A facelift/necklift is an operation designed to support the sagging tissues of the face and neck. The surgery consists of lifting and repositioning the skin, removing excess fatty tissue in the jowl and neck regions, and supporting the deep facial muscles. A facelift will not remove excess skin or fat in the upper and lower eyelids or the wrinkles around the mouth. Occasionally, other procedures may be recommended with a facelift to correct these conditions. We will discuss these options with you during your consultation.
Several factors influence the rate at which your skin ages: your genetic makeup, exposure to the sun, cigarette smoking, and chemicals that damage your skin. The sagging of facial and neck tissues is generally first noticeable at around age forty. A facelift performed at this age can produce subtle changes, often helping a person maintain a youthful appearance for an extended period of time. Others experience dramatic and more noticeable results when they elect to wait until their late 60’s or 70’s when the undesirable signs of aging are well established.
The effects of a facelift can be lasting. However, this does not mean that the aging process doesn’t continue. While your face will continue to age at the same rate as before surgery, the benefits of the facelift will always be present. The duration of improvement is difficult to accurately predict, but generally five to ten years will pass before an additional tuck-up procedure may be warranted. This secondary lift serves to improve and reinforce the effects of the initial surgery.
Before your surgery we will review your medical history and perform a complete physical exam with careful analysis of your face and neck. We will take medical photographs to aid our preoperative assessment and surgical planning. We will be particularly attentive to any questions you may have at that time. We will also give you a complete set of pre- and postoperative instructions, prescriptions for medications you might need, and a requisition for lab work.
Because a facelift results in little postoperative pain or discomfort, you can have the surgery performed as an outpatient and be discharged the same day.
You will enter the office or hospital several hours prior to your surgery. A facelift can be performed with either a general anesthetic or local anesthesia with intravenous sedation.
Operating time is usually four hours. No hair is trimmed or shaved. All incisions for the facelift are carefully hidden in the hair or within a skin crease in front of or behind the ear. These incisions will heal; resulting in a fine thin scar which is nearly imperceptible or is easily camouflaged with cosmetics or hair styling. In addition, we may place a well-hidden incision underneath the chin to remove fatty tissue from this area of the neck.
When the surgery is completed, we will place a bandage around your face and under your chin to provide continuous pressure overnight. We will remove this bandage the next morning and review your home care instructions.
You will experience some swelling and discoloration. It will be most visible 48 to 72 hours following your surgery. While bruising will slowly resolve over the first two weeks, swelling and lumpiness may persist to some degree for several more weeks. Be patient, it will take your body time to absorb these fluids.
To minimize swelling, we ask that you sleep with your head elevated. You may place several pillows under the head of your mattress. You will also need to sleep flat on your back to avoid pressure on the healing tissues. Cold compresses, applied several times daily, will help to reduce swelling and discomfort.
You may notice a sensation of tightness and some numbness in your face after surgery. This generally persists for several weeks but gradually subsides.
We will remove all sutures and skin staples on the seventh postoperative day in our office. After this visit, you may start cleansing your face with a mild soap and begin using a water-based make-up.
You should not undertake any activities that involve exertion for two weeks after surgery. The facial tissues heal quickly, but turning your head suddenly, running, or otherwise exerting yourself may adversely affect the results of your surgery.
You should anticipate a slight change in the position of your hairline in front of and behind your ear.
Remember that a single facelift may not result in a total correction of all skin sagging or wrinkling. This is especially true if you have a marked degree of skin laxity. In persons who do, some residual sagging may become evident after the first six to twelve months. In this case, you may need a small tuck-up procedure to achieve maximum results. While a facelift will eliminate facial skin laxity, the best management of deep wrinkling of the skin is with laserbrasion. We can perform this procedure as early as six weeks following your facelift.
Complications are uncommon, but they do sometimes occur. A small collection of blood may accumulate under the skin flap, requiring drainage. Infection of facial tissues may occur, but we do provide antibiotics to minimize this possibility.
If you smoke during the initial stages of healing, you will have a greater risk of wound infection and skin loss. Smoking constricts the small blood vessels and disrupts the circulation of the skin. We discourage your smoking for a two-week period following surgery to allow for optimal wound healing.
Numbness and tingling are associated with a facelift. In rare cases, they can persist for several weeks or months.
The facial nerves, which are connected to the muscles of facial expression, may be temporarily injured by stretching or swelling, or permanently injured by being cut. However, this risk is quite remote because the nerves are usually located deep to the area in which the surgery is performed.
Prominent scarring is unusual. If it occurs, it is mostly in the areas behind the ear where greatest tension is placed in closure of the incision. It may take up to one year for these scars to flatten and soften, occasionally requiring cortisone injections to accelerate their resolution.
The Tuck-up Operation
As we mentioned earlier, if you had excessive sagging and wrinkling, you may need a “tuck-up” procedure. This secondary procedure usually results in a more dramatic change than the initial facelift, as the skin tolerates more tension the second time. The incisions and scars are in the same place but the recovery period is shorter with less swelling.
The benefits of the first facelift will usually last from five to ten years. However, you should not be unrealistic about how much a facelift can accomplish; it does not rid you of all wrinkles or make you look like you did at age twenty.