The effects of the natural aging process on the face are obvious. The skin sags and wrinkles under the constant pull of gravity, becoming thinner, more irregular and less elastic. The upper cheek fullness of youth is lost; deepening of the nasolabial fold occurs; the jowls become prominent; the neck and jaw-line droop and wrinkle. Overall, the face assumes a duller, tired appearance.
The goal of facial rejuvenation is to diminish the effects and the appearance of the natural aging process. Because aging affects the entire face, I feel compelled to tell my Dallas patients that the ideal surgical rejuvenation addresses all areas of the face. This usually involves a combination of facelift, browlift and eyelid surgery (blepharoplasty). The goal is to create a “fresher”, “brighter”, “less-tired” appearance that is natural and balanced and not over-operated. A natural result means you will look younger, but you will still look like you. A balanced result appears natural because a younger appearing lower face looks like it belongs with younger appearing eyes and a younger appearing forehead. Performing a facelift without a browlift, for example, frequently appears unbalanced and is a common tell-tale sign of surgery.
Facial rejuvenation procedures will not remove every line and wrinkle from the face. Fine lines (especially around the corners of the eyes and mouth) result from the action of the underlying muscles of facial expression. As a result, complete absence of these lines makes a face appear expressionless, mask-like and very unnatural.
Video: Facelift Surgery or Non-invasive Fillers?
In the media, the term facelift has come to mean a surgical procedure to make the entire face appear younger. In reality, a facelift is a surgical procedure which addresses only the lower face and neck, elevating and tightening those tissues to improve the neck and jowls. This is usually done through incisions which begin in the hairline in front of the ear, around the ear and into the hairline behind the ear. Frequently there is also a small incision under the chin.
All facelifts are not equal. Historically, a facelift involved incisions around the ears, with removal of the excess skin, pulling the remaining skin tight and closing the incisions. In fact, this is still the operation most surgeons do when performing a facelift. The problem is the skin is the weakest, most stretchy layer of the face. Putting the tension (all of the pull) on this skin layer results in a facelift that initially appears overly pulled and tight; as the skin relaxes, much of the effect of the lift is lost, frequently within a year.
Fortunately, there is a solution to this problem. The face has a much stronger, deeper layer known as the SMAS, which is the layer that surrounds the muscles of the face. I leave the skin attached to SMAS, elevate the SMAS and put the tension (all of the pull) on the SMAS. This has several benefits. The SMAS is a much stronger layer of the face; there is no significant short term relaxation of the SMAS so the youthful result usually lasts longer. Because the SMAS is so strong, the skin does not have to be pulled tight on tension; the facial skin is simply re-draped resulting in a softer, natural result as opposed to a “wind-tunnel look”.
Another benefit to performing a deeper-plane, SMAS facelift is the ability to better improve the mid-face (primarily the cheeks). In many cases, the SMAS facelift allows me to effectively reposition the cheek mass higher on the face, recreating the more youthful fuller cheekbone appearance.
Patients frequently ask, “How long will my facelift last?” A well performed SMAS facelift will permanent set back the clock. This means that while you will continue to age, you should always look younger at any point in the future, than you would have looked had you not had the facelift.
Operating on the deeper layers of the face causes more swelling after facelift surgery. This is most evident in the first two to three weeks after surgery. Some swelling will persist for up to several months; but it is generally evident only to you; people looking at you will not notice it. Operating on the deep layers of the face also risks injury to the nerves that control the muscles of facial expression. Such injuries are very rare and if they do occur are almost always temporary; however, there is a very small risk of permanent facial nerve injury with this type of surgery.
Your Initial Consultation
At your initial facelift consultation at my Dallas practice, I will review with you all of your concerns about your facial aging. With a mirror, I will show you what areas can be improved and what areas I feel may not show significant improvement. I may show you additional areas of your face that could benefit from surgical rejuvenation or the use of injectables, such as the eyes and brows.
I will also review with you your medical history and current medications. If you have high blood pressure, this must be well controlled with medication prior to considering facial rejuvenation surgery. Current smoking is a contraindication to many facial rejuvenation procedures because your skin is at significantly increased risk for injury and skin loss. You must refrain from smoking for at least six weeks before and after facial rejuvenation procedures.
Once a patient decides to move forward with facelift surgery, photographs will be taken to assist me in planning, performing, and following-up on your procedure.
