When the term
face-lift is brought up, many people think of
a skin tightening procedure. This, in fact, used to be true
up until about 10 years ago. At that time plastic surgeons
began serious evaluation of the causes of facial aging. What
we have discovered is that skin stretching over time is only
a small part of the aging process. Other factors not previously
considered but very important have been found to be the major
contributors. Facial rejuvenation requires that all the contributing
factors be corrected in order to produce the most aesthetically
pleasing, natural result. The fruit of this research is that
face-lifting is much more predictable and effective at re-creating
the youthful appearance we once had.
If you look at any model, male or female,
you will see high cheeks that are full of fat. Now, look
at an older person. You will see that this facial fat has
fallen from the cheek area and now is located in the fold
above the upper lip and in the jowl area at, or even below,
the mandibular border. The results of facial aging are quite
predictable but only a small part of it is because of skin
stretching.
It is a very exciting time in plastic
surgery because we are just beginning to ”solve the
puzzle” of facial aging. Even though facial aging affects
the entire face and neck, sometimes a patient is really only
concerned with a particular area such as the neck. In this
situation, only the neck needs to be addressed. Many times
patients decide to have only their neck done because it bothers
them the most. Frequently, they are so impressed with the
results that they later have their face and forehead addressed
as well. This is an excellent way to approach facial rejuvenation.
You should only have corrected what really bothers you. You
can always come back and have other things done.
Most doctors technique for face-lifting
addresses ALL the causes of facial aging. It is not a skin
pulling procedure that is commonly practiced. Primarily,
it involves elevating the facial fat that has fallen into
the upper lip/cheek fold and into the jowl area. This fat
is then suspended back up to the cheek area where it should
be. This has a three-fold effect. It helps to reduce the
prominent upper lip/cheek fold and also re-creates a fuller
cheek area similar to that of youth. In addition, elevating
the fat from the jowls exposes the mandibular border. This
effectively widens the face at the cheek level and narrows
it within the jaw area. By doing this, an elegant triangular
shape is recreated. Look at yourself and an attractive young
model and then at a person with obvious facial aging. The
youthful model will have a triangular shape whereas the face
of the older person will have a more rectangular shape. Men'sy
doctors have developed sophisticated techniques to recreate
this triangular shape without an operated look.
Now, with the fat and muscles properly
re suspended the skin is draped over the face and any excess
skin is removed. The skin does not look tight or unnatural.
As far as the neck is concerned, our
doctors have developed a unique technique utilizing suture
suspension to elevate the tissues of the neck. This dramatically
tightens the hanging skin and eliminates the banding under
the chin that is so common with aging. This creates a neck
with a high, sharp angle above the Adams apple like that of
youth. This is discussed in more detail within the neck-lifting
section of this web site.
The results of face lifting and neck
lifting are quite dramatic. They can easily take 10 to 20
years off of your apparent age. You must, however, understand
that the aging process never stops. So, eventually the procedure
may need to be repeated in 10 to 15 years. Some people say,
Why bother? For them, it doesn't matter. But
for most people, if they can turn the clock back 10 to 20
years, it has a huge impact on their state of mind and subsequently
quality of life.
Benefits
The benefits of face lifting are numerous.
As mentioned above, the effect of “turning back the
clock” is profound in terms of state of mind and quality
of life. The results can be summarized as follows.
- Elevates fat that has fallen down
to the fold above the upper lip and back into the cheek
area.
- Elevates fat in the jowl area and
also back into the cheek area.
- Markedly reduces facial wrinkles and
excess skin.
- Markedly improves the fold above the
upper lip known as the nasal labial fold.
- Markedly reduces jowling or the hanging
skin at the jaw line.
- Creates a youthful, triangular facial
shape.
- Can address neck without touching
the face or vice versa to accomplish the desired results.
Are
you a good candidate?
