About Plastic Surgery

CONSIDERING A FACELIFT?

As people age, the effects of gravity, exposure to the sun and the stresses of daily life can be seen on their faces. Deep creases form between the nose and mouth. The jawline grows slack and jowly. Folds and fat deposits appear around the neck.

A facelift (technically known as a rhytidectomy) can't stop the aging process. What it can do, however, is turn back the clock, improving the most visible signs of aging by removing excess fat, tightening underlying muscles, and redraping the skin on your face and neck. A facelift can be done alone, or in conjunction with other procedures, such as a forehead lift, eyelid surgery or nose reshaping.

If you're considering a facelift, you’ll want a basic understanding of the procedure:

• When it can help
• How it's performed
• And the results you can expect

However, the best explanations can't answer all of your questions, since a lot depends on the individual patient and the surgeon. Please ask your surgeon about anything you don't understand.

THE BEST CANDIDATES FOR A FACELIFT 

The best candidate for a facelift is a man or woman whose face and neck have begun to sag, but whose skin still has some elasticity and whose bone structure is strong and well-defined. While most patients are in their 40s, 50s and 60s, facelifts can be done successfully on people in their 70s or 80s as well.

A facelift can make you look younger and refreshed, and it may enhance your self-confidence in the process too. But a facelift won’t give you a totally different look, nor can it restore the health and vitality of your youth. Before you decide to have surgery, carefully consider your expectations and discuss them with your surgeon.

ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK 

When a facelift is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, physical reactions and healing abilities, and the outcome is never completely predictable.

Complications that can occur include:

• Hematoma (a collection of blood under the skin that must be removed by the surgeon)
• Injury to the nerves that control facial muscles (usually temporary)
• Infection
• And reactions to the anesthesia

In addition, smoking can cause slow healing. In fact, poor healing of the skin is most likely to affect smokers.

Reduce your risks by closely following your surgeon's advice both before and after surgery.

PLANNING YOUR SURGERY 

Facelifts are very individualized procedures. During your initial consultation, the surgeon will evaluate your face, including the skin and underlying bone, and discuss your goals for the surgery.

Your surgeon should check for medical conditions that could cause problems during or after surgery, such as:

• Uncontrolled high blood pressure
• Blood clotting problems
• Or the tendency to form excessive scars

Be sure to tell your surgeon if you smoke or are taking any drugs or medications, especially aspirin or other drugs that affect blood clotting.

If you decide to have a facelift, your surgeon should explain:

• The techniques and anesthesia that he or she will use
• The type of facility where the surgery will be performed
• The risks
• And the costs involved

Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results.

PREPARING FOR YOUR SURGERY

Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly. 

If you smoke, it's especially important to stop at least a week or two before and following surgery. Smoking inhibits blood flow to the skin and can interfere with the healing of your incision areas.

If your hair is very short, you might want to let it grow out before surgery so that it's long enough to hide the scars while they heal.

Whether your facelift is being done on an outpatient or inpatient basis, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two at your home, if necessary.

WHERE YOUR SURGERY WILL BE PERFORMED 

A facelift may be performed in a surgeon's office-based facility, an outpatient surgery center, or a hospital. Facelifts are usually done on an outpatient basis, but some surgeons may hospitalize patients for a day when using general anesthesia. Certain conditions, such as diabetes or high blood pressure, should be monitored after surgery and may also require a short inpatient stay.

TYPES OF ANESTHESIA

Most facelifts are performed under local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and not able to feel pain in your face because of the anesthesia. (However, you may feel some tugging or occasional discomfort.) Some surgeons prefer a general anesthesia. In that case, you'll sleep through the operation

THE SURGERY 

A facelift usually takes several hours or somewhat longer if you're having more than one procedure done. For extensive procedures, some surgeons may schedule two separate sessions.

Every surgeon approaches the procedure in his or her own way. Some complete one side of the face at a time, and others move back and forth between the sides. The sequence of events and exact placement of incisions depends on your facial structure and your surgeon's technique.

Incisions usually begin above the hairline at the temples, extend down in a natural line in front of the ear (or just inside the cartilage at the front of the ear) and continue behind the earlobe to the lower scalp. If the neck needs work, a small incision may also be made under the chin.

In general, the surgeon separates the skin from the fat and muscle below. Fat may be trimmed or suctioned from around the neck and chin to improve the contour. The surgeon then tightens the underlying muscle and membrane, pulls the skin back, and removes the excess. Stitches secure the layers of tissue and close the incisions. Metal clips may also be used on the scalp.

Following surgery, a small, thin tube may be temporarily placed under the skin behind your ear to drain any blood that might collect there. Your surgeon may also wrap your head in loose bandages to minimize bruising and swelling.

