10 Things Patients Need To Know Before a Facelift
Article by Rod J. Rohrich, MD
Dallas Plastic Surgeon
1. Choosing the right surgeon.
This is key to a great result. Choosing the right plastic surgeon for your facelift is important as you do not want that “overdone wind-swept look.” You need to have a comfort level and good rapport with your surgeon. It is important to find someone who is open to answering pre- and post-operatives questions. I give my cell phone number as well as my email address to my patients so they can call, email or text me. In my opinion, there is no such thing as a silly or stupid question. I would rather have the patient contact me earlier, than find out something later at a post-op visit, when they should have called me long before their post-op visit.
2. What does SMAS stand for in the deep layer facelift?
SMAS stands for the Superficial Musculoaponeurotic System - for the purpose of a facelift this constitutes the most important part of the face and musculature. A deeper layer facelift helps to enhance the longevity, the shape, and appearance. Everyone’s face is different and each treatment should be individualized. Aging by fat loss and sagging of the facial deep structures are specifically analyzed in an individualized approach to facelifting in order to restore a youthful, balanced, and un-operated facial appearance.
3. When am I a candidate for a facelift?
You are a candidate if you are healthy, have no major medical problems, are realistic about results, and really want to remove some signs of aging, specifically the loss of facial fat and sagging of the face and neck. A facelift is not specifically indicated to totally remove all signs of aging or to remove wrinkles from around the lip area. Other techniques like laser or chemical peels can be done to improve these areas.
4. How long does a facelift last?
A well-done face/necklift can rejuvenate the face for 7-10 years. But it also really depends upon many factors including the condition of your skin, if you smoke or drink, and your age when you underwent surgery. The optimal time to undergo surgery is at a younger age. This way, as signs of aging appear, you will most likely continue to look much younger than your actual age. Further surgery and/or fillers remain an option. I usually begin soft tissue fillers at 1-2 years after surgery. This, along with good skin care, no smoking, sunscreens, and sun avoidance will maximize the longevity of the facelift.
The goal of a facelift is to restore a natural, youthful look and to turn back the clock, not to stop it. It is normal to have a small amount of wrinkles and nasal labial folds. It is abnormal to have a tight pulled or wind-swept Hollywood type look. That is not normal, nor is it something that most patients aspire to have. The goal is to make you look natural and youthful and to be a “better you” and not to be someone else. The goal of any good natural facelift is to return someone to a more youthful look so that they will look as good as they feel. The biggest concern of patients is that they will feel distorted, look like someone else, or look operated on. The sign of a good natural facelift is one that does not look like it has been done and the patient will only look refreshed, relaxed, and less tired.
5. What is the normal recovery period for facelift surgery?
Day 1: You will be in the hotel with a light head dressing which will be removed the same day. You will sleep elevated and take antibiotics the first 24 hours only. You will be out of bed that evening and eating clear liquids and fluids.
Day 2: You will be eating a regular diet, up and ambulating frequently. After the second day the dressing will be removed as will be the drains in your neck. Your hair will be washed and you can go home.
Day 5: You will return to the office to be seen for follow-up to remove the eyelid sutures and half of the other stitches. Scar management and incision healing management begin with some facial massage therapy to emphasis wound healing.
Day 10: All of the stitches will be removed and you may return to work day 10-14.
Week 3-4: You will be seen again in follow-up and will resume all skin care and all activities including exercise.
Month 3: You will be seen again in follow-up and post operative photos will be taken.
Annual: You will come in annually so that your surgeon can monitor your long term healing and results.
6. What are the most common post-op sequelae that occur after a facelift?
The most common questions relate to the occasional prolonged swelling and occasional duration of hardness in the neck area. These are easily resolved by massage therapy. The key is to allow for normal wound healing and this will take time. You will “look normal” way before you “feel normal,” because as normal wound healing occurs we go through the early phases of bruising and swelling to a hard feeling that will begin to soften at 2-3 months, especially in the neck areas. These are all very normal.
7. Will a facelift eliminate all of my facial wrinkles?
Of course not, it will dramatically rejuvenate the lower part of the face, but it doesn’t remove the wrinkles around the perioral area or the eyelids. We lift the deep layers with the SMAS with the “Lift and Fill” facelift and then the central part of the face is restored with fat augmentation. With early aging you lose facial fat and also have skin sagging later in your 40-50’s. The goal is to make you look younger and less tired, but it will not eliminate all signs of aging. If you want to eliminate the wrinkles in the perioral areas, chemical peels or lasers may be needed around the lips or the eyes.
8. Plan to take real time off.
This is very important for a facelift. I tell my patients there are three phases of a facelift - where they are presentable to their family (7-10 days), presentable to your friends (10-14 days), and then to the public (3-4 weeks.) I usually tell my patients they need to take between 2-4 weeks off, as bruising and swelling are variable. By 3-4 weeks they can be back in the public eye, such as public appearances or major social events. The most important thing is to stop aspirin and all non-steroid anti-inflammatories, as well as fish oil, at least 10-14 days pre-operatively, to minimize the bruising.
Maintaining a high protein diet will enhance wound healing and minimize fluid collection in the face. I really stress that vitamins along with supplements, as well as homeopathic medicines like Bromelain and Arnica Montana for minimizing bruising, can actually speed your recovery. Apply cold compresses or ice gel to your eyes. Most bruising and swelling occurs in the first 3-5 days and should be resolved by 7-10 days.
It is important to keep your head elevated and minimize your activity. Don’t get your heart rate above 100 for the first 10 days. It is very important not to begin exercising for at least 3-4 weeks, especially if you have had facial surgery, as an increased heart rate above 100 can cause increased swelling, bruising, and even bleeding.
9. How will I look after surgery and will I have pain?
Amazingly, you will not have a significant amount of pain, if any at all. You will have some feeling of tightness or compression as you will have a light head dressing on. You usually will also have 2 drains in place, which are usually removed at 2 days along with the dressing. This is also when your hair may be washed. Most of the time with a facelift you also have eyelid surgery. Eyelid surgery has more discomfort than the facelift surgery itself. The key is to keep you head elevated and to relax and enjoy soft music. This will help keep your blood pressure normal and allow you to relax better.
10. How long will it be before my face looks normal and when will my scars no longer be apparent?
By 3-4 weeks your face will definitely look very normal. However, the swelling in the face and the neck, especially the face, will take 4-6 weeks to go down. The numbness around the cheek areas will resolve in 3-4 months. You will look normal to others by 3-4 weeks. Your scars from incisions are placed in such a way that those persons who are in your “comfort zone or private space” will not notice them in 4-6 weeks. Those outside your “private space or comfort zone” will not notice them in 3-4 weeks. All of this process is totally normal. If you had eyelid surgery done at the same time, these lag behind the face about 4-6 weeks.