What Can A Facelift Do For You?

In my practice, a facelift is one of the most common procedures people come to me for consultation. A lot of people consider a facelift to be corrective of all aging signs to the face and neck. My goal in my consultation is to guide patients to understanding what the aging process does to the face and what a facelift can and cannot accomplish. First, I like to discuss the youthful face vs. the aging face as compared to a grape vs. a raisin. As a generalization, there are three main compartments to the face. There is the outer surface skin or peel, the underlying muscle layers and fat, and bone structure to the face. As we age, sun damage to the skin causes wrinkles to form similar to the peel of the grape becoming wrinkled. In addition, there is a loss of volume and fat that contributes to flatness in the cheeks and face. The bone also loses density. The last component of aging is the laxity that develops in the muscle layers resulting in the sagging in the lower face and neck.

There are many techniques to performing a facelift, but the primary goal is to tighten the muscle layers to reverse the sagging that occurs and to remove redundant, sagging skin. The deep wrinkles are not removed by a facelift. These wrinkles on the outside surface need to be addressed by other procedures such as laser resurfacing or peels to remove the damaged skin. Additionally, volume loss that occurs is not corrected by a facelift. Autologous fat transfer, fillers, or implants can reverse the volume loss and return the face to a more youthful appearance. Thus, a facelift can be very helpful in correcting sagging in the lower face and neck, and can even provide more dramatic results when combined with other procedures when there is evidence of volume loss or deep wrinkles.

Below, you will find answers to some common questions about a facelift procedure:

There are different techniques to performing a facelift but the goals remain the same, to reverse the signs of aging to the lower face, jawline, and neck. In order to understand what a facelift can accomplish one must understand the physical effects that occur with aging. A good picture analogy is to view the difference between a grape and a raisin. The outer skin becomes thin and develops wrinkles as we age while the structure of the face loses fat in the upper face and begins to droop to the lower face creating a heavier appearance to the lower face. Volume loss also occurs with a varying degree to the midface, cheeks and around the mouth. The degree of volume loss can compound the effects of aging. Injectable fillers like hyaluronic acid (Restylane , Juvederm, or Belotero) or calcium hydroxyapatite (Radiesse), or autologous fat transfer (using your own fat as a filler) can refill the loss of volume in these areas while a lower facelift and necklift can correct and tighten the skin along the lower face and neck to create a smooth jawline and take away the appearance of jowls (sagging along the jawline). However, one must understand that a facelift will not fill in areas of volume loss and will not remove deep wrinkles from the face. Depending on the depth of facial wrinkles, a chemical peel or laser resurfacing can be combined with a facelift to give the most dramatic results. Properly done and in combination with other procedures, a facelift can reverse the signs of aging by 10-15 years.

A facelift corrects the areas of sagging skin and soft tissue but the effects of aging will continue to effect the tissues even after surgery. On average, a facelift lasts 8-15 years, depending on the rate of aging in the face for each individual. Good skincare and frequent treatments to increase collagen deposition can help to prolong the results of a facelift by slowing the progress of aging.

A second important factor that affects the longevity of a facelift is the degree of dissection of the underlying muscle and fascial layers. Not all facelift procedures are created equal. Thread-lift procedures which use one or two sutures threaded under the skin to lift and suspend the soft tissues to an anchor point require the least dissection and thus result in minimal bruising and swelling, however, results last no longer than one year. A skin-only facelift requires more dissection by dissecting just beneath the skin for 2-3 inches with removal of redundant skin, but results last no more than 2-3 years. A SMAS facelift that involves dissection of the muscle layer called the submuscularis aponeurotic system or SMAS requires dissection of the skin and muscle layers separately and thus allows even more tightening and longer lasting results. Facelifts can also be done in a plane deep to the SMAS and platysma of the neck. A SMAS facelift or deep plane facelift gives longer results that on average last 8-15 years depending on the rate of aging that continues to the facial tissue and whether other procedures are combined to accentuate the results such as an autologous fat transfer, fillers, chemical peel or laser skin resurfacing, upper and lower eyelid surgery.

The length of recovery after a facelift depends on the extent of dissection with the facelift and whether additional procedures are combined with the facelift. The length of recovery also is dependent on each individual’s healing capacity.

The average length of recovery is 2-3 weeks. This is the amount of time I advise patients to be clear of social obligations. Bruising and swelling is almost gone by 2 weeks but there may continue to be some swelling that is noticeable to acquaintances and especially people you see frequently.  Avoid scheduling a facelift within a limited space in your schedule as you should always leave room for residual swelling and bruising that is outside the average window of 2-3 weeks.

People are often surprised by the limited amount of pain after a facelift. Usually, there is pain with head movements and some coinciding neck stiffness but this usually subsides by one week. If a facelift is combined with other procedures you should anticipate more pain, swelling and bruising.

Here are some other things to be aware of in terms of the recovery:

– Expect numbness in front and around the ears for at least 4 weeks. This numbness can last as long as 6 months, but most patients find this temporary numbness manageable. Men should expect some difficulty with shaving during this time.

– You will need to refrain from moving your head from side to side or looking over your shoulder for 2 weeks after surgery. The tightening provided by the surgery causes neck stiffness. This limits and impairs your driving ability for at least one week after surgery. You will then be able to slowly increase your head movements as the neck stiffness subsides.

– There will be some firmness in the tissues around your face and neck. As the healing process occurs, collagen will be laid down and this causes the tissue to feel firm to the touch for 3-4 weeks after surgery. Most patients like this as it makes the face appear more full and youthful. Over the following months the tissue will continue to soften and as this occurs there may be some relaxation to the skin around the neck and jowl area. Expect some relaxation to occur and for the fullness to dissipate unless fillers or autologous fat transfer was performed at the time of surgery.

 Botox is a neurotoxin that is used to treat certain wrinkles on the face that are caused by muscle motion. The wrinkles are then smoothed over time through paralysis of the underlying muscle. Botox is most commonly used for wrinkles in the forehead, frown lines, and wrinkles around the eyes. These are areas that can begin to show the signs of aging early on and Botox can help to diminish these wrinkles to restore a youthful look.

Fillers such as Radiesse, Restylane, Juvederm, and Belotero are helpful in restoring volume to the aging face. As mentioned earlier, aging has its effects on the face through volume loss in the face, sagging and laxity of facial soft tissues and skin, and wrinkle formation in the overlying skin. Fillers help to restore the volume loss, especially in the cheeks, smile lines (nasolabial folds), marionette lines, and prejowl area. Appropriately placed, fillers can help to mask the signs of aging and hide the signs of laxity in the midface and lower face. Fillers are a good alternative for those who which to choose a non-surgical approach and can help patients who have never had cosmetic procedures feel comfortable about making decisions to improve their appearance. Unfortunately, from an economical standpoint, fillers have a limited life span and requires frequent re-injection to provide lasting benefits. This reason usually causes patients that I see in my practice to choose a facelift when they finally feel ready to pursue a surgical alternative.