No one is immune to facial aging. It
is true, some ethnicities tend to age slower, but the descent
of facial fat and muscles, as well as the stretching of skin,
occurs in everyone. If it bothers you, you should have something
done. If you look at your face and think that you look older
than you feel, this may actually make you feel older somewhat
like a self-fulfilling prophecy. Good candidates include
those with the following.
- Jowling or fat accumulation
along the jaw line.
- Markedly pronounced fold above the
upper lip otherwise known as nasal labial fold.
- Saggy facial skin.
- Deep facial wrinkles.
- Deep circles underneath the eyes.
- Loss of cheek fat.
- Loss of youthful look.
- Corners of mouth have fallen down.
The candidates for neck lifting are referred
to the neck
lift section.
It should be mentioned that face lifting
does not improve the texture of the skin. This is best managed
with chemical
peeling or laser
skin resurfacing which would be done separately from the
face lift.
Possible
complications
The most common complication after face lifting is inadequate
resuspension of the facial tissues. The cause of this is
usually because the facial fat has faded away with time so
that it is not available for resuspension. In this case,
it may be beneficial to transplant fat into the areas where
it no longer exists. This is rarely necessary. Other risks
include asymmetry, nerve injury, infection, blood and fluid
collection, and unfavorable scarring. A list of possible complications
is provided by the American Society of Plastic Surgery and
this will be discussed and given to you during your consultation.
Do's
and Don'ts prior to surgery
-
Medications.
Certain medications thin your blood and should not be
taken within 3 weeks of surgery. The most notable is
aspirin and aspirin containing products. Vitamin E and
many herbal products also thin the blood and should not
be used within 3 weeks of surgery. Your doctor will go
over this more thoroughly prior to the procedure.
-
Sleep. It is important to get a good night's rest prior to the
procedure. If you think this may be a problem, please,
do not hesitate to ask your doctor for something to help
you sleep.
-
Smoking.
It is imperative that you do not smoke within 3 weeks
before and after any surgery but especially so for face
lifting. Smoking has a profound effect on reducing wound
healing capabilities. It significantly increases the
likelihood for infection, wound healing problems, and
scar formation. It also affects your airway, therefore,
making anesthesia much more difficult.
-
Eating.
Do not eat within 8 hours of surgery and do not drink
within 6 hours of surgery. Please discuss all medications
with your plastic surgeon and the anesthesiologist.
-
Washing.
It is important to thoroughly wash your face and scalp
the morning of surgery. Use more conditioner than normal
so that your hair is manageable and easy to comb. Do not
forget to wash inside your ears just like your mother
told you. After washing your hair comb it straight back
or straight down. Do not apply any clips or rubber bands. Do not apply any make up or hair spray.
-
Arrival.
It is best to arrival on time so things go smoothly.
Please be sure to have someone else drive you.
-
State of mind.
Remember, this should be a happy and exciting time. A
certain amount of nervousness is normal but you should
not be overly anxious. Excessive worrying can actually
be detrimental and you should discuss this with your doctor
prior to surgery so that something can be prescribed to
make sure you remain calm.
Anesthesia
The anesthesiologist will discuss with
you what type of anesthesia is best for you prior to the procedure. He/she will take into consideration your medical history,
the procedure, and your personal wishes.
General anesthesia is often the best
type of anesthesia for face lifting.
After
the procedure
The procedure itself will take about
3 to 4 hours but may take longer if other procedures are also
being done.
Immediately.
Right after the operation you will be watched for 1 or 2 hours
and encouraged to walk around. You will be given as much
pain medication as necessary both immediately after the operation
and for the postoperative period. Of course, there will be
swelling and bruising but there is surprisingly little pain. You will have a big head dressing on as well as ice packs
to help keep the swelling down. You must not lay with your
head down for the first week so that your face does not swell.
That
evening. It is recommended that you take
it easy. You can walk around, eat, but not too much more.
You must sit and lay with your head up on at least 3 pillows.
You should take as much pain medication as necessary and try
to go to sleep early. Apply ice packs every 2 hours for the
first 24 hours. You will be given medication to help keep
the swelling down as well as to prevent infection.
