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Facelift & Mini Lift

A facelift, also referred to as a rhytidectomy or cervicofacial rhytidectomy, is one of the most commonly performed facial plastic surgery procedures. It is a surgery intended to reverse the signs of aging, which can result in remarkable improvement in your overall facial appearance.

The inevitable natural aging process results in increased facial wrinkles and sagging skin, particularly along the jawline and upper neck. Together, these changes can make you look years older than you actually are. Facelift surgery can counter these changes and create dramatic improvements in the middle of the face, along the jawline, and across the upper neck and chin. The end result is that you look naturally younger and well-rested.

Facelift Candidates

Good candidates for the facelift include healthy men and women who are bothered by sagging, loose skin along the lower face and the upper neck. Patients may also have unwanted jowling along the jawline. The facelift does not improve deep smile lines known as nasolabial folds. These are better treated with a midface lift and/or volume enhancement with dermal fillers.

The Facelift Procedure

Using incisions hidden along the hairline and border of the ear, facelift surgery can effectively rejuvenate your face and restore that once youthful look. Although the term “facelift” implies lifting the entire face, the surgery actually targets the lower one-third of the face (below the eyes) and the upper neck. During the surgery, which can be done under a general or “twilight” anesthetic, excess skin along the cheek and neck is meticulously removed. The face and neck are then recontoured to provide a more youthful appearance. The surgery typically takes four to six hours to complete. If you have signs of extensive sun damage (finer wrinkles), additional procedures such as laser resurfacing may be recommended. Facelift is also commonly performed in conjunction with browlift and blepharoplasty for complete facial rejuvenation.

“I had a facelift which included having my eyelids lifted. i am much more confident and look more vibrant. Dr. Hilinski did an amazing job of making me look 10 years younger with out giving that pulled back look. Most people do not realize I had a facelift but say ‘wow you look fantastic you have lost weight?’ It has been over a year since the facelift I still look and feel fantastic!”

In patients who have previously undergone a facelift or those who require only limited enhancement, a “mini lift” may be more appropriate (see below). This is a minimally invasive version of the standard facelift procedure that allows much quicker recovery while still providing significant improvement.

Recovery from Facelift Surgery

While the facelift is typically performed in an outpatient surgery center, some facelift patients are observed overnight in the hospital for one day. Most patients demonstrate mild bruising and swelling during the first few days, which begins to subside after the first week. While patients typically experience discomfort rather than pain after the facelift, low-dose medication will be prescribed to control any pain or discomfort that occurs. The stitches are removed within five to six days.

A dramatic improvement is often seen once the bandages are removed at the one week postoperative visit. Healing continues for several weeks as the shape of your face begins to see even more refinement. Most patients are presentable in public after seven to ten days, at which time work can be resumed. Make-up can be worn at this time to help conceal any remaining bruising. Patients who are not bothered by the bandages may be able to return to work sooner.

Case Study

Learn more about facelift surgery through some case examples of Dr. Hilinski’s past patients.

About the Mini Lift

Ever give your face and neck a little tug while looking in the mirror? Like what you see? If so, you may want to consider a “Mini Lift” procedure by Dr. Hilinski.

The “Mini Lift”, also referred to as a mini facelift or an S-lift, is an alternative to the traditional, more formal face and neck lift procedure. Many patients seeking a more rejuvenated look do require a formal face and neck lift in order to achieve their desired results. These patients usually have more advanced signs of aging that require more extensive work, including surgery in the operating room under a general or twilight anesthesia. Some patients, however, do not necessarily need or want a formal face and/or neck lift procedure. In addition, some patients do not wish to undergo a deep anesthetic. The “Mini Lift” is an office-based procedure done under local anesthesia that is an alternative answer for these patients still seeking a more youthful look.

The “Mini Lift” can rejuvenate the lower face and upper neck to provide a more youthful and rested appearance. The best candidates include healthy men and women who are bothered by sagging, loose skin along the lower face and upper neck and sometimes unwanted jowling along the jawline. The procedure is intended to target early jowling, an aging lower face and excess sagging along the neckline (see diagram below).

These common problem areas combine to give the overall appearance of unwanted premature aging.

