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Facelift surgery , clinically known as rhytidectomy, is 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. Facelifts are not covered by insurance; however, there are many excellent financing options to help rhytidectomy patients manage the cost of plastic surgery. For qualified patients, facelift surgery can be an excellent investment, providing a fresher, more youthful appearance for years to come.
Facelift surgery can be an effective way to improve appearance and boost self-confidence, but it is not for everyone. Some patients might find that they can achieve their cosmetic goals with a non-invasive procedure, such as a chemical peel or microdermabrasion. Others may be happier with their results if they combine facelift surgery with other procedures, such as a neck lift or forehead lift (also known as a brow lift). Patients who understand both the possibilities and limitations of facelift surgery tend to be more pleased with their results.
Am I a Good Candidate for Facelift Surgery?
The best facelift candidates have realistic expectations and are willing and able to follow the pre- and post-operative instructions provided by their plastic surgeons. After a one-on-one consultation, the doctor can advise a patient as to whether he or she is a good candidate for a facelift, or whether an alternate procedure might be preferable.
Ideal candidates for facelift surgery share certain important traits. The following is a list of factors that can affect whether or not an individual is a good candidate for facelift surgery:
- Skin elasticity : A good facelift candidate will have skin that retains some of its natural suppleness and flexibility. This is important because, during the procedure, the surgeon tightens the facial skin to reduce the appearance of wrinkles. Successful healing with optimal results depends on having skin that is able to conform to its new, improved contours.
- Strong bone structure : Ideally, a facelift candidate will have a well-defined underlying bone structure to provide support and contribute to satisfying results. Patients with less distinct features may benefit from facial implants as an alternative or addition to a facelift.
- Realistic expectations : A candidate should understand not only what facelifts can accomplish, but also the limitations of facial plastic surgery procedures. Consulting with a qualified plastic surgeon can help a patient obtain the information needed to make the right decision about surgery.
- Good overall health : A good facelift candidate will be generally healthy and will inform his or her surgeon of any preexisting medical conditions well in advance. A facelift is an invasive procedure that requires significant healing and recovery, so it is essential that the patient be physically prepared for surgery.
- Loose skin on the face or neck : Facelift candidates typically want to remove excess skin from the face or neck, tightening skin and reducing the appearance of wrinkles simultaneously. The surgeon trims the loose skin during the procedure.
Facelift Surgery for Men
Facelift surgery isn't just for women. Men can also turn to rhytidectomy to erase the signs of aging and achieve a younger, rejuvenated look. The steps of the procedure are typically the same for both sexes, and both men and women can enjoy outstanding cosmetic results.
Are There Age Restrictions for Facelift Surgery?
Age is not the most important factor in determining candidacy for facelift surgery; skin elasticity and overall health have far more bearing on a patient's ability to undergo this procedure. Most patients who undergo rhytidectomy are between the ages of 40 and 70 years old. However, people older than 70 can benefit from the surgery, as well. A qualified plastic surgeon can further evaluate each patient's skin texture and condition to make individual judgments and recommendations regarding candidacy.
Facelifts for Seniors
More people over the age of 50 are turning to cosmetic surgery to improve their appearance, according to the American Society of Plastic Surgeons (ASPS). Seniors are lining up for facelifts, laser skin resurfacing, BOTOX® treatment, and blepharoplasty (eyelid surgery). The doctor will take into account each person's particular circumstances, including age, before approving cosmetic surgery. Seniors undergoing surgery should understand that they will not look 20 years younger, although they will certainly look more youthful.
Facelift prices can vary depending on the doctor and even the region. Nationally, the average facelift cost is about $6,000, not including anesthesia, prescriptions, or preparatory tests. Comprehensive facelift prices will include these costs, in addition to the surgical fees. If you are considering a rhytidectomy, you should discuss all costs with your surgeon.
