able to feel any pain. It is common to feel some tugging as the operation progresses and some discomfort is not uncommon. If your surgeon prefers to work with his patient under general anesthesia you will sleep through the entire operation and may spend the next day in the hospital for observation as the anesthesia wears off. Either procedure should cause very little discomfort, though with both, there will be some pain afterwards that can be controlled with medication.

Depending upon the procedure or procedures performed, a facelift operation can take several hours. If there is extensive work being done, the surgeon may schedule two separate operations. The traditional facelift involves making an incision starting at or above the hairline and in front of the ear. The incision is then drawn under the ear and upward behind the ear, ending in the hair or at the hairline again. The skin and fatty tissue are then pulled away from the underlying muscle tissue and connective tissue. At this point the underlying muscle and connective tissue can be tightened with sutures if needed. The skin is then pulled up and backward and excess skin is removed. The incision is then closed with sutures or staples. Some surgeons will leave a drain in the incision to remove excess blood. Bandages are then applied loosely to minimize bruising a swelling.

Each surgeon approaches the procedure their own way. Some work on one side of the face at a time and others alternate between sides all at once. The placement of sutures or staples depends on the individual structure of each patient's face and the surgery technique used. If there is any neck work to be performed, a small incision may also be made under the chin.

Depending upon the procedures involved, your surgeon may operate on some deeper tissue rather than solely on the skin and fatty layers, but the results and procedure are similar.

After your surgery you may experience some discomfort, but in general it is very mild and what pain there is can be lessened with medications prescribed by your surgeon. If you have severe or persistent swelling you should report it to your surgeon immediately. Numbness of the skin in the area of the surgery is very normal and should recede as the wounds heal, within a few weeks or months.

Your surgeon may tell you to keep your head elevated and to remain as still as possible for a couple of days after the surgery. This is to keep swelling down. If your surgeon has inserted a drainage tube, he will have you come into the office in a couple of days to have it removed. The bandages are usually removed in a few days. Though your face will appear pale and bruised, the puffiness will recede and you will look marvelous within a few weeks. Just keep in mind that the healing process takes time and energy. It is important to give your body both.

In most cases the stitches will be completely removed after about five days. Sometimes the scalp takes longer to heal and the stitches or staples may be let there for a few more days. If you are a smoker it is important to refrain from smoking while your body heals. As previously mentioned, smoking inhibits blood flow in the skin and without proper blood flow to the damaged areas, healing will be slowed or complicated.

After your facelift surgery you should be up and about on your feet in a couple of days. Be prepared to take it easy for at least the first week after surgery. Make sure that you are gentle with your face and hair. Your skin will be numb and you may not be aware of how roughly you are handling it. You do not want to cause damage to the procedure by poking or prodding the affected areas. Your skin might not respond normally at first and it will certainly feel odd for a few days.

Your surgeon will give you more specific instructions about gradually getting your life back to normal and resuming normal activities. Some of these guidelines may include avoiding strenuous activities, including exercising, heavy housework and sexual activity. Mild walking and stretching are fine for the first couple of weeks. Also, you should avoid alcohol, steam baths and saunas for several months. Perhaps the most important guideline is to get plenty of rest so that your body can concentrate on healing.

In the beginning your face will look and feel strange. The swelling and bruising associated with the surgical procedure and the healing process will give your face a distorted appearance. Facial movements may feel stiff and sluggish and you may feel somewhat self-conscious because of the scars. The bruising may persist for a few weeks and you may get easily fatigued as your body is spending most of its energy on healing. It is common for some patients to experience disappointment or depression in the first few weeks following surgery.

Usually by week three, you will look and feel much better. The bruising and scarring should have faded enough to make you feel more comfortable in public. Most patients find that they can return to work after about two weeks. If you are still concerned about the appearance of healing scars or bruising, it is possible to hide them with special camouflaging makeup.

The odds are that you will be completely happy with the procedure performed. Just keep in mind that the results may not be immediately apparent. Even after the swelling and bruises have disappeared, the hair around the temples may still be thin and your skin will likely feel dry and rough for several months. It is not uncommon for men to experience the strange need to shave in different area than before as the skin has been repositioned.

There will be some scars from the surgery, but these are most often hidden under the hairline or in the natural creases of your face. Even still, most of these scars will be very thin and most likely will fade and disappear in time.

The new you will still be the old you, only younger looking and most likely happier feeling. The self-confidence gained by looking younger often improves the mood of facelift patients as well as their looks. A facelift will not turn back the clock. It won't return you to the vigor and vitality of youth. It also won't stop the clock. You will still age with time and you might find that you want to repeat the procedure again in five or ten years. The effects of even one facelift are lasting however, and you will continue to look better than if you had not had a facelift at all.