Facelift

As we get older, there is typically a descending or drooping downward of the tissues of the face including skin and fat. This may then create a thickening of folds which had not been present as well as a tired appearance with loss of definition of the jaw line and no definition of the chin and neck. The goal of a facelift is to reposition the loose fatty tissue in the jowl area, remove the excess fat of the neck if present, and tighten the underlying muscle layer to provide a more youthful, rested appearance.

Before	After
Age: 60yo Procedures: Facelift, Midface lift, Upper and lower lid blepharoplasty, Perioral laser resurfacing with Derma K Time after surgery: 1 month

Surgery

The procedure is performed on an outpatient basis typically with either local anesthesia and sedation or general anesthesia. Incisions are made starting just below the sideburn, continuing along the inside edge of the ear around the ear lobe, in the groove behind the ear, and then into the hair to minimize the chances of distortion of the hairline. There may be additional components along the temporal hairline above the ear or within the temporal region. There are variations of this procedure involving shorter scars termed an S-Lift which applies to people with looseness more in the cheek region.

Before	After
Age: 51yo Procedure: S-lift Time after Surgery: 10.5 months

The surgery involves lifting the skin, tightening of the muscle layer, and repositioning of the fat, especially from the jowl region. The excess fat in the neck region is removed through a separate incision under the chin. The muscles in this region may also be tightened at this time. Upon the completion of the procedure, a bulky awkward dressing is applied consisting of cotton and rolled gauze.

Before	After
Age: 61yo Procedure: Facelift Time after Surgery: 5 months

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Recovery

The area which feels most tight after facial surgery is behind the ear, as this is where the tissues are suspended. To minimize sensation and decrease swelling, the patient is instructed to sleep with his/her head elevated on a wedge pillow to avoid flexion of the neck. This also helps to decrease swelling as it facilitates the gravitational flow of swelling, allowing it to dissipate into the neck. The patient is then seen on the 1st day after the surgery at which time the dressing is removed and a fresh dressing applied. This bulky dressing is left in place for approximately 4-5 days after which it is replaced with an elastic neck sling. The patient is asked to pretend that he/she has a stiff neck and minimize his/her twisting to avoid further swelling. The sutures in front of the ears and under the chin are removed at that time as well, and the patient is allowed to shower and wash his/her hair. A hair dryer is not permitted as there are staples within the hair that can become heated by the hair dryer and burn the scalp. 

The sutures behind the ears and staples are left in place for an additional week. The expectation is that the patient looks presentable at one and a half weeks and is able to entertain at approximately three weeks. The skin of the cheeks and neck will be numb for a period of months. The feeling comes back gradually over time, though not 100%. The patient is asked to limit his/her activity for the first two weeks from the day of surgery. At that time, he/she can gradually start resuming his/her normal level of activity with the expectation of being back to normal at approximately three to four weeks.

Before	After
Age: 56yo Procedure: Facelift, Upper and lower lid blepharoplasty Time after Surgery: 12 months

Risks and Complications

Risks and complications are uncommon although, they may occur. They include but are not limited to: infection, bleeding, scars, sensory changes of the overlying skin, facial nerve injury (temporary or permanent) which may affect the motion of the corner of the mouth (although this is extremely rare) and need for revision in the future.

Procedures that may complement:

• Blepharoplasty (eyelid)
• Browlift

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