A “Mini Lift” can help rejuvenate the lower face and upper neck by resuspending or lifting the soft tissue layers of the face and neck. Incisions are hidden in the hair and within the creases around the ear. The lower face and upper neck skin is then lifted in layers and repositioned into a more youthful contour. The surgery typically takes three to four hours to complete. Because the “Mini Lift” can be done in a minimally invasive fashion (compared to a formal face and neck lift), patients can opt to have the procedure done in the office under local anesthesia. Some patients elect to have additional oral sedative medication to further relax them. Because the “Mini Lift” is done without using a hospital operating room and anesthesiologist, cost savings to the patient can be substantial.

Patients are able to go home shortly after the procedure with a light bandage wrap. Bruising and swelling are fairly limited to the first few days following the procedure. There is generally more discomfort than pain associated with the mini facelift and this is well-controlled with low-dose prescription medication. Sutures are removed within five to six days, at which time a lighter, removable bandage is applied. Within 7-10 days, patients are typically presentable in public. Make-up can be worn at this point to help camouflage any remaining bruising. Patients are usually able to return to work within five to ten days, and often sooner for patients not bothered by the bandages.

Facelift FAQs

Q – What is a face lift?
The facelift, also referred to as rhytidectomy or cervicofacial rhytidectomy, is a plastic surgery procedure designed to rejuvenate the lower face and upper neck, providing a more youthful and rested appearance. It’s important to note that a traditional or standard facelift rejuvenates only the lower one-third of the face whereas a ‘full facelift’ would include a brow lift, blepharoplasty and midface lift in addition to a lower facelift in order to rejuvenate the brow, eyelids, midface and lower face.

Q – Are there any limitations to what a face lift can achieve?
Because a traditional or standard facelift targets the lower one-third of the face and the upper neck, patients should not expect the facelift to impact the forehead and brow position, the appearance of the eyelids, or the midface area. These areas may be better treated with a browlift, blepharoplasty, and/or midface lift. In addition, the facelift will not correct deep smile lines termed nasolabial folds which are better treated with a midface lift and/or volume enhancement with filler injections.

Q – Who is a good candidate for a face lift?
Healthy men and women who are bothered by sagging, lose skin along the lower face and upper neck may be good candidates for a facelift. Individuals with unwanted jowling along the jawline may also be good candidates. Patients with deep smile lines (nasolabial folds) will not benefit greatly from the facelift. While the surgery may soften these lines to some degree, they are better treated with a midface lift and/or volume enhancement with filler injections. Patients who actively smoke or have a history of a bleeding disorder are not considered candidates for facelift surgery as there is an increased risk of complications.

Q – Where is the face lift procedure performed?
Our facial plastic surgeon, Dr. John Hilinski, usually performs the facelift in an outpatient surgery center, although some facelift patients elect to remain overnight in the hospital or a recovery facility.

Q – What type of anesthesia is used for the face lift?
Patients may elect to have either deep sedation (twilight anesthesia) or general anesthesia for the facelift surgery.

Q – How is the face lift performed?
The facelift surgery begins with carefully planned and placed incisions that are hidden along the hairline and border of the ear. The skin located in front of, below and behind the ear is then gently lifted. The deeper tissue layer beneath the skin that attaches to the facial muscles is termed the superficial musculoaponeurotic system, or SMAS. It is the SMAS layer that is then lifted up and tightened in front of the ear. The SMAS is continuous below the ear with a wide, thin muscle that crosses the entire front of the neck, termed the platysma muscle. Similar to the work on the SMAS, the platysma is lifted and tightened below and behind the ear. By lifting and tightening both the SMAS and platysma, the lower face, jowls and neck line are repositioned to a more youthful level. Permanent sutures are used to stabilize the SMAS and platysma layers in their new position to ensure a long-term result with the facelift. Essentially all of the tension for the lift procedure is placed along the deeper SMAS and platysma layers, thus ensuring that no unwanted tension is transferred to the skin layer where it could cause excess scarring. In addition, improper technique that does not rely on the SMAS suspension and instead relies on pulling the skin excessively taut often leads to the undesirable and unnatural ‘windblown’ look.

