Mini Facelift in office under local: descriptions, experience

Issues: 40 years old, slightly sagging jowls,...

Issues: 40 years old, slightly sagging jowls, naso-labial, marionette. Have been doing Resty filler in tear-troughs and on cheeks for two years (every 5 months). Up to 2 syringes.

Research: I think that it is a bit difficult to talk about a procedure because the terms mean different things to different doctors. While I felt that "mini" meant that it would be short-scar and certainly no brow lifting (this seems consistent with all docs), I was also thinking mini was more like a Lifestyle lift: a pull up of skin, excision, stitch.

Probably, what is a mini means to the good, board certified in plastics surgeons, is that the muscle, fat and fascia are adjusted. What this means: Your facial skin is lifted up off of your muscle, with forceps and stretching, your facial muscles are repositioned, anchored, and then your skin is re-draped and sutured (after having excess cut away). you wear a compress for a week, in order that your skin can re-adhere to your facial muscles.
I believe that all mini-lifts, whatever the degree of work, can be done in the office, under local anesthetic. I abhor the idea of "going under," (and never waking again: irrational, but it's my thinking). So an office procedure under local anesthetic, combined with the description "mini," seemed like a good option for me.

While I thought "mini" was mainly about pulling skin and muscle, together, that's because I didn't (and don't, i'm a layman trying to explain what I researched and experienced) understand the anatomy, I had a vision of the procedure that was more Lifestyle Lift, ie skin-only, than what my doctor meant, which was muscle repositioning. So, it is important to know what *your doctor* means when s/he uses the terms: they may define mini as a short-scar, but they can also mean it to mean no SMAS work, or, yes SMAS work. You have to clarify these terms, so you can better compare apples to apples in terms of price, amount of work done, recovery time, etc.

The experience: My doctor meant that a mini-lift means SMAS work (which I needed, he is right to do that for me, I just didn't fully understand it). arrive at office having not eaten for 8 hours, take valium, rest in chair while lines are drawn on face and the doc and PA prepare. Local anasthesia is injected in various points on one side of the face, the face numbs, and the cutting begins. OK: You're awake. You hear everything. They're working right by your ears. Your skin is much, much thicker and tougher than you think: it sounds like thick carpet being cut into. You feel a bit of blood dripping, you hear the doc ask for forceps: Your skin will be lifted up off of your muscles. riiiiipppp. yikes. If you have ever considered doing meditation as a practice for calming the mind, start at least a month before you experience a fully-awake (no pain: I swear there was no pain) facelift. There is a tool that is electric, like a soldering iron, that probably cauterizes the wound and squelches bleeding (I *think* that's what's going on, but I'm not certain). So, you smell your burning flesh. They use this tool a lot. It takes about 2 hours on one side, 2 on the other (maybe slightly less, from initial numbing to suturing closed). You feel the sutures pulling up, bunching up your muscles, it's like drawing a very thick drawstring bag closed.
This experience is not to be taken on lightly: you can't have music in your ears, as the doc has to ask you often if you feel anything, if you're doing ok; such is the nature of local anesthetic. The virtue of the in-office local anesthetic procedure is that it cuts the cost (of the exact same) procedure about in half. The hospital OR, and the anesthesiologist, are very expensive, so you go through this surreal experience but you save perhaps in some cases 50%.

I was just not mentally prepared, so that's why I'm writing all this down. You have to know yourself, whether this is the kind of thing you can get through. I could and did, but it took focus.

Recovery:
1 day post-op: extreme swelling horizontally across the mid-face, ear to ear. It is very unsettling to look at, it is an aesthetically horrible weirdness, but: no bruising, no pain.
Day 2: the same. took hot shower to wash off dried blood in hair, around ears, and to encourage lymphatic drainage. Iced face 3times. took codeine at night, slept on couch with head elevated.
day 3: the same, slightly less swelling. You start to think: My god, I look like an alien AND ALWAYS WILL. relax: if you, or your kids, have every sprained an ankle, you know what swelling is. It's gross and bizarre, but not permanent.
day 4: the same, slightly less swelling.

