BEFORE AND AFTER GALLERY

Face Lift

Demystifying Facelifts


Facelifts are considered the quintessential procedure to treat aging and have been performed longer than most cosmetic plastic surgery procedures. They have been associated with movie stars and socialites and used to be only available to a few. With the advancement of surgery and anesthesia, facelifts now are safely performed in many more. More men and younger women are now considering facelifts.

Facelift techniques have evolved and improved over the years. These include lesser scars, lifts that treat certain areas and the use of endoscopes. Although a facelift always is a surgical procedure, the trend has been to less extensive techniques.

Facelifts have always been the gold standard among procedures to treat aging of the face. Many new procedures and technologies promise results comparable to facelifts and are marketed as facelift replacements. Despite all these claims and marketing, none have shown lasting results equal to a facelift. Some of these procedures, such as lasers, may be complimentary to a facelift; some, such as thread lifts, have not stood the test of time.

Signs of aging are most visible in the face and neck. These are caused by the pull of gravity and the loss of facial volume. The signs include deepening of the facial folds, jowling (droop of facial tissue below the chin line) and platysmal bands (vertical lines of the neck).

Traditionally a facelift only tightened the skin of the face and neck. These are called subcutaneous or skin-only lifts. These are safely and quickly performed, have little downtime and have immediately good results. They sometimes can result in an unnatural and "pulled" appearance. More importantly, the results of these skin-only lifts are not long-lasting. Most plastic surgeons do not perform these anymore.

In order to achieve more natural and lasting results, SMAS lifts also elevate the lining of the facial muscles. Most of the pull is on deeper structures, producing less of a "pulled" appearance and providing much longer correction. These lifts are more challenging for the surgeon and carry a small risk of injury to the facial nerves. The recovery is slightly longer than in a skin-only-lift.

Lifts that elevate the muscle of the face are called subperiostal lifts. These lifts are supposed to provide better correction of some areas, but also have more swelling and downtime. Few surgeons perform these because of the additional downtime.

Facelifts treat the neck also. The skin and muscles are tightened; liposuction is used to remove fat. Neck lifts can be performed by themselves and have shorter incisions.

The brow and forehead are elevated in a full facelift. Frequently these are treated at the time of facelift using an endoscope, thereby eliminating the full scar across the forehead.

During a facelift, Dr. Samimi will often use fat injections to restore volume. The facial folds, lower eyelid creases can be filled with fat. Newer fat grafting techniques have improved the degree fat survival, but often repeat fat injections are necessary to obtain a lasting result.

Extra skin and fat of the eyelids can be removed at the time of the facelift also. The chin can be enhanced by placement of a chin implant.

Dr. Samimi performs full facelifts under general anesthesia while some minor lifts can be performed in the office. You may stay overnight in the hospital following a facelift depending on the length of the procedure in addition to your age and health.

The full facelift incision extends from the forehead, around the front of the ear and the earlobe to the back of the ear. Placing the incisions in a way that they are not visible is part of the art of performing a facelift. Shorter scar techniques now are often used, eliminating the scar behind the ear or in the temple. If the incisions are well-placed, the scars are barely noticeable with time. The most visible scar ultimately may be the one behind the ear.

The recovery after a facelift depends both on you and the extent of the procedure. Sometimes a drain is placed, but usually removed the day after surgery. The whole head and neck are dressed and this bandage is changed to garment the day after surgery. Pain usually is moderate. Sutures are dissolvable and surgical glue is used to seal the incisions. This allows you to take showers and wash your hair 24 hours after surgery. A garment is worn until the swelling has resolved.

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 Dr. Samimi.

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 Dr. Samimi's advice both before and after surgery.

 

More than a physician, Dr. Samimi is a body artist.
Jan M.