Facelift - Choosing the Right Approach

Dr. Don Revis

by Dr. Don Revis | August 16, 2010 @ 01:00PM

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Rhytidectomy, also known as a facelift, is a surgical procedure to restore a more youthful appearance to the face. As we mature, the cumulative effects of stress, aging, sun damage, and gravity begin to show in our faces. Deep wrinkles, or rhytids, may form on the forehead, between the eyes, in the crow's feet area, and around the mouth. The skin loses its elasticity, causing the jaw line and cheeks to sag. Fat deposits may develop underneath the chin and in the jowl area.

A facelift, which usually includes treatment of the neck as well, can improve these visible signs of aging. Rather than give you a different appearance that is rather common with many face lifting techniques, newer techniques strive to restore a more youthful appearance to your face. You shouldn't look different, you should look younger and more refreshed.

This new approach to face lifting can be accomplished only by using the most advanced and latest state-of-the art techniques. The removal of excess skin, tightening of the underlying facial and neck muscles, and redraping of the facial skin can be performed with minimal incision techniques that result in less scarring and bruising and a faster return to your normal activities.

Face lifting is also commonly performed with other procedures to achieve the appearance you desire. Some of the other procedures commonly performed at the same time include brow lifting (raising the eyebrows), blepharoplasty (eyelid surgery), collagen or fat injections (to fill in deep wrinkles), and laser resurfacing or chemical peel (to reduce fine to medium wrinkles and remove age spots). The reader is encouraged to read about these procedures as well.

If you think you might be a good candidate for a face lift, this article will provide you with a basic understanding of the issues involved. However, it is extremely important to individualize treatment to your specific circumstances and goals. It is recommended that you visit a board certified plastic surgeon for a personal consultation.

The Consultation

During your initial consultation, the plastic surgeon will inquire about your medical history, prior procedures, medications, allergies, and your motivations for seeking plastic surgery. It is very important that you be thorough when providing your medical history, as this information helps to prevent complications during your care. When asked about medications, be sure to include any vitamin or herbal preparations, as these can affect your blood pressure and clotting ability. Honesty regarding your use of tobacco and alcohol is also very important, as these may have a profound impact on your recovery period and your ability to heal following your procedure.

After reviewing your medical history, your physician should discuss your concerns, priorities, and motivations for pursuing plastic surgery, as well as your fears. After examining you, he or she will be able to offer advice and options to help you achieve the appearance you desire. He or she should also explain the advantages and disadvantages of the different options you have before you.

At the completion of your consultation, you likely will be given a written estimate of the cost of your procedure. At this time, you will also have the option to schedule your procedure if you so choose. The decision to undergo a procedure is a very important one, and the final decision should be given very careful consideration. At no time should you feel pressured to make a decision. You are also encouraged to bring your spouse, significant other, family member, or a friend to your consultation.

Endoscopic (Subperiosteal) Midface Lift

This technique has only recently been developed, and few plastic surgeons have been trained specifically in this technique. This involves minimal incisions hidden in the hairline above the ear and inside the mouth, in order for your scars to be virtually invisible.

Through these minimal incisions, your plastic surgeon uses an endoscope, a small camera the size of a pencil, to elevate and re-drape the tissues of the cheek. This procedure can restore high cheekbones and give more definition to the face that is frequently lost with aging.

SMAS Face lift

This technique involves incisions around the ear and into the hairline behind the ear. Through these incisions, the surgeon elevates the skin of the face, allowing him or her to tighten the underlying muscles that sag with aging. The SMAS, or superficial muscular aponeurotic system, is the anatomical term for the muscles, suspensory ligaments, and support structures of the face.

This technique can also restore high cheek bones and improve definition of the face. It also has the added benefit of reducing fat collections in the jowl area. After your surgeon tightens the muscles of the face, he or she redrapes and removes excess skin.

Neck Lift with Platysmaplasty

This procedure is commonly performed in addition to one of the above face lifting techniques but may be used alone when your concerns are concentrated in your neck region only. Platysmaplasty is another term for tightening the muscles of the neck. Through a minimal incision beneath the chin, your plastic surgeon may remove fat collections in the neck or jowl area with liposuction. After the fat has been removed, the muscles of the neck will be tightened with suture techniques. This reduces the tendency of the neck skin to hang, and removes any double chin that may be present.

