Rhytidoplasty: The Facelift
The facelift operation is a commonly requested procedure, and the results are consistently satisfying. The operation, when performed with skill and care, is very safe. Rhytidectomy is the medical term for the operation designed to remove wrinkles and decrease the sagging that occurs on the face and neck with aging. The term "facelift" is often used incorrectly to describe a total rejuvenation process. Often, eyelid surgery, brow lifting, and fat transfer procedures are combined with the facelift to create a total rejuvenation.
The facelift operation is designed to reduce sagging and wrinkling in the lower face and neck. It does not correct problems around the eyelids, at the corners of the mouth, or creases of the lips. The facelift has become one of the most popular cosmetic operations performed in the head and neck, because as medical advances and better health have increased the average life span, many women and men find that they look older than they feel and act.
The operation may be done for one of two reasons: to help prevent the advancement of aging, i.e., to help relatively young individuals (about 40 or less) appear to stay young, or it may assist one who is already wrinkled or whose skin sags, to appear younger and fresher. The amount of improvement depends upon the degree of wrinkling and sagging already present. If minimal, then the changes may be subtle, but the aging process is markedly retarded. If the wrinkling and sagging are great, the results can be very dramatic.
How Long Does It Last?
The duration of improvement varies somewhat from individual to individual. Once the excess skin is removed and the sagging tissue is repositioned, the aging process still continues. The surgical changes that have been created will slowly age and change, but the improvements will last eight to 15 years, depending upon the skin tone, general health, previous and continued sun exposure, and smoking, including past and current use. Seeing our own patients up to 15 years after surgery has demonstrated that we are getting excellent, long-term correction. You should realize, however, that you will look much better at any given age than you would have without the operation. So, in a sense, the changes are permanent.
The facelift operation is most frequently performed using Light Sleep Anesthesia. Light Sleep Anesthesia is the use of medicines to induce a state of relaxation and a light sleep. After arrival to the surgery center, additional medications are given intravenously which induce a profound state of relaxation. Most often, patients go to sleep during the operation, usually have no memory of the operation itself, and experience no pain. Once the patient falls asleep, medicines are given to produce numbness of the surgical area. This type of anesthesia is most frequently preferred by patients, because it requires almost no recovery from the anesthetics themselves, unlike general anesthesia which may produce nausea after the surgery. It also carries a lower risk of complication. Because of the benefits of Light Sleep Anesthesia, we do not utilize general anesthesia for this procedure.
The operation is performed in such a way that the incisions are placed in creases in front of and inside the ears and in the hairline. After the operation, a pressure dressing is applied. The patient is recovered in the surgery center until fully alert, generally about one hour, after which time the patient may be driven home.
The First Two Weeks After Surgery
The patient should sleep with the head elevated about 30 degrees for the first two weeks after surgery. Place two pillows under the top of the mattress and one or two pillows under your head. Try not to roll on your face or sleep on your side.
The day after surgery, the patient returns to the surgery center for dressing removal. A light dressing is usually reapplied, and the patient may remove the new dressing the following day. A liquid diet is allowed during the first 48 hours and a soft diet for the next 48 hours. After that, a normal diet may be resumed.
We prefer that you stay in bed the first 12 hours after surgery. The following morning you may walk or sit but no activities beyond that should be attempted for 14 days.
There is minimal discomfort generally after a facelift operation, but pain discomfort will vary from patient to patient. Pain medicine will be prescribed and can be used when needed.
Avoid turning the head or bending the neck. When you must turn, move the shoulders and head as one unit or as though you had a stiff neck. This is of importance for three weeks.
Your sutures are of a dissolving type and will not need to be removed. Surgical staples are often used behind the ear and will be removed during the second post-operative week.
The face and neck will feel tight for several weeks after surgery. This is normal and will slowly disappear. A certain amount of swelling and discoloration is also normal after this operation. The majority of the swelling and all the discoloration will usually disappear in the first few weeks. Numbness around the ears and on the neck is a normal part of the operation, and will generally be gone by three to six months after surgery.
The wounds may get wet three days after surgery, and the hair may be shampooed at this time, but there should be no rubbing of the scalp until two weeks after surgery. Never wash your hair the day sutures or staples are removed. Wait until the following day.
Some developments may occur which are not in the normal post-operative course. You should call our office if any of the following are present:
Body temperature elevated to greater than 101 degrees
Sudden swelling or sudden discoloration
Increased redness and tenderness of the wound edges, indicating infection
Allergic reaction to drugs
String Suspension Facelifts, Lifestyle Lifts, and other Short Scar Facelifts
A new class of facelifts has emerged in the past several years that promise to create a refreshed and rejuvenated look without the scars, downtime, and bruising/swelling associated with the more time-tested classical face lifting procedures. Unfortunately, many problems are associated with these procedures. First and foremost, they do not last very long. Surgeons are often reporting a 30 to 40 percent need to re-do the procedure within one year. The longest results are about four years before a “re-do” is required. The recovery time for some of these procedures is as long as the more effective facelifts. The results are never as good as the more traditional types of facelifts, and often there is prolonged bunching with some short scar procedures, irregularities and extrusion of the strings. For these reasons, as well as the fact that we have been able to evaluate these procedures for a number of years and found them to be lacking, we have elected not to offer them.
We do perform mini-lifts in selected cases, which are short scar procedures. These, however, are never intended to create the same results as our classical face lifting procedures and are only offered in highly selective circumstances.
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