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.