Facelift (Rhytidectomy) | Beverly Hills & Mission Viejo
Taylor R. Pollei, MD
Fellowship Trained Facial Plastic Surgeon offers facelift surgery in Beverly Hills and Mission Viejo CA
How does the face age?
A facelift from Pollei Plastic Surgery of Beverly Hills & Mission Viejo can help combat the signs of aging. While aging is inevitable and everybody ages differently, there are three major areas of facial aging:
- Skin changes
- Soft tissue descent
- Bone loss
Soft tissue refers to the fat, muscle, and other connective tissue below the skin. Just like other body areas that gradually descend with age, gravity affects the face soft tissue as well. As the lower eyelid, cheek, and jawline areas age the descent results in visible “bags”, pronounced nasal lines, tear troughs, and jowling. With these tissues as well as with the lips, soft tissue volume is lost as well. This leaves behind a hollowness where there was at one point fullness. Although volumization can be helpful in some cases, the best way to treat this descent is through lifting, which can only be truly done with a surgical procedure.
Bone creates the solid foundation to our faces and gives the shape and structure for the soft tissue and skin to drape over. Aging results in slow and steady loss of bone, which is most notable on the cheek, upper and lower jaw. This results in depression of the cheeks, sunken lips, and accentuation of the “marionette lines.” Placement of volumizing filler can help greatly, as can more permanently placed implants, typically in the cheek and chin/jaw areas. However, these temporizing measures are not able to create the results that a lasting surgical procedure can.
The goal of any facial rejuvenation surgery is to counteract these signs of aging by tightening deep tissues, removing fat and trimming excess skin, giving the face a fresher, more youthful look.
What Can A Facelift Do For Me?
The goal of a facelift (called a Rhytidectomy) is to re-suspend and tighten the soft tissue structures that have slowly descended over time. The goal is not to tighten the skin, or give a “wind swept” appearance, rather replace in a more vertical direction the facial tissues that gravity has pulled down.
Most patients seek improvement in the cheeks, jawline jowling, and neckline. These areas are all addressed with a solid surgical lifting procedure. The term “facelift” really refers to more the lower ½ of the face, with the eyes, brow, and forehead areas addressed separately. Individual areas that are improved with a facelift are:
- Mid-face sagging
- Nasolabial folds
- Jowling (Marionette lines)
- Loose skin and fat under the chin and jaw
Who Are Good Candidates For A Facelift?
Whether or not a facelift is for you is not age dependent. It depends completely on facial anatomy, aging changes, and medical suitability. Better candidates are patients with a strong bone foundation, have a higher neckline, have a thinner skin for re-draping, and are not at risk for wound healing issues. Patients that will still benefit but need to have their expectations appropriately set are those with a weaker jawline, a low set hyoid bone, more thick or ruddy skin.
Additionally, patients that are smokers, have poorly controlled diabetes or blood pressure, have connective tissue disorders, or bleeding disorders are at a slightly higher risk of issues. Most importantly surgical candidates MUST have appropriate expectations, understand the limitations of surgery and have no concerning psychological or psychiatric issues.
How Is the Procedure Performed?
There are many variations of a facelift, especially when a patient consults “Dr. Google!”
The exact technique used in performing a facelift depends on the surgeon, the patient’s facial structures, and the extent of correction desired.
Over the years, surgical variations and modifications have come and gone, with the end goals staying the same: Increase surgical benefit and longevity while decreasing risks. This is done with standard incisions, and elevation of both skin and the soft tissue layer under the skin, known as the “SMAS.” This connective tissue layer is the strong, non-elastic layer that needs to be lifted up, re-oriented, and re-suspended. By re-draping the SMAS layer, the nasolabial folds soften, the prejowl creases decrease, and the loose skin under the chin and jaw tightens. There is no substitute for a solid surgical lift! After the SMAS and skin are re-draped and trimmed, great care is taken to reduce skin tension and minimize incision pull and scarring.
Other adjunct procedures can be performed at the time of a facelift, including eyelid surgery (Blepharoplasty), browlift, facial volumization with autologous fat injection, or a chin implant. This is helpful since sometimes a combination of filling and tightening are needed to maximize results.
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 earlobe, 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 help 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 Like?
As you wake up 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 the facelift with blepharoplasty, chin implant, brow lift, or facial volumization, most patients find a single downtime with recovery better than staging or staggering the procedures.
How Long Do The Effects 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 in 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 this surgery?
Remember, after all, this is surgery! Any surgeon that downplays or dismisses the potential risks and complications is not being upfront 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 was 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.
Contact our practice to learn more about the facelift procedure where we serve the Beverly Hills, Mission Viejo, and South Orange County areas.