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Facelift

Our face is our most unique and powerful means of communicating with one another.  In an instant, we can understand one's mood, ethnicity, age, and general health from a simple glance at the face.  Socially, we analyze facial expressions, appearances, and emotions hundreds of times daily. But, what does it mean to be attractive?

 

This question has been the subject of debate for centuries.  Scientists have attempted to equate beauty to a mathematical ratio or number, but this is likely an oversimplification of appearance. Most would agree that symmetry, an angled jaw line, and smooth skin texture are all attractive features.  High cheek bones, full lips, and a smooth brow are also indicators of youthful health and vigor.

 

Unfortunately, aging and sun damage contribute to loss skin elasticity and pigment abnormalities. Also, fluctuations in weight and age-related loss of facial volume lead to jowling, furrows around the mouth, and sagging of the neck. Some degree of facial aging is normal, and, frankly, unstoppable. However, premature aging can affect our self esteem and interpersonal relationships.  

 

Factors that contribute to premature aging include excessive sun exposure, smoking, poor nutrition, stress, and genetic factors. These contributors generally diminish skin elasticity leading to sagging and drooping of the skin and subcutaneous fat.  The fullness of the upper cheeks descends, exaggerating the nasolabial folds and jowls. The eyelids and neck may droop leading to a look of chronic fatigue or sadness. 

 

One's overall inward feeling of contentment, happiness, or vitality may be contradicted by their outward appearance due to premature facial aging.  Thankfully, modern surgical techniques can help to restore a refreshed and rested appearance without telltale signs of surgery. 

 

Who is a candidate for a facelift?

 

Many factors are considered in evaluating the benefits and candidacy for facelift surgery. In plastic surgery, safety is first and foremost. Overall a patient must be in good general health to undergo surgery. Factors such as diabetes, smoking, and heart disease increase surgical risks. Preoperative labs and surgical clearance by a general practitioner may be required prior to surgery.  

 

Additionally, not all facial aging is treated with facelift surgery. Plastic surgery results are the most ideal when approached on a least invasive to most invasive basis. That is, wrinkles around the mouth may be treated simply with fillers. Forrows on the brow may respond to Botox. A sagging neck may require a neck lift alone. 

 

When tissue of both the face and neck demonstrate laxity and sagging, however, a facelift may be the best option. In particular, facelift surgery is effective in restoring mid-face volume and minimizing jowling.  Nasolabial folds are also improved with surgery.  

 

To achieve the ideal facelift results, a patient should discuss at length with his or her physician expectations and desired surgical results. It is important to consider specific aspects such as facial volume, eyelid rejuvenation, and skin characteristics. It is not unusual for a facelift patient to undergo additional procedures such as blepharoplasty, fat transfer, chemical peel, or laser resurfacing at the time of surgery. These additional procedures address specific aspects of facial anatomy that a facelift may not correct. It is important to discuss these options prior to surgery to achieve the optimal outcome.

 

 

How is a facelift performed?

 

Facelift surgery is generally performed under local anesthesia, sedation, or general anesthesia depending upon patient preferences and the expected length of surgery. Following sedation, the face is anesthetized with a mixture of numbing medication. An incision is made in the hairline, in front of the ear, and often extending behind the ear depending upon the degree of skin laxity. The skin is elevated and the tissue beneath the skin is addressed. This subcutaneous tissue is known as the SMAS (superficial musculo aponeurotic system). 

 

Most modern facelift techniques include some modification of the SMAS. This dense layer of tissue beneath the skin contributes a layer of strength to facial tissue. The SMAS may be elevated and plicated or simply plicated.  This means that the excess tissue is tightened with sutures to suspend the mid-facial tissue, jowls, and neck.  

 

Antiquated facelift procedures of the past simply tightened the skin. This led to the classic "wind-blown" surgical appearance. The benefits of modifying the SMAS are multiple. The tension required to lift the neck and saggy tissue is significant. The SMAS is a robust layer that easily maintains sutures and long term surgical results. Thus, any surgical tension is maintained by tissue beneath the skin. This is a critical difference between modern and antiquated techniques. 

 

Skin, by nature, loses elasticity with time. Any facelift that relies on skin tightening alone is destined to fail over the short term. Facelifts incorporating SMAS modifications tend to deliver lasting results. The broad unsightly scars and post surgical look of older techniques and "lunch time" or "lifestyle" lifts should generally be approached with caution. These procedures often simply tighten the skin. The results are generally short lived. 

 

Facial rejuvenation is complex and should incorporate many factors. This means that specific lines and contours require undivided attention.  Volume restoration is crucial and may or may not necessitate fat transfer to the face. Each surgical procedures is ideally tailored to the individual.  Men or women with thin faces require an approach that is different from those with fuller faces. While fat was often excised from the face in the past, it is rarely our practice to do so today. Meticulous surgical techniques and attentive post operative care will generally yield imperceptible scars.

 

What to expect

 

Facelift surgery is not known to be extraordinarily painful. However, every surgery is associated with some degree of discomfort.  Postoperative pain and tenderness is easily managed with prescription medications. A postoperative compression garment is required for 7-10 days following surgery.    One should plan to be out of the public for at least 3-4 days. Bruising and swelling persist for 7-9 days. Evidence of surgery may be concealed by makeup in about a week.The lateral face and neck may feel tight for several weeks. There may be numbness of the skin of the neck and cheeks in the postoperative period.  This will generally resolve over the course of 6-8 weeks.