Facelift or Rhytidectomy (Surgery for removing face wrinkles)
Facelift is the most comprehensive method for treating face wrinkles and sagging facial skin caused by senility. It ranges from surgery with the lowest invasion rate (Lunchtime lift or thread lift: a method of surgery where temporary sutures are used for delicate but visible facelift.) to wider and complicated surgery. In this surgery, extra skin can be detached, subcutaneous tissue and muscles can be tightened and then skin can be stretched on face and neck again. This surgery, which is known as the “golden standard” of facial rejuvenation, eliminates the midface sagging, marionette linesand sagging in the lower part of the face around jowls as well as double chin. Every year, facelift surgery is performed on the thousands of individuals who are satisfied with the obtained results.
When to perform facelift?
- If you feel that your face does not indicate your young spirit and energy level.
- If you deduce that sagging and extra skin are considered as the social or professional barrier for you.
- If you have signs of senility in your face but still your skin has some elasticity.
- If you look at the mirror and feel that you are harmed by time, gravity, exposure to sunlight and inheritance and you are no longer satisfied with your countenance.
- Performing merely one surgery has resulted in improving most parts of your face.
- Facelift may remain effective for 10 years or more and makes you feel 10 to 15 years younger.
- Facelift will change the shape of your neck and jawline better than any other technique.
- Facelift does not make a “new” person, it merely makes you younger.
- When you perform facelift, you cannot accomplish some routine tasks of your life.
- You may need to repeat this surgery later depending on your age and type of skin.
These positive and negative aspects should be considered in the facelift. You should consult with your plastic surgeon if you emphasize on your specific negative or positive aspect.
Are you an appropriate candidate for facelift?
Some face features that make you an appropriate candidate for facelift are as follows:
- Sagging of the skin in the midface or around the jawline.
- The formation of deep wrinkles that extend from the nose to the corners of the mouth (Nasolabial folds, which is also called laugh lines).
- The creation of lines which are continued from the coroner of the mouth to the chin (marionette lines).
- Sagging or shifting fat (volume) of the face
- Loosening of muscle tone of the lower face which causes sagging in the lower part of the face near to the mouth.
- Formation of the double chin caused by loose skin and excess fatty deposits under the chin and jaw.
- Neck skin sagging and wrinkling.
It is very likely that you are a proper candidate for facelift if you are healthy and have positive attitude as well as realistic expectations.
(1). Deep wrinkles on the cheek, sagging of the lower face around jowls and loose skin of the neck as well as the face will be solved by facelift.
(2). The skin of your face and neck will become smoother, tighter and more fresh after the surgery.
Detailed information about this surgery
How to perform facelift?
Most of the facelift techniques concentrate on the lower part of the face such as the jawline, sagging of the lower face around jowls and cheeks. Also, it may be worked on the midface or forehead. In some of these techniques, deeper tissue of face may be shifted or tightened and became younger. In other methods, it may be need to remove or add fat or other filler tissues in order to achieve the best possible results. Nowadays, there are a huge number of techniques with reliable and safe results as well as enduring impact.Created incisions depend on the area of the face that is under surgery and the amount of your desired change.
After making incisions, various amount of skin is detached from the “undermining” tissue and deeper layers are stretched upwards. When the skin of face and neck is detached from the undermining tissues and muscles, it will become free or loose and will be put on the face and neck at the end of the procedure but be careful to be smooth.
Then the skin surgeon stretches the skin from the temples, cheeks and neck to the upward, raises or moves the undermining connective tissue and eliminates the fat and excess skin. If the facial surgery is accomplished together with the neck lift, the surgeon tightens the neck muscles and stitches them in the middle line to create a strong muscular strand and hold the neck and jaw. Surgeon may perform liposuction surgery of the neck, the sagging of the lower face around jowls and face implant to increase the volume of the cheeks or chin.
At the end of this surgery, surgeon stretches the skin on the new undermining structure and closes the location of incisions using suture or small metal clips. Drain tubes are used if it is necessary and usually padded dressing and retentive are applied.
The purpose of the plastic surgeon and the entire surgical team is to help you to reach the most beautiful and also natural condition of your face and make your surgery as convenient as possible.
