It's Back (and Better than Ever!)
Reviewed by Darrick E. Antell, MD
Injectables and fillers can help put the brakes on facial aging, but they are not substitutes for a traditional facelift (rhytidectomy). Similarly, a stem cell facelift uses fat injections to add volume to the aging face, but it does not provide the lift that a surgical facelift does. Unlike either of these nonsurgical options, which have limited staying power, surgical facelifts last more than 10 years. That said, facelift which is used to treat severe facial skin laxity and sagging is a major surgical procedure that requires considerable healing time.
There are five basic components of an aging face:
- Fine lines and wrinkles
- Skin pigment changes such as age spots
- Loss of volume such as hollow cheeks
- Loss of elasticity
Fine lines, wrinkles and age spots may improve with skin resurfacing techniques, such as laser skin resurfacing, chemical peels or microdermabrasion. Wrinkles may further improve with the use of injectables such as collagen or Botox. Loss of volume and folds, including nasolabial folds, may be treated with injectables such as Restylane and Juvederm. (Also called laugh lines, nasolabial folds are the deep folds which run from the side of the nose to the corner of the mouth.) The loss of elasticity and the effects of gravity on the face, however, can be improved only with traditional facelifts.
Are you a candidate for a facelift? You may be if your facial skin is loose and sagging, particularly along the jaw line or under the chin. People with a strong jaw line or well-defined bone structure are also good candidates for a facelift.
A facelift can correct many things to improve appearance, including:
- Sagging in the midface
- Deep creases below the lower eyelids
- Deep creases along the nose extending to the corner of the mouth
- Fat that has fallen or is displaced
- Loose skin and excess fatty deposits under the chin and jaw that can make even a person of normal weight appear to have a double chin
Preparing for Facelift Surgery
A consultation is the first step toward your new, improved face. This evaluation will determine if you are a good candidate for a facelift. Your surgeon will take a thorough medical history. He or she will evaluate your skin's elasticity, bone structure, wrinkles and folds, as well as your hairline, to better guide incision placement. Your expectations concerning the facelift will also be discussed, and the surgeon will likely take some "before" photos.
Once you have decided to have a facelift, chosen a surgeon and booked your procedure, your doctor will give you a list of pre-operative instructions.
In the two weeks before your facelift, your plastic surgeon will likely suggest that you stop taking certain medications, including aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) and blood thinners, all of which can increase bleeding risk. Certain herbal remedies may also increase bleeding risk. Just because a product or preparation is "all-natural" does not mean it is safe. For example, vitamin E, omega-3 fatty acids, green tea and gingko biloba all may increase bleeding risk during and after facelift surgery.
Make sure you tell your surgeon about EVERYTHING that you are taking. Never stop taking any medication abruptly without first speaking to your doctor.
Schedule a "brown-bag check-up" with your surgeon before your facelift surgery. A brown-bag check-up is when you gather all of your current medications and over-the-counter products into a "brown-bag" and show them to your doctor so he/she can look for any potential problems before they occur.
Some plastic surgeons may also suggest adding medications to your daily regimen in the weeks leading up to your facelift. The herb arnica and the enzyme bromelain, for example, may help minimize bruising and swelling after a facelift.
The pre-op instructions will also include a list of do's and don'ts about eating and drinking before your facelift.
Quitting smoking before your facelift is a must. Most surgeons recommend that prospective patients kick the habit for the month before and the month after the facelift. Smoking reduces blood flow to areas of the face. As a result, one in 10 smokers will experience skin death (necrosis) at the incision sites if they continue to smoke before and after surgery. Wounds may turn red and black, and the edges may start coming apart. Such wounds may require a skin graft, another surgery in which a patch of skin is surgically removed from one area of the body and transplanted to another area.
Many tools are available today to help smokers become ex-smokers. (See sidebar.)
Nicotine replacement products, such as nicotine patches, nicotine gum and nicotine lozenges, are available over-the-counter. A nicotine nasal spray and inhaler are currently available by prescription. These can help relieve nicotine withdrawal symptoms.
But keep in mind that nicotine patches and other nicotine replacement systems can't be used as smoking cessation aids immediately before or during surgery. They cause some of the same problems with wound healing as cigarette smoking. Tell your surgeon if you are using any nicotine replacement products.
Drugs such as buproprion SR (Zyban) and varenicline tartrate (Chantix) are non-nicotine pills that may help you quit smoking before a facelift. Talk to your doctor about a prescription.
Also, hypnotherapy or acupuncture may help some people quit smoking. Acupuncture involves placing extremely thin needles into the skin along specific acupuncture points to help curb the desire to smoke.
The Evolution of the Facelift
Over the years, the facelift procedure has evolved from a simple skin lift to the more complex deeper plane lift. There are many types of facelifts. You should ask your doctor about facelift variations, which include the deep plane lift, the superficial musculoaponeurotic system (SMAS) facelift, the endoscopic facelift, and the short scar facelift. Whereas facelift is often viewed to be a feminine procedure, the growth of male plastic surgery has fueled an associated growth in male facelift procedures. Although essentially the same surgery, there are a few key differences.
