Face Lift Patient Education

Doctors Who Perform Facelifts

To obtain the best results and the appropriate surgical technique with the minimal amount of risk, one should seek a board certified facial plastic surgeon. This is a cosmetic surgeon who specializes in facial reconstructive and cosmetic techniques. Read more in this face lift patient education guide.

Requirements for board certification include:

• Residency in plastic surgery or head and neck surgery
• Board certification in plastic surgery (passing appropriate oral and written examinations)
• Completion of a fellowship in facial plastic surgery
• Completion of 100 representative cases
• Passing completion of oral and written examinations by the Facial Plastic and Reconstructive Surgery Board

Additional suggestions include:

• Checking for hospital affiliation with your chosen facility
• Getting recommendations from previous patients
• Researching the surgeon for possible liability issues in the past

How to Prepare for a Facelift

As with other surgery, there are precautionary steps that one must take prior to the scheduled operation. These steps are listed below in our face lift patient education guide:

• Keeping away from aspirin use for one week prior. Usage of aspirin can cause abnormal clotting times and increased bleeding.
• Avoiding nicotine products for a minimum of two weeks prior (including cigarettes, cigars, chew, snuff, nicotine gum and nicotine patches). Nicotine interferes with cosmetic surgery healing
• Seeking medical clearance from your physician if there are any chronic medical problems. Make sure these conditions are under control with the proper medication.
• Arranging transportation for the day of surgery
• Dying hair prior to surgery if one routinely does so as no dye can be used for several weeks after the facelift (until incisions are completely healed)
• Avoiding skin agents on face the day of surgery (e.g. makeup, lotions)
• Using antibacterial soap on your face on the day of plastic surgery

Questions to Ask Your Doctor About a Facelift

As with any other medical/surgical procedure that you may be undergoing, it is prudent to ask questions and understand both benefits and risks prior to having the treatment performed.

Suggested questions listed in this facelift patient education guide include:

• Am I a candidate for a face lift?
• Would a non-surgical face lift provide the results that I want?
• What are the risks of a face lift?
• How long do the results of this type of facial cosmetic surgery last?
• How often could the surgery be repeated?
• How long is the recovery?
• Are there activities that I should avoid?
• How long would I be out of work?
• Will I be bed-ridden after surgery for any length of time?
• Would my insurance cover part of the procedure?
• Would the procedure be performed in a hospital or doctor’s office?

What to Expect

Knowing what to expect before, during and after cosmetic surgery will allow you to make a more educated decision about having the operation and will also make recovery easier. Read more in this face lift patient education guide (link to main overview page with anchor text “face lift patient education”):

Pre-Surgery

Prior to a facial cosmetic operation, it is crucial to meet with several specialists to discuss your expectations of surgery. Make sure that:

• Your goal for the end result is realistic
• You are a good candidate for the type of facelift requested
• The surgeon chosen understands the result that you hope to achieve and your reason for the surgery
• Everyone involved with your surgery knows your prior medical history and all medications taken

Expect that:

• You will need medical clearance from your family doctor if you have a current or chronic medical condition
• You will need to arrange transportation for after your cosmetic surgery
• You may need emotional counseling after the operation. Look into having a system in place

During Surgery

• An anesthesiologist will discuss sedation options with you, risks and side effects that you may expect from the type of sedation chosen.
• You will be given a hospital gown to wear and all street clothes will be removed.
• The face and neck will be cleansed with an antiseptic solution.
• Blood pressure cuff, pulse monitor and EKG leads will be applied.

Post-Surgery

When you awaken, you may notice a small, thin flexible tube (drain) inserted under the skin behind your ear to drain any fluid collection. This is only temporary and will be removed when no extra fluid is present. Bandages will be present, loosely wrapping the head to decrease the incidence of swelling and bruising.

Additionally, you can expect:

• Facial bruising (black and blue coloration)
• Moderate swelling
• Moderate discomfort/pain
• Bloodshot eyes
• Lethargy or moderate tiredness (for 7-10 days)
• Nausea/vomiting
• Feeling of skin-pulling or tightness
• Distorted face
• Possible depression

Other things to consider post-surgery:

• Pain-killers will be prescribed, as will antibiotics, to prevent a possible infection after the surgery.
• Cosmetics can be applied 2 weeks after surgery and you may return to work at this time.
• Normal healing of the face and neck can take up to one full year and initial distortion can remain for up to 3 months.

Technique Options for a Facelift

There are several options that can be used when targeting aging skin. Whether to undergo a surgical facelift or a medical, non-surgical treatment depends on the intended results, targeted area, and the extent of the damage to be corrected. Read more below in this face lift patient education guide:

Non-Surgical Cutaneous Options

The following non-surgical procedures improve the appearance of neck and facial areas:

Volumizers or plumpers – Loss of facial volume or decreased fat can be treated by fillers (volumizers). Fat may be obtained by removing it from other body areas (typically the abdomen) and injecting it into the face. There are also manufactured fillers that can be used to plump the skin or fill-in creases. Volumizing injections are suitable especially when the face is gaunt or “sunken in.”

