Face and Neck Lift
Background On Facelifts
Time, the effects of gravity and repetitive muscle contraction, cause changes to occur that may give one a tired-looking appearance. The skin becomes looser, wrinkles form and become deeper, the jaw line loses its sharp definition and the neck sags. The procedure known as a facelift is designed to give one a brighter, fresher, more rested looking appearance. Through inconspicuous incisions around the ears, the tissues of the face can be accessed, repositioned, and redundant tissues removed.
The facelift may be combined with other procedures, such as eyelid surgery (blepharoplasty), forehead lifting (browlift), or skin resurfacing (perioral dermabrasion), either at the time of the facelift or in a staged approach.
Dr. Capella will gather a thorough medical history, with particular emphasis on your weight, underlying medical problems such as diabetes or high blood pressure, history of cigarette smoking, and bleeding tendencies. Skin care regimen is reviewed as well. Following this, a thorough directed physical examination of all of your facial features is carried out, including upper face or brow, eyelids, midface or cheeks, and neck. The doctor vocalizes what he sees to give you a comprehensive overview of how he perceives your appearance has been affected by age, with an eye to how each component relates to the other, and what might be done to improve each surgically. For patients with fine wrinkles around the mouth, Dr. Capella may suggest dermabrasion.
Facelift Pre-Operative Visit
Approximately, two weeks prior to surgery you will meet with Dr. Capella. You will be asked to stop taking medications that can lead to surgical complications, especially bleeding. A list of medications to be discontinued will be reviewed. A general physical examination will be performed to ensure that no underlying medical problems exist that may interfere with the safety of the surgery. Patients with high blood pressure must have their condition well controlled prior to surgery. You should plan to take your blood pressure medication right up to the time of your operation.
Cigarette smoking must be discontinued for six weeks prior to surgery and afterwards. Serious wound healing complications can occur in patients who are exposed to smoke, even passively.
Prophylactic antibiotics are prescribed for 24 hours after surgery to reduce the risk of surgical wound infection. A prescription for pain medication is also written, so that you have your pain pills when you return home from the operation.
Pre-operative photographs are taken so that you can see the improvement from your surgery afterwards. You will be asked to sign a surgical consent, which enumerates the risks of the procedure in detail. These risks have been explained here, but are also discussed at the first office visit. You will need to arrange for an escort to drive you home from the nearby recovery facility the day following surgery. Patients cannot operate motor vehicles after surgery. We can arrange for medical transportation in the event that you cannot find an escort. It is mandatory to have someone stay with you for at least 24 hours after your return home from the nursing facility.
The balance of your surgical fee is due at this pre-operative visit.
Finally, Dr. Capella will write prescriptions for preventative antibiotics to decrease your risk of infection and a narcotic analgesic for post-operative pain relief.
Day of Facelift Surgery
Dr. Capella will mark the planned incisions prior to taking you to the operating room. Your hair is gathered in rubber bands to keep it out of the incision lines. Minimal amounts of hair are clipped to provide exposure to do your surgery.
The procedure usually takes about three hours, depending on the extent of your particular procedure. Incisions are made around the ear. Superficial facial muscles are tightened, excess skin is removed and the skin edges are then stitched together with very fine suture material. A small drainage tube is placed just beneath the skin and is removed the morning after surgery as are all dressings.
Facelift Recovery Process
Dr. Capella prefers that facelift patients recover at a nearby nursing facility the evening following surgery. During the first 24 hours, you are advised to do as little talking, chewing, or other movement of the face as possible in order to minimize swelling and reduce the risk of bleeding and/or bruising. You should maintain head elevation of at least 30 degrees from horizontal to keep the swelling down. There is usually only minimal discomfort following a facelift, and this is controlled with the pain medication that is prescribed. You will be advised to take an antibiotic for the first 24 hours following your procedure. Patients who have undergone dermabrasion will be asked to cleanse their face around the mouth with mild soap and water several times a day and to apply Vaseline to this area between washings.
Dr. Capella will see you the morning following surgery at the nursing facility to remove dressings and drains. If he feels you are ready, the doctor will discharge you home that day. Between five and seven days after surgery, you will return to the office for removal of some of the stitches. A couple of key stitches are removed between 12 and 14 days.
Most people take 7-14 days off of work to recover. You should avoid vigorous activities including sex, for two weeks after surgery (though walking and stretching are fine). Alcohol, steam baths and saunas should also be avoided for two weeks after surgery. Sun exposure should be limited for the first several months.
The face will be numb for weeks to months, and so heating pads and sun lamps are to be absolutely avoided. It can be disturbing at first to look at your new face. There is normally some distortion of your skin and a feeling of tightness, which can cause anxiety about how one will ultimately appear. These changes resolve over the first six weeks or so, but it is not unusual to feel self-conscious and even depressed at first. By the third to fourth week, you will look and feel much better. If bruising persists, we can offer assistance with camouflage makeup.
Risks of Facelift Surgery
Complications following facelifts are infrequent and usually minor. Nevertheless, individuals vary greatly in their physical reactions to surgery, their healing tendencies, their scarring potential, and certainly in their psychological reaction to the effect of surgery. Complications that can occur include hematoma (a collection of blood under the skin that must be removed by the surgeon), injury to nerves that control facial muscles (usually temporary), and skin death (usually small areas behind the ear). Poor wound healing is usually seen in cigarette smokers, and so Dr. Capella will not perform a facelift unless you are committed to discontinue cigarette smoking for at least six weeks prior to surgery and for six weeks afterwards.
Scars from facelifts are usually very inconspicuous, but in some ethnic groups they may be more obvious as a consequence of that person’s particular tendency to form thick scars. This cannot be predicted prior to operation, but treatment is available to minimize the appearance of thickened scars. Certainly, any history of poor quality scars should be mentioned to Dr. Capella at the time of the consultation.