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Treatments & Procedures

Facelift Overview from the Head & Neck Institute

(Also Called 'Rhytidectomy')

Aging of the face is inevitable. As the years go by, the skin begins to loosen on the face and neck. Crow's feet appear at the corners of the eyes. Fine forehead lines become creases and then, gradually, deeper folds. The jaw line softens into jowls, and beneath the chin, another chin or vertical folds appear at the front of the neck. Heredity, personal habits, the pull of gravity, and sun exposure contribute to the aging of the face. As the aging population grows, it is obvious why the facelift has become one of the most common facial plastic surgeries performed in the United States.

The following informative section will hopefully provide a few answers to the most common questions concerning this procedure. It should provide information on how a facelift could improve your looks or self-confidence, how a facelift is performed and what you can expect from this procedure.

Are you a candidate for a facelift?

Successful facial plastic surgery is a result of good rapport between patient and surgeon. Confidence, based on realistic expectations and exacting medical expertise, develops in the consulting stages before surgery is performed. Your surgeon can answer specific questions about your specific needs.

As with all facial plastic surgery, good health and realistic expectations are prerequisites. Understanding the limitations of the facelift is crucial and psychological stability is vital. There is no ideal in a facelift. Rather, the goal is to improve the overall facial appearance. Skin type, ethnic background, degree of skin elasticity, individual healing, basic bone structure, as well as a realistic attitude are factors that should be discussed prior to surgery. The procedure is sometimes performed on patients in their eighties. A facelift cannot stop aging. In essence it helps turn the clock backwards to restore a more youthful appearance. The natural process of aging continues. A facelift, when performed well, can help your face look its best and give you a look of health and a more youthful and refreshed appearance. A side benefit is that many patients experience increased self-confidence.

Your choice of a qualified facial plastic surgeon is of paramount importance. During the preliminary consultation, the surgeon will examine the structure of your face, skin texture, color, and elasticity. Photographs will be taken so the surgeon can study your face. Individual risks will also be examined, especially those related to medical situations such as high blood pressure, a tendency to scar, smoking, and any deficiency in blood clotting. The surgeon will take a thorough medical history, as well as assess the patient's mental and emotional attitudes toward the surgery. Because a realistic attitude is crucial to the success of the surgery, the surgical procedure and realistic expectations will be discussed.

After the decision to proceed with a facelift is made jointly by you and your surgeon, the surgeon will describe the technique indicated, the type of anesthesia, the surgical facility, any additional surgery, the pros and cons to include possible complications, and costs of the procedure.

The following images show one of Dr. Alam's patients before her facelift procedure. She has developed the natural sagging of the deeper muscular layers of her face. As the skin of her face loses its elasticity, wrinkles develop. This gives the patient an appearance of being tired. After detailed preoperative discussions she opted to proceed with a Bi-Vector facelift.

How is the procedure done?

Numerous techniques exist for performing facelifts. Traditionally, lifts involved pulling simply the skin layer back to reduce wrinkles. While effective in the short term, skin based lifts are short-lived procedures. The next major advance came with "deep plane lifts". The deeper muscle layers are pulled in these procedures to give a much longer lasting effects. This method is probably the most common form of facelift done today. While achieving acceptable long-term results. This method often results in a "pulled" appearance in patients postoperatively.

This occurs because the skin and muscle layers are pulled as a unit. Unfortunately, in the aging process, these layers stretch in different directions.

The solution to this problem has been the development of Bi-Vector face lifting. This modern technique allows for facial rejuvenation with the maintenance of a natural post-operative appearance as the process of aging is reversed exactly as it progresses. In simple terms, the deep muscle layers are pulled up vertically to reverse gravity's effects and then the skin is redraped in its natural orientation.

The surgeon begins the incision in the area of the temple hair, just above and in front of the ear, and then continues around the lobe, circling the ear before returning to the point of origin in the scalp. The skin is raised outward before the surgeon repositions and tightens the underlying muscle and connective tissue a vertical direction. Some fat may be removed, as well as excel skin. For men, the incision is aligned to accommodate the natural beard lines. In all cases, the incision is placed where it will fall in a natural crease of the skin for camouflage.

After trimming the excess skin, the surgeon closes the incisions with fine, which permits surgery without shaving hair from the incision site. The skin is redraped naturally to avert a "pulled" appearance. Depending on the extent of the surgery, the process generally takes four hours. When the procedure is performed under a deep level of sedation where the patient is unaware of the procedure but not still breathing on her/his own. The common serious complications during the surgery are related to anesthesia. Surgery at the Cleveland Clinic is done with staff anesthesiologists providing the care. This level of care provides the ultimate in safety for patients that can often not be achieved in the setting of the private office. Following the surgery, the surgeon will apply a dressing to protect the entire area where the incisions have been made.

What can I expect after the surgery?

Even though most patients experience very little pain after surgery, the surgeon will still prescribe medication. Some degree of swelling and bruising is unavoidable, and your surgeon may instruct you to use cold compresses to keep swelling to a minimum. If a dressing has been applied, it will be removed within one to two days. The surgeon will also instruct you to keep your head elevated when lying down, to avoid as much activity as possible, and to report any undue discomfort. Though there are few risks in facelift surgery and thousands are performed every year, some risks exist in any surgery.

In some cases, a drainage tube may have been inserted during the surgery. This will be removed on the day after surgery. All sutures are usually removed within five to ten days following surgery. Surgeons generally recommend that patients avoid vigorous activity. Patients should prearrange for post-surgery support from family and friends.

Recovery usually takes two to three weeks, though many patients go back to work in two weeks. Scars are usually not noticeable after enough time has passed for them to mature. In any case, they are easily disguised in natural skin creases, by the hair or, in pertinent cases, by makeup until total healing has occurred. Bear in mind that the aging process continues after surgery and that some relaxation of tissues will occur over the first few weeks.

Figure 3 shows the patient months after her procedure. The Bi-Vector technique has given her a youthful natural look. This is achieved without distortion of the face and the unwanted "operated" appearance. Facial plastic surgery makes it possible to correct many facial flaws and signs of premature aging that can undermine one's self-confidence. By changing how you look, cosmetic surgery can help change how you feel about yourself.