Aging is unavoidable;
unfortunately the outward signs usually appear while you still feel
young and have productive years ahead. The appearance of an aging
face can interfere with a happy, full life in these valuable years.
The outward manifestations of aging need not be accepted as a matter
of course. Facial rejuvenating procedures are highly rewarding and
satisfying procedures for appropriate patients.
Face lift
or rhytidectomy is operative procedure designed to remove the
major folds or wrinkles of the skin on the face and neck which
naturally occur with aging. It frequently is done in conjunction
with a similar procedure for the eyelids called blepharoplasty
since the aging process is usually present in this region also.
A forehead lift may be recommended to elevate the eyebrows and
remove deep creases.
Contrary
to some articles in popular newspapers and lay journals, a face
lift is not as simple as having a hairdo. The procedure is accomplished
by an operation and as in all operations there is risk involved.
Cosmetic surgery is an art and not a science; consequently no
assurance or guarantee of results can be given. All surgeries
have a possibility of complications and poor results; cosmetic
surgery is no exception. Fortunately, complications in this field
of surgery are uncommon. The procedure is designed to produce
a maximum benefit in the appearance of the face by removing major
wrinkles and sagging of the skin. It is impossible to remove every
wrinkle regardless of the treatment and too much surgery would
result in a pulled or plastic look. Fine wrinkles, particularly
those about the mouth, may require additional treatment, such
as dermabrasion, chemical peeling or fat injection.
The face
lift can be done in combination with removal of fat from beneath
the chin (submental lipectomy) and/or rearrangement of the platysma
muscle of the neck to give a more youthful chin line.
Where
are the incisions? These vary to some degree depending upon
whether the patient is male or female, the hairstyles, hairline,
age, previous surgery, etc. Generally the incision starts in the
temple, in front or within the hairline. It continues in front
of the ear, sometimes partially hidden with the ear (tragus).
It then goes under the earlobe, behind the earfold and ends wither
within the hairline or at the hairline behind the ear. Frequently
another incision is made under the chin in a natural skin fold.
This allows fat removal and tightening of the platysma muscle
in the neck.
Where
is the surgery performed? Face lifts and ancillary procedures
are usually performed at outpatients in a surgicenter. A one night
stay in post-operative care facility may be advisable in some
cases. Local anesthetic combined with intravenous sedation is
usually used. This will allow the patient to sleep through most
of the procedure. General anesthesia is available upon request
but usually is not necessary.
How will
I look after surgery? You should expect swelling, discoloration,
and bruising of the skin for several weeks after a face lift.
Individuals vary a great deal in their response, but commonly
the patient will be presentable within 3 weeks. Make-up can be
applied shortly after surgery. The marks left by the incisions
are often noticeable at first, but these gradually improve as
the wounds mature. The scars are not usually mature for about
6-12 months. A face lift will reduce the sagging and loose skin
and give a more youthful appearance to the face. The facial features
themselves are generally not appreciably changed. The fine lines
and wrinkles of the face are usually not much affected by a face
lift. Dermabrasion or chemical peel of the skin are sometimes
used to reduced fine lines during or after a face lift. Fat injections
may also be recommended.
How long
will it last? Because people vary so much, an exact time is
difficult to give. An average figure given is 5 to 10 years. You
may repeat the face lift procedure at that time if you wish. There
is always an improvement compared to not having the procedure,
even though the aging process continues in the future. In occasional
patients with very loose skin, early sagging may be seen as soon
as the first year and require a secondary procedure to tighten
the loose skin.
What are
the risks of surgery?
General
Risks of surgery include infection, pain, delayed wound
healing, hematoma (a collection of blood at the surgical site,)
bleeding, reactions to anesthetic.
Bleeding.
When blood collects beneath the skin it causes excessive discoloration.
Sometimes lumps which last many months may occur. If blood collection
is discovered, it is usually removed by taking out a few stitches
and squeezing the clot out, or inserting a needle and aspirating
it. If bleeding continues it is sometimes necessary to return
to the operating room to stitch the bleeding vessels. This risk
is increased in people who take aspirin or who bruise easily.
Let your doctor know if this is the case. Do not use aspirin
or aspirin-containing product for two weeks before and two weeks
after surgery. (See list of medications which may increase bleeding.)
Loss
of Skin: The skin may lose its blood supply. While uncommon
when this happens, an area of skin will fail to survive and
number of weeks are needed for healing. Rarely, a skin graft
may be needed to obtain healing. This risk in increased in smokers;
therefore, you must stop smoking a least 2 weeks before and
2 weeks following surgery.
Infection:
Infection in facial surgery in uncommon but can occur.
This requires antibiotics, possible hospitalization, and there
is an increased risk toward skin loss as mentioned above.
Facial
Nerve Injury: Permanent injury to the facial nerve is very
rare. It is not uncommon for branches of the facial nerve to
be bruised from the operation and for the muscles of the forehead
or the corner of the mouth to lose some or even a great deal
of their activity temporarily. Activity usually returns to normal
within a few weeks. In extremely rare instances, it may take
months or more.
Discoloration:
Sometimes the skin remains discolored for many months. This
may be related to the absorption of blood pigments during the
healing process. Permanent discoloration is rare.
Asymmetry:
Every effort is made to keep both sides even, but since
no face is symmetrical to begin, mild asymmetry may remain after
surgery. Some changes in the earlobe shape may occur as result
of skin tension and scars.
Numbness:
Parts of the face, forehead, eyes, ears and scalp may feel
numb for weeks or months after surgery; this is normal and expected.
On occasion, loss of sensation my be prolonged or permanent.
Scars:
Every operation creates some type of scar. Facelift incisions
are planned to hide and minimize visible scarring. Scars, however,
are not predictable and infrequently patients will develop scars
which are widened, thickened, raised, more red or generally
more visible than anticipated (hypertrophic or keloid). Normally,
scars go through a maturation process which takes months. This
includes an expected period of thickness, redness and firmness,
during the first 4-6 months. (More information on scars is available
upon request.)
Hair loss:
On occasion hair loss in the temple area or the hair behind
the ear may occur. This is usually temporary and the hair regrows
in several months. These situations are more the exception than
the rule but they do occur.
Pain:
Generally facial operations have surprisingly little pain. however,
pain is very subjective. On occasion a patient will experience
tightness and discomfort for a prolonged period of time. Scars
may remain sensitive for months. These situations are more the
exception than the rule but they do occur.
Depression:
Some patients may experience an emotional let down after this
surgery. This may be related to the normal chemical changes
after extensive surgery or overly high expectations. It is usually
self limited and does not require treatment
Alternatives:
Other procedures which may improve an aging face but are
less extensive include chemical peels, collagen or fat injections
or liposuction technique.
Photography:
Photographing, filming or videotaping of the treatment or procedure
for education or diagnostic use is standard and required part
of patient care.
No Guarantee:
The practice of medicine and surgery is not an exact science.
Although good results are expected, there cannot be any guarantee,
nor warranty, expressed or implied, by anyone as to the results
that may be obtained.
Complications
and Additional Surgery: Any of these problems or disorders
noted above may require additional surgery, hospitalization,
and time away from work. If this occurs, there will be additional
cost for surgical fees, supplies, anesthesia, etc. depending
upon the required operation. Complications of cosmetic surgery
generally will not be covered by medical insurance.
The better
known complications are discussed above. Please ask your surgeon
if you want to know about remote complications, or if you
have any other questions.
