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Facelift


If you are bothered by the signs of aging in your face, a facelift may be right for you. Technically known as rhytidectomy, a facelift is a surgical procedure designed to improve visible signs of aging in the face and neck. Typical changes that can be improved with a facelift include sagging in the midface, deep creases along the nose extending to the corners of the mouth, loss of muscle tone in the lower face, jowling, and loose skin under the chin and jaw that can make even a person of normal weight appear to have a double chin. As a restorative surgery, a facelift does not change your fundamental appearance and cannot stop the aging process. A facelift can only be performed surgically. Non-surgical rejuvenation treatments cannot achieve the same results, but may help delay the time at which a facelift becomes appropriate and complement the results of surgery. A facelift is a highly individualized procedure and you should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image.

Depending on the degree of change you’d like to see, your facelift choices include a traditional facelift, limited incision facelift or a neck lift. A traditional facelift incision often begins in the hairline at the temples, continues around the ear and ends in the lower scalp. Fat may be sculpted or redistributed from the face, jowls and neck, and underlying tissue is repositioned, commonly the deeper layers of the face and the muscles are also lifted. Skin is redraped over the uplifted contours and excess skin is trimmed away. A second incision under the chin may be necessary to further improve an aging neck. Sutures or skin adhesives close the incisions. These results are dramatic or subtle, depending on the current facial appearance. Because each individual has his or her own unique facial features and skin quality, the results vary with each individual. Rejuvenation procedures typically performed in conjunction with a facelift are brow lift, to correct a sagging or deeply furrowed brow, and eyelid surgery to rejuvenate aging eyes.

Dr. Miles has successfully performed hundreds of office-based facial cosmetic surgery procedures under local anesthesia, achieving excellent results and satisfied patients. These procedures include facelifts, upper and lower eyelid surgery, neck contouring, liposuction, and brow lifts. In the appropriate surgical candidate, this is a great alternative to traditional facial rejuvenation procedures routinely performed in the hospital setting. These procedures can usually achieve excellent results without the increased risks of general anesthesia and higher associated costs. The recovery period is usually quicker as well. If you are contemplating having a traditional facelift or other facial plastic surgery procedure, we encourage you to make an appointment to see if you are a good candidate for these types of procedures which have gained national media attention.

Questions about Facelift Surgery answered by Erik Miles MD

What is a facelift?

The face usually portrays the first visible signs of aging. This is due to the long term effects of gravity, decreased skin elasticity over time, and diminished facial volume. A facelift (also called a rhytidectomy) is a surgical procedure designed to improve the visible signs of aging in the face and neck. These signs include more prominent jowls, sagging in the midface, creases along the nose extending to the corner of the mouth, fat that has fallen or been displaced, loss of muscle tone, and loose skin and excess fatty deposits under the chin. Facelift surgery mainly addresses the lower part of the face and neck. There are other specific procedures that can address the nose, eyelids, or forehead. It is common to combine a facelift with other cosmetic surgical procedures.

Throughout history, people have sought to maintain a youthful appearance. Documented efforts to hide the telltale signs of aging date back to the ancient Greeks and Romans. The earliest report of a surgical facelift dates back to 1901, when a German surgeon named Hollander excised segments of skin at the hairline of a patient who desired wrinkle improvement. Facelift techniques have evolved significantly since that time, as we have gained a more detailed understanding of facial anatomy and the natural changes that occur with aging. While early facelift surgeries focused exclusively on tightening the patient’s facial skin, we now understand that the best results are obtained by addressing both the skin and its underlying support system. This gives the most natural and lasting results. A facelift won’t stop the aging process, however, it can help to turn back the clock to provide a more youthful appearance.

As a restorative surgery, a facelift does not change your fundamental appearance and cannot stop the aging process. A facelift can only be performed surgically. Non-surgical rejuvenation treatments cannot achieve the same results, but may help delay the time at which a facelift becomes appropriate and complement the results of surgery.

Is a facelift safe?

