Facial aging is influenced by cumulative effects of gravity, genetics, sun exposure, among other factors. Descent of skin and soft tissues occurs over time, resulting in volume loss of the midface (cheek and cheekbone region) with gradual accumulation of redundant skin and subcutaneous (fatty) tissue in the lower face (jowls, chin, and neck). Facial folds become accentuated as skin loses elasticity.
Facelift surgery addresses all of these structures affected by facial aging: skin, fatty tissue, and underlying muscles. During this procedure, face and neck skin is carefully re-draped and redundancy is eliminated. Excess fatty tissue is removed to increase definition of the lower face and jawline.
The underlying face and neck muscles, which have lost tone over time, are also re-suspended to restore facial contour to a more youthful appearance.
The terms “facelift” and “face and neck lift” generally refer to the same procedure, as the face and neck are a continuum. It is rare that a patient presents with concerns regarding facial aging that do not include the neck.
Occasionally a patient may present with isolated concerns regarding his or her neck (for example, platysmal banding, loss of skin elasticity resulting in redundant neck skin, or adiposity below the chin). A neck lift may be performed to increase definition of the neck and submental region (under one’s chin) or to reduce skin redundancy in this region without performing a full facelift.
Incisions and the resultant scars are meticulously placed, commonly extending from the sideburn hair region, around the ear concealed within natural skin creases, and then back within the hair-bearing scalp.
Procedures to Enhance your Facelift
Other procedures may enhance the results of facelift surgery depending on each patient’s unique presentation. If volume loss is quite significant and deep wrinkles are present, fat grafting at time of facelift may be beneficial.
If fatty tissue is significant in the submental region, liposuction may be effective in increasing neck definition. The surgical plan will be tailored based on each patient’s individual goals and clinical examination.
Facelift surgery is performed under general anesthetic in one of the three private operating rooms at 199 Avenue Road. Patients are generally admitted post-operatively to the overnight facility for observation until the following morning. Returning to work is usually permitted within 1-2 weeks, however strenuous activity and heavy lifting should be avoided for 4-6 weeks post-operatively.
Facelift Surgery FAQs:
- What are common concerns of patients considering face and neck lift surgery?
- Patients considering face and neck lift typically express concerns about signs of facial aging, including:
- Smile lines
- Decreased skin elasticity
- Prominent rhytids
- Jowl formation
- Redundant skin or increased subcutaneous (fatty) fullness in the submental region
Patients are often interested in more long-lasting facial rejuvenation than what may be achieved through lesser invasive options (e.g. soft tissue fillers).
- Who is a suitable candidate for a facelift?
Patients who meet the following criteria are generally suitable candidates for facelift surgery:
- Those presenting with signs of facial aging with well-defined concerns about their facial appearance
- Patients who are otherwise healthy or with well-controlled comorbidities
- Blood pressure is of particular importance for facelift surgery. It is important for patients with pre-existing hypertension to take their prescribed antihypertensive medication on the morning of surgery
- Blood pressure is carefully monitored during and after surgery because elevated blood pressure increases the risk of bleeding and hematoma formation following surgery (collection of blood or ongoing bleeding below the skin flaps)
- Non-smokers or those committed to smoking cessation at least 4 weeks pre- and post-operatively, as smoking increases risk of complications including skin flap necrosis, delayed wound healing, and infection.
- What are different types of facelift surgery?
- There are different planes of dissection (depth at which the flaps are elevated) and different techniques to address the superficial facial muscles (“SMAS” layer) to restore volume in the midface region during a facelift.One of the most commonly performed techniques is a SMAS plication, which involves stitching the muscles which have lost tone and descended over time to a higher position within the malar (cheek) region.Finally, a SMAS plication does not involve incising the facial muscles and carries a lower risk of injury to the underlying facial nerve and its branches.
- What to expect after a facelift?
- Facelift surgery is performed under general anesthetic in a private operating room setting.A board-certified anesthesiologist performs the anesthetic, carefully monitoring the patient’s blood pressure and ensuring maximum safety during the procedure as well as a smooth recovery once surgery has been completed.Afterwards patients are admitted overnight for care and observation in a post-operative recovery suite to ensure the following:
- Pain is well-controlled on oral medications by the time of discharge
- Patients are ambulating well following surgery
- Surgical sites remain free of complications (bleeding in particular)
Narcotic pain medication (most commonly Tylenol #3 with codeine) is generally required for a few days post-operatively. Patients may then transition to Tylenol plain or extra-strength as needed.
It’s recommended to shower daily and to gently wash the incisions with soap and water starting the day after surgery, and patients are recommended to sleep on 2-3 pillows for one month post-operatively to minimize swelling.
Patients are encouraged to mobilize around home immediately following surgery and to begin taking short walks a few days post-operatively. This lowers the risk of systemic complications (venous thromboembolism in particular). The small sutures within the hairline will be removed within the first week.
- What is the anticipated recovery after a facelift?
- Patients are discharged home the day after surgery once cleared by Dr. Power
- They are generally able to return to office-based work within 1-2 weeks
- Patients may gradually increase their activity level over the first few weeks post-operatively, however strenuous activity and exercise should be avoided for 4-6 weeks to lower risk of delayed complications (specifically bleeding)
Dr. Power will make individual recommendations for activity modifications based on each patient’s responsibilities and interests. Swelling may linger for several months post-operatively. This is to be expected and should not cause alarm.
Final scar appearance and surgical outcome is apparent by one year post-operatively following scar maturation.
- What are potential complications of facelift surgery?
Surgical site complications may arise following facelift including bleeding, hematoma formation, infection, facial nerve injury, and delayed wound or skin flap healing. Dr. Power generally performs a SMAS plication, which poses a lower risk of facial nerve injury vs. other techniques that involve incising the SMAS layer.Fortunately facial nerve weakness is uncommon following SMAS plication. If it does occur, the majority of cases are temporary and resolve within a few weeks of surgery.There are also systemic risks of facelift surgery, including venous thromboembolism and complications pertaining to the general anesthetic. Dr. Power will identify any pre-existing risk factors for deep vein thrombosis (DVT) or pulmonary embolism (PE) before surgery.Precautions are taken to lower risk of venous thromboembolism for all patients, including compression stockings and sequential compression devices which prevent blood from pooling in the lower extremities during and shortly after surgery.
Potential aesthetic complications may also develop, including asymmetry, over- or under-correction, dissatisfaction with cosmetic result, and specific complications generally relating to excess tension.
Dr. Power carefully performs each consultation and orders appropriate investigations (blood work and imaging) for patients considering facelift surgery in attempt to lower risk of complications.
Contact Power Plastic Surgery today to schedule your consultation. Our experienced and knowledgeable staff will be happy to answer any outstanding questions you have about the surgery and asses your eligibility for this procedure.