What is a Facelift?
A facelift, also known as a rhytidectomy, in Boston and Worcester, Massachusetts, is a procedure aimed to improve various signs of aging, which result from many factors such as stress, gravity, and hereditary aspects. A facelift corrects sagging or loose skin in the lower half of the face, deep creases along the corners of the mouth and lower eyelids, and loose skin or fatty areas under the chin and jaw.
Am I a good candidate for facelift surgery?
Generally, good candidates for a facelift are those who suffer from excess skin or sagging on the lower face and neck, possess quality skin elasticity, and have strong bone structure. Healthy men and women who are non-smokers and have realistic expectations for the outcome of their surgery can expect to see optimal results.
Facelift – Patient 126
A woman in her early 60’s who is bothered by an aged appearance of her face. She is shown before and again, 9 weeks after bilateral upper eyelid blepharoplasty with facelift utilizing a platysma window and lateral SMAS plication, combined with fat grating to the cheeks and upper and lower eyelids. The fat grafting improves the quality of the skin, but also helps to correct the “a frame” hollowing of her upper eyelids that adds to her aged appearance. She has significant volume loss of the cheeks with aging that is not corrected with skin tightening- it is corrected by the careful replacement of volume with fat grafting.
Facelift – Patient 125
A woman in her mid 70’s who is bothered by an aged appearance. She has also lost 100 lbs following a gastric bypass. Analysis of her face shows some brow asymmetry as she holds her left brow higher to compensate for some left eyelid ptosis. She has prominent fat pads of the lower eyelid and significant volume loss of the midface. A weak chin contributes to the laxity of her neck, and the vertical lines around her lip bother her as well. She is shown before and again, 3 months after bilateral upper eyelid blepharoplasty, bilateral lower eyelid blepharoplasty, lateral smasectomy face lift with placement of a chin implant, fat grafting to the midface and perioral dermabrasion. She is thrilled with her natural but markedly improved appearance. Dermabrasion is an “old fashioned” technique that works well to improve the vertical lines of the lip without as much a risk of bleaching of the skin that can be seen with laser or deep chemical peels. She has a natural look because our procedure was tailored to fit her aging deformity. We have “lifted and filled” not just pulled her tighter. The key to a natural appearance with facial aging is a careful diagnosis and then correction of the different components of the aging deformity- there is not one key that fits all locks.
Facelift – Patient 124
A woman is shown before and again 7 months after facelift combined with a chin implant. When a patient with a "weak chin" is requesting a facelift or a rhinoplasty, a chin implant is typically recommended at the same time to improve the subsequent facial balance and results.
Facelift – Patient 123
A woman in her early 60's who is bothered by the appearance of her neck. Evaluation shows that she has hypogenia, a "weak chin". An easy way to tell is to look at an imaginary line that connects the upper and lower lips. If the chin falls behind this it is "weak". A weak chin especially influences the result of a facelift or a rhinoplasty, and is frequently corrected at the same time. In her case, she elected for a chin implant combined with a face lift using a "lateral smasectomy" tightening of the deep tissues of the face, and an incision hidden in the front of the sideburn, to avoid over elevation of the side burn that would look unnatural. She is shown just 3 months after her procedure. A natural improvement of the neck line and jowls are seen. She did not choose to have fat grafting to the area of volume loss in her cheeks, wishing instead to focus only on her neckline. The scars that go in front and in back of the ear are already hidden. The sideburn scar is still red at 3 months and is seen on close inspection, but will continue to fade over the next year, and is designed to allow the new hairs at the edge to grow up through the scar and camouflage it further.
Our patient is shown again at 6 months. She has maintained her elegant neck and jawline achieved at surgery. Her scars have faded nicely. She has volume loss of her face that we typically see with aging, but did not wish to have fat grafting at the time of surgery. Facial fillers could be added later in the office is she wished, but she is thrilled with her improvement after surgery, and does not feel the need to replace her volume loss.
She is seen again at 12 months. Scars have faded and she has maintained a beautiful neckline after her surgery. She has a natural appearance after her surgery. Her acquaintances do not suspect that she has had surgery- but she likes feeling more confident about her appearance.
Facelift – Patient 122
A woman in her early to mid 60's who is bothered by the appearance of her neck. On examination she also has a "weak" chin. She is shown before and again, 2 months after a lateral smasectomy face lift combined with fat grafting and a chin implant, and perioral dermabrasion (sanding of the lines around the mouth) The quality of our results is often determined by the "fabric" that we are working with. When the skin elasticity is decreased, we can expect more recurrent laxity. At 2 months, she still has some swelling from the fat grafting which improves the appearance of the cheek volume lost with aging and the lines around the mouth.
She is now shown exactly one year after her surgery. The lines abound her mouth and cheek volume loss are improved from before her surgery, but a little more noticeable now as the swelling has completely resolved. She has maintained her improved neck and jaw line. She could now improve her lines and volume loss further with injections in the office of Restylane or Juvederm type products, but is pleased with her appearance. Her small skin vascular telangiectasias could be improved with Intense Pulse Light treatment as well, but do not bother her. Skin texture and color problems are not usually improved with a face lift alone, which only addresses the problems of looseness of the skin. The fat grafting does often give some improvement in the skin texture.
She is now shown more than 18 months after her surgery. She has maintained her improved neck line. The quality of the skin seems improved. Cheek volume and lines around the mouth appear better. This is felt to be a result of the micro fat grafting done at the time of surgery, that may show continued improvement in the skin quality with time. The theory is that a large source of stem cells reside in our fat stores, and are transferred along with the fat cells when they are grafted. She has had Juvederm 9 months ago to the lips. Her scar in front of the ear and sideburns is undetectable from even close inspection.
What are my options for a facelift?
There are multiple methods to a facelift, including the traditional facelift, the limited incision facelift, and a neck lift. A traditional facelift involves an incision from the hairline at the temples to the lower scalp. An additional incision under the chin may be required to tighten loose skin on the neck. A limited incision facelift calls for shorter incisions at the temples, which may extend under the lower eyelids or upper lip. Lastly, a neck lift involves incisions starting in front of the earlobe and extending behind the ear to the lower scalp. Dr. Hall will advise you in which type of facelift is right for you, based on the degree of change you would like to see.
Facelift surgery can be performed under a local anesthetic or general anesthesia. When local anesthetic is used, the patient is awake but does not feel any pain, while general anesthesia causes the patient to “sleep” during the surgical procedure. The outcome of facelift surgery is the same, despite which option patients choose.
What should I expect during recovery?
Downtime associated with a facelift varies on the type of facelift performed, though most patients take two weeks to heal. Patients will experience bruising and swelling around the ears, and bandages are wrapped around the incision sites to minimize swelling. Most patients feel minimal discomfort during recovery, though a dull ache behind the ears may occur. Medication is provided for a comfortable recovery.
It is advised that patients refrain from strenuous activities for a minimum of three weeks after surgery, and athletic activities for six weeks. While recovering, it is important to keep the head elevated while sleeping to ensure desired results.
“Dr. Hall and all of his staff are very welcoming and supportive. In addition, I am extremely pleased with the results of my procedure. I have already referred a friend to Dr. Hall!”
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