Because the face displays the signs of aging more than any other body feature, it is not surprising that so many people have sought treatment to reverse these facial changes. Often, such patients do not want to simply look younger; rather, they want their faces to show the vitality and youthful energy that they feel. They are worried that the changes of aging make them appear tired, angry, and anxious, when they actually feel vibrant and energetic. If you share these concerns, then you may be a good candidate for a facelift and/or neck lift.
Though many types of facelifts have been described, they all share the same goal – to lift the soft tissues of the face. The medical name for a facelift is “rhytidectomy”, which derives from the Greek terms for wrinkle (ritis) and excision (ektomi). A more important effect of facelifting, however, is the return of facial tissue to its youthful, more elevated position. Patients are thrilled when this occurs – they feel younger and more confident, and are excited to show how they have “turned back the clock” to an earlier age. The following description of facelifts will give you a good introduction to this rewarding procedure, and help you decide if a facelift is right for you.
You should keep in mind that a facelift also improves the appearance of the neck. So, if you are concerned with sagging skin of your neck or bands of tissue extending down from your chin (the “turkey gobbler” appearance), than you may also be interested in how a neck lift can improve the contour of your neck.
Types of Facelifts
The most complete, and arguably the most effective, facelift is the complete , widely undermined , facelift, which involves isolating and elevating both layers of the face – the connective tissue layer and the skin. The recovery from this type of facelift is slightly longer (see below under Recovery) but the results are often the most natural and longest lasting.The face lift rejuvenates the the lower cheeks, the jawline and the neck. Many variations of the facelift technique have been developed, and their names may be familiar to you – examples are the “S-lift”, the “limited incision facelift”,”the weekend facelift”, the “Lifestyle lift”, the “Quicklift” or the “mini-lift”. These techniques also lift the connective tissue and skin, but use less extensive approaches often resulting in quicker healing and less down time. . We prefer to call this limited procedure a “Mini-lift”. It works best on those with with the earlier signs of aging. We counsel you as to which is best for your face and neck.
Facial and Neck Anatomy
Although the skin is the visible layer of the face, and shows all the effects of aging, it is not the only type of facial tissue that is affected by the aging process. Under the skin is a tough, thin, fibrous layer of “connective tissue” that acts as the foundation of the face. So, during a facelift procedure, this tough layer can be elevated and secured in a higher position, and the skin will be gently elevated with it.
A similar anatomic relationship exists in the neck, with the skin being the outer layer. But, the deeper layer is not connective tissue – it is a thin layer of muscle. As with the face, both of these neck layers need to elevated and tightened in order to enhance the neck contour.
Suitable Patients for Facelift
Almost all facelift patients complain of sagging tissues of the face, including skin of the jawline (the “jowls”) and the sides of the cheeks. Patients may also dislike the loose appearance of their neck skin, especially the sagging in the middle of the neck that is most visible from the side. A facelift can correct both of these complaints, leading to a more youthful, rested, and relaxed appearance. If you share these complaints, and want your face to better express your youthful and energetic personality, then you may be an excellent candidate for a facelift.
Ideal patients should also be in good health, and should be able to avoid blood thinning medications around the time of the surgery. Non-smokers have the best chance of excellent results; patients who smoke can still have facelifts, but often a more limited surgery is required.
History of Facelifting
The history of facelifting began relatively recently, around the turn of the last century. The first description of anti-aging surgery was published by Charles Conrad Miller in 1907, in which he recommended cutting some facial muscles through incisions in the mouth and face. Interestingly, one consequence of his facial incisions was the creation of dimples in patients who had none. Fortunately, facelift procedures have evolved a long way since then. Research and experience have led to a very different, and much more effective, technique.
When you arrive at our San Francisco practice, you will be asked to complete a detailed questionnaire about your medical and surgical history. Dr. Kabaker will then take standardized photographs, and examine the position and texture of your face and neck skin. Most importantly, you will be given ample time to describe your complaints, and to learn about your proposed procedure and how it might help you. Our doctors will also use a state of the art computer photo alteration program to predict your surgical outcome.
As mentioned elsewhere in this website, we stress patient education. So, during the consultation, you will learn a great deal about the anatomic considerations that cause your complaints, how they will be changed, what you will experience during the recovery, and your risks and alternatives to treatment. You will be given much information in writing, and we are always available for a second consultation, if you wish to review anything.
The Pre-operative Process
For the two weeks prior to your procedure, you should refrain from using common medications that decrease your blood’s ability to clot, including aspirin, ibuprofen, Advil, Motrin, Bufferin, Naprosyn, and large doses of vitamin E. We will give you specific instructions based on your current medications. You should also avoid smoking for two weeks before your surgery. The night before your surgery, you should eat a normal dinner but avoid all oral intake after midnight. This includes drinking anything, even water.
When you schedule your surgery, you will be given a detailed set of instructions that includes much more information. A copy of these instructions is available for you to review now.
After you are properly anesthetized, incisions will be made that start in the hair of the temples, continue in front of the ears, curve behind the ears, and finish in the hair just behind the ears. Many patients worry that the scars from these incisions will be easily visible – this is not true. They are hidden so well by hair and existing skin creases that only you will know they are there. Your surgeon will then isolate the skin and deep connective tissue of the face, elevate these layers to a more natural and youthful position, and secure them with sutures. A similar approach is used in the neck, and occasionally a patient will need a very short incision under the chin. Again, this incision is so well hidden that the scar will be barely visible.
You will need to arrive about two hours prior to the start of your procedure. The entire procedure will take approximately three hours, and you will stay in our recovery room about two hours while you relax and recover from the anesthetic. After a facelift, we insist that you are cared for by a trained nurse for the first 24 hours, so your comfort and safety will be maximized. We will arrange for this after-care.
Most facelift patients receive deep sedation, which means they are completely asleep during the procedure but are breathing on their own, so there is no need for a breathing tube. This type of anesthesia is always provided by a highly qualified doctor or nurse anesthetist. Every patient will be completely comfortable and the procedure itself will be pain-free.
The discomfort after a facelift is usually very mild, and most patients are quite pleasantly surprised by this. You will be provided pain medication and other suggestions to minimize your soreness. Most patients report a sensation of heaviness tightness in their facial and neck skin, which arises from swelling. Actual pain, though, is fairly rare.
After a facelift, patients have a gauze dressing that is wrapped around your face and neck. This is designed to prevent excessive swelling, and patients occasionally complain about the tightness of the dressing. However, this dressing is extremely important, and sensations of tightness can be controlled. You will need to return to the office the day after surgery, at which point the dressing will be changed to a looser one. The next day, we will again see you in the office to remove the looser dressing, and provide you with further instructions. No more dressings will be needed. The sutures used for your skin incisions will be removed one week after surgery.
You will have mild swelling and bruising of your face and neck for one to two weeks. You should be able to return to light activities after your sutures are removed at one week, but heavy exertion and exercise should be avoided for up to three weeks.
The face lift test. Do this in the mirror and see if the improvement is significant to you Examples of the face lift test. This shows what a min-lift facelift might do for a prospective patient. It works on the lower cheeks, jaw line and neck for those with the earlier signs of aging. Those with more advanced changes are best served by a standard full facelift which still corrects only the lower cheeks, jaw line and neck.
The face lift test. Do this in the mirror and see if the improvement is significant to you.
Example of face lift test on live patient