Muscle relaxers – Injections of Botox relax the facial muscles underlying wrinkles, causing the wrinkles to vanish. This is not permanent and must be repeated to maintain the desired results.

Skin resurfacing – Sun damaged skin can be treated with several techniques within the skin-resurfacing category including dermabrasion or laser therapy, which remove damaged skin and cause dermal tightening with fresh collagen growth.

Acupuncture – Acupuncturists claim that a series of tiny needles inserted in appropriate “energy lines” twice a week for five weeks will remove wrinkles, skin sagging, and eyelid droop, as well as decrease deeper facial and neck lines. While some individuals confirm the validity, this is a controversial process and not a proven alternative to facial cosmetic surgery.

Surgical Facelift Techniques

Facelift Type	How it's Done	Benefit
Traditional facelift (aka SMAS or superficial musculo-aponeurotic system)	After sedation is administered, an incision is made in the hairline above the ear, curving around it to the hairline behind the ear. The skin is separated from the fat and muscle underneath. Sutures are inserted to lift, tighten, and reposition the muscle layer toward the ears. Excess skin is then removed and the incision line is sutured closed.	Sagging of neck and lower face is corrected and facial muscles are tightened to enhance look for extended period.
Cutaneous (skin) facelift	Same technique as traditional facelift, but without muscle tightening	Corrects sagging of neck and lower face
Temporal facelift	After local anesthesia and intravenous sedation are given, incisions are made in the hairline above the ears. Skin is dissected free from the underlying fat and muscle. The skin along the sides of the brow or forehead is lifted and pulled tight. Incisions are closed and a drain may be left in place above the hair to collect any pooled fluid or excess blood.	Corrects eyebrow droop
Deep plane facelift	After sedation is administered, an incision is made in the hairline above the ear, curving around it to the hairline behind the ear. The skin is separated from the fat and muscle underneath. A deeper plane is dissected and then muscle is lifted and repositioned. Excess skin is then removed and the incision line is sutured closed.	Its ability to provide a more natural outcome and give a more youthful appearance to the skin is debated.
Neck lift	After local anesthesia and intravenous sedation are given, small incisions are made under the neck and ears. Liposuction may be performed inserting a small cannula to aspirate excess fat. The neck muscles are manipulated and repositioned with permanent sutures to hold he tissue in place. Any excess skin is removed and the incisions are sutured closed.	Corrects sagging neck area
Platysmaplasty	After local anesthesia and intravenous sedation are given, small incisions are made under the neck and ears. The neck muscles are manipulated and repositioned with permanent sutures to hold the tissue in place. Any excess skin is removed and the incisions are sutured closed.	Decreases protrusion of the muscle cords from under the skin; often performed in conjunction with neck lifts and facelifts
Midface lift	Local anesthesia and intravenous sedation are given. A small incision is made right below the lower eyelid lashes, extending out at the outer corner of the eye. The complete midfacial tissue triangle is gingerly dissected from the bone, elevated vertically and attached to the bone at a higher level. Excess skin is trimmed and dissolving sutures are inserted to hold the changes in place as well as to close the skin incision.	Targets soft tissue in the cheekbone area and smoother lower eyelid region
Mini facelift	Similar to traditional facelift but with much smaller incisions, so that dissection between skin and tissue is not extensive	Done in the younger patient with good skin elasticity; quicker recovery; smaller incisions
S-Lift	Similar to mini facelift but with an “S” shaped incision	Restricted to those with mild skin looseness along jaw line; modified from mini facelift; rapid healing; short incisions
QuickLift or MACS lift	After local anesthesia and intravenous sedation are administered, an “S” shaped incision is made along the sideburn area extending along the ear, around the earlobe, and up to the hairline. Skin is gently dissected away from the underlying tissue and connective tissue and muscles are gently lifted and tightened. Sutures are inserted to hold the lift in place. Liposuction may be performed under the chin if needed. Excess skin is removed and the incision closed.	Modification of S-Lift; option for those with mild to moderate facial changes from aging; often done with liposuction or platysmaplasty; risk greater than with S-lift, but less than the traditional lift
Thread lift	Sutures are inserted into the facial tissue under the skin and tension is applied.	Similar to a facelift, but results are not as long lasting. Could be an option for patients concerned about surgery and healing time
Liposuction	After local anesthesia or sedation is administered, a small incision is made under the chin and neck. A small tube is then inserted with a suction device attachment that withdraws the fat using suction.	When used alone, is reliant on patient’s skin elasticity; often used in conjunction with facelift

Written by Barbara Hales, M.D.