Facelifts are very individualized procedures. In your initial consultation, Dr. Patterson will evaluate your face, including the skin and underlying bone, and discuss your goals for the facelift surgery. Incisions usually begin above the hairline at the temples, extend in a natural line in front of the ear (or just inside the cartilage at the front of the ear), and continue behind the earlobe to the lower scalp. If the facelift requires that the neck needs work, a small incision may also be made under the chin.
In general a facelift involves the surgeon separating the skin from the fat and muscle below. Fat may be trimmed or suctioned from around the neck and chin to improve the contour. The facelift surgeon then tightens the underlying muscle and membrane, pulls the skin back, and removes the excess. Stitches secure the layers of tissue and close the incisions; metal clips may be used on the scalp.
Following surgery, a small, thin tube may be temporarily placed under the skin behind your ear to drain any blood that might collect there. Dr. Patterson may also wrap your head loosely in bandages to minimize bruising and swelling.
Length: A facelift usually takes several hours or somewhat longer if you're having more than one procedure done. For extensive procedures, Dr. Patterson may schedule two separate sessions.
Anesthesia: Most facelifts are performed under local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and your face will be insensitive to pain. (However, you may feel some tugging or occasional discomfort). Sometimes general anesthesia is preferred. In that case, you'll sleep through the operation.
In/Outpatient: Usually done on an outpatient basis, Dr. Patterson may hospitalize patients for a day when using general anesthesia. Certain conditions such as diabetes or high blood pressure should be monitored after surgery, and may also require a short inpatient stay.
Side Effects & Risks
All surgery carries some uncertainty and risk. When a facelift is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable.
Complications that can occur include hematoma (a collection of blood under the skin that must be removed by the surgeon), injury to the nerves that control facial muscles (usually temporary), infection, and reactions to the anesthesia. Poor healing of the skin is most likely to affect smokers.
INCISIONS (SCARS): In the temporal area, Dr. Patterson can make the incisions within the hairline or in front of the hairline. If made in front, the scars will be visible but the hairline will not change. Scars made within the hairline cause hair to move up and slightly backward when the lift is done. We find it best to place the preauricular (in front of the ear) scar behind the tragus (small flap at the external opening of the ear), as that incision is least noticeable.
The incision behind the ear can also be made within or below the hairline. If made within the hairline, much of the scar will be hidden, BUT THERE WILL BE A CHANGE IN THE HAIRLINE AND THERE WILL BE MORE HAIR-FREE SKIN BEHIND YOUR EAR. If Dr. Patterson places the incision below the hairline, the hairline will remain intact, but the scar will be visible if you wear your hair up.
Longer, rather than shorter, facelift incisions produce better results, as more skin can be removed. On the other hand, longer incisions and more skin removal means that more changes will occur in the hairline if the incisions are placed there. Dr. Patterson can attempt to reapproximate the hairline behind the ear and eliminate the notching, but usually at the expense of the overall facelift result!
HEMATOMA: If excessive bleeding occurs under the skin after surgery, a collection of blood under the skin (a hematoma) can form. If the hematoma remains small, the body will absorb it gradually. If it becomes larger, it may need to be removed by suction. Further surgery to remove clots is uncommon, but occasionally necessary.
SKIN LOSS: Occasionally, poor circulation coupled with skin under tension will lead to blistering, redness, and, rarely, small areas of skin loss. Skin loss most commonly occurs behind the ears but can occur elsewhere. If this happens, it will delay healing, and superficial scaring may occur. You may require some “touch-up” procedures. (This is why we ask smokers to discontinue smoking for several weeks before and after surgery, as they are at the greatest risk for this complication).
POSTOPERATIVE SAGGING: Your surgeon will walk a tightrope during surgery. If the skin is pulled to tight, circulation diminishes and skin can die. Dr. Patterson will lift or tighten your skin as much as it is safe to do. If your skin does not have normal elasticity, it may stretch or sag sooner than desired. This is not your surgeon’s fault. A subsequent small tuck can be very helpful if you have this kind of skin.
NERVE INJURY: It is extremely rare for the main trunk of the facial nerve to be injured. Temporary damage to one of the peripheral braches is uncommon. If this should happen, you might have difficulty in moving your forehead, upper lip, or lower lip. Resolution usually occurs in a month or two*; however, permanent damage remains a remote possibility*. Occasionally, the sensory nerve that supplies the earlobe may incur damage despite the best efforts to preserve its function.
