A facelift is a surgical procedure to lift and tighten the skin and underlying muscle to reduce or eliminate facial wrinkles, redefine the chin and jaw area, and bring back a more youthful appearance to the face. The goal of facelift surgery is to achieve a natural, rejuvenated appearance. There are different types of facelifts depending on the extent of surgery necessary for optimal results and the patient’s desires. A face lift may concentrate on the cheek and chin margin only and involve an incision in front of the ear, around the underside of the ear, and slightly to the back of the ear. However, if treatment of the neck is also desired, the incision will be similar in front of the ear, but extend further behind the ear and into the scalp region behind the ear to allow treatment of the neck area.
During the procedure, the skin of the face is elevated to expose the muscle fascia, called the SMAS, which is a strong covering of the facial muscles. This is then elevated and pulled in an upward direction to tighten the underlying muscles and fat. This also places the tension on the deeper layer rather than the skin, which decreases scarring at the skin edge. The skin itself is then re-draped to reduce the wrinkles as well as improve the chin margin and neck and cheek contour. Absorbable and non-absorbable sutures are used to close the wounds. For a full facelift, a drain is used on each side to decrease the chance of blood collection underneath the skin. These are removed on the first day after surgery. The patient wears a wrap around the chin, cheeks and ears to decrease swelling and bleeding. The facelift procedure is a 3 to 5 hour procedure done in the operating room most commonly under local anesthesia with sedation. The first night after surgery, the patient needs to be watched carefully for any problems and therefore patients have the option of spending the night in the hospital, or having one of our office nurses or possibly a trained family member stay with them. The patient needs to keep their head elevated as much as possible, and ice on the area as much as possible the first 24 hours to decrease swelling and bruising. The outside sutures are removed in 5 to 7 days and makeup can be placed as soon as the incisions are healed. Discomfort at incisions is common for 3-7 days. Bruising may be present for 2-3 weeks. Numbness in the cheeks or neck is normal and sensation should return gradually with time. Patients may return to work in 1-2 weeks.
Realistic expectations are a very important part of the decision to undergo cosmetic surgery. It is important to remember that with any of these cosmetic procedures, they do turn back the clock; however, the clock keeps ticking. The facelift can be used to make the patient look younger by reducing the wrinkles and sagging of the skin, however, gravity continues to occur after the facelift. Results are permanent although you will continue to age. In other words, 15 years after the facelift, a patient can expect to look younger than they would have if they had not had the facelift, but they will have aged since the facelift procedure.
Risks with a facelift are possible, as with any surgery. A collection of blood called a hematoma is a possible complication usually seen in the first 24 hours after surgery. If an extensive surgery is performed, drains are placed and the patient is either monitored in the hospital or at home with a nurse for the first night to watch for any hematoma formation. Infection is possible but very unlikely. Problems with wound healing are possible, especially in patients who smoke and therefore a more conservative lift would be required to decrease the chance of complications. Scars will be present after the surgery, but are most commonly fine white lines that are very easily hidden. Widening of the scars can occur if tension is placed on the skin during the surgery, therefore this tension is avoided. Any wound healing problems would also lead to greater scarring. Asymmetry of the face is also possible. No two sides of the face are the same and this will also be the case after surgery. There are techniques that can be used to make the two sides of the face more symmetrical, but slight asymmetries are expected and normal for the procedure. When the skin is lifted from the underlying tissue, there will be numbness in the area of the skin treated with the surgery. This numbness resolves slowly with time. There is a rare risk of injury to the nerves of the face, which could cause muscle weakness of the face causing asymmetry.