Page:   1,  2,  3

The purpose of this communication is to enhance, not replace the discussion and consultation with your physician so that you can make an informed decision based upon the risks, benefits, and alternatives for your specific needs and desires. After reading this, you will be able to have a more meaningful discussion with your doctor.

It is important to remember that any decision to undergo plastic or cosmetic surgery must involve a commitment on your part to carefully follow the post operative instructions. Failure to follow these instructions can create serious complications and undo the desired surgical result. Optimal results from your procedure require both your patience as well as your active involvement in your recovery by following any treatments or restrictions provided.

Even if you are the optimal candidate for the procedure and have the best technical and artistic surgical care, failure to follow the specific recovery instructions will change the desired result. Remember, your post operative commitment is as an important component as choosing your surgeon and undergoing the right procedure for you.

FACELIFT

Facelift surgery and associated facial rejuvenation procedures are very common today. When properly performed on appropriately selected patients, they provide an effective method of reducing the signs of facial aging. A more youthful, rested, and refreshed appearance can be obtained.

Most patients are concerned with how they are going to look during the healing process, when they will be presentable, and when the swelling and bruising will go away. Of course the answers vary based on the patient and their unique healing process, their age and health, the surgeon and his or her technique and extensiveness of surgery as well as other factors. (Fig 1) These are a series of before and after photos of a 49-year-old patient who had an endoscopic browlift, upper and lower blepharoplasty and facelift. Preoperatively, she was concerned that she looked tired and wanted a natural and more refreshed appearance especially around her eyes, jaw line, and neck. These photos give you an idea of how your healing process might evolve postoperatively.(Fig 2 a,b) Two weeks after surgery, she is swollen with some bruising especially in her right lower neck. Incisions are readily visible as she is not wearing makeup. (Fig 3 a,b ) By two months after surgery, she is wearing makeup, but her eyes, cheeks, jaw line, and neck appear improved. Note that she is still swollen and skin wrinkles, which were really not treated by this procedure, appear improved because of swelling. (Fig 4a,b) By 4 1/2 months after surgery, her skin has relaxed more. Although she definitely demonstrates the benefits of the procedure, the skin wrinkles particularly around the brow and eyes not treated by this procedure are returning. These types of skin issues may be best treated by other modalities such as skin care products, injectables and laser or skin resurfacing procedures. It is important to note that early postoperative photographs after a facelift often reveal a result that looks better than it will after the tissues relax. I believe one of the most important goals is to not be too aggressive and to prevent a patient from looking surgical. It is far better to be conservative and make a natural result the top priority. Once a patient is pulled to tight, the world notices this and there are very limited options for improvement. This patient was happy that her surgery provided her with a very natural and refreshed look, and that she still looked like herself..just better.

Fig-1	Fig-2a
Fig-2b	Fig-3a
Fig-3b.jpg	Fig-4a
Fig-4b

(Fig 5a,b,c) These are her before and 6 month after photographs. Her makeup in the after photos certainly adds to the improvement in her result. Often after surgery, female patients become inspired to learn new and improved techniques for makeup application as well. It is also important to note that patients without dramatic problems or signs of aging, will not want or have as dramatic a change from their surgery. This often holds true for those patients having facial surgery at an earlier although appropriate time.

Fig-5a	Fig-5b
Fig-5c

(Fig 6 a,b) These are close up photos of this patient's ear as one might observe it at the dinner table with the hair pulled back. I think it is very important for a patient to feel comfortable rather than anxious and vulnerable that someone will detect and ugly scar, distorted ear anatomy, or a distorted hairline from surgery. Her scar is still red at this stage and visible to close scrutiny, although it will greatly improve with time.

Fig-6a	Fig-6b

(Fig 7a,b,c) reveals a before and after photo of a 59 year old sample patient 2 months following a facelift procedure. She also had a forehead incision browlift and a lower blepharoplasty procedure. The front, oblique, and lateral views shows an improvement that makes the patient look refreshed, younger and still very natural.