Factors That Affect the Cost of a Facelift
The national average mentioned above can vary significantly from patient to patient. When doctors and patients are determining the final total for a facelift, there are a number of considerations to take into account. These include:
- The type of facelift: There are several type of facelifts, designed to address certain signs of aging and improve the appearance of targeted facial features. Typically, a traditional full facelift will cost more than a mini or mid facelift, as these latter procedures are faster and involve smaller incisions.
- The type of anesthesia: Patients can choose between local and general anesthesia, and usually, full sedation will cost more than local anesthesia. In addition, individual anesthesiologists will charge varying fees.
- Techniques: Advanced methods, such as endoscopic facelifts, may have a higher cost than traditional procedures.
- Additional treatments: Many patients combine facelifts with other surgical procedures for more comprehensive results. It is important tro remember that these additional costs will not be included in the initial treatment estimate.
- Surgeon's skill and reputation: Highly respected doctors with advanced training will often charge more than their less experienced colleagues. Nevertheless, many patients feel that the extra cost is a small price to pay for peace of mind and excellent surgical results.
- Location: Just as cost of living changes depending on where a person lives, so, too, does the cost of cosmetic surgery. Facelift fees will typically be higher in large metropolitan areas.
Facelifts are elective procedures and therefore are not covered by insurance. Nevertheless, many surgeons offer excellent facelift surgery financing options to cover the cost of facelift surgery, including surgical fees. At their initial consultations, patients should ask their doctors about what repayment options are available. Most doctors accept cash, check, and credit cards. Many practitioners also offer sizeable discounts when procedures are paid for in full. Additionally, patients should inquire about repayment plans. Some doctors offer rdasonable fixed-interest or even no-interest financing options for those with approved credit.
Third Party Financing
When patients are researching their financial options, they should also learn more about outside financing options. Medical financing options, available through such companies as Compassionate Finance®, are intended specifically for elective procedures, including facelifts. This company and similar providers offer fixed interest rates, and some patients can even obtain no-interest financing if they pay for their procedure within a certain time frame. Other patients will take out bank loans or utilize similar financing options to make a facelift a reasonable and affordable option.
How to Choose a Surgeon
Facelift patients should be extremely judicious when they are selecting their doctor. Choosing an unqualified or ill-suited practitioner could lead to unsatisfactory cosmetic results, surgical complications, and significant expense. There are several important factors that patients should keep in mind when they are deciding on a surgeon.
Certification and Memberships
Before anything else, patients should find out whether a doctor is certified by the American Board of Plastic Surgery. Doctors who do not have this certification should not be considered. A surgeon should also be certified by the state's medical board. Though not necessary, membership in other associations can be good signs that a doctor is highly trained and well-respected in the field. These organizations may include:
- American Society of Plastic Surgeons®
- American Academy of Facial Plastic and Reconstructive Surgery
- American Association of Plastic Surgeons
Of course, it is also vital for patients to choose a doctor who has specialized training, and plenty of practical experience It is important to look for a doctor who calls him or herself a "facial plastic surgeon," rather than a "cosmetic surgeon." Legally, doctors who practice some form of cosmetic medicine can refer to themselves as cosmetic surgeons, even if they do not have advanced training in surgery. Additionally, if patients want a specific kind of facelift or if they are interested in a certain technique, they should look for a practitioner with experience in these particular areas.
When searching for a doctor, it is always a good idea to ask for recommendations. A general practitioner can often be a great person to start with. If a patient has family or friends who have undergone plastic surgery, they may also be able to recommend a good doctor. Patients should also check a doctor's record to look for any malpractice suits or complaints. State medical boards are required to make this information public. In some places, patients may be able to view these records online, but in other states, they may have to request them through the mail.
Most doctors have galleries of before-and-after pictures for potential patients to view. Individuals should examine these pictures closely and ask themselves if they like what they see. If the results look unnatural or if there are too few pictures to tell, they should choose another practitioner. Patients should also be cautious as they examine these images. They should look to see if the pictures are well-lit and taken from different angles. Poor image quality may be hiding unsatisfactory surgical results.
