Facelift

I tell my patients that a facelift will refresh their looks and make them look better whatever their age is.

Swelling in the face after a facelift is normal. This usually takes a few weeks for the majority of the swelling to resolve but the residual swelling may last several months to completely resolve.

If the skin of the face is very loose, then you might need a facelift. Sometimes for very mild laxity, lasers may help improve the laxity.

A double chin may be caused by lax skin and/or fat. These can be treated with liposuction and/or a neck lift.

Usually time is the critical factor. Swelling will go away naturally as you heal.

I tell my patients to eat healthy, exercise regularly, avoid smoking, and avoid medications or herbal supplements that can cause bleeding.

I have patients try to sleep with the head slightly elevated, and also wear sunscreen after the stitches are removed. I also want them to limit their exertion for a few weeks after surgery.

I usually have patients avoid aerobics for about 3 weeks and heavy lifting or exertion for about 6 weeks.

Most bruising will usually go away within 1-2 weeks.

The recovery can vary from patient to patient. This also depends upon the type of operation performed. In general, most facelifts are done in my accredited ambulatory surgery center and therefore go home the same day. I prefer that my patients go home with a nurse who can take care of them for a day or two if possible. Many of my patients have one or two drains that drain fluid from the face and neck region. These are often removed after a few days. Sutures are taken out over the first one to two weeks. Most patients will have some bruising and generalized swelling. The facial bruising usually goes away within a week to ten days but can last a bit longer for some. The facial swelling can last three to six weeks, but may persist to a small extent for several months after that. If patients have had fat injection, the swelling may persist a bit longer. Most patients can go back to light desk work within seven to ten days. Many can start light aerobic activity within about three to four weeks and then advance to more strenuous activity within about six to eight weeks.

There is not set amount of times a patient can undergo a facelift. I know of patients that have had 3 or more.

The question is what is a mid-face lift procedure. There are many different kinds and so the fee will vary.

A laser face lift is a marketing tool name. There is no specific laser that can perform a face lift.

A facelift result is permanent in the sense that there will always show some change. The quality of the result will vary from patient to patient based upon many factors.

A face and neck lift fee can vary from surgeon to surgeon. It can be as little as $5k and some charge more than $50K.

Usually a facelift improves the cheek, the jawline, and the neck.

A face and neck lift fee can vary from surgeon to surgeon. It can be as little as $5k and some charge more than $50K.

Another name for facelift is a rhytidectomy.

Facelifts are not usually very painful. It is more incisional discomfort that people have to deal with.

There are many different types of mid facelifts that will work to elevate the cheek soft tissue.

A neck lift is a neck lift. This is often done as a component of a facelift.

A face and neck lift fee can vary from surgeon to surgeon. It can be as little as $5k and some charge more than $50K.

A non-surgical facelift usually refers to facial filler product injection, botox injections, and laser treatments.

A deep plane facelift is a facelift that elevates the SMAS and the skin usually as one component.

A thread lift is a procedure incorporating either absorbable or non-absorbable sutures to lift the face through limited incisions.

A person is a candidate for a facelift when they have soft tissue descent of the cheeks, lax skin in the neck, and jowling.

There is no one best age for a facelift. It really is when the patient has signs of facial aging that warrant a facelift procedure.

In general, facelift surgery is safe. The most common issues that develop are prolonged skin numbness which often improves as the swelling goes down, and bruising which can last one to two weeks for most patients. Other less common risks include skin necrosis, fat necrosis, hematomas, fluid collections like seromas, infections, and contour irregularities as well as unfavorable scarring. While quite rare, there have been some reports of facial nerve injuries which can result in facial animation weakness. Many of these go on to heal without any sequelae or any need for further surgical intervention, and fortunately they are quite rare. Most of these procedures are performed under local anesthesia with sedation or general anesthesia, and of course there are some risks. Thanks to modern technology and advancements of anesthesia techniques, the risks of anesthesia are extremely low.

