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A facelift improves the most visible signs of aging in the lower face and neck by tightening the loose underlying muscles and re-draping the skin. Short-scar techniques are available for selected patients.
Facelifts may be performed alone or in conjunction with a browlift, eyelid rejuvenation, nose beautification, and/or laser resurfacing.
Endoscopic (minimally invasive surgery with camera-assistance) techniques may also be used to address the aging midface or cheeks.
The procedure is performed under local or general anesthesia in an outpatient setting.
“I interviewed many doctors over a 2-year period about a facelift…My first meeting with Dr. Grover made me feel very confident. I liked his approach, his suggestions and his candor about what to expect…He cared that I felt confident, comfortable and clear with him and what he was going to do. More importantly, my facelift was a huge success. I look exactly as I hoped to and my recovery was quick and trouble-free. I would go to Dr. Grover again in a heartbeat.”
S.K., face lift patient
As men and women age, they lose elasticity in their skin. The appearance of their skin changes due to photo-aging and sun damage. One may develop wrinkles or rhytides, volume loss or sunken or a hollow appearance, develop loose skin of the lower face, jowls, and looseness in the neck with muscle banding, or what we call platysmal banding or a turkey gobbler look. In addition to lower facial aging, we see periorbital or aging of the upper 1/3 of the face around the eyes. The brow may appear to descend. They may appear to have extra skin or excess skin on the upper and lower eyelids with lower eyelid bags. Full facial rejuvenation can address all of these signs of aging from the top down.
When one considers a facelift, generally speaking, that is addressing the lower face and neck. Most plastic surgeons will refer to a facelift as the lower face and neck. However, patients many times feel that a facelift is the entire face, which would be full facial rejuvenation. That would include potentially an endoscopic brow lift, a bilateral upper blepharoplasty to remove excess skin from the upper eyelids and sometimes fat, a lower eyelid blepharoplasty, and a facelift with a neck lift or platysmaplasty. Modern day facelifts utilize techniques that not only redrape the overlying skin but those that tighten the underlying tissues, what is called the SMAS or the superficial musculoaponeurotic system. This is a deep fibromuscular layer that descends with age and needs to be repositioned or tightened to redrape the underlying tissues. Following tightening of the underlying tissues and muscles in the neck, one can redrape the skin in a natural way so that they can obtain a very natural, more youthful appearance.
A facelift can take 10 to 15 years off of somebody’s appearance and will essentially “reset the clock” as the patient will continue to age, however, from a new starting point.
Most plastic surgeons will perform a facelift utilizing IV sedation or general anesthesia with a board-certified anesthesiologist in an operating room setting or outpatient surgery center setting that is accredited.
The procedure can take 3 to 7 hours depending on the extent of the procedure being performed. Full facial rejuvenation may take 5 to 8 hours depending on what is being done, especially if this includes an endoscopic brow lift, a bilateral upper blepharoplasty, bilateral lower blepharoplasty, facelift, and neck lift or platysmaplasty.
The incisions for a facelift are hidden in such a way that will make it very imperceptible for any friends or family to notice the scars. They may even fool one’s own hairstylist. Incisions for an endoscopic brow lift are hidden within the hair-bearing area of the scalp. The incisions for an upper blepharoplasty are hidden in the crease of the upper eyelids, and that for the lower blepharoplasty is hidden right underneath the lash line extending into a crow’s feet. Facelift incisions are hidden just underneath the sideburn so as not to raise the sideburn and leave a bald spot above the ear, and then further extend within the confines of the ear, into the ear and around the ear, back into the hair, so that the scars are virtually imperceptible. Again, it is important that one not pull to tightly on the skin in order to avoid the obvious bad signs of a poor facelift where the earlobe cartilage is displaced or moved forward, or the end of the earlobe is pulled down and extended, or one develops wide scars behind the ears. These are all potential signs of an inadequate facelift. The platysmaplasty or neck lift incision is hidden within the crease underneath the neck.
There are times when patients may benefit from a small chin implant as well to improve the neck contour and definition of the jaw line. This is performed utilizing the same incision underneath the neck or the submental crease and is placed during the same time as the neck lift.
Patients undergoing full facial rejuvenation may benefit from volume replacement, which may include autologous fat grafting or fat taken from one’s own body and placed back within the face. The new transplanted fat needs to develop a new blood supply in order to survive, and one can see varying amounts of survival, and this may take 3 months to determine.
Patients may also benefit from improvement of the skin appearance or resurfacing, and this may be done either at the same time or following the surgery depending on what needs to be done. This may include laser resurfacing, fractionated laser resurfacing, chemical peels, intense pulsed light treatments, or noninvasive radiofrequency treatments.
Different names are utilized for facelift procedures including a SMAS technique, which is a biplanar technique, an extended SMAS technique, the MACS lift, etc. Also, some facelifts may benefit from a mini facelift, which may be performed with a short scar technique utilizing limited incisions depending on if there is limited aging in the neck region.
Patients will generally have minimal bruising or swelling following the procedure. However, should give themselves 7 to 10 days of recovery time. Patients generally are not taking many pain tablets or narcotics following this type of procedure if the procedure is done with care. Final results may take 3 to 6 months to occur and scars take a whole year to fully mature.