So facelifts are another common procedure that I get asked about a lot
I'd say for me the key to getting a good face lift is sort of having a
conservative approach
which is you know sort my approach to all aspects of plastic surgery
but I think by really taking a conservative approach, not really trying
to get some
really huge dramatic difference, I think that you can get a very nice rejuvenated
appearance
without looking overdone, and you know that's what we always want to avoid
in plastic surgery
in my opinion. So, I would say the best candidates for
a facelift typically are people in their forties to sixties
I do have patients a little bit older than that sometimes as well. In my experience this really
doesn't have to do as much with the chronologic age, and really has to do
more with just the patient's facial anatomy
There's a lot of differences in how patients' faces change over time
we don't like our face to change and change over time, but they do, and that's a
fact of life
Patients who have for example in the sun a lot more when they were younger
sometimes the skin is a little bit more damaged, there's a little bit more sagging earlier on
Patients who smoke sometimes can have more
facial aging types of changes that you see earlier in life as well
so those are all basically differences between patients and it really depends
on the examination when the surgeon sees the patient
and really gets an idea of what specifically needs to be done
So, let's talk about operative details. The procedure itself is usually about
three-and-a-half to
four hours. It really depends on the patient like I mentioned before
Really what's done is
really highly individualized. I mean I'd say most almost
all plastic surgery procedures
are individualized by patient but I would say facelift is really one where it's
really very very highly individualized and I say that because
some people have facial aging changes that are more related to
to here in the jaw line in the jowls and cheek. For some people it's more in the neck area,
and you know some people want a little more lift in certain areas and
others and so there's really a lot of variation
in terms of anatomy and also in terms of patient goals so this is where it's very
important to have good communication between the surgeon and the
patient, and that will affect specifically the maneuvers that are done during the procedure
and consequently the results. There are different ways to do a facelift
My preferred method is to do it in two layers. I'll make a small incision
right where the ear meets the cheek, and so in that way I feel it heals
very well
and really is quite hidden from view once the scars have faded.
I will extend the incision sometimes behind the ear
depending on if the patient needs to have a necklift as well.
Oftentimes a facelift is combined with a necklift
and the reason for this is because the surgical incision and access is the same
so often times if you're their anyway it's very straightforward to just do the necklift at
the same time
Once the incision is made, I will lift up the skin
to reveal some of the underlying muscle and the muscle I will then tighten up
I put a lot of my tension sutures or the sutures that really tighten up
the facial anatomy sort of at the muscle layer
and I found in my experience that that sort of tightening at the muscle layer
really allows me to
get a very nice pull without really pulling on the skin layer
and benefit of this being that you can get a nice rejuvenation
without the skin looking like its pulled too tight.
With that, once this muscle is pulled up and tightened in the right position,
again every patient being individually tailored for the operation,
then the skin can be put down again and then just
carefully trimmed and then afterwards sutures placed
Depending on the patient, different amounts of skin are
re taken out. I have patients that come in saying I would like you to take as much
skin as possible
and I usually don't do that. I usually will tailor that depending on what I think will heal well
and will give them a nice rejuvenated appearance without
taking too much out. I mentioned earlier about the neck lift
If I do do a necklift, oftentimes I will incorporate a small incision underneath the chin
It's about a four to five cm incision
something tucked underneath so it's not conspicuous and that just gives me
access to the neck area so that I can really get
some tightening of the neck as well. Let's talk about the recovery,
in terms of post-operative recovery, after the operation I do put a lot of dressings around
the patient's face
I do use that to sort of tighten things up here and allow things to heal
in an upward position. Once the
procedure's been done, we want the skin to heal in an upward
position, so it doesn't quickly begin to sag right afterward.
I have patients keep this on usually for the first couple of days up to about about
a week
again depending on the patient and after that I like them when they go home to
start to wear this really as much as they can
even after that first week. A lot of the swelling and bruising is gone by about two weeks
but not necessarily all of it. The face does continue to improve I would say from about
six weeks up to about six months
Things do remodel, things tighten up a little bit, swelling comes down a little
further, and patients get a really nice result when they wait
especially after a couple months, but they really can see the result
in a couple weeks
I'll take out most sutures about one week or so after the operation
and then I tend to follow patients pretty frequently afterward to make sure there's no issue with
healing, to make sure the scar evolves well, and that's my approach to
doing the facelift, and again I think overall the
take away message really is just to be conservative
I think that by being conservative you can get a really nice result
and patients can look natural and be very happy
and they really don't look like they've had a facelift