Full Face and Neck Lift
Face lift or rhytidectomy is an operative procedure designed to remove the major folds or sagging of the skin on the face and neck that naturally occur with aging. It frequently is done in conjunction with a similar procedure for the eyelids called bleharoplasty since the aging process is usually present in this region also. A forehead lift may be recommended to elevate the eyebrows and remove deep creases.
Contrary to some articles in popular newspapers and lay journals, a face lift is not as simple as having a hairdo. The procedure is accomplished by an operation and as in all operations, there is risk involved. Cosmetic surgery is an art and not a science; consequently no assurance or guarantee of results can be given. All surgery has a possibility of complications and poor results; cosmetic surgery is no exception.
The procedure is designed to produce a maximum benefit in the appearance of the face by removing major wrinkles and sagging of the skin. It is impossible to remove every wrinkle regardless of the treatment, and too much surgery would result in a pulled or plastic look. Fine wrinkles, particularly those about the mouth, may require additional treatment, such as dermabrasion, chemical peeling or fat injection. The face lift operation should give an improved appearance for several years.
Skin aging will continue after the operations, but this process of aging neither speeds up or slows down because of the procedure. A face lift can be done in combination with removal of fat from beneath the chin (submental lipectomy) and/or rearrangement of the platysma muscle of the neck to give a more youthful chin line.
FREQUENTLY ASKED QUESTIONS
Where are the incisions?
These vary to some degree depending upon whether the patient is male or female, the hairstyles, hairline, age, previous surgery, etc. Generally the incision starts in the temple, in front or within the hairline. It continues in front of the ear, sometimes partially hidden within the ear (tragus). It then goes under the earlobe, behind the earfold and ends either within the hairline or at the hairline behind the ear. Frequently, another incision is made under the chin in a natural skin fold. This allows fat removal and tightening of the platysma muscle in the neck.
Where is the surgery performed?
Face lifts and ancillary procedures are always performed in an operating facility. A one-night stay in a post-operative care facility may be advisable in some cases. General anesthesia is recommended for this procedure. General anesthesia is now much gentler and shorter acting with very effective medications to combat nausea and discomfort.
How will I look after surgery?
You should expect swelling, discoloration, and bruising of the skin for several weeks after a face lift. Individuals vary a great deal in their responses, but commonly the patient will be presentable within 3 weeks. However, there is usually some residual swelling which gradually subsides over a number of weeks. Make-up can be applied shortly after surgery. The marks left by the incisions are often noticeable during the first few months, but these gradually improve as the wounds mature. The scars are not usually mature for about 6-12 months. A face lift will reduce the sagging and loose skin and give a more youthful appearance to the face. The facial features themselves are generally not appreciably changed. The fine lines and wrinkles of the face are usually not much affected by a face lift. Laser or chemical peel of the skin are sometimes used to reduce fine lines during or after a face lift. Fat injections may also be recommended.
How long will it last? Because people vary so much, an exact time is difficult to give. An average figure given is 5 to 10 years. You may repeat the face lift procedure at that time if you wish. There is an improvement, compared to not having the procedure, even though the aging process continues. In occasional patients with very loose skin, early sagging may be seen as soon as the first year and require a secondary procedure to tighten the loose skin.
What are the risks of surgery?
1. GENERAL RISKS of surgery include infection, pain, delayed wound healing, hematoma ( a collection of blood at the surgical site), bleeding, reactions to anaesthetic.
2. BLEEDING: When blood collects beneath the skin it causes excessive discoloration. Sometimes lumps which last many months, may occur. If blood collection is discovered, it is usually removed by taking out a few stitches and squeezing the clot out, or inserting a needle and aspirating it. If bleeding continues, it is sometimes necessary to return to the operating room to stitch the bleeding vessels. This risk is increased in people who take aspirin or who bruise easily. Let your doctor know if this is the case. Do not use aspirin or aspirin-containing products for two weeks before and two weeks after surgery. (See list of medications that may increase bleeding.
3. LOSS OF SKIN: The skin will sometimes lose its blood supply. When this happens, an area of skin will fail to survive and a number of weeks are needed for healing. Rarely, a skin graft may be needed to obtain healing. This risk is increased in smokers; therefore, you must stop smoking at least 4 weeks before and 4 weeks following surgery.
4. INFECTION: Infection in facial surgery is uncommon but can occur. This requires antibiotics, possible hospitalization. There is an increased risk toward skin loss as mentioned above.
5. FACIAL NERVE INJURY: Permanent injury to the facial nerve is very rare. It is not uncommon for branches of the facial nerve to be bruised from the operation and for the muscles of the forehead or the corner of the mouth to lose some or even a great deal of their activity temporarily. Activity usually returns to normal within a few weeks. In extremely rare instances, it may take months or more.
6. DISCOLORATION: Sometimes the skin remains discolored for many months. This may be related to the absorption of blood pigments during the healing process. Permanent discoloration is rare.
7. ASYMMETRY: Every effort is made to keep both sides even, but since no face is symmetrical to begin, mild asymmetry may remain after surgery. Some changes in the earlobe shape may occur as result of skin tension and scars. The redraping of neck skin may also result in asymmetry or differences in fullness in the submental areas.
8. NUMBNESS: Parts of the face, forehead, eyes, ears, and scalp may feel numb for weeks or months after surgery; this is normal and expected. On occasion, loss of sensation may be prolonged or permanent.
9. SCARS: Every operation creates some type of scar. Facelift incisions are planned to hide and minimize visible scarring. However, scars are not predictable and infrequently patients will develop scars that are widened, thickened, raised, more red or generally more visible than anticipated (hypertrophic or keloid). Normally, scars go through a maturation process which take months. This includes an expected period of thickness redness and firmness, during the first 4-6 months. (More information on scars is available upon request).
10. HAIR LOSS: On occasion, hair loss in the temple area or behind the ear may occur. This is usually temporary and the hair re-grows in several months Rarely, hair loss is permanent.
11. PAIN: Generally facial operations have surprising little pain, however, pain is very subjective. On occasion a patient will experience tightness and discomfort for a prolonged period of time. Scars may remain sensitive for months. These situations are more the exception than the rule but they do occur.
12. DEPRESSION: Some patients may experience an emotional let down after this surgery. This may be related to the normal chemical changes after extensive surgery, or overly high expectations. It is usually self limited and does not require treatment.
13. ALTERNATIVES: Other procedures that may improve an aging face but are less extensive include chemical peels, collagen or fat injections or liposuction technique.
14. PHOTOGRAPHY: Photography is for educational or diagnostic use is a standard and required part of patient care.
15. NO GUARANTEE: The practice of medicine and surgery is not an exact science. Although good results are expected, there cannot be any guarantee, nor warranty, expressed or implied, by anyone as to the results that may be obtained.
16. COMPLICATIONS AND ADDITIONAL SURGERY: Any of these problems noted above may require additional surgery, hospitalization, and time away from work. If this occurs, there will be additional costs for surgical fees, supplies, anesthesia, etc., depending upon the required operation.
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