A procedure used to reduce the appearance of facial wrinkles and other telltale signs of aging, with the goal of improving the overall appearance of the face and jaw. Facelift surgery can help to reverse the harmful effects of time, stress, and exposure to the elements. To perform this procedure, a facial plastic surgeon will lift and tighten the underlying muscles of the face to create more aesthetically pleasing contours appearance and rejuvenate the facial structure. Then he or she will remove excess pockets of fat and skin that can contribute to an aged, tired appearance.
An experienced, skilled plastic surgeon will perform this procedure with an artistic eye and extraordinary attention to detail so that patients will be left with negligible scarring and beautiful, natural-looking results. In addition to traditional full facelifts, there are several other variations of the procedure to address specific areas of the face. Many surgeons use advanced, minimally invasive techniques to minimize discomfort and downtime.
Types of Facelifts
One of the most important components of the initial consultation is determining the right type of facelift. With so many options, choosing the right type of facelift surgery depends on more than just budget. It is important to consider the specific areas that a patient wants to target, the length of recovery, and what a patient's expectations are for his or her post- facelift appearance.
- The standard facelift, or rhytidectomy
Starts with the careful placement of the incisions in the area of natural creases - just inside the hairline at the temple, extending down along the natural curve of the ear and behind it, then horizontally into the hairline. The incisions allow the facelift surgeon to visualize the underlying facial structure and make the appropriate manipulations. The surgeon will reshape and sculpt the face, tighten the muscles, restore fat to where it has lost volume, and pull the skin into its new position. In most cases, a layer of tissue known as superficial musculoaponeurotic system (SMAS) is also tightened by the surgeon by folding it and then pulling the layer back over itself. This helps to lift the cheeks, and give more definition to the jawline.
If the neck area is also being treated, your facelift surgeon will conceal a small incision under the chin, and manipulate vertical bands in the neck for a smoothing and complete effect. If necessary, fat pockets can also be corrected during this stage of the facelift surgery.
Finally, your surgeon will drape the skin over the new, sculpted foundation to remove the excess skin and close the incision sites with sutures or skin adhesives. Facelift patients generally go home from two to 24 hours after the procedure. Once healed, the incision lines are virtually invisible as they are well concealed within the hairline and in the natural contours of the face and ear. Most patients are able to return to work and perform light activities in one to two weeks. The improvements of a facelift become more apparent as swelling and bruising subside.
- Mini Facelift Technique
A mini-facelift is particularly popular among younger individuals in their thirties and forties who are just starting to notice the first signs of aging, though older patients also can benefit from the procedure. A mini-facelift addresses neck and jawline issues, specifically tightening the skin on the neck and fixing jowls. Though the results are comparable to what’s possible with a lower facelift, the downtime is remarkably less and patients who opt for a mini-facelift experience a much faster recovery.
The mini-facelift procedure typically takes around 1.5 hours to complete. The surgeon creates incisions that are hidden beneath the chin and behind the ears and then trims excess skin in the target areas. Liposuction is used to sculpt the underlying tissues and then the neck muscles are tightened. The surgeon will correct any issues with the jawline, removing jowls while giving the neck a more toned, younger-looking appearance. Following the procedure, patients typically spend about 2 hours in a recovery room before being permitted to go home.
Surgeon use a specially developed fibrin sealant that can significantly diminish a patient’s downtime following surgery. This sealant is responsible for decreasing bruising and swelling associated with the mini-facelift surgery as well as markedly diminishing pain associated with the procedure.
- Skin Facelift or Subcutaneous Facelift
One of the earliest facelift procedures to make a debut in the general public is the skin facelift, otherwise known as the subcutaneous facelift. This procedure was particularly popular in the decades leading up to the 1970’s. Patients who are at their ideal weight with excess skin on the face, but good positioning of the facial muscles are most appropriate for this procedure. Also patients who have had another, more invasive procedure performed could benefit from the skin facelift as a way to revitalize their look.
Having only excess skin and no underlying tissues like muscle or fat contributing to aesthetic issues is the key to finding successful subcutaneous facelift candidates. Because a skin facelift does not address problems with the musculature or fatty tissues underneath the skin, this type of procedure may not produce desirable results in all people.
The skin facelift procedure involves an incision around the ear that allows the surgeon to release the skin from the underlying fascia and muscle tissue. The skin is then pulled tight to produce a more youthful appearance.