Who are the proper candidates for facelift?
Several approaches are available for facelift surgery (please refer to “detailed information about this surgery”). Plastic and aesthetic surgeon recommends you an approach based on your goals and face features such as its shape. The location and length of the incisions are different and depend on the lift technique which is the most appropriate option for you. Surgeon may find that facelift with “short scar” is proper for you, where a short incision is usually created around the area of the ear.
Surgical operations with brand names for facelift like “lifestyle lift” or “quick lift” are some of the form of facelift. No method is superior to the other methods and the best treatment for you can be defined through the consultation with a plastic and aesthetic surgeon who has professional board.
Incision appearance and scars of facelift
In all techniques of facelift, some incisions are created in the skin of around the ear.
(1). The incision line usually prolongs along the hair growth line as well as inside the natural shapes located in front and back of the ears.
(2). Then skin is stretched backwards and closed.
Traditional Facelift: The surgeon makes some incision along the hair growth line at the temples which are extended downwards and inside the natural shape in front and back of the ears. Then they hide in the naturalwrinkles back of the ears in the lower part of the skin that has hair.
Facelift with limited incision: The surgeon makes some small incisions in the hair growth line started from temples and extended downwards as well as around the front area of the ears and then they hide in the natural wrinkles. Also, some incisions may be created in the lower eyelids, templesarea or under the upper lip.
Neck Lift: The surgeon makes some incisions started from the front of the earlobes and extended to around as well as the behind of the ears in the lower part of the scalp. A small incision is also made under the chin.
Adjusted incisions include variations of short scar with shorter incisions around the ear.
Facelift scars may be more or less invisible. They may be narrow, flat and completely located behind the ear in such a way that you can shave your hair.
The surgeon with professional board makes incisions in the hidden areas and parts where the scar looks like natural wrinkles. The healing of the incision depends on the surgical technique, prevention of the infection, reduction of the tension, nutrition, unknown and known underlying diseases, avoidance of smoking and your genetic tendencies.
The risk of “hypertrophic scars” and “keloids” is arisen whenever the skin is cut. This risk is higher among people with darker skin such as Black Americans (African Americans) and Hispanics. The injection of corticosteroid drugs or other treatments can be used to remedy the scar.
Choosing the Surgeon
Please choose a reliable surgeon.
It is important to consider the following items for choosing a surgeon:
- Education, training and having professional board
- Experience in facelift surgery
- Your comfort with the surgeon.
The members of the American Association of Plastic and Aesthetic Surgery are experienced and qualified to perform cosmetic surgery. Learn how to choose surgeon. When you find plastic surgeon with professional board experienced in facelift surgery, you should set an appointment with her (him) for consultation. Usually, you must pay for the initial visit because this counselling session is accurate and complete.
Initial appointment with the surgeon
Talk about your goals of beauty during the initial consultation. The surgeon assesses you to become a candidate for facelift and describes that how facelift can affect you. When the surgeon comprehends your goals and medical condition, alternative treatments may be considered for you (please refer to the relevant procedures).
It is significantly important to be absolutely honest in this consultation. Also, take some pictures of when you were younger with yourself. These photos may be considered as useful reference for talking about your goals. Be completely ready to answer the following questions:
- Do you have any disease or drug allergy? Are you under treatment?
- Have you everbeen under a surgery?
- Do you use any medicine, vitamin or herbal supplement?
- Do you use alcohol, tobacco and recreational drugs?
- Have you been subjected to any non-invasive cosmetic surgery?
- What do you expect from this surgery?
- What is your mainspring of performing this surgery?
The surgeon may also do the following items:
- Ask you to look at the mirror and specify exactly what you want to change.
- Take some few photos to complete your medical records, measure your face and use digital images to show you the potential improvements.
- Evaluate your health status such as diseases or previous risk factors.
- Assess the elasticity of your skin.
- Talk about your options and recommend a course of treatment.
- Describe the possible results like risks or potential complications.
- Explain the type of anesthesia.
Your treatment plan
Regarding your goals and physical characteristics as well as education and experience of the surgeon, he (she) will provide some recommendations and information as follows:
- A method for your surgery such the type of procedures or the combination of several procedures.