I keep my compression bandage on 24/7, remove to apply heat for lymphatic drainage (microwaved heat compress) and ice 3x day.

will update as days progress. might get brave to post photos.

swelling and the mental process, day 5

I hope that real self will let this link happen, as it's helping my mental state: http://www.makemeheal.com/mmh/education/pe/facelift/content/healingjourney/swelling_d0.html

day 5, today, is about the day when my mental resolve of "this too shall pass (in this instance, i mean the swelling)" started to waver. the husband suggested i call the doc and double-check that pumpkin-head is actually normal: thanks for the support, husband! oh, sigh. it's very unsettling to look freakish, and so i hope that the link above will help direct folks to a better description of what to except when you're recuperating, and look freakish: weirdly asymmetrical, bumpy, lumpy, garish yellow, bobble-headed pumpkin face. it takes a toll on your mental resolve.

day 7, stitches out, ventured into the world

face is not pumpkin bobble-head-size, but it's lumpy, bruised, mishapen, and healing perfectly well according to the ps. went to grocery store, ran errands, thinking that we tend not to really look at each other in public (which i think for the most part was my experience). i still cannot tell what improvements i'll have from the surgery (was hoping for less jaw saggage, naso labial smoothing), so guess you really can't know until the majority of the swelling is down.

i myself would not feel comfortable being around people i know, ie at work or with family: still look too strange, and certainly it's obvious what i had done.

day 11

hung out outside, daylight, with a couple friends. they of course noticed the swelling, but the yellow bruising has subsided. the phenomenology of feeling like you look deformed--ie, beaten up, like you've been in a fight or that you have had a reaction to medication--is probably more internal than it is a factor of other's noticing anything. my friends notice, but the folks at the cafe, or grocery store, probably don't unless they gaze a little longer. the experience, though, the subjective experience is that *everyone is staring.* like Financegirl said, this really isn't a 2 weeks back-to-normal procedure (DEFINITELY not one week). as a teacher i'm off for summer, thus, i'm not back at work among co workers after a week: i know that some of us do need to head back to work, and for you I would recommend going to the makemeheal website and looking at posts about how to use camouflage make-up.

day 14

last few stitches removed. spent time outside, with friends. while i had issues of bruising which can be covered, what was most disconcerting for me was the swelling and misshapen face: this is i think resolved enough that no one but me notices it, at day 14. my face is still bruised, there are numb parts, tight parts, and i wouldn't say that the swelling is down enough such that i know what the full effects will be, but probably it is 80% settled in.

day 18

returned to work and social life. tightness remains around ears, numbness around ears, slight swelling throughout jawline and cheeks. i wasn't ready to have after-photos taken, as i felt that my face is lifted and tight due to swelling, not just surgery alone. yellow bruising still on cheeks. my attitude is good, but i do read a lot on this site and on makemeheal to track my experience with that of others. i worse my pressure bandage for 2 weeks about 24/7, and slept elevated for 2 weeks as well.

One month post-op

feel and look normal. slight skin numbing along jawline and in front of ears. it seems as tho swelling must be largely dissipated, so that i can tell what the final results are, and they are good. the jawline is firmer, the nasolabial folds less deep, cheek padding higher and rounder. it's subtle, which is good: no windswept look.

the scarring along the earline is a concern: i have "free" earlobes, which means that the scar follows the natural crease, but there are definitely stitch marks which are noticeable. attached earlobes i would think would have a much more noticeable stitch-line. i will order theatre make-up to put along my ear, i expect the pinkness and scarring will be noticeable for at least a year.

1 year after mini/lower facelift

Scarring: unnoticeable
Numbness: none. full sensation along the ears and jawline has returned
Overall: Success. After about 6 months of healing I had Naso-labial fold filler, and I just got some Voluma for mid-face volume: to me, this completes the entire process. The facelift got rid of the extra skin/skin laxity, and the fillers added back the volume , which is the total package for facial rejuvenation. Very pleased with the results.

before after mini-lift photo

john michael tomassen

John Michael Thomassen, MD

5 out of 5 stars Overall rating
5 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
5 out of 5 stars After care follow-up
5 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
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