Safety is the foremost priority with any surgical procedure at North Charlotte Plastic and Reconstructive Surgery. It is our position that plastic surgery procedures should only be performed by surgeons who are board certified by the American Board of Plastic Surgery. Surgeons with this qualification have met the highest standards of training and board certification. Dr. Miles has these qualifications.

Facelift surgery is extremely safe when performed by a qualified and experienced surgeon such as Dr. Miles. Prior to any cosmetic surgery, all patients undergo a thorough medical history screening during the consultation process. Smokers should stop smoking in advance of surgery to minimize complications. Aspirin and other anti-inflammatory drugs such as ibuprofen can cause increased bleeding risks and are stopped prior to surgery. Dr. Miles will provide every patient with specific instructions to optimize outcomes. Medical testing and clearance for surgery from other providers will be obtained if necessary. Although complications can occur with any procedure, they are rare with a facelift. Dr. Miles does not use complicated or deeply invasive surgical techniques that could potentially risk injury to nearby vital structures. In rare instances when complications related to the procedure do occur, they are usually minor and can be managed effectively in the office based setting.

How long does a facelift usually take to perform?

Facelift surgery time will vary depending on the specific techniques used. Generally speaking it takes approximately 3 hours to perform a facelift. Procedures to rejuvenate the neck will add to the time. As mentioned, other facial procedures to address the eyes or forehead can also be combined which can further add to the surgical time. Because every patient is different and has different goals, the time to complete the surgery will vary. Attaining an aesthetically pleasing result is a high priority, and Dr. Miles will devote the necessary time to every patient to accomplish this goal.

How do you perform a facelift?

Facelift procedures have evolved greatly over the years. Today, several different techniques exist that tighten the underlying tissues and muscle, remove excess skin, and smooth the skin of the face and neck. Outcomes are now consistently reliable and durable.

Facelift procedures usually begin with incisions in front of and behind the ears. Sometimes the incision can be limited to the front of the ears only. If the neck is to be addressed, a small incision is made in a hidden area below the chin. Once the incisions are made, the skin is elevated (called undermining) in order to expose the deeper layers of the face. The muscles are then tightened to lift the skin. Liposuction of the neck and jowls may also be performed. Skin is redraped over the uplifted contours and the excess skin is precisely trimmed away. Sutures are used to close the incisions without tension. A small drainage tube is sometimes used for the first few days. A facial elastic dressing is placed at the conclusion of the procedure. The result can reverse the effects of gravity and aging to restore a more youthful contour to the face.

Can a facelift be performed under local anesthesia?

Dr. Miles has successfully performed hundreds of office-based facial cosmetic surgery procedures under local anesthesia, achieving excellent results and satisfied patients. These procedures include facelifts, upper and lower eyelid surgery, neck contouring, liposuction, and brow lifts. In the appropriate surgical candidate, this is a great alternative to traditional facial rejuvenation procedures routinely performed in the hospital setting. These procedures can usually achieve excellent results without undergoing general anesthesia and higher associated costs. The recovery period is usually quicker as well. If you are contemplating having a traditional facelift or other facial plastic surgery procedure, we encourage you to make an appointment to see if you are a good candidate for these types of procedures which have gained national media attention.

Who is a good candidate for a facelift?

Most patients requesting evaluation for facelift are looking for ways to refresh and rejuvenate their appearance. Both men and women can achieve excellent results. Patients who are concerned about sagging or loose skin in the face or neck, jowling, deep creases along the nose extending to the corners of the mouth, or fatty deposits in the neck that cause a double chin may be good candidates for the procedure. During the pre-operative consultation, Dr. Miles will take a thorough medical history and perform a physical examination. He will focus on specific patient concerns. During the physical examination, facial bone structure, skin thickness and elasticity, and the extent of facial wrinkles and loose skin will be assessed. This information will be used to formulate a highly individualized surgical plan to help meet each patient’s goals. Dr. Miles will explain the technique that he feels will offer the best results and the lowest risk.

