The continued force of gravity can have a profound effect on the lower face, creating jowls along the jawline, deep folds around the mouth, and excess skin hanging under the chin (the “turkey waddle”). A facelift, or rhytidectomy as the procedure is termed, tightens sagging skin on the lower face and upper neck. This is usually the most dramatic and direct means of reversing the signs of aging.
A facelift is the surgical procedure that removes this excess skin along the lower third of your face and often leaves a facial appearance many years younger. Maintaining a natural appearance rather than an artificial and “wind blown” look is an absolute premium and remains of paramount importance. The significance of this will be elaborated on during the consultation but it often means that not every wrinkle can be removed.
Understanding the Procedure
A facelift is usually performed under general anesthesia where you are totally asleep. In the operating room, a local anesthetic is placed around the face and the areas are thoroughly cleansed with special antibacterial soaps. The incision for a facelift is in the hair of the temple, around the ear, and back into the hair behind the ear (Figure 1). Occasionally a small incision is made under the chin in order to gain access to sagging skin or muscles in this area. One occasionally removes excess fat (liposuction) or tightens some of the neck muscles of this region (platysmal placation). Small modifications are made with men in order to avoid distorting the sideburns and other hair-bearing skin. The only part of the incision that is exposed is immediately in front of the ear lobe and it is designed in a way to be maximally camouflaged.
Through these incisions the skin and deeper tissues are carefully lifted and pulled up and back in order to tighten the lower face and upper neck regions. The excess skin is then removed from around the ears. Great care is taken to smooth out the jowls without creating an unnatural or “operated on” appearance. Maintaining a youthful but natural look is of greatest priority in facelift surgery. The incisions are closed in multiple levels and for the final layer, we use a very fine suture that will dissolve on its own. Incisions within the hair are closed with staples and removed about 10 days after surgery.
What to Expect After the Surgery
A large bandage is placed at the conclusion of the operation in order to maintain pressure on all areas that have been tightened. This bandage is cumbersome but essential in order to achieve an optimal result. Although the bandage is needed for pressure only to the lower face, a circumferential wrap is necessary in order to ensure that it does not slip off. This bandage should be kept dry, so bathing can only be performed from the neck down. This will be removed and replaced a day or two after surgery. For the second week, you will be given an elastic bandage which can be taken on and off as needed. We recommend wearing this most of the day, but it can be removed to shower, dine, or travel out of the house. From this point on, the incisions are exposed and it is imperative that they are kept clean and covered with a layer of ointment. They can be washed with warm water and regular soap. Avoiding sun exposure is essential during this recovery period.
Once you return home, it is best to relax with your head elevated, such as in a reclining chair or in bed with multiple pillows. Keeping your head elevated will minimize swelling. Because of the large bandage, most people find it difficult to eat full meals and softer foods are generally better tolerated. The incisions are all protected under the bandage so no specific wound care is needed.
Your first post-operative visit is usually the first day after surgery. At this time, your surgeon will remove the bandage in order to inspect the areas. At this time, the wounds will be thoroughly clean and a smaller dressing reapplied. This remains in place for 4-6 days after surgery. The second visit is about a week later where the head wrap is removed and the elastic bandage is provided. After this point, you may wash your hair and carefully brush or comb it, being careful of the staples. The staples will be removed about 10 days after surgery.
Bruising and swelling are inevitable with a facelift and generally occur in the neck and lower facial areas. This bruise is not unlike any other bruise on your body and usually requires a couple of weeks to resolve on its own. Camouflage makeup can be applied over the bruised areas to better conceal them. At times the bruising will migrate down onto your chest. This is perfectly normal and only reflects the effects of gravity. Like all bruises, they will transition through different colors and intensities. Once the bandages are removed you will be instructed on specific wound care such as cleaning the incisions and liberal use of a moisturizing ointment.
Pain is usually minimal throughout the recovery. Rather than pain, however, the bandage is a nuisance and tends to be the worst part of the recovery phase. The anesthesia can also have lingering effects and make people feel fatigued or lethargic. Nausea is not uncommon for the first day after surgery. In general, pain should never increase as days pass. If this does occur, you should notify your surgeon.
Frequently Asked Questions?
How long will the effects of a facelift last?
There are two ways to view the duration of a facelift. First, they can last forever in the sense that the effects of the operation will remain with you as you continue to age. For example, if a facelift gives the appearance of being 10 years younger, it will continue to do so as time goes by and you will always appear younger than if you had not had the surgery. On the other hand, the force of gravity will act on the tightened skin shortly after surgery and traces of recurrent sagging will inevitably occur eventually; the “new” face is not immune to the normal aging process. In reality, the lifted skin appears to age slightly slower than normal skin due to the scarring that occurs beneath the skin.
If I have a facelift, will I ever need another one?
Although revision lifts are easily performed, a great majority of patients have only one facelift. The impression is that many people may want to look ten years younger at some point in their lives, however, during more senescent years, they are content with appearing their chronologic age. This is a personal decision and as people stay healthier longer, there appears to be a trend for second and third aesthetic procedures.
What complications can arise from a facelift?
Fortunately, complications are extremely uncommon, but a number of them are possible and they are reviewed in greater detail with the surgeon in person. All-important structures of the face are at some risk during a facelift. This includes damage to the nerve that animates your face and nerves that provide sensation to the face, leading to numb areas of skin. There can be unusual bleeding, necrosis to patches of skin, and unusual scarring.
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