Facelift

How is a facelift procedure performed?

Most facelift techniques focus on the lower facial areas, such as the jawline, jowls and cheeks. A facelift can also focus on the midface or the forehead. In some techniques, deeper facial tissues may be repositioned or tightened to restore a more youthful contour. In other techniques, removal or addition of fat or other soft-tissue fillers may be necessary to achieve the best results. Today, many different techniques exist with outcomes that can be consistently reliable, safe, and durable. Your incisions will depend on the area of the face that is targeted and the amount of change you want.

Once the incisions are made, various degrees of ‘undermining’ of your skin is performed, and the deeper layers of your face are lifted. Undermining separates the overlying skin of the face and neck from the muscles and tissues deep to the skin. This frees or loosens facial and neck skin so it can be redraped at the end of the procedure, making sure skin is smooth.

Then, your surgeon will raise the skin from the temples, cheeks, and neck, and lift and reposition the underlying connective tissue, removing excess fat and skin. If this procedure is performed in conjunction with a neck lift, the surgeon will draw the neck muscles together, stitching them together at the midline to form a strong sling of muscles that supports the entire neck and jaw. Your surgeon may also include liposuction of the neck and jowls. Facial implants may be added to increase cheek or chin volume.

Finally, your surgeon redrapes the skin over the new underlying structure and closes the incisions with stitches and/or small metal clips. Where needed, drainage tubes may be inserted. A padded, supportive dressing is usually applied.

The goal of your aesthetic plastic surgeon and the entire staff is to help you achieve the most beautiful and natural-looking results, and to make your surgical experience as easy and comfortable as possible.

What are my options?

There are several approaches to rhytidectomy surgery (see How is a facelift performed?). Your plastic surgeon will recommend an approach based on your goals and facial characteristics, including the shape of your face. The placement and length of incisions vary, depending on the facelift technique that best suits you. Your surgeon might find you appropriate for a ‘short scar’ facelift procedure in which a short incision is usually limited to the area around the ear.

What will my facelift incisions and scars be like?

Regardless of the type of facelift you undergo, you will have incisions that involve the skin around your ear.

1. The incision line usually runs along hairline and within the natural contours in front and behind the ears.
2. Skin is then pulled back and the incision is closed.

Traditional facelift: Your surgeon will make incisions in your hairline at the temples, continuing down and around the front of your ears and hidden in the natural creases behind your ears in your lower hair-bearing scalp.

Limited-incision facelift: Your surgeon will make short incisions in your hairline, starting at your temples and continuing down and around the front of your ears, hidden in the natural creases. There may also be incisions in the lower eyelids, temporal area, or under the upper lip.

Neck lift: Your surgeon will make incisions starting in front of your earlobes and continuing around behind your ears in your lower scalp. There will also be a small incision underneath your chin.

Modified incisions include variations of the short scar with shorter incisions around the ear.

Facelift scars can be virtually invisible: narrow, flat, and well placed behind the ear so you can wear your hair close-cropped.

Your board-certified surgeon will place the incision in areas that are hidden and in areas where the scars look like natural wrinkles. Incision healing depends on surgical technique, infection prevention, reduction of tension, your nutrition, any known or unknown underlying medical conditions, no smoking, and your genetic tendencies.

There is a risk of ‘hypertrophic scars’ and ‘keloids’ anytime the skin is cut. This risk is greater in darker-skinned people such as Blacks and Hispanics. Injections of a corticosteroid medication or other treatments, might be used to improve scar appearance.

Your initial consultation appointment

During your initial consultation, you will have the opportunity to discuss your cosmetic goals. Your surgeon will evaluate you as a candidate for a rhytidectomy and clarify what a facelift can do for you. Alternative and additional treatments may be considered, once the surgeon understands your goals and medical condition. (See related procedures.)

It is important to be completely honest during the consultation. Also, bring pictures of yourself at an earlier age; they may serve as a good point of reference for discussing your goals. It’s a good idea to be fully prepared to answer these questions:

• Do you have any medical conditions or drug allergies? Are you being treated for any medical conditions?
• Have you had any previous surgeries?
• What are your current medications and vitamin and herbal supplements?
• What is your current use of alcohol, tobacco, and recreational drugs?
• What is your history with any noninvasive cosmetic procedures?
• What outcome do you expect from the surgery?
• What is your chief motivation in undergoing a facelift?

Your surgeon may also:

• Ask you to look in a mirror and point out exactly what you would like to see improved
• Take photos for your medical record, measure your face, and use computer imaging to show you possible improvements
• Evaluate your health status, including pre-existing health conditions or risk factors
• Evaluate the elasticity of your skin
• Discuss your options and recommend a course of treatment
• Discuss potential outcomes, including risks or potential complications
• Discuss the type of anesthesia that will be used

Your treatment plan

Based on your goals, physical characteristics, and the surgeon’s training and experience, your surgeon will share recommendations and information with you, including:

• An approach to your surgery, including the type of procedure or combination of procedures
• The outcomes that you can anticipate
• Your financial investment in the procedure
• Associated risks and complications
• Options for anesthesia and surgery location
• What you need to prepare for your surgery
• What you can expect to experience after surgery
• Before-and-after photos of cases similar to yours and answers to any questions you may have, so you can make the most informed and intelligent decision

Questions to ask your aesthetic plastic surgeon

It is important for you to take an active role in your surgery, so please use this list of questions as a starting point for your initial consultation.