Facelifts are commonly performed on patients from their 40’s all the way into their 80’s! Some patients who prematurely age due to weight loss, extensive sun exposure, and genetic variability have come in for facelifting in their mid-40’s, while, there are many that come in much later. It really varies in terms of age. Initially, people present with facial soft tissue sagging in their cheeks, jowl area, and necks. They notice loose skin as well. Some of these patients show early signs of aging and quite often can benefit from facial fillers to stave off surgical intervention. Eventually, facial rejuvenation surgery is warranted. I see many patients that have seen doctors that can not perform surgery that have overcompensated by overfilling patients’ faces, and these same patients can look a bit puffy. I always tell my patients that I have a full tool belt of potential treatments that I can offer. While I do not think that everyone needs surgery, I think many require a delicate balance of filler products, neuromodulators like Botox, and facial surgical rejuvenation procedures. Over the past several years, I have added facial fat grafting to many procedures because I think that facial aging is a combination of both deflation and sagging. I do not think that one specific procedure or non-surgical intervention is right for every patient. Many times it is a mix of both to get a very natural, long lasting result.

A limited scar facelift is one in which the incision used courses from the top of the ear or sideburn region superiorly, and extends to the base of the earlobe or just behind it. It is best in patients that do not have a lot of redundant skin who undergo a SMASectomy or a SMAS plication. SMAS stands for the superficial muscular aponeurotic system.

Usually the deeper tissues of the face are repositioned as opposed to pulled. The skin should not be used to lift the tissues. The skin should be draped in a more perpendicular orientation to the incision so it does not potentially lead to telltale signs of a facelift, such as lateral swoops of skin.

Quite often the neck is treated at the same time as the face. The two are strongly interconnected and to just treat the face would create an imbalance with the neck and it would look out of place.

Facial aging usually consists of two main problems. One is deflation or soft tissue atrophy, and the second is skin laxity or poor elasticity. For many patients, fat injection is a nice adjunct to provide volume to the face while elevating, draping the skin and removing the excess. However, too much of either one (skin excision or fat injection) may lead to unnatural results.

The recovery for a facelift is relatively easy for most patients. I like patients to go home with a light dressing and to keep their chin to neck angle about 90 degrees for the first week or so to avoid tension on the incision closures. Often if drains are used, they will be removed within a few days. I usually remove about half of the sutures within a week and the remainder by 10-14 days after surgery. Many patients can go back to work within a week to ten days but residual bruising might be present.

Many patients can return to work within about one to two weeks. There may still be some bruising after this time, but for women, make-up can be applied to camouflage any bruising.

The type of facelift performed and who is doing the procedure will determine where the incisions will be placed. Traditionally the incision starts in the temporal hairline and extends in front of the ear tragus and then goes behind the ear and back into the occipital hairline. I have found that these incisions are not always best in patients with severe skin laxity. This results in loss of good quality hair along the neck and the side-burn. Additionally, the pre-tragal incision can leave a very noticeable scar. I prefer in many cases, to place the upper portion in front of the hairline or sideburn to preserve the hair in this region. Typically, I will also place the incision behind the ear tragus, which is called a retrotragal position. In turn, this will better camouflage the incision in this area. When the incision goes behind the ear, I often like to keep it along the hairline as well to avoid loss of hair in this region. If performing a limited incision facelift, then the incision starts near the side-burn and ends at the base of the earlobe, or slightly behind it. My goal is to use the least amount of incisions and maintain a natural ear appearance and hairline to avoid telltale signs of a facelift.

It was fairly common during a traditionally designed facelift that the hairline along the sideburn and behind the ear would sometimes be distorted. Patients would sometimes get the windswept appearance. In my opinion, the goal is to preserve the hairline and maintain a very natural look. Often I will set the incision along the border of the hairline so that the hairline is not distorted.

Poor quality work is often related to unfortunate designed incisions, poor execution, and a lack of understanding the various techniques to improve the facial appearance. I think a good quality facelift is one that does not look strange or weird. The goal is to provide high quality work that maintains a very natural appearance while improving the facial aging.

Lateral sweep lines occur along the side of the face in some individuals after a facelift. This can be due to improper re positioning of the skin during a facelift. In my opinion, it happens more commonly in those patients when the surgeon pivots the skin in a superior fashion to lift the face. In general, I believe that the deeper tissues should be used to reposition the soft tissue, and the skin should be draped perpendicular to the incision in most cases. This should minimize the risk of sweep lines.

When ears are pulled down after a facelift onto the cheek, this is sometimes referred to as a pixie ear because of the pointed nature along the attachment of the earlobe to the face. This happens when there is too much tension on the face skin or when the earlobe is detached from its normal position. Patients have come to me with this problem from prior work done by others. I have fixed this by hitching up the skin underneath the ear and detaching the lobe from the cheek to allow it to properly dangle.