- Results that you can predict.
- Your financial investment in the surgery.
- Associated risks and complications.
- Anesthesia options and surgical location
- Things you need for the surgery
- What can you expect after surgery?
- To make a more conscious and intelligent decision, check the photos of before and after surgery of individuals who are similar to you and find the answer of all of your questions.
You should ask the following questions from your plastic surgeon:
To have a complete overview of the questions that you should ask the surgeon related to his (her) field of work to ensure the safety of the plastic surgery and also to plan the surgery please refer to Planning Toolkit.
These questions are provided to help you:
- Make the most informed and smart decision about your surgery.
- Ensure that you have chosen an appropriate surgeon for your surgery.
- Make your initial counseling as effectual as possible.
- Find out the available options, potential results and risks.
It is necessary that the candidate of facelift plays an active role in the surgery. Therefore, please use the following questions as a starting point for your initial consultation:
- Am I a proper candidate for facelift?
- Are my expectations logical and realistic?
- Do you have any photos from the before and after surgery of the previous facelift candidates?
- Will my scars be visible?
- What type of anesthesia do you recommend for me?
- What is the cost of my facelift?
- In your opinion, what should I do to achieve the best results from the facelift?
- How long my recovery? When I can resume my normal activities?
- What are the risks and complications of my surgery?
- How to deal with complications?
- What should I do if the result of the facelift does not meet the goals we agreed on?
Preparing for the surgery
How to prepare for this surgery?
The surgeon gives you the complete pre-surgery instructions, answers all of your questions, receives your medical records and examines you to specify whether you are ready for the surgery. Maybe it is necessary to provide the consent of your family doctor or intern for this surgery.
After your examination, the surgeon will describe all the details of the surgery and your preparation for the surgery will begin.
If the surgeon recommends you to keep your weight steady prior to the surgery or provide you other suggestions about your lifestyle, you should try as much as possible to follow them in order to ensure that the best results will be achieved and the surgery complications will be minimized.
Before the surgery, the surgeon will ask you to:
- Do not smoke from the six weeks before the surgery to better heal your wounds and minimize scars. Smoking also rises the risk of harmful complications.
- Avoid taking aspirin, non-steroidal anti-inflammatory drugs (NSAID like Advil, Motrin and Aleve) and vitamin or homeopathic regimen.
- Hydration is remarkably imperative before and after the surgery to have a safe recovery.
Your facelift may be performed at hospital or outpatient surgical facility. If your surgery is outpatient, you should go home with the help of someone who should stay for 24 to 48 hours with you unless you and your surgeon choose other options for your recovery after the surgery.
In order to have the least problems during the recovery period, it is necessary that:
- If you want to color your hair, you should do this before the surgery. Otherwise, you must wait at least one month after surgery.
- Fill up your refrigerator with fruits, vegetables and low-fat proteins. Low-fat proteins help to heal wounds. Do not consume salt since sodium increases the inflammation. Prepare frozen foods for yourself before the surgery. High-protein, low-salt and soft foods are the most appropriate choice for the first few days after the surgery.
- Plan for your recovery location. If you have rocking chair, the best thing to do is to keep your legs, knees and head high. If you do not have rocking chair, use a plenty of pillows to rest your head and knees. Put the telephone and remote control of TV next to your bed if possible.
- Select the clothes that you want to wear in the first few days after the surgery. These clothes should be open front, so that you do not compel to drag them on your head. You should wear the same kind of the clothes on the day of the surgery. Also, you should wear comfortable shoes.
- Be sure to take a lot of time to rest and refrain from doing house works, lifting heavy things and exercising. Do not use the hot-water shower and tub as well as sauna for up to 2-3 weeks.
What should be expected on the day of the facelift surgery?
- They will give you medicine to be relax during the surgery.
- Usually, regional anesthesia with analgesic is used for the facelift surgery although general anesthesia can also be applied. An anesthesiologist or nursing anesthetist may be there to give you analgesic medicine (or perform the general anesthesia) and help the monitoring.