• Am I a good candidate for a facelift?
• Are the results I am seeking reasonable and realistic?
• Do you have before-and-after photos I can look at for this procedure?
• Will my scars be visible?
• What kind of anesthesia do you recommend for me?
• What will be the costs associated with my facelift?
• What will you expect of me to get the best results?
• What kind of recovery period can I expect, and when can I resume normal activities?
• What are the risks and complications associated with my procedure?
• How are complications handled?
• What are my options if the cosmetic outcome of my facelift does not meet the goals we agreed on?

How do I prepare for a facelift procedure?

Your surgeon will provide thorough preoperative instructions, answer any questions you may have, take a detailed medical history and perform a physical exam to determine your fitness for surgery. You may also be required to obtain medical clearance from your personal family physician or internist.

Preparation for surgery begins after the surgeon examines you and discusses the details of the procedure. If he recommends that you stabilize your weight before surgery or makes other lifestyle suggestions, do your best to follow them to ensure the best results and minimize complications.

In advance of your procedure, your surgeon will ask you to:

• Stop smoking six weeks before your surgery to promote good wound healing and to reduce scarring. Smoking also increases your risk of serious complications.
• Avoid taking aspirin, nonsteroidal anti-inflammatory medications (NSAIDs: Advil, Motrin, Aleve) and vitamins/homeopathic regimens. These can increase bleeding.
• Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery.

Your facelift may be performed in a hospital or an outpatient surgical facility. Be sure to arrange for someone to drive you home after surgery and stay with you for the first twenty-four to forty-eight hours, unless you and your surgeon have decided on other post-operative recovery options.

For the easiest recovery period, prepare carefully:

• If you color your hair, you should do it just before surgery or you will need to wait at least a month.
• Stock your refrigerator with lots of fruits and vegetables and lean protein. Lean protein assists in healing. Sodium increases swelling; avoid it! Prepare frozen meals in advance. High protein, low sodium foods are best for the first couple of days.
• Plan where you will recuperate. If you have a recliner chair, it is best for elevating the feet, knees and head. If you do not have a recliner, be sure to have lots of pillows available to prop up your head and knees. If possible, keep your phone and remote control for the T.V. by your bed.
• Decide what you will wear for the first few days; pick items that open in front and do not have to be pulled over your head. The same kind of clothing should be worn on the day of surgery. Wear slip-on shoes.
• Be sure to get plenty of rest and plan on not doing any housework, heavy lifting, or exercise. Avoid hot showers, hot tubs and saunas for two to three weeks.

What can I expect on the day of facelift surgery?
Facelift surgery, which may be performed in a hospital, freestanding ambulatory facility or office-based surgical suite, requires at least several hours to complete, though more extensive procedures may take longer.

• You will receive medications to keep you comfortable during the surgical procedure.
• Local anesthesia combined with sedation is commonly used during facelift surgery, though general anesthesia can be used instead. An anesthesiologist or nurse anesthetist may be present to administer sedatives (or general anesthetic) and assist in monitoring.
• For your safety during the surgery, various monitors will be used to check your heart, blood pressure, pulse, and the amount of oxygen circulating in your blood.
• Your plastic surgeon will follow the surgical plan discussed with you before surgery. Once the operation has begun, he or she may decide to combine various techniques or change a technique to ensure the best result. It is important that you feel comfortable and trust your doctor to make these decisions.
• After surgery, you will be taken into a recovery area where you will continue to be closely monitored.
• Your incisions will likely be covered with bulky bandages that provide gentle pressure to minimize swelling and bruising. A small tube might be placed under the skin behind one or both of your ears to drain any excess blood or fluid.
• Before leaving for home on the day of surgery, you or someone looking after you should feel comfortable emptying and resetting the drains.
• You may choose to go home on the day of surgery or spend the night with an office consultant or nurse, unless you and your plastic surgeon have made other plans for your immediate post-operative recovery. Under no circumstances will you be permitted to go home alone.

What will my recovery and healing from a facelift be like?
Your surgeon will discuss how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will receive detailed instructions about your post-surgical care, including information about:

• Drains, if they have been placed
• Normal symptoms you will experience
• Potential signs of complications

Immediately after your facelift surgery

• You may be placed in a compression garment or wrap immediately after surgery. Wear this exactly as directed. Remove it only as directed for cleansing incisions or showering.
• To minimize swelling, recline rather than lie down. This will be more comfortable for you, and can reduce swelling. Always keep your head elevated. Do not bend forward or over.
• You will have a mild to moderate amount of pain and discomfort. This should be easily controlled with oral medications. If it is not, call your surgeon.
• The discomfort and pain should begin to decrease within forty-eight hours after surgery. If you have a significant increase in pain after this period, call your plastic surgeon. Severe pain is rare; if you experience this, call the doctor immediately.
• Expect bruising and swelling. These symptoms will peak within the first thirty-six to forty-eight hours after surgery and will gradually subside over the next ten to fourteen days. To minimize swelling, sleep with your head elevated for a couple of weeks after the surgery.
• It is not unusual to have some slight drainage for the first forty-eight hours. A bulky cotton compression dressing with drains will cover your scalp and face for one to two days to help prevent blood collections under the skin.