Fig-7a	Fig-7b
Fig-7c

(Fig 9a,b,c) demonstrates before and after photos of a 54 year old patient two and one half months following a facelift procedure. She also had a browlift performed with reduction of a bony prominence in the center of the forehead. A more youthful and refreshed appearance was desired and obtained.

Fig-9a	Fig-9b
Fig-9c

(Fig 10a,b,c) Here are before and 3 month after photos of a 44-year-old man who had a browlift, upper blepharoplasty, facelift and rhinoplasty performed. These photos are shown to give you an idea of how presentable you might be at this time, especially for males who cannot conceal scars easily. Look closely around the ears also for signs of recent surgery. The tightness of his tissues, swelling, and areas of firmness will continue to change over the next 4-6 months as these areas settle and heal.

Fig-10a	Fig-10b
Fig-10c

(Fig 11a,b,c) These are before and 6 week after photos of a 53-year-old patient who had a browlift, upper blepharoplasty, and facelift performed. She is presentable in public at this time although her healing process is not complete. Despite swelling, and areas of firmness and numbness she looks refreshed and natural at this stage. Skin texture issues as well as fine wrinkling around the eyes and mouth are not addressed with these procedures. The qualitative skin issues are best treated with effective skin care products, injectibles or laser skin resurfacing technology.

Fig-11a	Fig-11b
Fig-11c

(Fig 12a,b) These are photos of the same patient with the afters taken 6 months after her procedure when for the most part she is healed. Look carefully at her hairline, where the scar for her hairline browlift was performed to preserve her hairline. For this patient, this scar was a good choice and is not noticeable. Although she will continue to age naturally, she has benefited from these procedures. A facelift alone is not designed to remove this wrinkle near the mouth. Many surgeons have excellent ways of addressing these issues with injectables, grafts, and resurfacing techniques.

Fig-12a	Fig-12b

(Fig 13a,b,c ) This is a 41-year-old woman who has had a browlift, upper and lower blepharoplasty, facelift, Rhinoplasty and laser resurfacing around her mouth. The after pictures were taken 10 months after her surgeries. These procedures have allowed her to continue looking like herself, but just naturally refreshed and younger and not surgical. Again, it is important to understand that facelifts, and browlifts by themselves, do not change the quality of your skin. These operations just remove extra skin and shift tissues to more youthful locations.

Fig-13a	Fig-13b
Fig-13c

DESCRIPTION OF PROCEDURE

Although people definitely age at different rates, and with different degrees of severity, there are classic signs and anatomical changes associated with aging in everyone. First, there are progressive Skin Quality Changes that occur from a variety of factors including genetic and environmental influences. Repeated animation, trauma, cumulative sun exposure, and byproducts from smoking contribute to aging changes in the elastic architecture of our skin. These factors among others, can lead to undesirable changes in texture, pigmentation, wrinkling and scarring. In addition to qualitative skin changes, there is also a progressive Accumulation of Excess Skin and Tissue that Sags and Descends. Facial skin, muscle, and fat become lax and descend under these influences as well as from the effects of gravity. Tissue becomes less dense (atrophic) leading to less youthful fullness around the eyes, face, and lips.

AGING CHANGES

SKIN QUALITY CHANGES

(Fig 14) Wrinkles are permanent structural changes made in the skin areas subject to repeated animation and UV damage. Raising your eyebrows repetitively creates (a) horizontal lines in your forehead while squinting causes vertical and horizontal frown (b) wrinkles between and around the eyes. Repetitive smiling creates permanent wrinkles around the (c) corners of the mouth and (d) outer eyes as mobile skin is pushed up like an accordion around the eyes to cause what we call crow's-feet wrinkles. (e) Wrinkles also form around the lips and mouth from associated repetitive movement. These wrinkles indicate there has been permanent damage to the skin just as if a cardboard box had been folded repetitively. These changes cannot be completely reversed and will return if the muscle activity that causes them continues.