AFTER YOUR SURGERY

There isn't usually significant discomfort after surgery. If there is, it can be lessened with pain medication prescribed by your surgeon. (Immediately report severe or persistent pain, or sudden facial swelling, to your surgeon.) Some numbness of the skin is quite normal and should disappear in a few weeks or months.

Your doctor may tell you to keep your head elevated and as still as possible for a couple of days after surgery to keep the swelling down.

If you've had a drainage tube inserted, it will be removed one or two days after surgery. When used, bandages are usually removed after one to five days. When that happens, don't be surprised if you see a pale, bruised and puffy face. Just keep in mind that in a few weeks you'll be looking normal.

Most of your stitches will be removed after about five days. Your scalp may take longer to heal, and the stitches or metal clips in your hairline could be left in a few days longer.

GETTING BACK TO NORMAL 

You should be up and about in a day or two after your facelift, but plan on taking it easy for the first week after surgery. Be especially gentle with your face and hair, since your skin will be both tender and numb, and may not respond normally at first.
Your surgeon will give you more specific guidelines for gradually resuming your normal activities, including:

• Avoid strenuous activity, including sex and heavy housework, for at least two weeks (walking and mild stretching are fine).
• Avoid alcohol, steam baths and saunas for several months.
• Above all, get plenty of rest and allow your body to spend its energy on healing.

At the beginning, your face may look and feel rather strange. Your features may be distorted from the swelling, your facial movements may be slightly stiff and you'll probably be self-conscious about your scars. Some bruising may persist for two or three weeks, and you may tire easily. It's not surprising that some patients are disappointed and depressed at first.
By the third week, however, you'll look and feel much better. Most patients are back at work about 10 days to two weeks after surgery. If you need it, special makeup can mask most bruising that remains.

YOUR NEW LOOK 

The chances are excellent that you'll be happy with your facelift, especially if you realize that results may not be immediately apparent and full healing will take time. Even after the swelling and bruises are gone, the hair around your temples may be thin and your skin may feel dry and rough for several months. Men may find they have to shave in new places, such as behind the neck and ears, where areas of beard-growing skin have been repositioned.

You'll have some scars from your facelift, but they're usually hidden by your hair or in the natural creases of your face and ears. In any case, they'll fade within time and should be scarcely visible.

Having a facelift doesn't stop the clock. Your face will continue to age with time and you may want to repeat the procedure one or more times, perhaps five or 10 years from now. But in another sense, the effects of even one facelift are lasting: Years later, you'll continue to look better than if you'd never had a facelift at all.

Source: American Society of Plastic Surgeons

 

FACE TREATMENT GUIDE

Browlift (Forehead Lift)	raise the forehead and eyebrows to create a more pleasant, rested appearance
Cheek Augmentation	using fillers, implants, or grafts to contour and angle the cheeks
Cheek Fat Removal (Buccal Fat Pad Excision)	removal of fat in the lower cheeks to slim and contour the face
Ear Surgery (otoplasty)	pinning back of prominent ears or reducing and reshaping overly large or malformed ears
Endoscopic Facial Surgery	minimal-incision surgery using tiny cameras and long instruments; for browlift, facelift, midface lift
Eyelid Ptosis Surgery	raise one or both droopy upper eyelids to restore an alert appearance and possibly improve visual fields
Eyelid Surgery (Blepharoplasty)	remove excess skin and tissue of the upper and/or lower eyelids to improve appearance
Eyelid Tightening (Canthoplasty)	correct sagging lower eyelids caused by aging or previous surgery
Facelift (Rhytidectomy)	reduce jowls under the cheeks and improve the jawline and neck for a more youthful look
Facial Implants - Cheek, Chin, Jaw, Midface, and Tear Trough	improve facial contour, projection, and fullness with facial implants
Fat Injections (Fat Transfer)	transplant fat from one area of your body to the face or lips to correct hollowness and / or add fullness
Lip Augmentation	temporary or permanent injectables or surgery with or without implants creates fuller, more appealing lips
Lip Lift	remove a thin strip of upper lip skin to surgically raise the lip and yield the appearance of a fuller lip
Lip Reduction	reduce the size of the upper and / or lower lip by removing a thin strip of tissue
Liposuction - Cheek, Jowl, Chin, and Neck	small volumes of fat are removed through tiny tubes to contour the face and neck
Midface Lift (Cheek Lift)	raise the middle of the face, the cheek, to enhance cheek and undereye fullness and contour
Neck Lift	remove excess skin to raise the neckline, correct "turkey neck", and improve your profile
Neck Muscle Repair (Platysmaplasty)	repair a separated muscle under the chin and in front of the neck to create a better neckline
Nose Surgery (Rhinoplasty)	reshape the nose for a more aesthetically desirable appearance
Revision Rhinoplasty	repair previous nose surgery to improve contour, projection, support, and overall appearance
Soof Lift	raise the fat pad (sub-orbicularis oculi fat) at the top of the cheeks to improve cheek and undereye contour