Q. What is a facelift?
A. Several rejuvenation procedures go by the common name “facelift,” but they are very different in what they do and how long they last. One type of “facelift” is the older “pull up” method. This requires an incision around the ear and below the hairline behind the ear. It separates the skin from the underlying tissue and pulls it up and back tightly. This results in the “mask” appearance people often think of when they hear the term “facelift.” And since skin is elastic, the face eventually returns to its former appearance.
I perform a procedure called the platysma cervical lift (PCL). This is a procedure designed to produce a more natural appearance, without the “tipoffs” that give away the fact that a facelift has been done. Everybody ages differently. Some patients develop severe wrinkling in the skin of the face, others develop lines around the mouth, and still others develop jowls and have excess fatty deposits in the neck. Aging occurs not only on the external facial skin but also in the underlying facial muscles and supporting tissue structure. A facelift must rejuvenate both the external skin and the underlying facial supporting structures. My operation was designed to do just that. It will restore a youthful angle in the neck, eliminate wrinkled skin in the neck, soften lines along side the nose, the so- called nasolabial folds and soften facial wrinkles. This is done without creating a mask-like wind blown look so commonly seen on “overdone” actresses and celebrity personalities.
Q. What are the advantages a PCL lift?
A. Instead of simply pulling the facial skin back, the PCL sculpts the internal framework of the face, tightening sagging facial muscles and removing nasolabial prominences (which cause cheek grooves). It also eliminates the aging appearance of the neck. Fatty neck deposits in the neck and excess skin are removed and the platysma muscle, which is responsible for those unsightly neckbands, is tightened and partially divided. As the platysma muscle is tightened, a sling is created which holds the face from the inside, placing little tension on the skin itself. This produces a longer lasting, more natural result with a smooth neck and a beautiful jawline curve. Jowls are gone and the corners of the mouth regain a youthful position.
The PCL also addresses the problem of excess skin. Special care is taken to remove skin without making the face look over-corrected. The proper amount of tension is critical to avoid that unnatural, pulled back look. It is my opinion, that the PCL is the state of the art in face-lifting today, providing long-lasting, completely natural-looking results.
Q. At what age should I think about having a facelift?
A. Although most people start to consider a facelift in their 50s, some of the best results occur with patients in their 40s. Younger patients in their 20s and 30s, particularly those with acne scarring which is greatly minimized by a lift, get wonderful results. And patients in their 70s, as long as they are in good overall health, are candidates as well.
But everyone ages differently. If you have stood in front of the mirror and pulled back your facial skin to see how you’d look or if people have remarked that you look tired or grumpy (and you’re not…it’s facial sagging and lines) or if you have become dissatisfied or depressed about facial aging, then you should think about a facelift, no matter what your chronological age.
Q. Where is the surgery performed? How long does it take? Will I be asleep?
A. A PCL is performed as an outpatient procedure using sedation and local anesthesia at the Renaissance Center, our own state-of-the-art surgery suite. You will be breathing on your own and in a “twilight sleep.” It takes approximately 3 1⁄2 to 4 hours for completion and generally all recuperation is done at home.
Q. Is having a facelift painful?
A. The sensation of pain is, of course, subjective and depends upon a patient’s particular tolerance. But the operation itself is painless and approximately 50% of patients require NO pain medication afterward. Some patients do complain of their ears throbbing but this is more of a discomfort than actual pain and it resolves within the first few days after the surgery. Other patients experience a sensation of “tightness” in the lower face and neck. This is normal and will resolve as facial swelling diminishes in time.
Q. What can I expect before and after surgery?
A. All patients are screened for any serious medical problems to assure they are healthy prior to surgery. You must avoid aspirin for 4 weeks before and two weeks after the procedure. You need to avoid garlic, vitamin E, alcohol, Chinese food (and MSG), Indian food (and curry powder), and the medications in the “Drugs to Avoid” handout. Patients are forbidden to smoke for at least two weeks before and two weeks after surgery. (Those who cannot stop smoking or who have diabetes, heart disease, lung disease, bleeding disorders, or any other serious medical condition are not good candidates for this procedure.)
After the procedure, you will have bruising, which is part of all facelift operations. It usually lasts 2 to 3 weeks but may take longer to disappear, especially in older patients. I also have some patients take vitamin C (1000 mg a day) for three weeks after surgery to help with healing. I routinely give pain medication and anti-nausea medication in case it is needed after surgery.
Q. Are there risks involved?
A. All surgery is associated with a certain number of complications no matter how slight. Facelifts are no exception although the usual complications after facelifts are minor. Infection and hematoma (bleeding) are the most complications but are usually prevented by antibiotics and eliminating blood thinners before surgery. Numbness and bruising are considered part of the procedure and do not last very long. Please read the Consent Form for a complete listing of all possible complications.
Q. Are the scars noticeable?
A. No. While the incisions do leave scars, care is taken to hide them in the hairline and the natural grooves in front of the ears. Over time they fade into fine lines that are very difficult to discern and rarely noticeable to others. Scar revisions might be required afterward but this is rare.
Q. Are there any special dressings used afterwards?
A. After surgery your head and neck will be totally wrapped in bandages, making you look like a nun. These are essential for achieving the results you want after surgery. They must be kept on until I remove them at your first post-surgical visit, 3 to 4 days after the procedure. After they are removed, there are no bandages on your face.
Q. When can I drive my car or go back to work?
A. You cannot drive until the head-wrap bandages come off (3-4 days post-op.)
Once they are removed, you will have some noticeable bruising. But at that point, you can resume driving. The decision when to return to work is, of course, an individual one and depends on the type of work you do. If your job does not entail much physical activity (or contact with the public), I recommend taking at least 1 week completely off, then return to work. Cover-up makeup can disguise the bruises. However, if your job involves much walking or lifting, such as a waitress, cook, steward, landscaper, etc., it is best to take 10 to 14 days completely off, and then return to work during the third week after surgery performing activitiescommiserate with your level of healing. Specific restrictions will be discussed at your post-op visit if necessary.
Q. Afterward, when my friends and family ask why I look so good, what should I tell them?
A. It depends on how open you want to be about your surgery. Of course, you can tell them you had a PCL, or you can come up with an interesting “story” about rest, dental surgery, or a lifestyle change. However, a common tactic many patients take is simply to change their hair style or hair color. That is what acquaintances or casual friends will notice first, and in almost every case, they will attribute your changed looks to that obvious difference.
Finally, although the results of a facelift are usually dramatic, it is not the same as being transported back through time. Realistically speaking, a PCL is a surgical procedure in which suitable, healthy patients trade inconspicuous scars for a more refreshed, rested, and youthful look. It effectively corrects both the internal and external signs of aging and helps delay their recurrence…but nothing can halt the aging process altogether.