Facelifts produce a more youthful appearance by lifting the skin of the face and neck. Sometimes we combine this with removal of excess fat (if any) from the front of the neck and below the jaw lines, and sometimes with a tightening of the muscle layer just beneath the skin.
The incision for a facelift usually begins in the hair over the temple, drops downward to hide in the contours in front of the ear, then goes up behind the ear and into the hair again. The skin of the face and neck is separated from the deeper tissues and pulled upwards and backwards, much like tightening a sheet on a bed. The "overlap" is removed, and everything is sewn together again using special techniques.
Extra fat in the front of the neck and just below the jaw lines obscures the clean lines of youth, and we often remove it with a suction technique when we perform the facelift. In some cases a very thin sheet of muscle under the skin may have sagged and caused "turkey wattle" folds on either side of the neck. When this has occurred, we tighten this muscle layer along with the skin.
Wrinkles in the forehead and between the eyebrows can be reduced by extending the facelift operation to include the forehead. This also lifts the eyebrows a bit and is known as a "forehead lift" or "browlift." Upper and lower eyelid surgery is also quite commonly combined with a facelift.
The facelift operation is performed with general anesthesia (complete sleep) and takes three to four hours depending on the exact procedure.
Complications are rare following a facelift, and if they do occur they are usually minor. Because the skin is lifted up, numbness in the cheeks and ears is normal until the nerves have time to grow back in. Where the temple is lifted, hair growth may not be as vigorous as before, especially if the hair in this area was already thin. Because the temple area is moved upwards, the sideburns and hairline are sometimes a little higher than before surgery. Incisions behind the ear may be hard to conceal in an upswept hairstyle.
Patients commonly ask whether we "shave" or remove hair for this surgery. The answer is "yes" (it makes the operation easier), but we tailor the hair removal carefully so that you have no bare areas after your surgery.
Sometimes bleeding occurs underneath the skin layer within a few hours after surgery; if substantial, this must be corrected. Minor lumps and bumps under the skin are common for two to three weeks, and sometimes longer. Injury to facial nerves can theoretically occur, causing changes in expression, but we have almost never seen this complication in clinical practice.
Because the skin is lifted away from the deeper tissues, circulation within the skin itself becomes very critical. If circulation fails, scarring and hair loss may result. Studies have shown that nicotine causes these tiny blood vessels to shrink, and that smokers have a much greater chance of developing these problems than nonsmokers.
We strongly recommend that you discontinue smoking completely for at least one month before surgery and one month after surgery. If you are a smoker and do not stop smoking for your surgery, you are taking unnecessary risks.
After a facelift, most people have very little discomfort. Because you will still be sedated, it is important that you stay in our Casa and have nursing care for one night after surgery. This precaution also helps us detect any potential problems before they become serious, and makes it easy for us to check the results of your surgery the following morning, before you go home.
There is always a little swelling and discoloration following a facelift, but usually much less than people anticipate. Average recovery time is about two weeks.
People frequently want some facial or neck rejuvenation without a "full" facelift. In most instances, this request stems from not understanding how a facelift works.
The drawings in the previous section show that trying to do the face or neck alone, instead of doing them both together, imposes great restrictions on the amount of potential improvement. The face and neck are connected rather closely, and it's difficult to improve one significantly without including the other. The so-called "mini-lift" is simply a facelift with limited incisions, limited dissection and limited benefits.
When patients have a poorly defined neck because of fat deposits, fat suction alone will often improve the neck contour but may leave some residual wrinkling of the skin. If the cheek folds alongside the upper lip are excessively deep, they can be improved by removal of some excessive cheek tissue, but the incisional line is not as well concealed as in a facelift. If wrinkling (rather than sagging) is the main problem, it can be improved with sanding or treatment with the "ultrapulse" laser.