Fig-14

Obviously, it is not desirable to paralyze the entire face, but weakening or limiting function of some of the select muscles around the eyes and brows which create these wrinkles can help diminish their appearance. Focused weakening and paralyzing injections of BotoxT can really improve wrinkles but the effect is temporary and lasts from one to ten months. There are numerous other tissue injectables available such as Restylaner, Juvedermr, Perlaner, and fat among others which additionally temporarily improve wrinkles in a different way. They do not actually weaken or paralyze muscles, but rather act as fillers or a type of temporary tissue replacement to fill out the creases. In addition to improving wrinkles, fillers can also be used to fill volume and contour the face in areas such as the temples, cheeks, around the eyes, lips, and jawline! Dermabrasion, chemical peels, and laser applications also improve wrinkling and other signs of aged skin itself such as pigmentation, and texture issues. Effective high performance skin care products can also bring significant improvement in the quality of your skin. They can diminish wrinkles, improve texture, radiance, smoothness, tone, pore size, and pigmentation issues as well. These additional treatments are mentioned however as they may be indicated and provide a solution for problems not addressed by a facelift or removal of skin. Your surgeon may decide to utilize some of them as an added treatment along with your facial surgery to provide enhancement of the overall result. The significance of these additive procedures is that they can change the "quality" of your skin and a facelift can not.

(Fig 15a,b) These are before and 2 month after photographs of a patient who has had an aggressive laser resurfacing of the face. Obviously, the laser does not remove skin; however this is an excellent example of how the quality of the skin can be improved. The laser has produced some tightening of the skin and improvement in the fine wrinkles and texture problems. Unfortunately, some of the improvement is due to swelling and as that subsides and the patient continues to animate, wrinkling will return.

Fig-15a	Fig-15b

(Fig 16) These are before and 8 week after photos of a patient who only used high performing, scientifically validated skin care products (CellCeuticalsT Biomedical Skin Treatments") to improve her wrinkles and the tone and texture of her skin. She had a very impressive but not surprising result. Photos were taken with standardized VISIA photography.

Fig-16

A facelift is not designed to change the quality of your skin. It is designed to remove excess skin, and shift tissues that are sagging back to a higher and more youthful location. These effects are not possible with the additive skin treatments previously discussed. Used together however, there can be reduction of excess tissue, lifting of tissue that is sagging, and improvement in the quality of your skin.

ACCUMULATION OF EXCESS SKIN AND SAGGING TISSUE

With increasing age, there are varying degrees of the characteristic anatomical signs of aging which are improved with facial rejuvenation surgery. Generally, the effects of gravity pull skin and tissue straight down, while the effects of repeated animation such as talking, smiling, and chewing pull the tissues centrally toward the mouth and middle of the neck.

(Fig 17) As we advance in age, the brow starts descending causing (a) excess tissue and hooding over the eyes. Excess skin forms in the (b) upper and (c) lower lids, along with bulging of (d) fat pockets around the eyes. Tissue that once provided a full and youthful cheek (e) descends and makes the nasolabial fold much more prominent. This also accentuates (f) hollowness under the eye. Facial fat descends pivoting against (g) restraining facial ligaments to form jowls and the jaw line becomes less and less distinct. In the neck, the sheet like muscle called the platysma (h) starts to separate in the midline forming varying degrees of bands. These bands can develop into what often is called a turkey gobbler with varying degrees of excess skin. The quality of her skin is less youthful as it is less dense, has more wrinkles, and there is diminished tone and elasticity. The skin is thinner and the texture has deteriorated.

Fig-17

NECK REJUVENATION

(Fig 18a,b) Careful evaluation and treatment of the neck is critical in achieving a more youthful appearance. These before and after photos are of a patient who had a facelift, browlift, and eyelid surgery performed. The reduction of the fat in her neck improved her jawline contours which provided a more youthful appearance. When evaluating your neck, your surgeon must distinguish which anatomic structures need to be addressed to improve your contours. These may include not only the skin, fat, and muscles, but also prominent saliva glands.

