The Facelift-How to Decide if You Want to Have Facial Rejuvenation Surgery
I have been a plastic surgeon for 25 years and I can tell you that almost every patient I have seen who wants to look younger starts their consultation with me by saying “I don’t want a face lift’. My impression after all of these years is that it is not fear of face lift surgery but fear of “what people will think” that is worrying most people who are considering a face lift, at least in Boston where I practice.
Will I look natural after a face lift/ I don’t want the “windblown” or unnatural “too tightened” look.
Everyone has seen famous entertainment personalities who have a very unnatural look after a face lift. People who look unnatural after a face lift either have had “bad surgery” or have had multiple face lifts. These are unusual cases and do not represent the usual result after a properly executed face lift on an appropriate candidate done by a skilled experienced plastic surgeon. A properly done face lift by an experienced skilled surgeon should create a beautiful, youthful natural looking face that looks like the face you saw in the mirror 10 or 20 years before. The face should look natural, not “operated on”. The key to a natural looking face following a face lift is proper technique.
Every face is different, unique, and the direction of pull and tightening must be done in the appropriate direction and with appropriate tension. Before a face lift I analyze and plan the “vectors”, the correct direction of tightening for each segment of the face to recreate the appearance of the face before aging and laxity. When this is done properly a face lift will restore a natural youthful appearance to the face.
How long will I be out of work, what is the recovery time following the face lift?
The quick answer is 2-3 weeks but I have had patients who are back to near normal activity in one week. Do not believe that you can “return to work the next day” after any face lift that provides meaningful facial improvement that lasts-it does not happen in spite of the advertisements that promise this.
The major factor in a happy outcome following a face lift is having realistic expectations of not only the result but also of the post operative recovery. Recovery from a properly done face lift is not terribly difficult for most people who have a skilled surgeon and who have realistic expectations. The worst thing is to have time pressure when you are recovering from surgery. Plan at least 2 weeks when you have no significant responsibilities and can be at rest with the support of a friend or loved one. You will be up and around day 2, able to eat, go to the bathroom, and visit your doctor, but you should not do lifting, housework, or other strenuous activity or have social obligations or work obligations for the first 2 to 3 weeks.
Even though some patients feel recovered after 5-7 days I do not recommend return to normal activity. My worry is that they will exert themselves and “pop a stitch” or otherwise disrupt their healing process.
Will I have pain after my face lift?
Surprisingly my patients do not complain of pain following a face lift. Patients tell me that that their face feels “tight” after a face lift, but they do not feel pain. This is most likely due to the fact that many of the nerves which carry pain sensation are disrupted during the face lift so pain is not perceived; actually the cheeks and the area around the ear are numb after a face lift. Usually the facial sensation or feeling returns after a period of months.
How will I look after my face lift?
The morning after a face lift I remove the dressing and usually a small drain placed to collect any fluid from beneath the skin, and then have my patients take a shower, comb out their hair and the wear a scarf. The face looks tight and patients can see the dramatic improvement in the cheek, jaw line, and neck. There may be some bruising usually in the neck and slight swelling along the cheek and jaw line, but most patients are very pleased with how they look the first day. I have all of my patients sleep with their head elevated so that bruising and swelling can drain down into the neck where the swelling can be removed by the lymph nodes in the neck. As the days progress the bruising moves downward into the neck.
I use a natural herb Arnica which is taken in pill form and in my experience bruising is less using this regimen. Some patients undergo a face lift and have very little bruising and swelling.
Will my friends be able to tell I have had a face lift?
I tell my patients to not tell anyone other than close friends or family that they are having a face-lift. Your friends and casual acquaintances will notice that you look good, refreshed, but after a good face-lift people will not pick up on what is different about you.
No one studies your face as carefully as you do when looking in a mirror. They scan your face in a much less careful manner. To see that you have had a facelift requires careful inspection of the area around your ear and few people get that close to you other than your hair dresser.
Your face lift is your private business and if you do not tell people most of them will not know, will only see that you look rested and fresh. I tell my patients to tell friends they have been on a new diet, working out, or have been on a great vacation-that is all that is usually necessary.
What can go wrong with a face lift?
Complications can occur with any surgery and it is very important that you receive proper informed consent from your doctor before having a face lift. Fortunately complications are unusual following a face lift performed by an experienced board certified plastic surgeon.