Once the SMAS and platysma have been tightened, the skin is redraped and the excess amount is trimmed. The skin layer is then closed in meticulous fashion with fine sutures, which includes recreating and realigning the natural skin creases in front of the ear, such as the tragus. If liposuction of the front neck is planned, this is performed with thin instruments through a very short incision below the chin. If the platysma muscle requires tightening in front of the neck, termed a platysmaplasty, this is done through a slightly wider hidden incision below the chin and the muscle is tightened much like a corset to form a tight sling or hammock effect across the neck and below the chin. This will essentially redefine the desired youthful angle along the front neckline. Once all of the incisions are closed, a compressive facelift dressing is applied to stabilize the surgical changes while minimizing the risk of bleeding.

Q – How long does the face lift take to perform?
The standard or lower face lift typically takes four to six hours to complete.

Q – Where are the incisions made for a face lift?
The incisions for the facelift are generally well-concealed in and around the natural curves of the ear and extending into the hairline behind the ear. A slightly modified incision in front of the ear is usually required for male facelift patients. In these cases, the incision is placed more along the border of the bearded facial skin, ensuring that hair-bearing skin is not lifted onto the ear where it can create problems with shaving after surgery. An additional short incision is made hidden beneath the chin if there is an excess of fat beneath the chin or if the front of the neck is going to be tightened along with the lower face (during a platysmaplasty).

Q – Are there scars after a face lift?
While the incisions made for the facelift will result in scars, they are generally well-concealed in and around the natural curves of the ear and extending into the hairline behind the ear. In some cases, an additional short incision is made in a well-concealed location beneath the chin. Once healed, facelift incisions are very difficult to see.

Q – Is the face lift a painful procedure?
Any pain or discomfort that patients experience after the facelift is usually not significant and is well controlled with low-dose prescription medication. Facelift surgery is often described as being more uncomfortable than painful.

Q – What is the recovery like after a face lift?
After the facelift, patients can elect to be admitted overnight to the hospital for nursing observation rather than going home with close observation by a responsible party. San Diego Face and Neck Specialties can assist you in arranging for a private nurse to accompany you home if necessary. Patients should sleep with the head slightly elevated at a 30 degree angle during the first few days to minimize swelling in the face and neck. Any pain or discomfort that patients experience is well controlled with low-dose prescription narcotic medication.

Within twenty-four to forty-eight hours after surgery, the bandages will be changed and patients will be checked to make sure that there is no unwanted bleeding along the surgical site. Patients are then seen again on day five or six after surgery during which time the sutures are removed and a lighter, removable bandage is placed. Patients will be instructed on wound care and will then be seen every several weeks for the first few months.

Swelling and bruising can be seen to various degrees during the first seven to ten days after surgery. You can help to minimize swelling and bruising by avoiding blood thinners like aspirin and ibuprofen for at least two weeks before surgery and by taking Arnica Montana before and after surgery. Most patients are presentable in public and able to return to work within seven to ten days after surgery. At this time, make-up can be worn to help conceal any remaining bruising. Though the scars may appear pink to red for several weeks after surgery, they will begin to gradually fade with time and will fully mature and disappear within six months or more.

Facelift patients are advised to minimize rotation of the neck (for instance, turning your head to look backward) for the first several weeks of their recovery. This helps to decrease the amount of unwanted pull, or tension, along the back of the ear, which could otherwise cause excess scarring. While the aging process resumes from the point of the last suture being placed, facelift patients have undergone a permanent change to their anatomy with rejuvenating changes that typically will always allow them to appear that much younger for that particular age.

Q – When will I be able to return to work after undergoing a face lift?
Patients are usually able to return to work within seven to ten days after the facelift, or sooner if they are not bothered by the bandages.

Q – When will I be able to exercise after my face lift procedure?
Aerobic activity and reconditioning can usually be resumed within ten to fourteen days after the facelift, while more strenuous activity and resistance workouts may be resumed within three to four weeks.

Q – When are the stitches removed after the face lift?
The stitches are removed within five to six days after the facelift.