Of course, the reputation and certification of the doctor is essential, but it is equally important for patients to inquire about the place where their surgery will take place. Any surgeries that do not take place at a hospital should occur at a facility that has been accredited by the American Associations for Accreditation of Ambulatory Surgery Centers. To receive accreditation, a facility must maintain excellent safety and surgical standards.
If a doctor works at an accredited outpatient surgery center, patients should also make sure that the doctor has privileges at a local hospital. First, this ensures that there will be emergency care available, in the unlikely event of surgical complications. Additionally, doctors must have strict safety and ethical standards in order to acquire these privileges. Thus, when patients choose such a surgeon, they can rest assured that they are in good hands.
While safety and cosmetic outcome are certainly the most important considerations, patients should also feel comfortable with their plastic surgeons. The decision to undergo a facelift is an extremely personal one, and patients should choose a doctor who respects their privacy and cosmetic goals. At the initial consultation, doctors should ask patients about the results they hope to achieve and the exact procedure in which they are interested. If a doctor does not seem willing to tailor the surgery to meet a patient's objectives, this is a sign that he or she may not be the optimal choice. Additionally, a doctor should never pressure a patient to undergo more surgery than he or she actually needs or wants.
The Initial Consultation
When a patient selects a plastic surgeon, he or she will have a thorough consultation and examination. First, the doctor will determine whether or not a facelift is a suitable procedure, considering health history, skin type, and goals for treatment. It is important for a patient to be honest with his or her doctor, especially regarding health history. Certain medical conditions, such as autoimmune disorders or heart disease, can increase the risks of plastic surgery. Although not all underlying conditions will prevent a patient from receiving a facelift, it is important for the surgeon to know about these concerns so that he or she can take necessary precautions.
At the first appointment, the doctor may also address the issue of smoking. Again, the patient should be upfront, as smoking can raise the risks of plastic surgery and slow healing. Although this habit does not automatically keep someone from qualifying for a facelift, he or she will need to stop smoking for at least two weeks before and two weeks after the surgery, if not longer.
Planning the Procedure
After determining that a facelift is a viable solution, doctor and patient will work together to create a personalized treatment plan. They will determine:
- The type of facelift
- The type of anesthesia
- The location of the incisions
- How the doctor will close the incisions
- Which procedures, if any, should be combined with the facelift
- The approximate recovery time
The doctor or the administrative team can also explain financing options and help the patient to determine the best repayment plan for his or her budget.
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.
Choosing the right type of facelift surgery depends on more than just budget
Treatment options include:
Traditional Full Facelift
A full facelift offers the most comprehensive results. With this procedure, the doctor can address deep creases below the eyes, sagging around the cheeks, lines around the mouth, excess fat and skin under the chin, jowls, and more. Because it targets a larger area, the treatment requires a longer incision. It usually runs along the temple, around the ear, and down to the neck, as described above. Full facelifts can address more dramatic signs of aging, and, thus, they are popular among patients in their 50's and 60's.
During a mid facelift, a surgeon can lift and tighten the tissues below the eyes and around the cheeks. To perform this procedure the doctor will create incisions that are similar to those used in a traditional facelift, but they will typically be deeper. This technique allows him to lift the muscles that are normally untouched by a traditional facelift. He may also use fat grafting or facial implants to enhance contours and create more defined cheekbones. Because this procedure does not address all the signs of aging, it is often suitable for men and women in their 30's and 40's who are simply looking to rejuvenate their appearance.
Mini facelifts involve smaller incisions and a shorter recovery time, which is why this procedure is sometimes referred to as a "weekend facelift." As with the mid facelift, this surgery targets a smaller area, primarily treating the jaw, lower cheeks, and neck. The doctor will usually locate the incisions along the hairline and behind the ear. Through these incisions, the doctor will lift the muscles, remove fat unwanted fat deposits, and eliminate excess skin. Many surgeons perform mini facelifts using endoscopic techniques. Like mid facelifts, this procedure is common among somewhat younger patients who are showing the first signs of aging.