Fig-18a	Fig-18b

(Fig 19, 20, and 21 ) These are before and after photos of patients that I performed extensive and detailed neck and chin work on to improve their contours dramatically. These changes obviously provide a more youthful and appealing look as well as giving the appearance of weight loss. These are types of procedures that take time consuming and detailed work and never can be characterized appropriately as "simple and easy".

Fig-19a	Fig-19b
Fig-20a	Fig-20b
Fig-21a	Fig-21b

(Fig 22 ) This 57-year-old patient benefited from a detailed facelift and necklift and contouring procedure. She was bothered by the extra skin and fat in her neck. The after pictures were taken 5 months after her procedure. Her jaw line and neck are more defined, feminine, and youthful and were the most important area of need for her improvement.

Fig-22a	Fig-22b

(Fig 23a,b,c) Here is an example of a 39 year old male who wanted to make his chin and jawline stronger. The contour of his neck was certainly one of the areas that impacted his appearance the most. A necklift with open contouring of the fat and muscle of the neck along with a chin implant helped to accomplish his goals. Often, liposuction techniques can be utilized to help improve this area as well. Additionally, this patient had other procedures including a browlift, Rhinoplasty and blepharoplasty.

Fig-23a	Fig-23b
Fig-23c

(Fig 24a,b,c,d) Generally, a (a) browlift provides lifting and modification of the skin, muscle, and tissue above the eyes and corner of the eyes. (b) Blepharoplasty or eyelid lifts provide removal of skin and fat, and tightening of the upper and lower eyelid skin. (c) M personal facelift technique is designed to lift and modify skin and underlying tissue between the corner of the eye and the bottom of the neck. (d) Midface lifts, generally raise that skin and tissue from below the eye to the corner of the mouth.

Fig-24a	Fig-24b
Fig-24c	Fig-24d

Keep in mind that there is a tremendous variation in names of procedures, techniques used, and the extent of effect of procedures utilized by thousands of surgeons. The informative description here certainly does not apply to everyone and you should discuss these details with your surgeon during your consultation.

(Fig 25) Although there are many techniques in facial rejuvenation surgery, the goal of a facelift is to improve specific effects of aging and have the result look natural, not surgical. The (a) sagging tissue below the cheekbone should be lifted up to provide youthful fullness in the cheek, (b) the hollowness under the eye should be improved, and (c) there should be improvement in the nasolabial fold. The jowls (d) should be removed and the jaw line should become distinct once again. The contours of the neck (e) should be improved as the bands are retightened or released and the excessive skin removed and redraped. Excess fat in the face and neck can be removed under direct vision or with liposuction to further improve the facial contours.

Fig-25

(Fig 26 ) Although excess skin will be removed, the skin that is left is still your old skin, and its quality will be unchanged without accessory procedures. The patient is wearing makeup in her after photo on the right, which makes her skin quality look better than it is without accessory procedures.

Fig-26

(Fig 27 ) This is a before and after photo of a patient who has benefited from a browlift, upper and lower eyelid surgery, facelift, and a chin implant. Specifically, the facelift has allowed her to regain the youthful fullness in her cheeks as well as the clean contour of her mandible and neck as the jowls were improved. She enjoys the natural result and looking like the same person, just more refreshed.

Fig-27

To accomplish these goals, there are very important additional considerations. You want to have a very natural and enduring result, minimal scars, and no distortion of anatomic landmarks such as the ears or hairline. This should all be accomplished safely. The effects of face-lifting should not extend to the mouth causing distortion as this indicates the pull is too hard. The wind tunnel look is certainly not natural or desirable and should be avoided at all costs. Most skin wrinkles and the nasolabial fold cannot be completely removed. Small children have nasolabial folds, and its complete absence is unnatural because the face appears stretched. Excessive tension ultimately gets transmitted to the incisions causing distorted hairlines, earlobes, and bad scarring. This can lead to anxiety rather than confidence and comfort in public without a crafty hairstyle.

