A BLACKLEDGE FACELIFT

The medical term for facelift, “rhytidectomy”, is derived from the Greek word, rhytid, which means “wrinkle”. Therefore, rhytidectomy, or facelift, is an operation designed to reduce and remove the wrinkles and sags in the face and neck. The goal is to lift the sagging muscles and tissues of the neck and cheek and then redrape the excessive skin into a more youthful position.  It remains the “foundation surgery” to rejuvenate the face.

 Patients undergoing facelift surgery desire surgery for one of two reasons: those who want to “turn back the hands of time” and look younger, and those who want to prevent the aging process and “appear to stay the same age” for an extended period of time.  The facelift operation is designed to address both of these goals. The only difference is the patient and his or her condition.  Patients often ask “how much younger will I look?” The answer depends on how pronounced the signs of aging are on the face.  Patients with significant signs of aging, such as those with deep wrinkles and pronounced sagging of the cheeks and neck, will obviously get a much more dramatic result. Younger patients who have only minimal signs of aging will get less dramatic results and appear to stay the same age for an extended period of time. These patients treat the conditions as they arise and get a more subtle result.

Facelift surgery is becoming more and more popular primarily because of new advances that reduce the downtime and restore the face to a natural appearance, changes in the placement of incisions so that they are camouflaged in the hairlines and behind the ears, and techniques designed to provide for a longer lasting lift.  Also, the stigma that was once associated with plastic surgery is quickly disappearing as patients desire to look younger or just look the way they feel.

The most common statements we hear is “I don’t want to look different, I just want to look fresher” and “I want to look the way I feel”.  The facelift techniques that we use are designed to give you a natural appearing result.  There are several different types of facelifts that range from full facelifts to “mini-lifts.”  Each type is reviewed with you during your consultation.  Then based on your facial analysis and your desires, the proposed operation is customized to fit your needs and goals.

Even though the recovery period technically starts immediately after surgery, there are several things that you can do before your surgery day to make the recovery period smoother. During your consultation, we will talk to you about the importance of being physically and mentally prepared for surgery to ensure that we get the best results possible.  

 The key to a successful outcome and satisfied patient actually starts well before the day of surgery. During your consultation, we will discuss the components to a thorough preoperative evaluation. We will begin by reviewing your past medical history and discussing your current medicines. This includes any vitamins or herbals because some of these can have an effect on bleeding. We want to assure that you are in optimal health for surgery. It is during this time that we will recommend an herbal vitamin to take starting a week prior to surgery to reduce bruising. You will also get all of your prescriptions so that you can have them filled prior to surgery. Attention to every detail makes for a much smoother recovery period.

Patients often ask us, “what is a facelift?”  A facelift can ultimately address four areas of the face: the forehead, the temporal area and lateral brows, the cheeks and jowls, and the sagging neck.  Obviously, if the aging process does not affect all areas of the face, then only the lifts that are appropriate are performed.  Just like the individual, each facelift is different and addresses only the areas that need rejuvenation.  A proper facelift should not make you look different, only younger!  Most patients like the way they look, they just want to look like themselves ten to fifteen years earlier.

The earliest signs of aging in the face are sagging cheeks, the development of jowls along the jawline, and the deepening of the nasolabial fold, which is the groove that runs from your nostrils to the corner of the mouth.  A facelift is designed to improve all of these conditions. There are two areas that facelift surgery does not address.  It does not address sags and excess skin around the upper and lower eyelids.  Eyelid surgery, or blepharoplasty, is required to address these conditions and may be performed at the same time as facelift surgery.  It also does not address the lines around the upper and lower lips.  This condition requires some type of resurfacing procedure such as laser, dermabrasion, or chemical peel.  If a facelift is pulled so tight that it eliminates these lines, then the face has the infamous “stretched” look and does not appear natural.

We get this question quite often and the answer is always the same. The results of facelift surgery vary significantly in “how long it lasts” depending primarily on internal factors that affect the aging process. We do not know for sure everything that affects the aging process, but we are certain of a few. For example, we know that illness and mental and physical stresses speed up the aging process. Therefore, it is not uncommon for a patient who has had a facelift and then unfortunately has a stressful event to reaccumulate the signs of aging sooner than later. The good news is that we also know that aggressive skincare slows the signs of aging. Patients who maintain a good skincare program after facelift surgery are much more likely to prolong the results of their facelift.

One common myth is that facelift surgery stops the aging process. Unfortunately, there is no “magical potion” that stops the aging process. Facelift surgery simply “turns back the hands of time.” A typical facelift is designed to make one look approximately seven to ten years younger than the stated age.

The key to a successful outcome and satisfied patient actually starts well before the day of surgery. During your consultation, we will discuss the components to a thorough preoperative evaluation. We will begin by reviewing your past medical history and discussing your current medicines. This includes any vitamins or herbals because some of these can have an effect on bleeding. We want to assure that you are in optimal health for surgery. It is during this time that we will recommend an herbal vitamin to take starting a week prior to surgery to reduce bruising. You will also get all of your prescriptions so that you can have them filled prior to surgery. Attention to every detail makes for a much smoother recovery period.