- SMAS (Superficial Musculoaponeurotic System) Facelift Technique
Superficial musculoaponeurotic system or SMAS facelift is used to treat sagging cheeks or jowls by removing excess skin and addressing the deeper SMAS layer, which is a sheet of muscle and connective tissue joined together in the cheek. Over time, there is a gradual loss of elasticity in the top layer of the skin and the SMAS can become lax and sag, resulting to jowls as well as deepening of the nasolabial folds. The end result is a familiar look of an aging face.
An SMAS facelift is performed by making an incision at the temple above the hairline and extending it downward in front of the ear. The surgeon then continues to cut below the ear lobe and then behind the ear. The next step involves lifting the skin, cutting the excess and tightening the SMAS tissues. The surgeon then sutures the areas back in place. This technique provides adequate correction to jowls and skin laxity. When done correctly, the facial skin looks tight, but not pulled. Also, the result is more extensive and tends to last longer than a skin-only facelift.
- Deep Plane Facelift Technique
The deep plane facelift technique was specifically designed to address the deficiencies and limitations of the previous generation facelift procedures. Today, it is one of the most effective techniques used to give patients long-lasting correction of the jawline as well as excess skin and fat in the neck. It is also useful for correcting the signs of aging in the mid-face and upper cheeks since the surgeon can reposition the tissues in those areas. The results are achieved by cutting deeper to adjust and reposition thicker planes of the face. The surgeon is also able to release the suspensory ligaments below the mid-face to correct mid-facial drop and to soften the nasolabial folds.
Because of the deep incision, the flap is thicker than in the subcutaneous or SMAS techniques, and some surgeons believe that a deep plane face lift could be a safer option for smokers because of the better blood supply in the flap. But still, smokers are more susceptible to complications, regardless of the technique. Lastly, the deep plane facelift can be performed along with the mini-facelift to achieve the maximum amount of correction during a single facelift surgery while using the tiniest incisions.
Skin type and age influence facelift results, so individuals who are interested in facelift surgery should meet with a qualified cosmetic or plastic surgeon to discuss appropriate expectations. Skin will continue to age after the procedure. Patients should also realize that some facelift scarring is unavoidable following the procedure, although the surgeon will strive to make it as inconspicuous as possible.
- Long-term Results
Though a facelift is not a permanent solution to aging, it can set back the clock by several years. Once the swelling has gone down and your face has finished healing, you will have a chance to fully appreciate your facelift results. The goal of facelift surgery is to rejuvenate the face and give it a fresher appearance.
- Managing Expectations
Some patients may struggle with disappointment or depression immediately following facelift surgery, because the positive results often take several weeks to become noticeable. Bruising, puffiness, and other negative temporary side effects associated with facelift surgery may initially mask the effects of the procedure, and can make the recovery period is very trying on the patient. After one or two weeks, makeup can be used to conceal skin discoloration. The worst swelling should subside within 12 to 14 days, but skin dryness may persist for several months. Scars will fade somewhat as time passes. Most patients will begin to notice the improvement in their appearance and see the facelift results after about three weeks.
The benefits of facelift surgery continue to expand as the procedure becomes more comprehensive and complex. Today, the procedure has an unparalleled ability to restore a patient's youthful appearance.
- Turning Back the Clock
When properly performed, facelift surgery turns back the clock, firming up muscle tone, smoothing the skin, and restoring an attractive facial contour. Facelift surgery is not designed to make a person look like someone else, but to make that person look and feel years younger.
- Repairing Loose, Sagging Skin
Facelift surgery is best-known for tightening loose, sagging skin that has begun to droop with age. By removing these extra tissues, a surgeon can address jowls, turkey wattles, drooping skin around the eyes, and an overall aged appearance. Although this component of facelift surgery remains an important part of the procedure, surgeons have realized that this tightening works best (and looks more natural) when the face's underlying structures are also restored to a youthful configuration.
- Improving Facial Contour
Unlike older, less sophisticated facelift techniques, which only tightened superficial facial skin, today's techniques also address the underlying structures of the face, the Sub-Muscular Aponeurotic System (SMAS). Cheek fat and other structures of the face sag downward with age, as skin loses elasticity and becomes lax. Today's surgeons first rearrange these underlying structures into a more youthful configuration before addressing the superficial layer of the face. Doing so puts less tension on the skin and helps the facelift last longer. Therefore, one of the benefits of contemporary facelift procedures is the restoration of a youthful configuration to your face's muscles, fat, and connective tissue.