Recovery time frame after a facelift
Follow all post-surgery instructions, including information about bandages, drains, taking an antibiotic (if prescribed), and the level of activity that is safe. Your doctor will let you know the signs of problems to watch for, such as signs of infection. Recovery time will vary by patient and in relation to the extent of your surgery.

The first week

• You may not drive for at least a week after surgery.
• A feeling of tightness in your neck is not unusual after surgery. This sensation is most pronounced in the first one to two days after surgery while the bulky dressing is in place.
• During your first post-op visit, the bulky dressing and usually the drains will be removed. You may be placed in a supportive elastic face garment that is to be worn according to your doctor’s instructions.
• Do not take any aspirin or any anti-inflammatory compounds for two weeks before and two weeks after your surgery unless you first discuss it with your surgeon.
• It is recommended to sleep with your head elevated forty degrees for two weeks; an additional pillow or two under your mattress may help, if necessary.
• Apply cool (not cold) compresses to your eyes. Do not apply ice or anything frozen directly on the skin. Soak soft, white washcloths or gauze squares in ice water and wring out well. Apply directly to the eyes, but not to the cheeks or neck. Do not apply any pressure. Apply cool compresses for no longer than twenty-minute intervals. Do not apply heat.
• Stay up (sitting, standing, walking around) as much as possible after you return home. This helps to decrease facial swelling.
• Avoid bending or lifting heavy things for one week. Besides aggravating swelling, this may raise your blood pressure and encourage bleeding.
• You may wash your hair gently twenty-four hours after your surgery. Do not use the usual heat-type hair dryer; use the cap type or use the cool setting on the blow dryer.
• You may shower or bathe the day after surgery, but do not let the spray directly strike your face. It is permissible to get your suture lines wet, however.
• Report any excessive bleeding that persists after applying pressure for fifteen to twenty minutes.

Two to six weeks

• Don’t go swimming, diving, water skiing, or participate in strenuous athletic activity for at least one month after surgery.
• You can expect to experience some numbness around your ear lobes, face, and neck for several weeks after surgery.
• Refrain from any strenuous exercise and from bending or lifting.
• You may begin sleeping in a modified reclining position, but do not sleep lying flat or on your stomach. If you are a side sleeper, two pillows under your head and a soft pillow under your mid-back and shoulders may offer more comfort.
• Do not wear makeup until you have been told to do so.
• During the first four to six weeks your scars may appear red and be slightly firm and raised then the redness fades and the scar softens. It takes a minimum of one year for the scar to achieve its final appearance.
• Refrain from direct sun exposure. Wear sunglasses and a wide-brimmed hat. If you are outdoors, apply at least an SPF thirty at least thirty minutes before sun exposure. Your face will be highly susceptible to sunburn or the formation of irregular, darkened pigmentation.

Long term
You may ease into your regular fitness routine. However, wear protective eyewear and a hat. Discomfort or tightness and tingling in your face will resolve. Be prepared to wait at least six months for your facelift to completely heal inside and out. It is important to see your doctor as scheduled.

Your genes, skin quality, and maintenance routine are important factors in the longevity of your facelift, but the facelift technique is the number one factor in determining how long the result will last.

• Minimal facelift techniques with fast recoveries will last the least amount of time
• Mini-facelift, or ‘S-Lift,’ refers to a facelift with a small amount of skin undermining with limited SMAS (muscle/fascia) mobilization. With this technique, recovery is fast and results can last up to five years.
• Full or standard classic facelift: There are many versions of the operation that fall into this class, and can be called SMAS platysma, SMAS-ectomy, SMAS imbrication, deep plane facelift, composite lift, or subperiosteal. These all require extensive rearrangement of the underlying facial tissues in addition to significant skin undermining. Full facelifts are technically demanding procedures that are undertaken by trained, board-certified aesthetic plastic surgeons. The recovery is longer (two to four weeks), but the results generally can last over ten years.
• The more extensive the procedure, the longer the recovery period will be, and the longer you will enjoy the results.

Maintain a relationship with your aesthetic plastic surgeon
For safety, as well as the most beautiful and healthy outcome, it’s important to return to your plastic surgeon’s office for follow-up evaluation at prescribed times and whenever you have any questions about your facelift healing and results.

The cost of a facelift varies from doctor to doctor, from one geographic area to another, and based on the facelift technique that is performed.

See the national average for physician fees per procedure.

These numbers only reflect the physician/surgeon fees last year and do not include fees for the surgical facility, anesthesia, medical tests, prescriptions, surgical garments, or other miscellaneous costs related to facelift surgery.

Because a facelift is an elective cosmetic surgery, insurance does not cover these costs. Many surgeons offer patient financing plans to make the procedure more affordable.