Q – Are there risks or complications with the face lift?
As with all types of surgery, there are potential risks associated with the facelift. The risk of infection and bleeding are very low provided that patients follow instructions to stop taking blood thinners for two weeks prior to surgery and discontinue smoking for at least two to three before and after surgery. As with any surgery performed on the face, there is a potential risk of damaging the facial nerve. This is the nerve that helps control movement on that side of the face and there are five separate branches that can be injured individually or altogether. Because these branches happen to run along a predictable path below the SMAS and platysma layers, there is very little risk of damaging the facial nerve as long as the surgery does not extend too deep below these layers. In some cases, temporary weakness can be seen in select branches of the facial nerve due to swelling and bruising near the nerve. This recovers fully in nearly all cases and only rarely does permanent damage of the facial nerve develop. There is also a chance that patients may experience numbness around the ear resulting from injury to the great auricular nerve, which runs adjacent to the platysma layer. In most cases, numbness is temporary due to bruising of the nerve and permanent numbness of the great auricular nerve is fortunately quite rare after facelift surgery. Despite excellent technique by the surgeon, some patients may still develop unfavorable scars. This is related more to the patient’s inherent ability to heal and form scars rather than the surgeon’s ability to close the incisions properly. This may manifest several weeks after surgery as slightly raised or deeply red scars. In most cases, management with topical or injectable steroids will help calm down this process and improve the appearance of these scars.

Q – Does insurance cover the face lift procedure?
The facelift is generally not covered by insurance when performed for cosmetic reasons alone.

Read more about the facelift procedure.

Mini Facelift FAQs

Q – What is a mini facelift?
The mini facelift, also known as an S-lift, is a plastic surgery procedure designed to rejuvenate the lower face and upper neck in order to provide a more youthful and rested appearance. The mini facelift is ideal for patients who do not have advanced signs of aging and/or do not wish to undergo a more extensive formal lower facelift.

Q – Are there any limitations to what a mini facelift can achieve?
The mini facelift targets the lower face and upper neck and will not affect the forehead and brow position, the eyelids, or the midface area. Other procedures like a browlift, blepharoplasty or midface lift can better treat these areas.

Q – Who is a good candidate for a mini facelift?
Good candidates for the mini facelift include healthy men and women who are bothered by sagging, loose skin along the lower face and upper neck. Patients with unwanted jowling along the jawline may also be good candidates for the procedures. The mini facelift is ideal for patients who do not wish to undergo a more extensive formal lower facelift or those who not have advanced signs of aging. The mini facelift is not appropriate for patients who actively smoke or those with a history of a bleeding disorder due to an increased risk of complications.

Q – Where is the mini facelift procedure performed?
The mini facelift is an office-based procedure.

Q – What type of anesthesia is used for the mini facelift?
The mini facelift is performed with local anesthesia with or without oral sedation.

Q – How is the mini facelift performed?
The mini facelift begins with carefully planned and placed incisions which are located in a  hidden position along the hairline and border of the ear. Once the incisions are made, the skin located in front of, below and behind the ear is gently lifted. The SMAS layer is then lifted up and tightened in front of the ear. The SMAS, or superficial musculoaponeurotic system, is the deeper tissue layer beneath the skin that attaches to the facial muscles and is continuous below the ear with a wide, thin muscle that crosses the entire front of the neck, termed the platysma muscle. The platysma is also lifted and tightened below and behind the ear. This lifting and tightening of both the SMAS and platysma allows the lower face, jowls and neck line to be repositioned to a more youthful level. Permanent sutures stabilize the SMAS and platysma layers in their new position, ensuring a long-term result with the mini facelift. By placing essentially all of the tension for the mini lift along the deeper SMAS and platysma layers, there is no unwanted tension transferred to the skin layer where it could cause excess scarring. After the SMAS and platysma have been tightened, the skin is redraped, excess skin is trimmed, and the skin layer is then meticulously closed with fine sutures. This includes recreating and realigning the natural skin creases in front of the ear, such as the tragus. If the front of the neck requires liposuctioning, this is first performed with thin instruments through a very short incision below the chin. After all of the incisions have been closed, a compressive facelift dressing is applied. This dressing is intended to stabilize the surgical changes while minimizing the chances of bleeding.

Q – How long does the mini facelift procedure take to perform?
The mini facelift takes about three to four hours to complete.

Q – Where are the incisions made for the mini facelift?
The incisions for the mini facelift are similar to those for a formal lower facelift as they are located in and around the natural curves of the ear and extending into the hairline behind the ear. They are generally well-concealed and, once healed, will be very difficult to see. Male patients will require a slightly modified incision located in front of the ear, more along the border of the bearded facial skin. This will ensure that hair-bearing skin is not lifted onto the ear where it can create problems with shaving. Patients with excess fat beneath the chin will have an additional short incision hidden beneath the chin.