Regardless of the type of facelift you and your surgeon decide on, many of the key steps are the same:
Anesthesia. Normally a facelift is performed with a combination of mild sedatives, local anesthesia and a mild intravenous anesthesia. Some less extensive facelifts can be performed using only local anesthesia. Occasionally, a facelift may be performed under general anesthesia.
Incision. The facelift procedure usually involves incisions in front of and behind the ear. The incisions may extend into the scalp. In all cases, the incision is placed where it will fall in a natural crease of the skin for camouflage. Some surgeons may suggest that you grow your hair longer if it is currently very short, because longer locks will hide incisions during healing. In men, the incision is aligned to accommodate the natural beard lines.
The facelift. Once the incisions are made, various degrees of undermining of the skin are performed, and the deeper layers of the face are "lifted." Excess skin is removed, and some fat may be removed with liposuction. In other cases, the skin and muscle tissues are reshaped. The underlying muscle may be tightened with the skin, or separately. After the tightening or removal of excess skin, the skin is re-draped and sutured or stapled in place.
Following the surgery, your surgeon will apply a dressing to protect the entire area where the incisions have been made.
Recovery After Facelift Surgery
A facelift usually takes anywhere from two to four hours. It is usually an outpatient procedure, but overnight stays are possible.
There is some discomfort afterward, but it can be managed with either over-the-counter or prescription pain medications. Also, you may experience moderate swelling of the eyelids and other areas.
A large, fluffy dressing is usually applied immediately after surgery. Typically this dressing is removed and may be replaced with an elastic wrap within a day.
In the first 24 hours, many facelift patients are black and blue. They often have drainage tubes in place to reduce swelling and remove any excess blood. In some cases, drainage tubes are left in place for several days.
You should be allowed to wash your hair in two days. You should avoid strenuous activity while recovering from facelift until the swelling has subsided. This may take four to six weeks; however, within two weeks the swelling should be reduced enough so you can engage in some social activities. You will likely want to remain under the radar for the first one or two weeks after your facelift. After that, it is usually OK to participate in activities such as dinner with family members and close friends.
By three weeks, your new face will probably be ready for prime time, but sometimes healing takes longer. Most surgeons recommend that you undergo a facelift a minimum of three months before attending major social events such as your daughter's wedding. The longer you wait, the better your face will look.
Skin may feel dry and rough for a few months after a facelift.
Remember that a facelift is meant for folds and creases of laxity; it is not meant to improve the appearance of wrinkles. Strategies to treat the entire face often include a combination of procedures and treatments, such as blepharoplasty (eyelid surgery), facial implants, soft tissue augmentation with Juvederm, Restylane or other fillers, resurfacing techniques and injectables to erase wrinkles. Many patients also opt to remove unwanted hair using laser hair removal.
All surgeries have risks, and a facelift is no exception. Facelift risks may include:
- Unfavorable scarring
- Bleeding or the collection of blood beneath the skin (hematoma)
- Poor wound healing or skin necrosis. This can occur in front of or behind the ear and may result in a visible scar by the wound.
- Anesthesia risks
- Facial nerve injury with weakness
- Facial asymmetry
- Skin loss
- Numbness or other changes in skin sensation
- Death of fatty tissue found deep in the skin (fat necrosis)
- Fluid accumulation
- Skin contour irregularities
- Skin discoloration, sensitivity or swelling
- Suture problems requiring removal
- Hair loss
- Dissatisfaction with results
- Deep vein thrombosis, cardiac and pulmonary complications
- Possibility of revision surgery
Consult a Qualified Plastic Surgeon for your Facelift
Before deciding on a facelift, be sure to talk with a board-certified plastic surgeon. Plastic surgeons do their residency training in general surgery and should be certified by the American Board of Plastic Surgery. Board certification ensures that your chosen surgeon has had extensive training and is up to date on new technology and techniques. Choosing a qualified plastic surgeon will help minimize the risks and maximize your satisfaction with the results of your facelift.
Those interested in facial rejuvenation may also be interested in smile revitalization through cosmetic dentistry.
About the Reviewer of This Article
Darrick E. Antell, MD, is an educational spokesperson for the American Society of Plastic Surgeons. He is a board-certified plastic and reconstructive surgeon who has been in private practice for more than 20 years in New York City. Dr. Antell is a member of the American Society for Aesthetic Plastic Surgery and the American Society of Plastic Surgeons. He is also a Fellow of the American College of Surgeons. Dr. Antell received his general surgery training at Stanford University Medical Center and his specialty training in plastic/reconstructive surgery at the New York Hospital/Cornell Medical Center and the Memorial Sloan-Kettering Cancer Center in New York City.
American Society of Plastic Surgeons website article on facelifts.
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