What You Need to Know About Facelift Surgery

facelift

Facelift (rhytidectomy) is a major procedure to treat severe facial skin laxity and sagging. The procedure often provides a benefit for more than 10 years.

It's a popular procedure: Americans spent more than $1 billion on facelift and facial surgery in 2005, according to the American Society of Plastic Surgeons.

The Facelift Surgery Procedure

There are many variations of facelift surgery. You should ask your doctor about facelift variations, which may include the deep plane lift or composite lift, SMAS lift, subperiosteal lift, skin lift, mid facelift, and feather or thread lift.

Facelift plastic surgery may be performed by making an incision at the temples behind the hairline. The incision typically extends downward, along the natural creases in the skin, in front or on the edge of the ear, in the crease of the ear lobe, and behind the ear. Making the incision in the natural creases helps hide scarring after surgery.

The surgeon then separates the skin and muscles of the face from the deeper facial tissues.

In some cases the skin is removed, while in others 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.

Facelift patients normally undergo general anesthesia. Depending on the extent of the procedure, a facelift may be performed under local anesthesia — while you are numbed and sedated, but awake, or a light general anesthetic, where you are lightly sleeping. You should discuss anesthesia options with your plastic surgeon and the anesthesiologist.

Time in surgery is approximately 90 to 120 minutes. In some cases, drainage tubes are left in place under certain areas of the skin for several days to reduce post-surgical swelling.

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Facelift Planned? Protect Yourself from MRSA Risk

It may be slight, but there is a risk of developing methicillin-resistant Staphylococcus aureus (MRSA) infections following a facelift, according to research reported in the March/April 2008 issue of Archives of Facial Plastic Surgery.

About one-half percent of 780 people who got facelifts at a New York outpatient surgical center between 2001 and 2007 developed surgical site infections that tested positive for MRSA.

But choosing the right surgeon and the right facility, along with asking the right questions before your facelift, can help bring your risk for MRSA closer to zero.

What is MRSA?

MRSA is a type of bacteria that is resistant to certain antibiotics, including methicillin, oxacillin, penicillin and amoxicillin, according to the federal Centers for Disease Control and Prevention. More virulent than other forms of staph infection, MRSA spreads through the tissue more rapidly, is difficult to control and causes infections that can be fatal.

Staph infections, including MRSA, tend to occur most frequently among people in hospitals and healthcare facilities who have weakened immune systems. This is known as healthcare-associated MRSA (or HA-MRSA).

In contrast, MRSA infections that occur in otherwise healthy people who have not been recently hospitalized or had a medical procedure within the last year are known as community-associated MRSA (or CA-MRSA).

What are risk factors for HA-MRSA infections?

Current or recent hospitalization
Residence in a long-term care facility
Presence of invasive devices such as feeding tubes or catheters
Recent antibiotic use

How can I reduce my risk of developing MRSA after cosmetic surgery?

Make sure your plastic surgeon asks the right questions during your preoperative evaluation. A full medical history should include information on possible prior contacts with people at high risk for carrying MRSA. He or she should ask if you have recently taken antibiotics, been hospitalized, visited sick relatives or friends in the hospital, been in contact with health care workers or had previous MRSA infections.

If you have been hospitalized during the last month or visited a sick relative in the hospital recently, your surgeon may treat you with mupirocin nasal ointment (a brand name is Bactroban). This is the treatment of choice for people who may be MRSA carriers. If you have staph on your skin or in your nose but aren't sick, you are "colonized" but not infected with MRSA. Healthy people can be colonized with MRSA and pass the germ to others.

Consider having your cosmetic surgery in an accredited ambulatory surgical center. This can be safer than a hospital, because such centers typically do only cosmetic surgery on healthy individuals, and no sick patients are there to pass along infectious agents. For the same reasons, consider cosmetic surgery retreats for aftercare, unless staying in a hospital is deemed necessary.

Ask your doctor if you are a candidate for antibiotic-coated sutures, designed to kill infection-causing bugs at the site of the wound. At this juncture, there is no hard evidence that they decrease infection, but they do decrease bacterial colonization, so it's reasonable to think they may reduce susceptibility to infection.

Inquire about your surgeon's policy on preventive (prophylactic) antibiotics. While many surgeons will give an initial dose of antibiotics to people undergoing facelifts, there is no evidence that this is helpful past 24 hours. In fact, additional antibiotics after this time can actually increase the risk of MRSA and other antibiotic-resistant infections, which developed due to the over-use of antibiotics. Antibiotics may be required for longer periods of time for other procedures, particularly those involving implants.

Always choose a plastic surgeon certified by the American Board of Plastic Surgery. This ensures that the surgeon has specific and rigorous surgical education and training and is up to date on the latest advances in surgery as well as infection control.

Finally, use common sense. If the place looks dirty and the staff looks unkempt, choose another surgeon and/or facility.

Reported by Denise Mann; reviewed by Scott R. Miller, MD, FACS

Recovery After Facelift Surgery

After surgery, patients may experience moderate swelling of the eyelids and other facial areas. Immediately after surgery a large fluffy dressing is usually applied. Typically within one day after surgery it is removed and may be replaced with an elastic wrap.

Normally you would feel some discomfort following facelift surgery, which can be managed with medications.

You should avoid strenuous activity until the swelling has subsided. This can take four to six weeks; however, within two weeks the swelling should be reduced enough to engage in some social activities. Many patients prefer to delay significant social activities for four weeks after surgery.

The skin may feel dry and feel rough for a few months.

Smoking and Facelifts

Smoking reduces blood flow to areas of the facial skin, so you shouldn't smoke a month before and a month after surgery. Stopping smoking will help the healing process.

One in ten smokers will experience skin death at the incision site if they continue to smoke after surgery.

Secondary Facelift Surgery

Unfortunately, people continue to age. Your skin may eventually start to loosen and sag again. Secondary facelift procedures are not uncommon, to reposition and tighten the facial skin, underlying tissue and/or muscles.

Another reason for a secondary procedure is that after undergoing facelift surgery, the untreated areas of your face may appear more lax than the treated area. You may want a secondary facelift to provide a more consistent balanced appearance.

The extent of the secondary procedure depends upon the extent of the first facelift procedure and the effects of natural aging. For example, many deep plane facelift patients are fully satisfied with a secondary "tuck" procedure and do not require a more extensive secondary procedure that may be required for a patient who underwent a less invasive initial facelift.

Facelift Does Not Affect All Facial Areas

The treatment plan for a facelift patient may include other plastic surgery procedures and minimally invasive procedures to provide a full facial rejuvenation.

The facelift itself involves improvements to the jaw line, cheeks, and nasiofold area, but not necessarily the neck, brow, forehead and eyelids. During the consultation with a plastic surgeon, he or she will evaluate your face to develop a comprehensive treatment plan.

During the face lift procedure, your plastic surgeon may perform a procedure to improve the appearance of the eyelids, called blepharoplasty (eyelid surgery). Blepharoplasty may also be performed after recovery from the facelift.

A forehead lift (browlift) may also be performed during the facelift or after the recovery period. The endoscopic browlift procedure may be an alternative browlift approach that is less invasive than the traditional browlift.

You may consider a neck-lift to improve the appearance of your neck and provide a more balanced youthful appearance.

A facelift is meant for folds and creases of laxity; it is not meant to improve the appearance of wrinkle lines. Wrinkle lines may be improved after plastic surgery 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 to produce a fully satisfactory outcome.

These solutions may not completely eliminate the signs of aging, including sagging, laxity, volume loss and folds. Successful strategies often include a combination of procedures and treatments, such as blepharoplasty, to achieve facial rejuvenation.