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As people age, the effects
of gravity, exposure to the sun, and the stresses of daily life can
be seen in their faces. Deep creases form between the nose and
mouth; the jawline grows slack and jowly; folds and fat deposits
appear around the neck.
A facelift (technically
known as rhytidectomy) can't stop this aging process. What it can do
is "set back the clock," improving the most visible signs of aging
by removing excess fat, tightening underlying muscles, and
‘redraping’ the skin of your face and neck. A facelift can be done
alone, or in conjunction with other procedures such as a forehead
lift, eyelid surgery, or nose reshaping.
Best candidates
The best candidate for a
facelift is a man or woman whose face and neck have begun to sag,
but whose skin still has some elasticity and whose bone structure is
strong and well-defined. Most patients are in their forties to
sixties, but facelifts can be done successfully on people in their
seventies or eighties as well.
A facelift can make you look
younger and fresher, and it may enhance your self- confidence in the
process. But it can't give you a totally different look, nor can it
restore the health and vitality of your youth. Before you decide to
have surgery, think carefully about your expectations and discuss
them with your surgeon.
Risks
When a facelift is performed
by a qualified plastic surgeon, complications are infrequent and
usually minor. Still, individuals vary greatly in their anatomy,
their physical reactions, and their healing abilities, and the
outcome is never completely predictable.
Complications that can occur
include hematoma (a collection of blood under the skin that must be
removed by the surgeon), injury to the nerves that control facial
muscles (usually temporary), infection, and reactions to the
anesthesia. Poor healing of the skin is most likely to affect
smokers.
You can reduce your risks by
closely following your surgeon's advice both before and after
surgery.
PLANNING YOUR SURGERY
Facelifts are very
individualized procedures. In your initial consultation the surgeon
will evaluate your face, including the skin and underlying bone, and
discuss your goals for the surgery.
Your surgeon should check
for medical conditions that could cause problems during or after
surgery, such as uncontrolled high blood pressure, blood clotting
problems, or the tendency to form excessive scars. Be sure to tell
your surgeon if you smoke or are taking any drugs or medications,
especially aspirin or other drugs that affect clotting.
If you decide to have a
facelift, your surgeon will explain the techniques and anesthesia he
or she will use, the type of facility where the surgery will be
performed, and the risks and costs involved. Don't hesitate to ask
your doctor any questions you may have, especially those regarding
your expectations and concerns about the results.
PREPARING FOR YOUR SURGERY
Your surgeon will give you
specific instructions on how to prepare for surgery, including
guidelines on eating and drinking, smoking, and taking or avoiding
certain vitamins and medications. Carefully following these
instructions will help your surgery go more smoothly. If you smoke,
it's especially important to stop at least a week or two before and
after surgery; smoking inhibits blood flow to the skin, and can
interfere with the healing of your incision areas.
If your hair is very short,
you might want to let it grow out before surgery, so that it's long
enough to hide the scars while they heal.
Whether your facelift is
being done on an outpatient or inpatient basis, you should arrange
for someone to drive you home after your surgery, and to help you
out for a day or two if needed.
TYPES OF ANESTHESIA
Most facelifts are performed
under local anesthesia, combined with a sedative to make you drowsy.
You'll be awake but relaxed, and your face will be insensitive to
pain. (However, you may feel some tugging or occasional discomfort.)
Some surgeons prefer a
general anesthesia. In that case, you'll sleep through the
operation.
THE SURGERY
A facelift usually takes
several hours-or somewhat longer if you're having more than one
procedure done. For extensive procedures, some surgeons may schedule
two separate sessions.
Every surgeon approaches the
procedure in his or her own way. Some complete one side of the face
at a time, and others move back and forth between the sides. The
exact placement of incisions and the sequence of events depends on
your facial structure and your surgeon's technique.
Incisions usually begin
above the hairline at the temples, extend in a natural line in front
of the ear (or just inside the cartilage at the front of the ear),
and continue behind the earlobe to the lower scalp. If the neck
needs work, a small incision may also be made under the chin.
In general, the surgeon
separates the skin from the fat and muscle below. Fat may be trimmed
or suctioned from around the neck and chin to improve the contour.
The surgeon then tightens the underlying muscle and membrane, pulls
the skin back, and removes the excess. Stitches secure the layers of
tissue and close the incisions; metal clips may be used on the
scalp.
Following surgery, a small,
thin tube may be temporarily placed under the skin behind your ear
to drain any blood that might collect there. The surgeon may also
wrap your head loosely in bandages to minimize bruising and
swelling.
After your surgery
There isn't usually
significant discomfort after surgery; if there is, it can be
lessened with the pain medication prescribed by your surgeon.
(Severe or persistent pain or a sudden swelling of your face should
be reported to your surgeon immediately.) Some numbness of the skin
is quite normal; it will disappear in a few weeks or months.
Your doctor may tell you to
keep your head elevated and as still as possible for a couple of
days after surgery, to keep the swelling down.
If you've had a drainage
tube inserted, it will be removed one or two days after surgery.
Bandages, when used, are usually removed after one to five days.
Don't be surprised at the pale, bruised, and puffy face you see.
Just keep in mind that in a few weeks you'll be looking normal.
Most of your stitches will
be removed after about five days. Your scalp may take longer to
heal, and the stitches or metal clips in your hairline could be left
in a few days longer.
You should be up and about
in a day or two, but plan on taking it easy for the first week after
surgery. Be especially gentle with your face and hair, since your
skin will be both tender and numb, and may not respond normally at
first.
Your surgeon will give more
specific guidelines for gradually resuming your normal activities.
They're likely to include these suggestions: Avoid strenuous
activity, including sex and heavy housework, for at least two weeks
(walking and mild stretching are fine); avoid alcohol, steam baths,
and saunas for several months. Above all, get plenty of rest and
allow your body to spend its energy on healing.
At the beginning, your face
may look and feel rather strange. Your features may be distorted
from the swelling, your facial movements may be slightly stiff and
you'll probably be self-conscious about your scars. Some bruising
may persist for two or three weeks, and you may tire easily. It's
not surprising that some patients are disappointed and depressed at
first.
By the third week, you'll
look and feel much better. Most patients are back at work about ten
days to two weeks after surgery. If you need it, special camouflage
makeup can mask most bruising that remains.
Even after the swelling and
bruises are gone, the hair around your temples may be thin and your
skin may feel dry and rough for several months. Men may find they
have to shave in new places-behind the neck and ears-where areas of
beard- growing skin have been repositioned.
You'll have some scars from
your facelift, but they're usually hidden by your hair or in the
natural creases of your face and ears. In any case, they'll fade
within time and should be scarcely visible.
Having a facelift doesn't
stop the clock! Your face will continue to age with time but years
later you'll continue to look better than if you'd never had a
facelift at all.
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