As the name implies, lower facelifts target the bottom third of the face. This procedure can be an excellent way to eliminate jowls, reduce deep nasolabial folds, lift the sagging corners of the mouth, and enhance the jaw. The procedure itself is similar to other types of facelifts, and the doctor will create incisions along the patient's ears and hairline. Lower facelifts are suitable for patients of all ages who want to decrease the signs of aging and enjoy a more youthful appearance.
Thread facelifts are a quick, minimally invasive alternative to traditional facelifts. During this procedure, a surgeon will create tiny stitches just below the skin to lift the underlying muscles. This procedure can often be performed without anesthesia and leaves no visible scars. Because the entire treatment takes about one to two hours, it is sometimes referred to as a "lunchtime lift." This treatment is most suitable for patients in their 30's and 40's who simply want to make minor adjustments to their appearance.
Traditional facelifts and its variations can be performed using several different surgical tools and incision patterns. Each technique has its own advantages and disadvantages, which a doctor can explain during the initial consultation. Ultimately, the optimal procedure and technique will be different for each person.
Many surgeons use endoscopic technology to perform all types of facelifts. An endoscope is a microscopic camera, attached to a small, handheld wand. To perform an endoscopic facelift, a doctor will create three smaller incisions, each an inch long or less. She will then insert the endoscope through one incision to obtain a clear view of the underlying facial structure. Through other two incisions, she will use tiny surgical instruments to lift the muscles and remove excess tissue. Endoscopic facelifts are typically best when patients want to address drooping muscles and misplaced fat, but they do not have a large amount of excess skin.
Endoscopic techniques are especially useful in mid and lower facelifts, since these procedures target smaller areas that are harder to access with traditional surgical instruments. Additionally, because the incisions are smaller, patients who choose endoscopic techniques usually enjoy a faster recovery time.
The oldest type of facelift, this technique only addresses sagging and excess skin. The surgeon will create a long incision, running along the hairline. Via this incision, she will gently lift the skin and suture it higher up in place. Because this procedure does not affect the muscular structure, it carries a reduced risk for nerve damage and other complications. However, the results do not last as long, and many experts believe they do not look as natural. Often cutaneous facelifts can leave patients with a stretched or "windswept" look.
SMAS (Superficial Musculoaponeurotic System) Facelift
Today, the cutaneous facelift has been nearly eliminated by the more comprehensive SMAS facelift. In fact, when people hear the word "facelift," they almost always think of this procedure. During the SMAS facelift, the doctor will lift and tighten the underlying muscle structure to improve facial contours and achieve an overall more youthful appearance. Although the doctor will also eliminate extra skin, this treatment offers more far reaching and natural results than early forms of the facelift.
During an S-lift, a doctor will create S-shaped incisions in front of the ears. Because these incisions are smaller than those used in traditional facelift surgery, recovery time is shorter, and costs are often lower. However, this procedure does not offer results that are as dramatic as those in traditional facelifts. S-lifts are most suitable for treating the jaw and lower face.
Deep Plane Lift
During a deep plan lift, a surgeon will work on the layers of tissues below the SMAS layer. Instead of separating the muscles and lifting them separately, the doctor will lift the entire facial structure as a single unit. Deep plane lifts are especially effective in treating the mid face, including deep nasolabial folds. However, this technique does involve more risks, especially to the facial nerves. Therefore, there are relatively few doctors equipped to perform this procedure.
Subperiosteal facelifts go even deeper than deep plane lifts, although both procedures address sagging in the mid face. This procedure targets the tissues just above the facial bones, through incisions below the lower lash line or inside the mouth. While deep plane lifts are relatively specialized procedures, there are even fewer surgeons who offer the subperiosteal facelift.