First
48 hours. You can take a cool shower the
next day. Just be gentle. Let the cool water run over your
scalp. It is important to have someone help you shower. Your
hair will be a disheveled with possibly some blood in it. Apply a generous amount of conditioner first to untangle your
hair and then wash your hair gently. Reapply another generous
amount of conditioner and then comb your hair straight back. Be careful as the comb may get caught up in the sutures or
staples. The incisions will continue to ooze for about about
3 days. You will see your palstic surgeon in his/her office
the first or second day after surgery. At that time, he/she
will take the dressings down, clean up the area, apply antibiotic
cream, make sure things are going well, and then reapply another
head dressing.
First
week. At about day 3 you can move around
normally. The majority of the bruising and swelling will
go away in about 3 weeks.
Beyond.
Swelling will not completely resolve for about 6 months but,
as mentioned above, the majority of it will be gone by 3 weeks.
Skin contraction will not start until about 4 weeks after
the procedure and will continue to contract until about 6
months. The final result will not be evident until 6 months
when all the swelling has resolved and skin contraction is
complete but you will certainly notice a significant improvement
right away.
Recovery
time
The swelling and bruising will resolve in about 2 to 3 weeks.
Some people with sedentary jobs go back to work after 10 days.
If your job, however, requires strenuous activity then it
may take as long as 4 to 6 weeks to return to work. Most
people return to work in about 2 to 3 weeks.
Consultation
We have outlined below what you can
expect from your face lift consultation. Read carefully,
as there are many suggestions that will save you time, clear
up questions, and help you convey to your plastic surgeon
what you want to accomplish.
Health
History
All cosmetic surgery consultations
begin with a thorough health history. This is especially
true if general anesthesia is being used, but also applies
to local anesthesia. Breast augmentations are usually
done under general anesthesia. Rarely, if the implant
is placed above the muscle, local anesthesia can be utilized.
Prior to meeting with your plastic surgeon you will be
given a health history questionnaire
to fill out in the waiting area. There are five areas
of your health you will be asked about. Be sure to answer
it with detail so that your surgery and anesthesia can
be optimized for you.
General health problems are important
to discuss so that your surgery is as safe as possible.
Be sure to mention any chronic illness. Of particular
concern are: high blood pressure, diabetes, heart problems,
liver and kidney disease, stroke, cancer, bleeding problems,
and wound healing problems.
What will the plastic surgeon
do if I have medical problems?
In short, he/she will make sure your
health is optimized as much as possible to ensure your
safety. This may mean referring you to your private physician.
If you have
a health problem or are over 50 years of age you can often
save yourself time by getting a letter from your private
physician prior to your cosmetic consultation stating
what the health problem is, how it is being treated, and
whether or not you are able to tolerate general anesthesia
safely.
If you are
seeing any specialist (cardiologist, kidney doctor, psychiatrist,
etc. ) be sure to bring a letter from them stating that
you are able to tolerate surgery.
If you are not able to tolerate general
anesthesia it may be possible for your breast augmentation
to be done under local anesthesia if the implant is placed
above the muscle. This must be discussed with your plastic
surgeon.
Be sure to
let your plastic surgeon know if you have ever had a blood
clot.
On your questionnaire you will be
asked about previous surgeries.
Be sure to identify any problems you may have had with
anesthesia. Of particular concern are previous
cosmetic surgeries especially if you do not like the result
and are interested in revision. With breast augmentation
it is especially important to mention all breast surgeries
including breast biopsies.
Be sure to list all medications you
take including aspirin and over-the-counter medications.
These are important as they may increase bleeding and
affect your surgery. It is extremely important to stop
taking aspirin and aspirin containing products at least
10 days before surgery. Tylenol is a good alternative.
Here is a partial list of aspirin containing products and other products
to be avoided prior to surgery.
Information about medications that
cause allergies is very important so that these medications
can be avoided. Of particular importance is the reaction
you had, especially if you had trouble breathing. Be
sure to include this information! Nausea is not an allergy
but it is important to mention as well.