Specific surgical fees for facial rejuvenation procedures depend on the nature and extent of the planned operation. My office staff will provide you with detailed estimates of the surgical fee, anesthesia fee and facility fee. All fees for cosmetic surgery are payable in advance of surgery. These fees are based on my estimate of the time required to complete your facelift surgery. If more time is required to assure the best possible result, you may be billed additionally by the surgical facility. The surgical fees include the cost of surgery and all post-operative follow-up care and visits.
Your Facial Rejuvenation Procedure
Facial rejuvenation procedures are usually performed under general anesthesia. This is done for your safety during the operation. The complete facelift procedure will usually require from three to four hours in the operating room, depending on the extent of surgery. You will spend the night after your surgery in the surgical facility. Your incisions will be closed with a combination of absorbable suture and removable sutures. Incisions behind your hairline will be closed with surgical staples.
After Your Facial Rejuvenation Procedure
Your face will feel swollen and areas will feel numb. These sensations are normal and will resolve with time. Numbness may persist in some areas for several months after facelift surgery. You may feel tightness in your neck which will improve significantly over several weeks. There may be a variable amount of discomfort around the ears which should also resolve after several weeks.
The majority of swelling and bruising should resolve within two to three weeks after surgery. Small amounts of residual swelling will take up to four to six weeks to resolve; however, this swelling will only be noticeable to you and not to anyone who looks at you.
Limitations, Risks and Possible Complications
Cosmetic surgery procedures are meant to improve your appearance as much as possible. Ideally, those specific areas which detract from your appearance are addressed and improved, while the positive aspects of your appearance are undisturbed, resulting in an overall improvement. How happy you are with the results depends on how effectively you communicate to me what specific areas concern you, how well I communicate to you what improvements a specific procedure can yield and how realistic you are about your expectations. Plastic surgery is a combination of art and science. Some factors related to your overall result are not totally within your or my control. These include your healing characteristics, the age and quality of your skin, the amount of facial fat beneath your skin, your facial bone architecture and hereditary and hormonal influences.
All procedures that involve the creation of an incision leave a scar. The scars will be slightly raised, red and firm for about six to 12 weeks following surgery. Eventually, the scars soften, flatten and fade to a color similar to or lighter than the surrounding skin. Exposure to sunlight during this maturation period may lead to permanent scar redness or excessive pigmentation (color). Sunscreens should be worn postoperatively to minimize this possibility.
In order to achieve the desired results, skin must be extensively elevated off of the face and neck, and redraped under some increased tension. If circulation to this skin is compromised, delayed healing or partial skin loss could occur. When this occurs, it is usually evident by blistering or crusting at the surface of this skin and, in most cases, heals spontaneously with simple care. If large areas of skin loss occur, additional procedures may be required and increased scarring could result. Significant loss of skin is very rare.
In up to 5 percent of patients, excessive bleeding under the skin may occur after facial incisions have been closed. This is caused by the accumulation of blood beneath the skin and results in bruising, swelling, and discomfort. In serious cases, the patient may need to undergo surgery to reopen the incision and remove the blood or fluid.
Infection is extremely rare after facelift surgery, but if it occurs, the patient may need to take antibiotics or use a surgical drain. Patients are given antibiotics during and after surgery to reduce the risk of infection.
During the course of mobilization of the facial skin and deeper tissues, the branches of the facial nerve that control the movements of the face could become bruised or injured. When this occurs, there is an inability to symmetrically (equally) control the muscles of both sides of the face (in smiling, for example). This weakness is temporary in the vast majority of cases and resolves over a period of weeks. The possibility of permanent nerve injury and weakness is very small, in the range of 1 to 2 percent.
When critically examined, the two sides of any individual’s face are different. I will make every effort to correct excessive wrinkling and sagging to the same degree on both sides of the face; however, the operation cannot achieve perfect symmetry because no one is perfectly symmetrical to begin with.
Any change in your appearance affects your perceptions and self-image. It is very common for my Dallas facelift patients to go through a period of adjustment and have feelings of doubt or low mood during this time. These feelings usually last for up to three weeks after surgery and are rapidly replaced by positive feelings as the healing process progresses and you adjust to your improved appearance.
Today’s state-of-the-art facial rejuvenation procedures allow you to regain a bright, rested, energetic, youthful appearance that is balanced and natural. These improvements are very long-lasting because you are permanently setting the clock back.
If you have any questions regarding your decision about facelift surgery, please do not hesitate to contact my Dallas office for further information.