Before the Procedure
Adequately preparing for facelift surgery can keep patients relaxed and healthy before, during, and after the procedure. Preparation begins at the pre-surgery consultation, and patients should carefully follow all pre-surgical instructions. Two weeks before the procedure, patients will need to stop smoking. This habit prevents oxygen from flowing freely throughout the body, and, therefore, it could increase recovery time and the risk for surgical complications. Certain medications and nutritional supplements, such aspirin, blood thinners, and Vitamin E, can also cause post-surgical complications, so patients may need to alter their medications, according to their surgeon's instructions.
Patients should also get ready for their surgery by mentally preparing for the downtime and making arrangements for transportation and after-care. Most people should plan on taking one to two weeks off from work, although specific time will vary, depending on the type of procedure they select. Patients may find it helpful to make a "recovery kit," so that they have everything they need at hand during their downtime. This kit should include:
- Healthy, low-sodium foods that are easy to prepare
- Over-the-counter pain medication
- Any prescription medications
- Pillows to keep the head elevated
- Button-down clothes that do not have to go over the head
Often facelift surgery procedures can be performed using local anesthesia. This gives patients the option of remaining relatively alert during their facelift, although general anesthesia is always an option. During more intensive procedures, general anesthesia may be required. In many cases, the length of a patient's facelift surgery determines whether local or general anesthesia will be used. Since many of the complications associated with facelift procedures result from negative reactions to anesthesia, patients should discuss possible facelift risks with their cosmetic surgeon.
Often facelift surgery procedures can be performed using local anesthesia
Location of Incisions
In placing incisions during facelift surgery, cosmetic surgeons aim for the best combination of effectiveness and discretion. Doctors commonly make incisions above the hairline so that any scarring will be hidden. They may also follow natural facial creases (e.g., the line where the ear meets the side of the face), since these locations heal well and hide possible scarring better than other areas. In most facelift surgery procedures, the incision begins behind the hairline on the side of the head, somewhat above the temple. It then follows the hairline down to the ear, running along the crease between the ear and the cheek, wrapping around the earlobe, and continuing into the lower scalp under the hair.
Achieving a More Youthful Appearance
After making the incisions, the surgeon will lift the facial skin from the underlying tissue. He or she will remove excess fat and skin and tighten the surrounding muscles to improve the contours and appearance of the patient's face. The skin is then repositioned with stitches or staples, and the treated area is wrapped in bandages. The removal of accumulated fat and excess skin generally results in a noticeable reduction of sagging and age lines in the face. Combined with the tightening of facial muscles, such facelift surgery procedures can give patients a refreshed, younger-looking, and more vibrant appearance.
Combining Facelift with Other Procedures
In some cases, an additional treatment can help to augment or enhance facelift results. These treatments may include additional surgery, or a doctor may recommend a non-invasive skin treatment for a more youthful appearance.
Common Surgical Procedures to Add
Cosmetic surgeries frequently combined with facelift surgery include:
- Facial liposuction: If unwanted deposits of fat have accumulated in the face and seem unresponsive to diet and exercise, a surgeon can gently suction these cells out using a small, handheld cannula. This treatment is particularly suitable for the area under the chin.
- Lip augmentation : A doctor may use several techniques to give patients fuller, plumper lips. Dermal fillers, fat grafting, and lip implants are all effective options that typically have very short recovery times.
- Eyelid surgery (blepharoplasty): Facelifts can enhance the area around the eyes, but not the eyelids themselves. During blepharoplasty, a doctor will lift sagging eyelids, excise drooping skin, and remove fat pockets from the area to give patients brighter eyes and a more alert appearance.
- Facial implants: Silicone implants can add volume to the cheeks and improve a sloping or ill-defined chin.
Common Non-Surgical Procedures to Add
While facelifts can dramatically enhance sagging skin and deep creases, the procedure cannot address find lines, sun damage, and other surface blemishes. To target these concerns, a surgeon may recommend a procedure such as:
- Chemical peels: During a chemical peel, the doctor or skin care specialist will apply a chemical solution to a patient's skin. This substance will remove the damaged outer layer of skin to reveal the healthy, younger-looking skin underneath. Light, medium, and deep chemical peels use solutions with different strengths to target different types of skin irregularities.
