A great facelift is one that makes someone appear refreshed, and younger, but not different or “done”.
With a rhytidectomy, the underlying structures (SMAS) are elevated, not just the skin. Loose skin is then re-draped the elevated underlying fat.
Dr. Neavin has unique training in face lift surgery with advanced aesthetic surgery training under renown facelift plastic surgeons in Beverly Hills, Richard Ellenbogen, and at the world renowned University of Pittsburgh Plastic Surgery under some of plastic surgery’s pioneers. Dr. Neavin also augments this procedure with fat grafting to restore full cheeks and volume to the desired areas where fat was lost with aging.
Things you should know…
Be wary of aggressive, TV ads promising quick results at very low prices. There is an old adage, “you get what you pay for”. You aren’t shopping for a designer purse, you are shopping for your face (and life). First and foremost, make sure you are a safe candidate. Your primary care doctor should know about your plans. We make sure we get clearance from your medical physicians before proceeding with surgery. Two, understand that techniques differ, and surgical talent differs. Avoid cookbook strategies where only one type of lift is performed. A facelift should be customized to the the aging patterns and desires of the man or woman. Part of the process is proper diagnosis. While aging patterns are often similar, there are differences among different people.
So, how long will my face lift last?
This is a common question. A face lift will not prevent you from normal aging. You will continue to age. But, this does reverse the hands of time. The results of a good face lift will last for years.
Different Types of facelifts
A standard facelift is generally a cheek lift with a neck lift. This is performed in an operating room under general anesthesia. The skin is lifted with incisions made in the creases beside and behind your ears. The incisions are well camouflaged and generally heal without noticeable scars. The underlying tissues (SMAS layer) is also elevated and tightened. The skin is then advanced and trimmed to redrape the skin. This redraped skin is not pulled tightly. It is gently redraped to look natural to resolve your jowls, and loose neck. This is often performed in conjunction with forehead lift (browlift), blepharoplasty (eyelid lift), earlobe surgery, and fat grafting.
An office mini-facelift is performed under local anesthesia. It primarily lifts the cheeks improving jowls with some lifting of the neck. Ideal candidates for this procedure are younger patients with early skin sagging, or men and women that have had a previous face lift and just need extra tightening. There are many marketing names for this type of face lift (ie Lifestyle Lifts). But, they all generally accomplish the same thing – a refreshed, and more youthful face. These procedures have gained popularity because of their ability to be performed under local anesthesia an office setting. While the mini lift is fantastic, it does have its limitations. The results of a mini lift do not last as long as a standard facelift. Fat grafting can be combined with a mini lift.
Other types include “liquid lifts” which refer to the use of injectables to create the appearance of a facelift, and a volume lift with fat transfer. The idea in liquid and volume lifts is to camouflage areas of aging, to rejuvenate areas that have lost volume, and to restructure the architecture of the face to make it more top heavy or heart shaped.
Am I a candidate for a face lift?
If you believe you are looking more tired or older and you desire to look fresher and younger then a facelift might be the right operation for you. The best candidates are health men and women who do not smoke (smoking can interfere with healing). Men and women who benefit most from this have some element of loose skin and descent or loss of fat in the midface. Poor candidates are very heavy faces with no clear skin looseness. An in person evaluation is the best way to determine where on that scale you register.
During your visit with Dr. Neavin, a complete health history will be obtained as well as a review of all current medications. Some medications are safe to stop before surgery. Others are not. The decision to hold medications will be determined by your prescribing doctor. Your health is of paramount importance. Because cosmetic surgery is elective, Dr. Neavin will see that you are properly evaluated by your doctor and any other health provider to see that surgery is safe for you.
During your evaluation, Dr. Neavin will evaluate you in horizontal 4’s: Hairline to eyebrow, eyebrow to bottom of nose, nose to bottom of chin, and neck. Each area will have its own pattern of aging. Some will invariably be more “distressed” than others.
Upper fourth aging includes hairline recession, fat loss in temples, eyebrow ptosis, and upper orbital hollowing.
Eyebrow to nose aging includes lower eyelid bags or excess skin, fat loss with or without descent of tissue, ptotic nose (droopy nose (often with thickened tip), enlarged earlobes, and fat loss in front of the ear.
Bottom of nose to bottom of chin aging includes an elongated and involuted upper lip, loss of lip volume and pout, deepened laugh lines from tissue descent and fat loss, downward turning of the corner of the mouth with marionette lines, jowls, and chin descent.
Bottom fourth aging includes skin laxity of the neck, excess fat distribution in neck, and loose neck muscles (platysma).
Only after a thorough evaluation can a plan be generated.
Depending on the extent of surgery one needs will determine the plans, and hence, details of surgery. Standard incisions will run from above the ear into the hairline along the natural crease in front of the ear, around the ear, and behind the ear. The incisions will leave scars that are not easily detectable. Skin will be lifted off the underlying tissues, and the underlying tissues (SMAS) will be elevated off the muscles below. Both skin and SMAS will be lifted and secured (in different vectors) to restore volume to the cheek and recreate a top heavy face. Some skin is almost trimmed, but the goal is never to “tighten the face”. Skin should be redraped over the deeper, suspended tissues.
In most cases, a neck lift is combined with a facelift to some extent. A small incision may be made under the chin to access the neck for fat removal and platysmal tightening. All incisions will be closed with stitches that will need to be removed in about 7 days. Sometimes a small, temporary drain is placed in the neck.
In most cases, fat will be harvested from the lower back and injected into areas to either fill depletion of recreate a more top heavy face.
Surprisingly, the face doesn’t experience much pain after surgery. However, if fat was harvested, there will be some soreness at the harvest site. Bandages will be removed after the first day or two. If a drain was placed it will be removed in the office painlessly. One should expect weeks of swelling. Most of the swelling will subside by 10 days. However, depending on the extent of surgery, mild swelling can exist for longer. Bruising is more common when eyelid surgery is performed. Most bruises subside by 7 to 10 days.
Stitches will need to be removed in the office in about 7 days. In some cases depending on the extent of neck surgery, a wrap may need to stay in place for a week.
One should consider their face as a bun in the oven baking. This means that after surgery, your body will continue to slowly heal to reveal the results. Everyone heals at their own pace. But since most of the swelling is gone in 3 weeks, the results are best seen by then. Scars will fade over time. They are placed in natural creases so they have the advantage of being hidden from the start.