Facelift (Rhytidectomy)
Taylor R. Pollei, MD
Fellowship Trained Facial Plastic Surgeon
Where are Facelift incisionS placed?
An amazing lift and beautiful facial rejuvenation can quickly be overshadowed by poorly planned or placed incisions that can lead to increased scar visibility. Facelift incisions most often run along the front edge of the temporal hair tuft (the sideburn) versus behind the temporal tuft. Then the incision traces along the ear/cheek junction with several steps of irregularity to break up the inevitable scar and make it less visible. The incision can cut in front of or behind the tragus, which is the visible firm cartilage that sits just in front of the ear canal.
Next, the incision curves just below the ear lobe, and up along the back of the ear skin to join the hairline. Incisions then can curve into the hairline, or along the hairline tracing down toward the neck, but the key is to place the incision in the least conspicuous location.
Avoiding undue tension by tightening the SMAS and deep tissues and allowing the skin to gently re-drape without any tightness is key. Proper suture choice, and gentle handling of the skin and tissues helps markedly.
What is the preoperative & day of surgery process?
Once you decide to pursue surgical facial rejuvenation, a lengthy and detailed pre-operative visit is scheduled. This gives an opportunity to review all concerns, review the day of surgery and postoperative instructions, and obtain prescriptions and supplies that will be needed to avoid as much “day of surgery” stress as possible. Consent forms are completed, photographs are taken and reviewed, educational information discussed, and extreme care is taken to make sure both patient and surgeon expectations are congruent.
The surgery itself is typically performed as an outpatient procedure in my office-based surgery center facility located at the Lasky Clinic (Beverly Hills) or the Crown Valley Surgery Center (Mission Viejo). Patients have a choice of IV sedation or general anesthesia, both have their benefits. The procedure takes about 3 hours depending on the degree of correction needed and whether adjunct procedures are also being performed.
Waking up early in the morning the day of surgery with some butterflies in the stomach is totally expected. Nothing is to be eaten after the midnight preceding surgery. Prior to the surgery, the patients face is washed, clothes are changed and after meeting with the anesthesiologist and having an IV started, surgical markings are placed. This is a very important step. Typically the next thing you will remember is waking up in the recovery room following surgery with a gentle facial wrap bandage in place. Once you are awake and alert enough you are discharged home with a loved one or friend that will accompany you overnight and help you return the next day to the office for you initial postoperative visit. I find that patients tend to recover best in the comfort of their own home, but arrangements can be made for convalescent home or nursing services following discharge.
What Is The Recovery From A Facelift Like?
As you wakeup in the recovery room, you will be kept comfortable and encouraged to eat and drink as you feel ready. A bandage is placed at the end of surgery to hold gentle pressure on the cheeks, jawline and neck. This dressing stays in place until your follow-up appointment the next day where your hair is also washed and wound care instructions are reviewed. Appointments can be made sooner if needed, but at 7 days from surgery the initial sutures are removed.
Swelling, numbness, bruising and a feeling of tightness or tension in the face and neck is often felt. The face may look puffy, and facial muscles may feel stiff during the first few days. Most of these side effects resolve within 1-2 weeks, and if there is a decreased sensation of the face, it typically returns to normal within a few weeks as well. At the 2-week mark you can return to most physical activity remembering to listen to your body if you are overdoing it! By the 3-week mark, scars become less pink, bruising is typically completely gone, and you can return to most daily activities. Over the next several weeks, scars become less raised, lumpy and itchy.
If you are looking to combine facelift with blepharoplasty, chin implant, browlift, or facial volumization, most patients find a single downtime with recovery better than staging or staggering the procedures.
How Long Do The Effects Of A Facelift Last?
The effect of a facelift is permanent, but the aging process continues from the time of surgery. I liken this to taking several steps back on a conveyor belt… the belt keeps moving, but you are at a better spot than you were yesterday. Truly, the surgically rejuvenated face looks more youthful than if no surgery had been done at all. Once the initial postoperative healing is complete, it is common to see some mild return of skin laxity, soft tissue descent and age changes over the next 5, 10 or 20 years.
A facelift does not improve the look of the brow, eyelids and nose, and some parts of the mid-face. A patient who wants improvement to these areas as well would benefit from other adjunctive procedures such as brow lift or eyelid surgery, and/or with injectable soft-tissue fillers, facial implants and skin resurfacing.
What Are The Risks Of A Facelift?
Remember after all, this is surgery! Any surgeon that downplays or dismisses the potential risks and complications is not being up front with you. Transparency and honesty are key. During the consultation and the preoperative visit a detailed review of the risks, benefits, and alternatives to surgery occurs. This allows you to make an informed decision and consent to the surgical plan.
Possible complications of a facelift include bleeding, infection, bruising, swelling or discoloration, allergic reaction to the anesthesia, or medication taken, skin blistering or loss of skin blood flow (more often seen in smokers), nerve injury, and temporary or permanent loss of sensation in the face.