- Laser skin resurfacing: Laser skin resurfacing works along similar principles. This treatment uses high-power beams of light to gently and accurately removed damaged skin, layer by layer. In addition to removing wrinkles and blemishes, laser skin resurfacing can sometimes improve large oil glands, as well as yellowed, pale complexions.
- Microdermabrasion: Like the two treatments listed above, microdermabrasion removes the top damaged layer of skin, revealing the healthy layer underneath. To perform this procedure a doctor or cosmetic specialist will blow air, filled with thousands of microscopic particles, at the treatment area. These particles will gently scrape away the damaged cells.
Of course, not all of these additional treatments are suitable for every patient. Surgeons will discuss these options at the initial consultation. In this way, they can integrate them into the treatment plan in a way that will minimize surgical and recovery time.
Of course, recovery time can vary somewhat, depending on the type of facelift and whether a patient chooses to add other procedures. In general, however, there is a basic recovery timeline.
The Day of the Procedure
When the anesthesia wears off patients may be a bit nauseous or cold, but these feelings will typically subside quickly as the medication leaves their bodies. Usually, patients will have bandages on their faces, and there may be some drainage tubes as well, depending on the extent of the procedure. If patients do have these tubes, they should expect drainage for at least 48 hours. Surgeons will provide instructions about how to clean and care for the tubes. Patients often experience swelling and discomfort, particularly during the first day, but these symptoms can often be controlled with over-the-counter or prescription pain medication.
Many doctors ask their patients to come in the next day for a checkup. This visit allows him or her to carefully monitor recovery and ensure that a patient is not at a high risk for post-surgical complications.
During the first week after a facelift, patients should focus on recovery and avoid strenuous activities. However, they should avoid being overly sedentary; taking a walk around the room every few hours will stimulate blood flow and prevent blood clots. Typically, patients will return 5 to 7 days after their surgery to have their stitches removed. There are several other steps that individuals can take to minimize discomfort and promote healing. In addition to following specific instruction from their surgeons, patients should:
- Wear bandages and change them regularly
- Clean and care for drainage tubes, as instructed
- Return for a post-surgery follow-up and to have the drainage tubes removed
- Avoid getting their faces wet
- Use cool compresses on their eyes
Swelling and bruising may persist for several weeks after a facelift, but as recovery progresses, patients will begin to see the results of their facelifts. Most people feel good enough to go out about two weeks after their surgery. Nevertheless, patients will still have some restrictions and they should carefully follow their doctor's directions. In particular, they should:
- Sleep with their heads elevated for the first two weeks after surgery
- Avoid lifting and other strenuous activity until recovery is far enough along
- Keep away from saunas, hot tubs, and pools
- Avoid alcohol, aspirin, and non-steroidal anti-inflammatories until otherwise instructed by a doctor
- Not wear makeup until the doctor gives approval
In the weeks and months following a facelift, patients should attend all follow up appointments with their surgeons. They should also carefully monitor their progress and alert their doctors if they notice the signs of post-surgical complications. It may take several weeks for patients to see the final results of their facelifts. Nevertheless, as recovery progresses and swelling subsides, patients should begin to enjoy a younger, more alert appearance.
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.
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.
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 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.
Those who are concerned about the risks listed above should know that these complications occur very rarely. The vast majority of patients experience a smooth procedure, quick recovery, and pleasing cosmetic results. In fact, a comprehensive survey, conducted by Dr. John S. Rhee, the Chairman of Department of Otolaryngology and Communication Sciences at the Medical College of Wisconsin, reveals the very slight chance of facelift complications.
According to Rhee and his colleagues, hematoma is the most common post-facelift complication, affecting 1 to 3 percent of women and 7 to 9 percent of men. While the risk is obviously higher for males, other factors that may raise a patient's chances of developing a hematoma include smoking, the use of NSAIDs or aspirin, and high blood pressure. Patients who combine a facelift with a specialized neck lift procedure known as anterior platysmaplasty also have a higher risk for this complication.
