THE BEST CANDIDATES FOR A FACELIFT
The best candidates for facelifts are men or women whose faces and neck have begun to sag, but whose skin still has some elasticity and whose bone structure is strong and well-defined. Most patients are in their forties to sixties, but facelifts have been done successfully on people in their seventies or eighties as well.
A facelift can make you look younger and fresher, and it may enhance your self confidence in the process. It can’t, however give you a totally different look, nor can it restore the health and vitality of your youth. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.
ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK
When a facelift is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable.
Complications that can occur include: hematoma (a collection of blood under the skin that must be removed by the surgeon); injury to the nerves that control facial muscles (usually temporary); infection; and reactions to the anesthesia. Poor healing of the skin is most likely to occur in smokers.
You can reduce your risks by closely following your surgeon’s advice both before and after surgery.
PLANNING YOUR SURGERY
Facelifts are very individualized procedures. In your initial consultation, the surgeon will evaluate your face, including the skin and underlying bone, and discuss your goals for the surgery.
Your surgeon should check for medical conditions that could cause problems during or after surgery, such as: uncontrolled high blood pressure; blood clotting problems; or the tendency to form excessive scars. Be sure to tell your surgeon if you smoke or are taking any drugs or medications, especially aspirin or other drugs that affect clotting.
If you decide to have a facelift, your surgeon will explain the techniques and the type of anesthesia that will be used, the type of facility where the surgery will be performed, and the risks and costs involved. Don’t hesitate to ask any questions you may have, especially those regarding your expectations and concerns about the results.
PREPARING FOR YOUR SURGERY
Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly. If you smoke, it’s especially important to stop at least a week or two before and also after surgery. Smoking inhibits blood flow to the skin, and can interfere with the healing of your incision areas.
If your hair is really short, you might want to let it grow out before surgery, so that it is long enough to hide the scars while they heal.
Whether your facelift is being done on an outpatient or an overnight basis, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two if needed.
WHERE YOUR SURGERY WILL BE PERFORMED
A facelift is performed in an outpatient surgery center. Patients usually stay overnight in the center. It can be done on an outpatient basis, but since it is usually a 2-3 hour delicate procedure under general anesthesia, certain conditions such as diabetes or high blood pressure should be monitored after surgery and may also require a short inpatient stay.
TYPES OF ANESTHESIA
General anesthesia is preferred so that you’ll sleep through the operation, as it can be long and complicated.
A facelift can take several hours or somewhat longer if you’re having more than one procedure done. Every surgeon approaches the procedure in his or her own way. Some complete one side of the face at a time, and others move back and forth between the sides. The exact placement of incisions and the sequence of events depends on your facial structure and your surgeon’s technique.
Incisions usually begin above the hairline at the temples and extend in a natural line in front of the ear (or just inside the cartilage at the front of the ear), continuing behind the earlobe to the lower scalp. If the neck needs work, sometimes a small incision may also be made under the chin.
In general, the surgeon separates the skin from the fat and muscle below. Fat may be trimmed or suctioned from around the neck and chin to improve the contour. The surgeon then tightens the underlying muscles and tissue, pulls the skin back, and removes the excess. Stitches secure the layers of tissue and close the incisions. Metal clips are usually used on the scalp.
Sometimes a small drain tube may be temporarily placed under the skin behind your ear to drain any blood or fluids that might collect there. The surgeon may also wrap your head loosely in bandages to minimize bruising and swelling.
AFTER YOUR SURGERY
There isn’t usually significant discomfort after surgery. If there is, it can be lessened with the pain medication prescribed by your surgeon. Severe or persistent pain or a sudden swelling of your face should be reported to your surgeon immediately. Some numbness of the skin is quite normal and will disappear in a few weeks or months.
It is important for you to keep your head elevated and as still as possible for a couple of days after surgery, to keep the swelling down. Keep your chin up and restrict any head turning.
If you’ve had a drain tube inserted, it is usually removed one or two days after surgery. Bandages, when used, are usually removed after one to five days. Don’t be surprised at the pale, bruised, and puffy face you may see. Just keep in mind that in a few weeks you’ll be looking normal. Most of your stitches will be removed after about one week. Your scalp may take longer to heal, so the metal clips in your hairline are left in a few days longer.
GETTING BACK TO NORMAL
You should be up and about in a day or two, but plan on taking it easy for the first week after surgery. Be especially gentle with your face and hair, since your skin will be both tender and numb.
Your surgeon will give more specific guidelines for gradually resuming your normal activities. They’re likely to include these suggestions: Avoid strenuous activity, including sexual relations and heavy housework, for at least two weeks (walking and mild stretching are fine); avoid alcohol, steam baths, and saunas for several months; above all, get plenty of rest and allow your body to spend its energy on healing.
At the beginning, your face may look and feel rather strange. Your features may be distorted from the swelling, your facial movements may be slightly stiff. Some bruising may persist for two or three weeks, and you may tire easily. It’s not surprising that some patients are disappointed and depressed at first.
By the third week, you’ll look and feel much better. Most patients are back at work in about two weeks after surgery. If you need it, special camouflage makeup can mask any bruising that remains.
YOUR NEW LOOK
The chances are excellent that you’ll be happy with your facelift-especially if you realize that the results may not be immediately apparent. Even after the swelling and bruises are gone, the hair around your temples may be thin and your skin may feel dry and rough for several months. Men may find they have to shave in new places such as behind the ears, as some of the neck’s beard-growing skin may have been repositioned in the facelift.
You’ll have some scars from your facelift, but they’re usually hidden by your hair or in the natural creases of your face and ears. In any case, they’ll fade within time and should be scarcely visible.
Most patients never need to have another facelift. Having a facelift, however, doesn’t stop the clock. Your face will continue to age with time, and you may want to repeat the procedure, perhaps five to ten years down the line. But in another sense, the effects of even one facelift are lasting. Years later, you’ll continue to look better than if you’d never had a facelift at all.