Facelift
Indications
Laxity of the facial skin and descent of facial fat causing jowls, deep smile lines and an ill defined neck line. A tired appearance.
Intended Results
A youthful contour to the face. Restoration of a sharp jawline. Correction of hanging neck skin. Improvement of the nasolabial folds. A more vibrant appearance.
Consult
We frequently see patients for “facelift” consults. Because the word facelift means different things to each person, we put a mirror in front of the patient and have them describe the changes that they would like to see. For we as plastic surgeons, a facelift concentrates its effect at the jawline, jowls and smile lines. The upper face, including the brow and eyelids are addressed with their own separate procedures. These procedures are commonly done together to rejuvenate the entire face in one operative endeavor. Occasionally, what the patient really wants or may need does not necessitate a surgical approach. In these situations, we will discuss all of the non invasive techniques that can be used to accomplish their goals. Laser treatments, fillers and acid peels can all be done to improve the quality of facial skin and lessen the appearance of wrinkles. Should a surgical result be desirable, we will then discuss the different approaches and the likely outcomes of the Ageless™ Minilift, face and neck-lift or Liteshape™ procedures for facial rejuvenation. Computer imaging can be helpful in delineating and depicting the anticipated results. The risks, benefits and comparative downtimes of the various procedures can then be compared. Thus, the informed patient can truly make an intelligent decision about how to achieve their plastic surgical goals within their constraints of outcomes, longevity of result, risks, healing times and cost.
Procedure
In a facelift, the lax tissues of the facial muscles, fat and skin are repositioned to a more youthful appearance. Anesthesia can be local with oral sedation for the Ageless™ Minilift done in the office or a general anesthetic when more area of the face needs to be addressed as in the lower face/neck lift. Liposuction of the neckline and jowls is usually done to some degree and often fat removed here can be moved to other locations where it is deficient as in the cheeks bone area or tear troughs around the eyes. Dr. Salzman has utilized tumescent infiltration similar to liposuction to aid in the skin separation from the underlying fat for about 10 years. Following repair of the muscle laxity, Tisseel™ fibrin glue is used to agglutinate the flap to the underlying tissues. This speeds recovery by not allowing blood or fluid to accumulate between these layers. The patients are less bruised and do not need drains placed.
Recovery and Healing
The patient leaves the operating room or office with a light dressing around the head. They may remove this and shower or bathe and wash their hair the next morning. Sutures around the ear and in the temple area are removed after 5 days. Staples, if placed in the hair behind the ears, are removed in 10 days. Bruising is usually minimal and our aestheticians can provide you with adequate cover up makeup to have you presentable amongst your friends and co-workers within a week to 10 days. Swelling lasts about a month and final healing takes about 6 weeks. The scars that are initially more raised and red in color will flatten and more closely match your natural skin color in 6 months. We have many lasers in our Skin Spa that have clinically been shown to improve scars if necessary.
Other Options
Facelifts are commonly combined with forehead, eyelid and resurfacing wrinkle reducing procedures such as peels or lasers. Often times, the facelift is done first and non ablative skin improving lasers such as the Affirm™ are done in the post operative period to improve the skin quality. Fillers such as Juvederm™ or Radiesse™ can also be used adjunctively to improve the smile lines or pre jowl sulcus. Fat removed from the neck or elsewhere can be placed into the cheeks, lips, tear troughs or pre jowl sulcus to improve the overall balance and restoration of a youthful facial contour.
Notes
The specific risks and suitability of this procedure for a give patient can be determined only at a consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are unusual.