(Fig 28) Here is an example of a distorted anatomic area such as the ear. On the left, scarring and a poorly designed pull has left no visible doubt to a casual observer that surgery was performed. On the right, is a patient who has had a facelift, however surgical attention to detail and proper design allows the appearance of an ear that was not operated on.

Fig-28

INDICATIONS

A facelift should be contemplated by a person when there are definite needs that can be improved, and the patient is willing to trade the chance of improvement for the exposure to risks, the recovery period, and the expense for that improvement. I advise against doing facial surgery too early or too often. A patient should carefully measure how much improvement they are really looking for from such an extensive procedure. In my opinion, doing the small minilifts should be reserved as the last lift in your lifetime. They do not last as long and distort valuable anatomy needed for the more thorough lifts. Because they are less extensive and easier to perform, it makes sense to do these as a touch up procedure later in life when your health is not as good. It is then that a shorter time in the operating room, relatively less extensive procedure, and easier recovery period makes sense. Your physician should not cut corners doing your initial lift as these violations of dissection planes and formation of scar tissue can affect the success of your future surgeries.

TECHNIQUE

The proper technique to be utilized for face-lifting is based on your surgeon's comfort, judgment, and experience and your individual unique tissue qualities. In very general terms, there are basically two types of lifts.

There is a superficial skin lift and a deeper plane lift. This deeper plane lift has many names depending on how deep the dissection level is, and the anatomical extent dissected. Some associated names include the Composite lift, SMAS lift, and subperiosteal lift, among others. The advantages, disadvantages and differences in outcomes from these various techniques are not really clear, and controversial among many surgeons. Outstanding results can be achieved with any technique in certain surgeon's hands. You should go over the technique planned very carefully with your doctor because there are many variations.

A skin lift involves dissecting and lifting up the skin and redraping it after removing the excess. It is probably the fastest, least technically demanding and most common type of facelift. It is Dr Fisher's opinion that this type of lift more frequently leads to poor scarring, unnatural wind tunnel type pulls, and shorter lasting results since so much tension must be placed on the elastic skin.

Deeper plane lifts are more technically challenging. They involve a deeper dissection and lifting of the deeper tissues and muscles. This deep tissue is lifted and put under tension and acts as a vehicle to transport the overlying skin to a more youthful location. Therefore there is less tension on the skin, which theoretically leads to less tension on the scars. Ultimately, the scars and skin have a more favorable opportunity to heal well as the circulation is not as compromised. Some surgeons will tighten the deep plane with sutures without actually dissecting under it.

Some surgeons will advise doing a facelift through an endoscope. This is a small mechanical lighted tube like a periscope shown here, which is used to view and perform the surgery. This generally means that very small incisions will be made and scarring will be kept to a minimum. Usually, the deeper plane is entered and the tissues are suspended by a series of sutures until scar tissue forms and holds the tissues in place.

Although this technique may result in smaller scars, many surgeons feel possible disadvantages with endoscopic facelifts are that excess skin can not be excised, and generally, not as much can be done through the small openings as they could with traditional techniques. Competent plastic surgeons have different levels of experience with certain techniques and appropriate reasons for why they choose different procedures. Again, there are many appropriate and useful procedural designs, variations, and techniques to perform a facelift.

Every year, there are numerous "new" names given to facelift procedures dealing with the "same" anatomy. Although the names are very different, often the actual techniques are not. What seems to be an advancement in technology is just the presentation of a new marketing angle. When ever a facelift procedure is performed the scars should be as "short" as possible and not any longer than necessary. The length of the scars is usually determined by the relative amount of excess skin to be removed. The length and location of scars also obviously impacts hairlines. Not only should excessive tension be avoided, but preserving hairlines, detailed anatomic features of the ears and limiting scar visibility is critical to achieve a natural high quality result. Don't be lured in by marketing shortcuts that are more intended to get you to schedule surgery than to offer an effective long term solution to your issues.