- In order to keep you safe during the surgery, multiple monitors are employed to control your heart function, blood pressure, pulse and oxygen levels in your blood.
- The surgeon performs the surgical plan you spoke about together. After starting the surgery, the surgeon may be decided to merge several techniques or modify the technique to ensure the best result. You should be comfortable and trust your doctor’s decisions.
- After the surgery, they will transfer you to the recovery room and observe you carefully.
- In order to minimize swelling and bruising, your incisions may be covered with thick bandage. A small tube may be placed under the skin of behind the one or two ears to drain the excess blood and fluids.
- Before going to home after the surgery, you or your caregiver should demonstrate that you are not upset about discharging or reinstalling drains.
- You may want to go home on the surgery day or you may want to spend your night with a consultant or nurse unless you and your surgeon have provided another plans for your recovery. They will never allow you to go home alone.
Post-surgical(postoperative) care and recovery
Recovery and healing wounds
The surgeon will tell you how long it takes to return to your normal activity level and work. After the surgery, you and your caregiver will receive detailed information about the post-surgical (postoperative) care such as the following items:
- Drains, if they are embedded.
- Normal symptoms that you will see.
- Potential signs of the complications.
For information about the short-term recovery locations, please refer to the Aftercare and Recovery in Planning Toolkit.
Immediately after the facelift surgery
- They may be place you to the compression garment device or wrap immediately after the surgery. You should wear these clothes according to the instructions given to you and remove them only for cleaning the incisions or taking shower.
- To minimize the swelling, lounging instead of lying down. This has led to more relaxation and may reduce the inflation. Keep your head always high. Do not bend to the front.
- You will feel slight to moderate pain which can be controlled by oral medications but you can call your surgeon if not controlled.
- Pain should be reduced up to 48 hours after the surgery. If pain will increase significantly after this 48 hours, you should call your plastic surgeon. You will rarely get acute pain after this surgery but if you feel severe pain you should call your doctor immediately.
- You should expect to see bruising and swelling. These symptoms will reach their peak in 48 to 36 hours after the surgery and then they will gradually reduce over the next 10 to 14 days. To minimize the swelling, keep your head high for sleeping for a few weeks after the surgery.
- Usually, remarkably little amount of drainage will be seen during the first 48 hours after the surgery. A thick cotton pressure dressing equipped with few drain will cover your scalp for one or two days to prevent the accumulation of blood under your skin.
Recovery time frame after the facelift surgery
Please follow all post-surgical instructions including bandaging, drain, using antibiotic (if recommended) and the safe activity level. The doctor will make you aware of the symptoms of problems like infection that you should take care of them. The recovery period is different for each patient and depends on the extent of the surgery.
The first week after the surgery
- You should not driving for at least one week after the surgery.
- It is not unusual, if you feel tightness in your neck after the surgery. This tightness will feel more during the one to two days after the surgery that the thick dressing is not removed.
- In the first appointment with your doctor after the surgery, thick bandage and usually drains will be removed. Your face may be covered by a supportive elastic face garment which should be kept on your face in accordance with your doctor’s instructions.
- Do not use aspirin or anti-inflammatory drugs two weeks before and after the surgery unless you consult with your surgeon.
- It is recommended that keep your head up with 40-degree angle for two weeks. Placing one or two pillows under the mattress will help you to do this if necessary.
- Put a cool (but not cold) compress on your eyes. Do not directly put ice or any frozen thing on your face. Soak towels or white and soft square gauzes in cold water and squeeze them well. Then, put them directly on your eyes but they do not touch your cheek or neck. Do not push them. These cool compresses do not use for more than 20 minutes in each use. Do not put any warmth thing on your eyes.
- When you go back home, try to stay awake as far as you can (you can be siting, standing or walking). This helps to reduce the swelling of the face.
- Avoid bending or lifting heavy things which has resulted in the rise of swelling and may increase the blood pressure and cause bleeding.
- You can smoothly wash your hair 24 hours after the surgery. You should use type hair drier or a hair dryer that has cool setting instead of common hot hair dryer.
- You can take shower or bath the day after the surgery but water should not sprinkle on your face. It is not problem if your stitch line become wet.