Nerve damage, the most dreaded complication of facelifts, is the second most common risk of this surgery. Even so, the rates are still reassuringly low. Rhee reports that nerve paralysis occurs in a mere 0.5 to 2.6 percent of all facelift patients. Sensory motor damage, which can cause reduced sensation in the face, is more common, occurring in up to 7 percent percent of all cases.
Only two other side effects have a high enough occurrence for Rhee and his colleagues to gather associated data. Alopecia, or hair loss affects 0.2 to 1.8 percent of all facelift patients. Incidents of infection are even rarer. Less than 0.2 percent of facelift patients experience this complication. [i]
Thanks to its dramatic results and low rate of complications, facelifts are incredibly popular procedures. In fact, according to the American Society of Plastic Surgeons (ASPS), facelifts are the fifth most popular cosmetic surgery procedure in the country. Surgeons performed 113,000 of them in 2013 alone, a 6 percent increase from the year before. While facelifts are significantly more popular among women than men (90 percent of all facelift patients are female), the procedure enjoyed a 7 percent increase in popularity among men between 2013 and 2012.
Because facelifts are intended to address the signs of aging, most patients are above the age of 40. According to the ASPS, the breakdown is as follows:
- Patients aged 13 to 19 - 0 procedures
- Patients aged 20 to 29 - 381 procedures (A 4 percent increase from 2012)
- Patients aged 30 to 39 - 2,053 (A 7 percent increase from 2012)
- Patients aged 40 to 54 - 43,510 (A 4 percent increase from 2012)
- Patients aged 55+ - 103,463 (A 5 percent increase from 2012)
Facelifts are more popular in some areas than in others, although, in comparison to other types of cosmetic surgery, their frequency remains fairly standard across the country. Again, based on 2013 data from the ASPS:
- 31 percent of facelifts occurred in the Western (Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming) and Pacific (Alaska, California, Hawaii, Oregon, Washington) areas
- 23 percent of facelifts occurred in the South Atlantic area (Delaware, Washington, DC, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia)
- 20 percent of facelifts occurred in the New England (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont) and Middle Atlantic (New Jersey, New York, Pennsylvania) areas.
- 14 percent of facelifts occurred in the East South Central (Alabama, Kentucky, Mississippi, Tennessee) and West South Central (Arkansas, Louisiana, Oklahoma, Texas) areas
- 12 percent of facelifts occurred in the East North Central (Illinois, Indiana, Michigan, Ohio, Wisconsin) and West North Central (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota) areas. [ii]
For patients who are apprehensive about the idea of surgery and for those looking for more conservative enhancements, there are several other possibilities to choose from. They include:
- Laser facelift: By applying a powerful beam of light to the treatment area, a doctor can destroy the damaged top layer of skin cells to eliminate fine lines, sun spots, acne scars, and other blemishes. The laser energy can also stimulate collagen production. However, this treatment cannot eliminate excess skin or tighten the underlying facial structure.
- Liquid facelift: Using a combination of injectable skin treatments, a doctor can create a personalized treatment plan to address a patient's individual needs. Dermal fillers, such as Juvederm®, Radiesse®, and Sculptra® can fill in deeper lines and wrinkles. Botox®, made with a small dose of botulinum toxin, blocks the nerve impulses and muscle contractions that cause wrinkles. Again, however, this treatment cannot remove loose skin or target the deeper underlying layer of muscle.
- Ultrasound therapy: By sending sound waves to the treatment area, a doctor can lift and tighten the skin. State-of-the-art ultrasound therapy can even target the muscles underneath the treatment area, although the results will not be as dramatic as a full surgical facelift.
