By Barry J. Cohen, M.D., P.C.
Diplomate, American Board of Plastic Surgery
As the baby boomers are approaching middle age, more and more people are inquiring about facial rejuvenation surgery. The face and neck are common areas that show the effects of gravity, exposure to sun and stresses of daily life. The areas of the face which are improved with face and neck lift surgery are the jowls, wrinkles of the cheek, and laxity of the neck, commonly exemplified by the turkey gobbler neck. Indeed, the best candidates for a face lift can be either a female or a male whose face and neck have begun to sag, but whose skin has some remaining elasticity. The average age currently for people seeking face lift are in the mid 40’s. Perhaps this is due to the desire not to look 20 years younger, but rather to look rejuvenated before peoples’ friends and family are aware that they have had surgical intervention to turn back the clock. Perhaps this is due to the downsizing seen in many large firms and the desire to attain a youthful appearance to remain competitive in the job market. Regardless of the reason, facelift surgery has become more common amongst the younger patient population and more accepted as a right of passage, rather than a frivolous self indulgence. Face lifts can be done just as successfully in patients in their 70’s or 80’s as well, who wish to retain their youthful appearance. In most cases facelift surgery will make you appear younger, but not give you a completely different look.
The risks and complications associated with face lift surgery can be substantial. However, most complications are quite minor and infrequent. The major risk associated with facelift surgery include hematoma or collection of blood underneath the skin that must be surgically removed. Injury to the nerves that motor the facial muscles can be seen in one of several thousands of patients. Fortunately, this is usually a temporary phenomena due to the extensive cross over seen in facial nerve anatomy. Injury to the nerve that allows one to have feeling in the ear can also be seen, however, this is typically infrequent. Infections of the skin can also occur, but are much more common in patients who smoke. Mild asymmetries after surgery are noted in some patients, but this will usually pass with time.
Planning face lift surgery is individual to each and every patient. Every person’s face ages differently. Some patients depict greater jowling than others, while some patients have increased laxity of the neck or perhaps wrinkling on the cheeks. The area most difficult to improve with facelift surgery is the nasolabial folds, or the crease where the cheek meets the area of the lips.
The types of anesthesia that can be used during face lift surgery vary from local anesthesia with intravenous sedation to complete general anesthetic. The choices frequently are left to the patient. When a facelift is combined with other longer procedures, such as a brow lift and upper and lower eyelid surgery, general anesthesia is often chosen.
The surgery for face lifts can be done in an office based operating room or an outpatient surgery center or hospital. It is rare for patients to be hospitalized when facelifts are done as a sole procedure. The surgery itself can take three to four hours and longer if more procedures are being done at the same time. It is quite common to combine face lift surgery with other areas of facial rejuvenation, such as upper and lower eyelid blepharoplasty, brow lift, lip lift, laser surgery and chemical peels. Not all procedures can be combined at once due to the increased propensity of scarring when face lifts, for example, are combined with either full face laser surgery or chemical peels. Staged procedures are then chosen.
The incisions for face lift surgery usually begin above the hairline at the temples and extend in front of the ear or just inside the ear cartilage. The incisions then continue behind the earlobe and then into the scalp or hairline. The surgeon then separates the skin from the underlying fat and muscle from below. Excess fat, such as in the area of jowls and neck, are removed either by direct excision or liposuction. Most surgeons will also perform some type of procedure to tighten the underlying muscles of the face to give the facelift a longer lasting affect. The average duration for which face lifts last is 5 to 10 years. This depends upon your underlying skin elasticity, your history of smoking, as well as the amount of sun damage that you had of your skin at the time of your first face lift.
Post operatively, there is usually minimal discomfort associated with all facial rejuvenation surgery, which is easily relieved by modest pain medication. Some surgeons choose to use a drainage tube inserted through a separate incision, which is removed one or two days after surgery. Bandages are usually removed quite quickly after surgery and are usually there for padding.
Most patients are able to be seen in public in approximately 10 to 14 days. Strenuous activities should typically be avoided for at least two weeks after surgery. This is to help prevent collection of blood underneath the areas of surgery, which can result from these strenuous activities.
In the immediate post operative period, one’s features appear rather distorted due to swelling and bruising. Most patients are quite self conscious about their scars and exhibit self doubts about their initial motivations for surgery. It is also not uncommon to be upset with the physician in the immediate post operative period for inflicting such trauma upon them in an elective fashion, These self doubts typically take 10 to 14 days to dissipate and as the new, more youthful face emerges from the underlying bruising, most patients are quite delighted with the outcome. Camouflage make up can be worn relatively quickly to allow the patient to be seen in public. Most patients are delighted with the outcome of their facelift and are thrilled with their new youthful appearance. It is important to remember that having a face lift only turns back the clock, but does not stop it. Revision is frequently necessary in 5 or 10 years to continue the lasting effects of the facial rejuvenation surgery.