Facelift patients should be in good physical health, nonsmokers, and have realistic goals in mind for the improvement of their appearance. A facelift should not be done to fulfill someone else’s desires or to try to fit any sort of ideal image.

What are realistic expectations for a patient having a facelift?

Facelift surgery is one of the most commonly performed cosmetic procedures due to excellent results and high patient satisfaction. A facelift is an excellent way to achieve a more youthful and refreshed appearance. Patients feel more confident in their appearance after surgery. These results can be dramatic or more subtle, depending on the current facial appearance. Because each individual has his or her own unique facial features and skin quality, the results vary with each individual. Remember that the goal of facelift surgery is to provide a more refreshed look that makes one look more youthful or “good for their age.” No one should look “operated on” or unnatural after the procedure.

During the initial consultation, Dr. Miles will listen to patient concerns and make recommendations about how to best meet a patient’s goals. Pictures will be taken to enhance the discussion and give patients different views of their face and neck. Dr. Miles will perform a thorough examination on every patient to assess skin excess in the neck and jowls, skin elasticity, extent of wrinkling, and existing scars from prior surgery if present. It is important for patients to honestly discuss their expectations with Dr. Miles prior to surgery so he can determine whether or not they can be realistically achieved.

Fortunately, complications from facelift surgery are rare. When they do occur, most complications are minor and can be effectively managed without further surgery. Some of the potential complications that may occur include hematoma (an accumulation of blood under the skin), infection, and minor wound healing problems. Facelift incisions heal remarkably well and are quite inconspicuous. Patients who smoke or have medical conditions such as diabetes are at a higher risk of delayed wound healing or tissue loss along parts of the incision. Smokers will be asked to stop smoking well in advance of the surgery. Certain medications that increase the risk of bleeding (such as Aspirin) should be discontinued prior to surgery.

Facelift surgery is a great way to set back the clock and address the signs of facial aging. The results are generally long lasting, however longevity is dependent on the quality and elasticity of each patient’s skin. Gravity and the effects of aging will continue after the procedure and revision surgeries are sometimes performed many years after the initial procedure. Long term follow up with Dr. Miles is beneficial.

How long does it take for a patient to recover from a facelift?

The vast majority of facelift patients go through the recovery and healing process without any delays or complications. Dr. Miles follows patients very closely after any surgical procedure and he is always available to address any concerns. After surgery, patients will have surgical dressings over the incisions and an elastic facial wrap to apply gentle pressure to the face and neck. This wrap will minimize the chance of fluid collection under the skin and provide comfort due to its supportive nature. The supportive wrap is worn for the first week as much as possible. After that time period, Dr. Miles will often provide another type of garment that is worn for several more weeks only at night. Patients will generally have surgical drains placed during the procedure, which are small tubes placed under the skin to drain any excess blood and fluid that may collect. The drains are painlessly removed in the office on the second or third day after surgery. Elevation of the head is helpful for reducing the initial post-operative swelling. Dr. Miles also advises the use of ice packs intermittently. Patients can shower and wash their hair after the second day. The drain management and wound care instructions are very simple, and all patients are given specific written instructions. The sutures are removed on the seventh day.

The amount of time it takes to recover after a facelift varies between patients. Early after the procedure, there will be visible bruising and swelling. Postoperative discomfort is usually mild and managed well with prescription pain medication in the first few weeks. Patients generally take 2-3 weeks off from their regular activities. The office can provide excuse notes for work if needed. Most patients can resume non-strenuous activities after 2-3 weeks, however exercise should be avoided for about 6 weeks after surgery. Complete healing generally takes 6-8 weeks, but it may be months before swelling and induration (a firm feeling in the cheeks) fully subsides and the final results are evident. Some patients will notice some temporary numbness around the incisions which may persist for several months. The incisions will initially be red or pink in color. Makeup can be applied after a few weeks. The incisions will fade over time. Patients should avoid direct UV light on their healing incisions until they completely fade.

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