- PelleveTM: Using radiofrequency waves, the doctor can tighten the skin and cause the collagen fibers in the deeper layers to contract, thus stimulating the body's natural production of collagen. While this treatment tightens skin enough to reduce lines and wrinkles, it does not remove large amounts of excess skin.
- Microcurrent facelift: Like ultrasound and radiofrequency therapy, microcurrent treatments use electrical stimulation to tighten skin, increase blood flow, and stimulate collagen production.
A one-on-one consultation with a surgeon will also help patients to determine whether one of these substitutes can help them achieve the look they desire, or if surgery is necessary for optimal results.
Frequently Asked Questions
How long will my results last?
No cosmetic procedure can stop the effects of time and aging. However, the results of a facelift can last for years, and even when lines and wrinkles do start to appear, you may still enjoy a more contoured and defined face for life. The procedure you select will determine how long your results last. The effects of a full facelift may remain for a decade or more.
What type of anesthesia is best for me?
Doctors can perform facelifts under local or general anesthesia. IV sedation, which will induce a twilight sleep, is also an option. All three choices are very safe. In fact, with local sedation, patients have a much lower risk for anesthesia complications. However, some patients do not feel comfortable with the idea of being awake during their procedure. Ultimately, the only way to determine the right type of sedation is by talking to your plastic surgeon.
I've seen pictures of really bad facelifts. Will that happen to me?
Magazines and other news outlets love to publish pictures of facelifts gone wrong, but they can only do so precisely because they are news. There are hundreds of thousands of facelifts performed in this country every year, and the vast majority of them yield subtle, natural results. The likelihood that you will be left with a tightened or windswept look is low, especially when you choose a qualified surgeon who works on the deeper layers of facial muscle.
Can a facelift change the shape of my face?
No. Facelifts are designed to enhance and rejuvenate your natural facial structure. If you want to alter that structure, you may be a better candidate for cheek implants, chin augmentation, chin reduction, rhinoplasty, or a similar procedure.
What can I do to ensure long-lasting results?
Again, nothing can ever stop the effects of age and gravity, but there are certainly things you can do to protect your skin and youthful appearance. One of the most important things is limiting your sun exposure. Be sure to wear sunscreen, sunglasses, and hats when you are outside. Never go to tanning beds; this will age your skin and significantly increase your risk for cancer. Additionally, you should moisturize regularly, use dermatologist-approved skin treatments, and stay hydrated.
Are there foods I can eat that will help my skin look younger?
Absolutely! After your facelift, you will want to do everything you can to maintain your glowing, youthful look. Vitamin A stimulates cell turnover, while vitamin C increases collagen production. Some experts believe that soy can help reduce fine lines and wrinkles. Certain antioxidants can reduce your risk for skin cancer. Therefore to protect your skin, you should eat a diet full of healthy choices such as romaine lettuce, apples, strawberries, tempeh, eggs, and almonds. In addition, olive oil, already touted as one of the best choices for heart health, can also help protect your skin against UV damage.
Is a facelift a good option to tighten sagging skin after weight loss?
Body contouring, such as tummy tucks or thigh lifts, can be great ways to enhance your body after massive weight loss, removing and tightening the skin. In some cases, a facelift can do the same thing. However, in many instances, facial skin will naturally tighten within a few months, especially if you are young. If you have recently lost a large amount of weight you should wait several months after you have stabilized before considering a facelift. You should also explore other options, such as laser skin tightening or microcurrent therapy, before settling on a facelift.
Can I have more than one facelift?
Yes, but you should do so with caution and the approval of your doctor. While touchup treatments can be helpful, choosing an excessive amount of plastic surgery can give you an unnatural appearance. Additionally, addiction to plastic surgery is a very real and growing problem. If you feel compelled to undergo plastic surgery again and again, talk to your doctor. He or she may recommend seeing a therapist or other mental healthcare professional.
[i] Rhee, John S., et al. Complications of Facelift Surgery (Medscape, 2012)
[ii] 2013 Plastic Surgery Statistics Report (American Society of Plastic Surgeons, 2013)
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