Gone are the days of an unnatural, pulled facial contour after facelift surgery. Today's surgeons precisely rearrange the underlying structures of the face to restore a lasting and attractive facial contour. In addition, a facelift can be combined with facial liposuction to further address jowls, a fleshy neck, and other areas.
Facelifts are common and typically successful procedures, but, like any surgery, they are not without risks. While facelift surgery can turn back the clock, correct sagging skin, tighten facial muscles, and improve your facial contour, it can also cause problems such as:
- Poor reactions to anesthesia: For most patients, anesthesia is extremely safe. However, for patients with underlying health conditions, there may be some risk for heart attack, stroke and other serious complications.
- Infection: All surgeries pose some risk of infection. However, when doctors and surgical centers follow proper sanitation protocol, this risk is extremely low.
- Hematoma: Bleeding under the skin can cause immense discomfort, as well as swelling and skin discoloration. Surgery is the only way to repair this problem.
- Nerve damage: In rare cases, a nerve may be cut, nicked, or cauterized, causing numbness or facial paralysis. Fortunately, when this does occur, the damage is not always permanent.
- Visible scarring: Although there will always be some scars remaining after a facelift, in most cases, they are hidden. Occasionally, there may be some faint marks that are not concealed behind the ear or in the hair.
Before making an informed decision about whether to undergo rhytidectomy, patients must weigh the benefits of facelift surgery against its risks and potential side effects.
Facelift complications are infrequent, but there are certain things that patients can do to reduce their risks even further. First, they should choose a qualified facial plastic surgeon, following the guidelines listed above. An experienced, qualified doctor will have certain safety standards in place to prevent infection and achieve a more desirable cosmetic outcome. Second, they should be upfront and honest with their doctors, especially regarding health history, smoking, and drug use. Failure to disclose this information could lead to serious complications that could otherwise be avoided. Additionally, it is important to follow the doctor's pre- and post-surgical instructions. Finally, it is extremely important to quit smoking two weeks before and two weeks after a facelift. Patients who fail to heed this advice are far more likely to have difficulties healing, visible scarring, and unsatisfactory results.
Temporary Side Effects
While the risks listed above are rare, many patients may experience some passing side effects that typically dissipate within a few weeks. These may include:
- Temporary anesthesia reactions: Some patients may experience some nausea, dizziness, or chills as the anesthesia wears off. These symptoms are common, however, and are rarely cause for alarm.
- Discomfort : A facelift is major surgery, and, therefore, it is not uncommon to experience some tenderness and sensitivity in the face following surgery. Generally, however, this discomfort is minor, and patients should inform their doctors if they experience severe pain or a sudden increase in pain.
- Bruising: Most patients will experience some minor bruising after their facelifts, particularly around the eyes. This side effect will usually go away within a few weeks. If any bruising remains after the second week, patients can generally cover it up with cosmetics. However, they should wait for their doctor's approval before they begin to use makeup again.
- Swelling: Swelling can often accompany bruising, and it typically follows a similar pattern, dissipating within a few weeks of the procedure. Nevertheless, if swelling is severe, appears suddenly, or is accompanied by redness or skin discoloration, patients should immediately alert their doctors.
- Scarring: Typically, scars will not be visible, but patients should be aware that scars may look worse before they start to heal. In the early stages of recovery, new scars may be visible, even when they are covered by hair.
- Temporary numbness: Some patents may experience a loss of sensation following their facelifts. While this can be a sign of nerve damage, it can also be a passing side effect that should resolve itself within a few weeks. Nevertheless, patients should tell their doctors if they experience numbness in the face.
- Slow healing: Healing may take longer for some patients than for others. Short-term skin discoloration, crusting around the incision sites, and incisions that are slow to close are possible side effects, especially for smokers.
Controlling Side Effects
Although these concerns will typically resolve themselves within a few weeks, patients can take steps to minimize side effects and speed healing. Discomfort can typically be controlled with over-the-counter or prescription medications. Patients should always follow their doctors' instructions regarding medication, and they should never take over-the-counter drugs without consulting their doctors. Certain non-steroidal anti-inflammatory medications, such as ibuprofen, can cause slow healing. Compression bandages help control swelling, and they can also help skin conform to new facial contours. It is important for patients to wear these bandages as directed and to keep them clean and dry. Typically, patients can remove them within a week of their facelift.
Additionally, patients can enhance healing by following a healthy diet, full of essential vitamins and nutrients. Lean proteins, fresh produce, and whole grains are always good choices. High sodium foods are to be avoided, as these can cause water retention and exacerbate swelling.