The nasolabial creases run alongside the mouth up to the nose, and often are accentuated with smiling. As a person ages, the soft tissues deflate and sag and the nasolabial folds often become deeper. Sometimes facial fillers like the hyaluronic acid products can help improve this area. Fat grafting can do the same, and may be a more permanent solution. Facelift techniques can be performed that will lift tissues around the cheek and will help soften the nasolabial folds. Effacing or completely flattening the folds can be performed but is not recommended. Nasolabial folds are part of the normal facial anatomy and should be present to some extent. Removing them completely causes patients to look a bit robotic.

Perioral rhytids or lip lines are not treated by a facelift per se. They can be treated at the same time as an ancillary procedure. Often laser procedures using Erbium, CO2, or Fraxel can help improve the quality of the lip lines. Dermabrasion is another method to soften the lines. Sometimes I will use a neuromodulator such as Botox/Dysport/Xeomin to weaken the muscle a bit. Fillers can be used to fill the lines as well.

A face after a lift should not feel too tight. Certainly the deeper tissues will be repositioned and so some internal tightness may be felt, but the patient should be able to turn their head back and forth and lift their chin upward. Over the ensuing few weeks post-op, as the swelling subsides, the tissues become softer and more mobile.

A composite facelift is a type of facelift that entails elevating the SMAS (the superficial muscular aponeurotic system) with the skin as one unit. This also includes repositioning the orbicularis oculi (the muscle around the eye in the same flap). It is different from the subperiosteal facelift.

A subperiosteal facelift is a technique that works mainly on the upper two-thirds of the face. This procedure elevates the soft tissues of the cheeks and forehead below the level of the soft tissue just above the bone. Commonly this is performed with an endoscope, a small camera, to assist with the dissection. It does not treat the neck directly.

MAC’s lift refers to Minimal Access Cranial Suspension. A short scar facelift approach is performed, and looped sutures are used in the upper neck and cheek region to vertically raise the tissues. The advantage is a shorter operation using shorter incisions. However, it does not really treat the neck to any degree, and in someone who has severe laxity of the soft tissues, may be a better candidate for a more traditional approach.

SMAS refers to the superficial muscular aponeurotic system. This is a connective tissue layer superficial to the muscles but deep to the subcutaneous fat layer. When a high SMAS extended facelift is performed, the SMAS is released at or above the malar eminence and extended across the cheek region just past the region of the zygomaticus major muscle. This allows for elevation of the malar fat pad and enhancement of the cheek region. The soft tissue can be suspended in a superolateral vector and even imbricated to augment the cheek region. This is a very versatile procedure and I use it quite often on my patients.

A short scar facelift is any one of a number of operations that refers in general to the length of the incision used to perform the facelift. It often runs from the side-burn extending downward by the ear and stopping just at the earlobe or slightly behind it. Various techniques to treat the deep tissue can be offered with this approach. It may not be appropriate for someone with severe skin laxity.

In the analysis of all new patients, I always examine the entire face and discuss treatment options as indicated. The surgery is individualized for each patient and is not necessary in everyone. If the patient could benefit from eye surgery and/or brow surgery, it can be staged at a later time or not done at all. This really depends on the individual patient’s desires. Of course, if only the facelift is performed than a youthful lower two-thirds of the face will be out of sync with a tired looking upper one-third of the face. Nevertheless, the choices are always up to the patient.

One way to avoid the removal of the sideburn and temporal hair is to properly design the incisions for a facelift. In addition, the ear can sometimes be distorted looking like an elf or pixie as well. I spend a lot of time designing and properly closing the incisions so that the risk of these deformities is minimized. This also adds a lot of time to the overall surgical procedure, but it is well worth the result!

The pulled look is commonly the result of actually pulling on the skin to give the lift and pulling it too tightly. Some surgeons use the skin to lift the face in a supero-lateral vector. The skin is pulled tightly to try to elevate the deeper soft tissues and as a result, distorts the face. I usually mobilize the deeper layers of the face to obtain the proper contour and then only remove the redundant skin as necessary.

A facelift results will vary based upon many different factors including a patients genetics, the quality of their skin, their age, etc.. It is hard to predict.

Fat transfer is a procedure that can provide permanent results. I usually find that about 60-70% of the fat will survive, so additional procedures may be necessary. But this can vary from patient to patient.