The most common complication is that some loose skin beneath the neck or chin is not fully tightened or recurs after a short period of time. Rarely bleeding can occur after a face lift and if drains were not used, the blood has to be removed from beneath the skin. Numbness of the face is common but usually the sensation returns, although in some patients the ear and skin around the ear can be permanently numb after a facelift.
The most serious problem is injury to one of the facial nerves. Statistically this happens in 2% of cases but fortunately the nerve injury is reversible in 75% of cases. This can be a very noticeable and distressing complication but fortunately it is unusual and can usually be avoided by careful face lift technique.
Scarring is usually well hidden and not noticeable, however in some cases the scar, particularly behind or above the ear can be red or widened. Hair loss can also occur especially right above the ear, but usually this is covered well by the surrounding hair.
Fortunately these complications are rare but when they occur it is very difficult for the patient. The most important thing is having a doctor you can trust who is supportive and can help you through your recovery.
Am I a good candidate for a facelift?
The answer to this question depends first on your general state of medical health and secondly on your unique facial anatomy and facial aging characteristics. Generally speaking you should be in good health with no medical problems if you are going to have a face-lift. Uncontrolled high blood pressure, heart or vascular disease, smoking, and any condition that results in poor wound healing such as severe diabetes or immune deficiency diseases are contraindications for a face lift.
The face lift can tighten loose sagging skin on the face and neck, improve jowls, nasal labial fold lines, marionette lines, and sagging cheeks, but the face lift cannot remove wrinkles. People with strong jaw lines and high cheek bones get better face-lift results although lack of these features can be corrected by facial implants. People with dark thick skin generally get better and more long lasting facelift results than those with very fair thin skin with a lot of sun damage.
Equally important is that the patient have reasonable and realistic expectations, a good support system, and appropriate time to recover without time and work pressure after the facelift.
Should I have a non-surgical facelift?
Recently with the many technological advances in non-surgical facial rejuvenation and skin tightening, the concept of a non-surgical facelift has emerged, and more and more people are asking me about the possibility of a non-surgical facelift as opposed to a traditional facelift. There are many procedures which are advertised as a non-surgical facelift, but the most widely mentioned are the various skin tightening procedures using infrared and radiofrequency energy to heat the deep layers of the skin causing the collagen in the skin to shorten and thus tighten the skin. The more popular of these skin tightening technologies are LuxIR, Aluma, ActiveFX Laser, Refirme, Titan and Thermage.
These new skin tightening procedures, which are called the non-surgical facelift, are expensive, averaging about $4000.00, they are new, and while subtle skin tightening is possible with the non-surgical facelift, results are not comparable to those achieved with traditional facelift surgery. Thus it is very important for prospective patients to understand their goals and expectations and have a realistic understanding of what the non-surgical facelift can and cannot achieve.
I have had a lot of experience with the non-surgical facelift and can tell you that the best results with current technology are about a 20-30% tightening of the facial skin with some improvement in skin texture and wrinkling especially around the jaw line. While these results are definitely visible when you review pre and 6 month post treatment photographs, most patients in their 50’s, who have significant skin laxity in the face, jaw line, and neck are disappointed. The cost of the non-surgical facelift or skin tightening procedure is about a third of the cost of a facelift. Although non-surgical facial rejuvenation and skin tightening techniques have improved and are getting better I believe they are more appropriate for younger patients in their 30’s and 40’s who have minimal facial laxity and have younger skin which responds better to skin tightening techniques. In my experience most patients with significant facial skin laxity in their late 40”s and older get a better result and are happier after a facelift done by an experienced skilled plastic surgeon.
The decision to have a facelift is a very personal one. If you are healthy and having a youthful looking face is important to you, and a qualified, experienced, skilled board certified plastic surgeon thinks you are a good candidate, and you can afford a two week recovery time then a facelift is a good option.
If you decide to have a facelift by all means the most important factor is to find an experienced skilled plastic surgeon. Ask friends or relatives who have had a good experience for a recommendation. Ask the surgeon to show you pictures of patients who have had a facelift with the doctor. Ask to speak to prior patients who have had a facelift.
I believe in Result Oriented Plastic Surgery, find a doctor who will listen to your goals and help you achieve them.
If you would like to learn more about facelift, facial rejuvenation, prevention of facial aging, or non-surgical facial rejuvenation read Save Your Face or contact me.