We will mention the anesthesia process here, but a more thorough discussion of the types of anesthesia used can be read in the anesthesia chapter. The majority of our facelifts are performed under “twilight anesthesia.” Most patients are relieved when they find out that they have the option of not undergoing general anesthesia.

The facelift is a three-layer process: the facial tissues are elevated, excess fat is removed by liposuction in the jowl area and then redundant skin is elevated and removed. The skin incisions are closed with a combination of deep and superficial sutures. Scars are hidden in the hairline, within and behind the ear and in natural skin creases. Our facelift is designed to keep the hairline in its natural position. When incisions are placed in the temporal hair for a brow lift or behind the ear for a neck lift, we do not shave any of the hair in these areas. Because of this, our patients are able to “be presentable” in a much sooner fashion.

Following surgery, the face is wrapped in a dressing that is left in place overnight and then removed the following morning.   We prefer to use this type of dressing instead of drains.

Absorbable sutures are then used to close all of the incisions, and no drains are used. Instead a dressing is placed around the patient’s head that will be removed the following morning.

Even though the recovery period technically starts immediately after surgery, there are several things that you can do before your surgery day to make the recovery period smoother. During your consultation, we will talk to you about the importance of being physically and mentally prepared for surgery to ensure that we get the best results possible.   Now back to the recovery period. Immediately after surgery, compression dressing is placed around your face and head to reduce swelling and removed the following morning. You have the option of either staying overnight or going home. This decision will be discussed with you at the time of consultation. Most patients sleep the remainder of the day and night after surgery. The following morning the dressing will be removed and at this point you will be taught how to keep the incisions around your ears clean with peroxide swabs and then moist with ointments. All of these measurers allow for a more pleasing scar. The first day after surgery is strictly a “bed rest” day. Most patients feel better than expected, so the temptation is to “over do” it on this first day. However, patients have less bruising and swelling if they rest with their head elevated on the first day. Swelling is typically mild to moderate reaching its maximum on the third postoperative day, and then it starts to decline. We allow you to resume limited activities and also apply makeup by day four. Stitches are removed on day seven, and most people are presentable to the general public (with camouflage makeup) by day ten. Of course, this varies with the individual healing process. All of the “do’s and don’ts” for facelift surgery will be given to you separately.

Bruising

Bruising is expected after any kind of surgery. The amount that you bruise is extremely individualized – some people will bruise more than others. However, with every patient, we can expect a reduction in the amount that you bruise by taking Bromelain during the preoperative and postoperative period. We encourage you to drink at least 8 glasses of water each day during your recovery period to flush the bruising out of your system. Our experience with facelift surgery is that the combination of Bromelain and water intake will reduce the amount of bruising that you normally would have had.

During the recovery period, you will notice that your bruising changes colors. All bruises initially appear red and change to a purplish hue. By day five, the majority of your bruises will have changed to a green and then yellow color. Once you have reached the yellow stage, you are almost “bruise free.”

Swelling

Just like bruising, expect swelling. The day after surgery, once the dressing is removed, swelling will actually increase over the next day. Typically, swelling begins to decrease on the third day after surgery. We often get the question, “what can I do to reduce swelling?” You will be scheduled during the recovery process for a procedure called lymphatic massage, which works to reduce swelling. Our estheticians are trained to manually massage the swelling out of your face and into the neck area. Lymphatic massage has been proven to significantly reduce postoperative swelling. I usually do not recommend ice packs. Remember that there will be areas on your face that are numb initially after surgery. You can actually “freezer-burn” your skin if you have an ice pack over an area that is numb.

Sleeping

It is best to sleep in an upright position with your head at least above the level of your heart for the first two weeks after surgery. This helps to reduced swelling and also bruising.   The best beds are usually either a recliner or an incline pillow. Both of these keep the head and shoulders in a natural position. If you try to sleep with your head elevated with pillows, you wind up sleeping in an unnatural position and develop muscle spasms in your shoulders.

 Exercise

You may begin light walking on the fourth day after surgery. In fact, we usually encourage this because it helps to improve your circulation, which in turn gets rid of bruising and swelling quicker. You can gradually increase the intensity of your walking over the next few days as your body tolerates it. Your body will tell you how much exercise is enough. We usually recommend that you refrain from any competitive sports such as tennis or golf for at least two weeks. When it comes to exercise, don’t pull against any tight sensations that you may have.

Pain

A popular question is “how much pain will I have after a facelift?” Most patients will tell you that they had little to no pain after surgery. The common response is that everything felt “tight.” This is usually due to swelling and the tight sensation begins to subside after about 2 – 3 weeks. Patients are given prescriptions prior to surgery for pain medicine and are encouraged to take theme as directed for discomfort. However, most patients switch to Tylenol soon after surgery.

Eating

Because of the tight sensation in the cheek and neck after surgery, you will be advised to stay on a soft diet for at least the first week after surgery. Any foods that do not require aggressive chewing (such as soups) will make the first week a comfortable experience.

Obviously, this is a very individualized answer. The average patient is able to go back in public without being obviously swollen or bruised by about 10 – 14 days.