ASYMMETRY: No one’s face is totally symmetrical. Many people notice asymmetry for the first time when they scrutinize themselves after a facelift. Because this surgery is as much as an art as a science, surgical asymmetries can occur. Further surgery is rarely necessary.
CHRONIC PAIN: Most facelift procedures cause very little discomfort for more than a few days* and all the skin sensation will have returned to normal in 3-5 months*. In very rare cases, patients have noted chronic pain at the surgical site that lasts a year or occasionally longer. Rarely, patients complain that the operated areas become superficially hot or red. These symptoms can occur following exercise or for no apparent reason and can occur for several months*. The reasons for all the above symptoms are unclear and specifically treatment is unknown. Massage and ice packs may be symptomatically helpful. Some patience and understanding while the symptoms clear over time is “required”.
SWELLING AND PAIN IN THE PAROTID AREA: The surface of the parotid gland (a large salivary gland below and in front of the ear) is exposed as part of the procedure for tightening the deeper layers. Occasionally swelling of the parotid gland or discomfort while eating may occur for 1-4 weeks* after surgery. This is a self-limiting problem will resolve without treatment.
SCARS: Scars will occur and may go from pink and firm to faded and soft over a period of six to twelve months*; some scars may widen, become depressed, or appear raised, firm, and “ropey” red which may take two years or longer to fade and soften; scars will be permanent and visible*.
HAIR LOSS: Possible loss of some hair along the incision lines on the scalp.
FLUID COLLECTIONS: Fluid collections may accumulate under the skin and may require drainage or aspiration (withdrawal by needle).
INJURY TO DEEPER STRUCTURES: Blood vessels, nerves and muscles may be injured during facelift. The incidence of such injuries is rare. (See Nerve Injury)
There isn't usually significant discomfort after surgery; if there is, it can be lessened with the pain medication prescribed by the surgeon. (Severe or persistent pain or a sudden swelling of your face should be reported immediately).
Some numbness of the skin is quite normal; it will disappear in a few weeks or months*.
You should keep your head elevated and as still as possible for a couple of days* after surgery, to keep the swelling down.
If you've had a drainage tube inserted, it will be removed one or two days* after surgery. Bandages, when used, are usually removed after one to five days*. Don't be surprised at the pale, bruised, and puffy face you see. Just keep in mind that in a few weeks* you'll be looking normal.
Most of your stitches will be removed after about five days*. Your scalp may take longer to heal, and the stitches or metal clips in your hairline could be left in a few days longer.
You should be up and about in a day or two*, but plan on taking it easy for the first week* after surgery.
Be especially gentle with your face and hair, since your skin will be both tender and numb, and may not respond normally at first. Dr. Patterson will give more specific guidelines for gradually resuming your normal activities. The following suggestions are likely: Avoid strenuous activity, including sex and heavy housework, for at least two weeks* (walking and mild stretching are fine); avoid alcohol, steam baths, and saunas for several months*. Above all, get plenty of rest and allow your body to spend its energy on healing.
At the beginning, your face may look and feel rather strange. Your features may be distorted from the swelling, your facial movements may be slightly stiff and you'll probably be self-conscious about your scars.
Some bruising may persist for two or three weeks, and you may tire easily. It's not surprising that some patients are disappointed and depressed at first. By the third week, you'll look and feel much better. Most patients are back at work about ten days to two weeks* after surgery. If you need it, special camouflage makeup can mask most bruising that remains.
After surgery, you'll present a fresher, more youthful face to the world.
The chances are excellent that you'll be happy with your facelift, especially if you realize that the results may not be immediately apparent.
Even after the swelling and bruises are gone, the hair around your temples may be thin and your skin may feel dry and rough for several months*.
Men may find they have to shave in new places, like behind the neck and ears, where areas of beard-growing skin have been repositioned.
You'll have some scars from your facelift, but they're usually hidden by your hair or in the natural creases of your face and ears. In any case, they'll fade within time and should be scarcely visible.
Q. Can a face lift stop the aging process?
A. A facelift (technically known as rhytidectomy) can't stop this aging process. What it can do is "set back the clock," improving the most visible signs of aging by removing excess fat, tightening underlying muscles, and redraping the skin of your face and neck.
Q. Will the scars be visible?
A. You'll have some scars from your facelift, but they're usually hidden by your hair or in the natural creases of your face and ears. In any case, they'll fade within time and should be scarcely visible.
Q. Can I see before and after pictures?
A. Yes! During your consultation with the Doctor, you may view before and after pictures of procedures similar to the one you are interested in.