Facelift

As people age, they usually gain some weight and, as tissues lose elasticity, gravity pulls the face downward. The result in the lower part of the face is the development of jowls, facial folds around the mouth area, and excess fat and skin under the chin. In addition, the skin stretches and wrinkling occurs. Ultimately, there is a gradual transition to a “bulldog” look and loss of the sharp angle between the chin and neck, which is an important factor in having a youthful appearance.

The facelift it is the gold standard for reversing these changes. This is accomplished through incisions hidden in the natural creases around the ear, which are extended along the hairline behind the ear and also for a short distance in front above the “sideburns”. The skin is elevated about halfway to the midface. If there is a lot of excess skin under the chin, a small incision is made here and the skin under the chin is elevated as well. Excess fat under the chin is removed and liposuction under the edge of the jaw bone is done to thin and sculpt this junction of the face with the neck. Most, but not everyone, will benefit from some fat removal under the chin. While some people can have this part done without a facelift, it is considered to be part of the typical facelift. After the skin has been elevated, attention to the sagging tissue under the skin is addressed. A second, shorter elevation of the underlying tissue in front of the ear is done. This tissue is pulled up and back, pulling the excess underlying tissue tighter and reducing the heavy jowls and folds around the mouth and jaw. Five or six very strong sutures are placed on each side to hold this tissue tightly. Afterwards, the skin is then carefully draped around the ear and hairline incisions and the excess is excised. It is critical to have a perfectly closed incision in front of the ear so this scar is not visible. This area is closed with delicate perfectly placed sutures while the thicker skin in the hairline is usually closed with staples. Some surgeons occasionally place drains under the skin for removal later. All patients will have a bulky cotton pressure dressing wrapped around the sides of the face and neck so that the skin will heal to the underlying tissue. This is usually removed in a few days and replaced with a lighter wrap.

I like to remove the stitches around the ear in three to five days to avoid the risks of visible stitch marks. The staples are usually removed from the hairline incisions in seven to 10 days.

The surgery usually takes around three hours and can be done in conjunction with other procedures such as eyelid or brow surgery. Most people don’t have much pain, but the bulky dressing the first few days can be pretty bothersome. Staying sedated the first few days with the medication provided after surgery helps get through the “bulky bandage” period and after that, recovery is very easy. The face is usually a little puffy after a week, but often very publicly presentable. The neck bruising is usually the most noticeable thing after a week and can take two weeks or more to clear, and is best hidden with a scarf. While some people might feel comfortable in public after one week’s recovery, planning on two weeks would be a safer bet.

Because a facelift is a bigger and more expensive procedure with a longer recovery time, it is important that you communicate thoroughly with your surgeon and listen to their advise so that both of you will be happy with decisions you need to make together.

I have often seen women asking about facelifts when they really were not ready for one yet. As an honest physician acting in the best interest of my patient and not my pocketbook, I will recommend they wait a few years. Just like any other good physician, I take pride in my work and I want every patient I operate on to be delighted with the results and what it took to get them. Nothing makes a surgeon happier than to have a happy patient with good results, and that is the ultimate goal.

 

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