I feel that it is more important that the surgeon is experienced and skilled with the technique he or she chooses than whether the technique is new or not. Sometimes new techniques are later abandoned after extensive scrutiny over time reveals they were not such a good idea to begin with. Because of this, enthusiasm over unproven new technology should be hopeful, but tempered.

(Fig 29) The incision and ultimate scar location vary and are very important. Generally, with non endoscopic techniques, incisions can be placed in the (1) temporal area within, or (2) in front of the hairline. The advantages of being within the hairline as in incision number 1, is an easier ability to hide the scar. The disadvantage is that the entire hairline can be pulled back unnaturally. Incisions in front of the hairline like incision number 2 may yield scars that are easier to see, however the hairline is generally preserved. The incision locations and lengths vary and those shown in this figure only represent where they potentially could be.

Fig-29

(Fig 30) The incision and scar placement around the ear is also critical. The normal and natural anatomy of the ear should be preserved, and the scar not visible to prevent an easy tip off that you have had facelift surgery from across the dinner table. Incisions can be made in front of the ear as shown with line (3), or in a variety of ways inside the ears as shown with line number (4).

Fig-30

(Fig 31) Scars in front of the ear as shown on the left, are often very noticeable even though they preserve the anatomy of the ear. You can readily see the scar as well as the skin color and texture change with this incision choice. These are very difficult to conceal. Incisions inside the ear are ideal if done correctly as shown on the right. Be sure you ask for and see before and after photos of the ears of your surgeon's facelift patients. It is even better if you can actually look at and talk with some patients of that surgeon prior to selecting that surgeon to perform your facelift.

Fig-31

(Fig 32) Here is a similar example in men who usually have shorter hairstyles. This attention to detail is even more important for them. An incision in front of the ear on the left certainly saves time for the surgeon, but is difficult to conceal for a lifetime for the patient.

Fig-32

(Fig 33) Incisions and resulting scars from face-lifting generally continue behind the ear and (5) into or (6) down along the edge of the hair behind your ear. These incisions are often necessary to provide adequate exposure to your neck area for removal of excess neck skin and possible contouring. Again, scars should be minimized and the hairline should be preserved, allowing you to wear a pony tail, or feel comfortable with a short haircut.

Fig-33

(Fig 34) Here is an example of a scar by which you would be handicapped by on top. Its location and appearance would cause a great deal of anxiety for you and prevent you from wearing certain hairstyles. However, the scars on the bottom would allow you the freedom of any hairstyle. These incision choices are even more important in men who usually have shorter hair. These detail issues should be very important to you so understand your options.

Fig-34

For more information and more details on facelift scars, please click on this link for a more in depth discussion by Garth Fisher MD®

COMPLICATIONS

Although thousands of patients each year have facelifts without major complications, complications can and do occur. The severity and frequency of these complications vary depending again, on the surgeon, technique, and medical health of each particular patient. Your surgeon should highlight your individual unique risks during your consultation. Patients who smoke or have specific health problems have higher risks. It is wise and often required to have your family doctor perform a thorough medical checkup prior to contemplating this procedure to optimize your health and your results.

Again, facial plastic surgery is generally safe and many clinical studies describe the rate of these individual risks at approximately 5% or less. Nonetheless, you should be fully informed of potential risks, while keeping in mind the relatively rare occurrence of these complications.

ALTERNATIVES

You may have already considered the alternatives to having facelift or browlift surgery. When applicable, these may include changing your present diet or beginning a new diet program, changing your exercise routines, or possibly addressing a current medical problem. Consideration can be given to the benefits of chemical peels, laser resurfacing, creams, injection of different fillers or injectables in the skin, and various promoted techniques to tighten the skin. Facelift and browlift surgery are elective surgical procedures and if you choose not to have them performed, you will avoid the risks associated with the procedure. You should consult with your physician about available alternatives other than a facelift.