These three will certainly affect
your surgery and MUST be mentioned so that your surgery
can be optimized. Smoking causes a profound decrease
in wound healing and will lead to worse scarring and a
less favorable result. With large
procedures such as a face lift, neck lift, tummy tuck,
and breast lift smoking must be stopped at least 2-3 weeks
before and after surgery. Otherwise, the results could
be disastrous leading to non-healing wounds, poor scarring,
and/or infection. With smaller procedures
such as eyelid surgery, nose surgery, breast augmentation,
and liposuction smoking will hurt the overall result but
this may or may not be noticeable. In this case smoking
cessation is strongly advised but is not mandatory.
What Do You Want To Change?
It is important that you have a clear
idea of what you want changed when you go for consultation.
The least favorite thing a plastic surgeon wants to hear
is: What do you think I need done?
Look in a mirror and identify what
bothers you. Be specific. It is helpful to break up the
face region into six parts. 1) Eye Brow 2) Upper Eyes
3) Lower Eyes 4) Temple Area 5) Cheeks 6) Jaw Line.
Evaluate each one of these areas individually as this is
what the plastic surgeon does in his exam. A face lift
does not address the first 3 problems. If you are concerned
about these areas you may be best treated by having a brow
lift, upper blepharoplasty,
and/or lower blepharoplasty
in conjunction with your face lift. Click on these areas
to see if you want more information and discuss this during
your consultation.
Common complaints
-
Temple: Crow's
feet, droopy skin
-
Cheeks:
Loose/hanging skin, loss of cheek fullness, large
nasolabial folds
-
Jaw
line: Jowling.
Ideal Facial Shape
Physical
Exam And Treatment
The key to the face physical exam is
to determine exactly what is causing the problem. Below
is a typical sequence that an experienced plastic surgeon
uses to evaluate the neck and what can be done to correct
problems.
With aging, facial fat either descends
or goes away, or a combination of both. In the temple region
this causes a sunken area characteristic of aging droopy
skin also is a result. Crow's feet with smiling are not
uncommon and are acceptable as long as they are minimal.
Permanent wrinkles and/or deep lines during smiling give
an aged appearance. A face lift will elevate some of the
descended temple fat as well as smooth out the wrinkles.
Wrinkles with smiling will not be eliminated but should
be improved. Concurrent lower blepharoplasty may be necessary
to treat significant crow's feet
Similarly, facial fat in the cheek
descends or goes away. As it falls it bunches up just above
the nasolabial crease giving the typical fallen face appearance.
During your consultation, your plastic surgeon will pinch
this area and elevate the fat upward, thus, simulating a
face lift. During a face lift, the surgeon will reposition
this upward by 1 of 3 methods.
The Three Most Common Face Lift
Methods
-
The skin is undermined to an appropriate level determined
during the physical exam. The skin is then advanced
laterally and slightly upward to put it back where it
was during youth. This effectively tightens the skin
and smoothes out the facial contour. Care is taken
to put all the skin tension above and behind the ear
so that there is minimal tension in front of the ear
itself. This avoids an operated look.
-
Subcutaneous
Face Lift with Fat Suspension
This is a Subcutaneous Face Lift but in addition
the descended fat is elevated back into position
with sutures.
-
SMAS is an acronym for Superficial Musculo-Aponeurotic
System. It is a fibrous/muscular layer under the
skin. Above it lies the cheek fat. Below it sit
the facial muscles that animate the face. A SMAS
face lift will elevate the SMAS and thus, concomitantly,
elevate the facial fat and muscles.
It has been shown
that all three types of face lifts can achieve excellent
results. Which is best for you depends on what needs to
be corrected and what your plastic surgeon is most comfortable
with.
Like the cheek, your plastic surgeon
will evaluate your jaw line by pinching the soft tissue
on top of it and elevating it to see what is the best treatment.
Jowls are a combination of fat and SMAS that have descended
with age. During a face lift this tissue is re-suspended
back into the cheek area where it belongs.
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