- If you have excessive bleeding for more than 15 to 20 minutes after pushing your face, you should report it to your doctor.
Two to six weeks after the surgery
- Do not swim, dive, ski or participate in extreme sport activity for at least one month after the surgery.
- During the few weeks after the surgery, you may feel that the around of your earlobe, face and neck are numb.
- Avoid extreme exercising, bending or lifting heavy things.
- You can begin to sleep in moderately lounging position but do not sleep on the abdomen. If you sleep on your side, you may feel more comfortable by placing two pillows under your head and a soft pillow under the middle of your back and shoulders.
- Do not make up until you have the permit.
- Your scars may be redand slightly stiff during the first 4 to 6 weeks after the surgery. Then, the red color will disappear and the scar become soft. It takes at least one year that your scars reach their final appearance.
- Do not expose to direct sunlight. Use sunglasses and put slouch hat on your head. If you want to go out, use sunscreen with at least SPF 30 and at least 30 minutes before exposing to the sunlight. Your face will be significantly sensitive to sunburn or the formation of irregular dark pigments.
You can slowly and accurately go to normal exercises for fitness but you should use eye protection and hat. Feelings of pain, tightness and burning will be solved. Complete healing of the facelift takes at least six months, prepare yourself for this waiting. Please see your doctor on the specified dates.
The durability of the facelift results
Although genes, the quality of your skin and taking care of your skin affect the durability of the facelift, the lifting technique is more important than anything.
- The durability of minimalist facelift techniques, which has fast recovery, is less than all other methods.
Mini-facelift or S-lift: In this techniques, a small amount of skin is detached from the undermining tissue and muscles and the displacement of Superficial Muscular Aponeurotic System (SMAS – muscles/fascia) is limited. It has fast recovery and its result may last for up to 5 years.
Classic standard or complete facelift: This surgery can be performed through several techniques called SMAS-platysma, SMAS-ectomy, SMAS-imbrications, deep plane, composite lift or sub-periosteal. All of these approaches require extensive rearrangement of the undermining muscles of the face as well as the remarkable detaching of skin from the undermining tissues and muscles. Also, these techniques need procedures that must be performed by trained aesthetic and plastic surgeons with professional board.Their recovery is longer (two or three weeks) but results may be last for more than 10 years.
- The broader the procedure, the longer the recovery period, so that you enjoy the results of the procedures for longer time.
Keep in touch with your aesthetic and plastic surgeon
In order to preserve your safety and obtain the most beauty and the healthiest results, you should visit your surgeon on the specified dates for evaluation and whenever you have question about the healing of your facelift and its results.
Costs of this surgery
The cost of facelift is varied based on the doctor, geographical area and facelift technique.
In order to know the doctor’s wage for each surgery, you should be aware about the average of this fee throughout the country.
This fee merely includes the doctor’s or surgeon’s wage in the last year and do not include the cost of surgical facilities, anesthetic, medical tests, used drugs, surgical costumes or other miscellaneous expenses associated with the facelift surgery.
Since facelift is an optional surgery, insurance does not pay these costs. A large number of surgeons suggest some financial plans to patient in order to make this surgery more affordable.
Choose your surgeon by considering the quality of his (her) work, training received and work experiences not based on the costs.
By observing the important certifications, training courses and testimonials of the members of ASAPS, you can see why they are widely known for their professional work in the field of aesthetic and plastic surgery as they perform their work with the highest standard.
Limitations and Risks
Fortunately, facelift rarely has considerable complications. This surgery is still considered as the golden standard for facial rejuvenation and usually performed without problem.
You should talk about the potential risks and complications of this surgery during the consultation with doctor. These risks are identical in most of the surgeries. Some of the potential complications of all surgeries are as follows:
- Inappropriate reaction to anesthesia
- Hematoma or serum (the accumulation of the blood or fluid under the skin that may need to be removed.)
- Sensory changes
- Scarring effect
- Allergic reactions
- Damage to the undermining structure of the skin
- Unsatisfactory results that may leads to more surgeries.
You can minimize some specific risks by following the tips and instructions of the aesthetic and plastic surgery with specialized board before and after the facelift surgery.