Face Lift Surgery
if you’re considering a facelift...
As people age, the effects of gravity, exposure to the sun and the stresses of daily life can be seen in 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 rhytidectomy) can’t stop this aging process. What it can do is set back the clock, improving the most visible signs of aging by removing excess fat, tightening underlying muscles, and redraping the skin of your face and neck. If you’re considering a facelift, this brochure will give you a basic understanding of the procedure: when it can help, how it is performed and what results you can expect.
Images © ASPS/ASAPS 2008.
The best candidates for a facelift
The best candidate for a facelift is a person whose face and neck have begun to sag, but whose skin still has some elasticity and whose bone structure is strong and well-defined. Most patients are in their forties to sixties, but facelifts can be done successfully on people in their seventies or eighties as well.
A facelift can make you look younger and fresher. It may enhance your self-confidence in the process, but it can’t give you a totally different look, nor can it restore the health and vitality of your youth. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.
All surgery carries some uncertainty and risk
Complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, their 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 anaesthesia. Poor healing of the skin is most likely to affect smokers.
You can reduce your risks by closely following your surgeon’s advice, both before and after surgery.
Planning your surgery
Facelifts are very individualized procedures. In 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 clotting. If you are smoking, please stop smoking for at least 2 months before the procedure date. This will help expedite your recovery period and encourage better healing on cellular level.
If you decide to have a facelift, your surgeon will explain the techniques and anaesthesia that will be used, the type of facility where the surgery will be performed, and the risks and 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 after 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 if needed.
Where your surgery will be performed
Types of anaesthesia
A facelift usually takes one to two hours — or somewhat longer if you’re having more than one procedure done. Every surgeon approaches the procedure in his/her own way. Some complete one side of the face at a time and others move back and forth between the sides. The exact placement of incisions and the sequence of events depends on your facial structure and your surgeon’s technique.
Incisions usually begin above the hairline at the temples, extend 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 skin. Stitches secure the layers of tissue and close the incisions. Following surgery, a small thin tube may be temporarily placed under the skin behind your ear to drain any blood that might collect there.
After your surgery
After your surgery
There isn’t usually significant discomfort after surgery; if there is, it can be lessened with the pain medication prescribed by your surgeon. If you are smoking, please stop smoking for at least 2 months before the procedure date. This will help expedite your recovery period and encourage better healing on cellular level. (Severe or persistent pain or a sudden swelling of your face should be reported to your surgeon immediately). Some numbness of the skin is quite normal; it will disappear in a few weeks or months. Keep your head elevated and 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 three (3) days after surgery. Bandages, when used, are usually removed after one to five days. Don’t be surprised at the pale, bruised, and puffy face you see. Just keep in mind that in a few weeks you’ll be looking normal.
Most of your stitches will be removed after about two (2) to three (3) weeks.
Getting back to normal
You should be up and about in a day or two, 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 more specific guidelines for gradually resuming your normal activities. They’re likely to include these suggestions: 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, you’ll look and feel much better. Most patients are back at work within ten days to two weeks after surgery. If you need it, special camouflage 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 the results may not be immediately apparent. 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-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 ten years down the line. 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.