FACELIFT

Hematoma: A hematoma is a collection of blood under your dissected facial skin which could develop after surgery. It usually can be evacuated with a very small procedure if it occurs, with no impact on your final result.

Asymmetry: Although asymmetry may be noted as a complication, careful examination of the face reveals asymmetry in everyone. Your surgeon will never be able to make both sides of your face look exactly the same. They really never have been anyway. More obvious discrepancies are possible however.

Scarring: Poorer scarring than expected, changes in the color of some of the dissected skin, and even areas of hair loss can result from surgery. These problems can be quite noticeable, and ultimately limit the choice of hairstyles you wear. So, the location of the incision should be carefully discussed with your surgeon.

You should also be careful not to expose your incisions to sunlight until your doctor lifts this restriction. Excessive sun exposure the first 3-4 months on a healing scar can cause increased pigmentation and darkening of the scars. Try to avoid excessive sunlight and wear sunscreen postoperatively.

(Fig 35 ) This is an example of a problematic scar behind the ear from facelift surgery. An inaccurate estimate of excess skin and poor planning for the incision has left this patient with a bald spot and a break in her natural hairline behind her ears. Unfortunately, she will not ever be able to put her hair in a ponytail without feeling very vulnerable and uncomfortable. The correction for this problem often requires hair grafting techniques. Be sure you discuss with your surgeon your scar locations and related hairline issues.

Fig-35

Displaced Hairline: (Fig 36) This is a photograph of a patient who had a previous facelift and now has a formidable problem. Again, an inaccurate estimate of excess skin and poor planning for the incision has left her with a tremendously displaced hairline, which is almost impossible to conceal, especially if the wind blows. This makes her look much older than she is. The scars within the hairlines are visible however they came with a steep price. The dotted lines represent her original hairline which has been pulled back unnaturally to the location you see in front and in back of the ear. A well-intended attempt to hide the scar within her hair was not a good choice. This hairline deformity is a much more difficult problem to conceal and usually requires hair grafting techniques to improve. Be sure to discuss these issues with your surgeon.

Fig-36

Infection: Infections can occur with any surgery, however they are usually rare with facelifts.

Poor Healing / Skin necrosis / loss: If the healing skin has a more severe compromise of its blood supply from excessive tension, an infection, bleeding, or generally poor tissue qualities, a portion of the skin could die or slough. This rare event seems to occur more frequently in patients whom smoke. It usually involves an area of skin behind the ears and will require a longer recovery period or a revisional surgery.

Nerve Damage: Perhaps one of the worst complications would be damage to a nerve that controls some particular sensation or movement of your face. If a sensory nerve is damaged, you could have numbness in areas of your face or ear. If a motor nerve controlling movement is damaged, you may lose the ability to move that portion of your face. With browlifts, this may be the ability to raise an eyebrow. With facelifts, this may affect movements around the brow, eyes, mouth, or lips. Usually in this rare event, the loss of feeling or movement will only be temporary but it could be permanent. Generally, there is a higher risk of experiencing nerve damage if a deep plane technique facelift is performed.

Blood Clots: There is a chance during and after surgery that blood clots can develop in the lower extremities. Rarely, these blood clots can travel in the bloodstream to the lungs. This is called pulmonary embolization. These events can lead to the need for hospitalization and occasionally shock and death in the most severe instances. Precautions taken during surgery such as placement of compression stockings significantly lower the risk of this rare complication. A return to activity such as careful walking soon after surgery also decreases these risks. It is extremely important to go over these and other risks with your surgeon and have your general health evaluated.

Return of Tissue Laxity: The amount of time a facelift lasts varies tremendously. Obviously, the old removed skin will never come back, however your existing old skin, will continue to age and sag over time. A facelift will not arrest the process of aging but you will continue from a more youthful place than your current state. Immediately after surgery, your skin will be pulled tight. The skin always settles some however, as the effects of gravity and animation continue. This is similar to when jeans are taken out of the dryer and worn; they are initially very tight but loosen up by the end of the day. Your facelift should make you look naturally younger, more rested, and hopefully it will be 10-15 years before you will want another one.