Additionally, this technique removes any vertical bands that have formed in the neck. The neck is one of the most critical aspects of face lifting, as the neck often reveals one's true age. With the above techniques, your plastic surgeon will be able to rejuvenate the entire face, from the base of your neck to your forehead.

Where Your Procedure Will Be Performed

Sometimes you have a choice in the location of your surgery, whether in a hospital, ambulatory surgery center, or office surgery setting. Some surgeons prefer to perform the majority of their procedures in their own office surgery suites as a convenience to themselves and to save money. Others prefer to do only minor procedures in the office while performing major operations in a local hospital or ambulatory surgery center.

Any physician, regardless of his or her training, can open an office surgery suite and advertise as a plastic surgeon and perform plastic surgery on the unsuspecting public. Regulation of office surgery settings is currently voluntary and often substandard. New laws are being passed in an attempt to correct this potential problem. If you decide to have your surgery in an office surgery suite, choosing a physician who is board certified by the American Board of Plastic Surgery, who also has hospital privileges to perform the same procedure, and whose surgery suite is accredited, adds an additional level of quality assurance.

To obtain hospital privileges to perform a procedure, surgeons must provide proof of education, training, and experience. This provides an added level of assurance that the surgeon has been properly educated and trained. Avoid a surgeon who operates in his or her office but does not have hospital privileges to perform the same operation.

Type(s) of Anesthesia

Anesthesia is an essential part of any surgical procedure and must be performed safely. General anesthesia is the deepest form of anesthesia. You are asleep, feel no pain, and will not remember the procedure.

Deep intravenous sedation, called "twilight sleep," is a combination of local anesthetic administered at the surgical site by your plastic surgeon and intravenous sedation administered by the anesthesiologist. You breathe for yourself, but you are in a deep sleep throughout the procedure. You should feel no pain, and you should not remember the procedure.

Your plastic surgeon should discuss these options with you more thoroughly at the time of your consultation, and please ask about anything you do not understand.

Details of the Procedure

Face lift surgery usually takes three to four and a half hours to perform, depending on whether or not you are having additional procedures performed at the same time. After you are properly anesthetized, the minimal incisions are made necessary for insertion of the endoscopic camera. Through these limited incisions, your plastic surgeon works with small instruments to elevate the skin of the face and neck. He or she may perform liposuction in the jowl area or beneath the chin if you have these troublesome collections of fat.

After the skin is elevated, he or she repositions the cheek tissues and tightens the underlying muscles, or SMAS. With very precise suture techniques, these tissues are re-suspended and the muscles are tightened. After the completion of this step, any extra skin that is present is trimmed away. After tightening the muscles of the neck, your incisions will be carefully closed to minimize your scars.

You may have a drain placed beneath the skin on your neck at the end of your procedure. This allows drainage of any fluid that would otherwise accumulate and have to be absorbed by your body. This technique also hastens your recovery and decreases swelling.

Afterwards, a sterile dressing is applied to the incisions.

After Your Procedure

Face lifting may be performed as an outpatient procedure, or you may choose to spend the night in the hospital. Most patients choose to stay overnight, particularly if they live alone or are from out of town. After recovering in the recovery room for approximately one hour, you will be able to go home in the company of a friend or family member, or will be transported to your room.

Your dressing should be removed by your plastic surgeon on the day after surgery, either in his office or in the hospital. Another light dressing may be placed at that time if he feels it is necessary. You should wear a hat, sunglasses, and scarf to protect yourself from the sun and to provide a degree of modesty.

You should plan to take it easy following your surgery. No strenuous activities, heavy lifting (over 20 pounds), aerobic exercises, swimming, contact sports, tennis, or golf should be planned for the first several weeks. As your plastic surgeon monitors your recovery, he or she will advise you when it is safe to resume specific activities.

The Results You Can Expect

You will notice an improvement in the appearance of your face after approximately one week. It will take a total of three or more weeks for the swelling to resolve completely. You may experience numbness of the facial skin for several weeks, so it is important to test the temperature of your bath or shower. You should be able to resume your normal daily activities the day after surgery, and you should be able to resume all of your physical activities within three weeks of surgery.

This article provided by Dr. Don Revis.

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