Q – Are there scars after a mini facelift?
The incisions made for the mini facelift do leave scars. In general, however, they are well-concealed in and around the natural curves of the ear and in the hairline behind the ear, resulting in scars that will be very difficult to see once they are healed.

Q – Is the mini facelift a painful procedure?
The mini facelift is generally thought of as more uncomfortable rather than painful. Further, any discomfort or pain that patients do experience after surgery is well-controlled with low-dose prescription narcotic medication.

Q – What is the recovery like after a mini facelift?
After the mini facelift, patients are sent home to recover in the presence of a reliable party. During the first few days, patients are advised to sleep with the head slightly elevated at a 30 degree angle to help minimize swelling in the face and neck. Low-dose prescription narcotic medication can control any pain or discomfort that patients experience.  The bandages are changed within twenty-four to forty-eight hours after surgery, at which time patients will also be checked to ensure that there is no unwanted bleeding along the surgical site. The stitches are then removed within five to six days after surgery and a lighter, removable bandage is put in place. Patients will also be instructed on wound care. During the first few months, patients will be seen every several weeks.

Varying degrees of swelling and bruising will occur during the first seven to ten days after surgery. This can be minimized by avoiding blood thinners for two weeks before surgery. Taking Arnica Montana before and after surgery can also help to minimize swelling and bruising. Within seven to ten days, most patients are presentable in public and able to return to work. Makeup can usually be worn at this time to disguise any remaining bruising. The scars may appear pink to red during the first few weeks after surgery. However, they will begin to gradually fade and, though it may take upwards of six months to a year, they will fully mature and disappear. Patients are advised to minimize rotation of the neck, for instance turning the head to look backward, for the first several weeks of recovery after the mini facelift. This will minimize the amount of unwanted pull, or tension, along the back of the ear, which may otherwise result in excess scarring. Though the aging process does resumes from the point when the last suture has been placed, mini facelift patients have fortunately undergone a permanent change to their anatomy with rejuvenating changes that usually allow them to appear that much younger for their particular age.

Q – When will I be able to return to work after undergoing a mini facelift?
Patients are usually able to return to work within five to ten days after the mini facelift. Patients who are not bothered by the bandages may be able to return to work sooner.

Q – When will I be able to exercise after my mini facelift procedure?
Aerobic activity (reconditioning) can be resumed within ten to fourteen days after the mini facelift, while strenuous activity (resistance workouts) may be resumed within three to four weeks.

Q – When are the stitches removed after the mini facelift procedure?
The stitches are removed within five to six days after the mini facelift.

Q – Are there risks or complications with the mini facelift?
As with all types of surgery there are potential risks associated with the mini facelift. In general, the risk of infection and bleeding is very low as long as patients follow instructions to stop taking blood thinners two weeks before surgery and stop smoking at least two to three weeks before and after surgery. As with any surgery of the face, there is the potential risk of damaging the facial nerve which helps to control movement on that side of the face. There are five separate branches that can be injured individually or altogether, but because these branches happen to run along a predictable path below the SMAS and platysma layers there is very little risk of damaging the facial nerves provided that the surgery does not extend too deep below these layers. Swelling and bruising near the nerve may result in temporary weakness in select branches of the facial nerve, though this recovers fully in nearly all cases and only rarely does permanent damage of the facial nerve develop. There is also the risk of numbness occurring near the ear which can result from injury to the great auricular nerve which runs adjacent to the platysma layer. Numbness in most cases is temporary and caused by bruising of the nerve. Permanent numbness of the great auricular nerve is quire rare after mini facelift surgery. It is also possible for some patients to develop unfavorable scars despite excellent technique by the surgeon. This is related more to the patient’s inherent ability to heal and form scars rather than the surgeon’s ability to properly close the incisions. This may occur several weeks after surgery as slightly raised or deeply red scars and, in most cases, the appearance of these scars can be improved with topical or injectable steroids.

Q – Does insurance cover the mini facelift procedure?
The mini facelift is considered cosmetic and, as such, is typically not covered by insurance.

Read more about the mini facelift procedure.

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