Other: Although complications are infrequent, they do occur with any operation, and a facelift is a surgically sophisticated and complex procedure. Other complications could occur and possibly lead to permanent deformities, the need for revisional surgery, hospitalization and even death. Be sure to carefully discuss these risks with your surgeon and the possible related financial responsibilities.

OPERATING TIME

The time it takes to perform a facelift varies among surgeons based on different techniques differences in the anatomy of the patient and the extensiveness of the individual procedure among other reasons. This should be discussed with your surgeon.

ANESTHESIA

Facelifts are safely and frequently performed under both general and local (with sedation) anesthesia. With a general anesthesia, you are completely asleep and your breathing is controlled by the anesthesia provider. Under a local anesthesia, usually you are sedated and the areas to be operated on are made numb with a series of injections.

POSTOPERATIVE INSTRUCTIONS

Post operative instructions also vary among surgeons and should be carefully followed to increase the likelihood of a favorable result. Be sure to keep all scheduled postoperative appointments so your surgeon can monitor the healing process and evaluate for the development of any potential complications!

RECOVERY PERIOD

The recovery period also varies greatly depending on the technique utilized, particular surgeon, and the patient. Usually, the recovery from a facelift is not a painful one. The skin on the face is actually numb until the sensation returns. Bruising and most of the swelling should resolve within two weeks allowing you back to work by then. It may be 4-6 months however, before you really feel that you have completely healed. Usually exercise or vigorous activity should be avoided for 4-6 weeks. Your healing incisions should be kept out of the sun, or at least covered with sunscreen for 3-4 months to allow better healing.

Your surgeon will outline a unique recovery plan for you. It is often a great idea to spend a night or two in a recovery facility or under the care of a nurse. This will add some additional safety, comfort, and convenience for you and your family.

Frequently, small drains are placed during surgery under the skin on your face or neck. These will collect any additional fluid or oozing to help you recover faster with less bruising. They are usually painlessly removed one or two days after surgery.

One word of advice in regard to these advertised facelifts which you recover from in 1-2 days. Chances are that either you do not need it, or the procedure you are paying too much for is an inappropriate short cut that is truly not what it is advertised as.

(Fig 37a,b) These are the preoperative photos of this patient prior to her deep plane facelift, forehead incision browlift, eyelid surgery, and dermabrasion laser peel of the area around the mouth.

Fig-37a	Fig-37b

(Fig 38a,b,c) These photos were taken 5 days after surgery and again give you an idea on what to expect during the healing process. Most of the skin sutures will be removed on this day. Unfortunately, some of the improvement that you see is secondary to swelling. As the swelling subsides, and the tissue relaxes, some of the wrinkles will return.

Fig-38a	Fig-38b
Fig-38c

(Fig 39a,b,c) Here she is ten days after her procedures. This is usually a time when a patient can be seen in public. She is not wearing makeup, but could conceal areas enough with makeup to be presentable. Some scabs and crust are seen at incision sites, but these can be cleaned with hydrogen peroxide.

Fig-39a	Fig-39b
Fig-39c

(Fig 40) These are photos 3 weeks after her procedure. She is not wearing makeup, but could easily be out in public especially if she were wearing makeup.

Fig-40a	Fig-40b
Fig-40c

(Fig 41) These are her before and after photos 6 weeks after her surgery. She also is wearing makeup. We are both pleased with her results and the improvement of her appearance. Although every wrinkle was not removed from her face, the results look very natural, which I feel is more important. She still has the option of having a chemical peel or laser resurfacing over her entire face at a later time.

Fig-41a	Fig-41b
Fig-41ac

Page:   1,  2,  3

Copyright © 2000-2010 Garth Fisher M.D.®, F.A.C.S. - All rights reserved.
Twitter - Glossary - Facebook - Contact Dr. Fisher

Web Development by Imaginary Trout