If you are considering a facelift…
As people age, elastic fibers in the skin decrease and the effects of gravity, exposure to the sun and the stresses of daily life can be seen in their faces. The cheeks appear to descend, deep creases form between the nose and mouth, the jaw line grows slack, double chins, heavy jowls and “turkey neck” may also appear.
If you are considering a facelift, the following information will give you a basic understanding of the procedure. This information may also assist you in understanding when a face lift can help, how it is performed, and what results you can expect. This will, however, not answer all of your questions since a lot depends on the individual patient, health history and the surgeon. Please feel free to ask Dr. Gutstein about anything you do not understand.
Who Can Benefit?
The best candidate for a facelift is a person whose face and neck may have begun to sag, but whose skin still has some elasticity and whose bone structure is strong and well-defined. Most patients range in age from their forties to sixties, but facelifts can be done successfully with good results on people in their seventies or eighties, as well. Lesser lifts, or “tucks,” may also be performed on people in their thirties, especially those in print or film media.
A facelift can make you look younger and fresher, and it may enhance your self-confidence. It can’t give you a completely different look, nor can it actually restore youth itself, but it can give you a more youthful appearance. Before you decide to have surgery, think carefully about your expectations and discuss them with the doctors.
Surgery Carries Some Risk
When a qualified plastic surgeon performs a facelift, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, their healing abilities and the outcome is never completely predictable.
Complications that can occur include hematoma (a collection of blood under the skin that must be removed by a surgeon), swelling around, or injury to, the nerves that control facial muscles (usually temporary), infection, and reactions to the anesthesia. Poor or slower healing of the skin is most likely to occur in smokers and people with diabetes.
Types of Anesthesia
Facelifts may be performed under local anesthesia, combined with a sedative to make you drowsy. You’ll be awake but relaxed, and your face will be insensitive to pain. You may feel some tugging or occasional discomfort. Some patients prefer general anesthesia. In that case, you will be deeply asleep throughout the operation. An intermediate method call dissociative anesthesia keeps you asleep, but breathing on your own without the need for a breathing tube.
A facelift usually takes several hours, depending upon whether you are having one or more concomitant procedures performed.
Incisions usually begin in the hairline at the temples, extend in a natural line in front of the ear or just inside the cartilage of the front of your ear, and continue behind the earlobe to the lower scalp area. If the neck needs work, a small incision may also be made under the chin.
In general, the surgeon separates the skin from the fat and muscle below. Fat may be trimmed or suctioned from around the neck and chin to improve contour. The surgeon then tightens the underlying muscle and fascia, pulls the skin back and removes the excess. Stitches are used to secure the layers of tissue and close the incisions; fine metal clips may be used on the scalp.
Occasionally, a small, thin tube may be temporarily placed under the skin behind your ear to drain any blood that might collect there. The surgeon may also wrap your head in soft bandages to minimize bruising and swelling.
Usually there is minimal discomfort after surgery; if there is discomfort, it can be lessened with the pain medication prescribed. Severe or persistent pain or sudden swelling of the face should be immediately reported. Some numbness of the skin is normal and it generally disappears in a few weeks or months. You will also be advised to keep your head elevated for several days after surgery to minimize swelling.
If you’ve had a drainage tube inserted, it will be removed one or two days following surgery, along with the bandages. Don’t be surprised at the slightly bruised and puffy face you see. Just keep in mind that in a short time you’ll be looking normal and better than ever.
Most facial stitches will be removed in about one week. Your scalp may take longer to heal, and the stitches or metal clips in your hairline will be left in a few days longer.
Getting Back To Normal
You should be up and about in a day or two, but plan to take it easy for the first week after surgery. Be very gentle with your face and hair, since the skin will be both tender and/or numb, and may not respond normally at first.
The doctors will give you more specific guidelines for gradually resuming your normal activities. They are likely to include the following suggestions: Keep your head elevated, avoid strenuous activity including sex and heavy housework for at least two weeks (walking and mild stretching are fine). Avoid alcohol, steam baths and saunas for several weeks. Limit your exposure to the sun for several months. Above all, get plenty of rest and allow your body to spend its energy on healing.
At the beginning, your face may look and feel rather strange. Your features may be slightly distorted from the swelling; your facial movements may be slightly stiff. It’s not surprising that a small percentage of patients experience depression at first.
By the second week, you’ll look and feel much better. Most patients are back at work in seven to ten days following surgery. If you need it, special makeup can mask any bruising that remains.