The following is information regarding face lift surgery which is important to review, understand and discuss with family or friends before choosing to proceed with this surgery.
GOALS OF FACE LIFT SURGERY
The goal of face lift surgery is to partially reverse the signs of aging which are due to skin laxity, fat accumulation and loss of facial contour due to skin sagging. Some wrinkles will be “effaced” or smoothed out by the procedure, but deep crevices and creases, particularly around the nose and lips may be only partially improved. If the bony contour of the face has become blunted due to loose skin or excess fat, this will be improved through the face lift procedure. In any given patient, these goals may be only partially met.
LIMITATIONS OF THE PROCEDURE
The face lift procedure does not affect the forehead, eyes or upper lip. In addition, deep wrinkles, skin blemishes and scars will not be improved. The procedure cannot create younger skin nor can it alter developmental asymmetries or prevent continued aging. It is important to realize that this procedure does not make you “look younger” but gives you a refreshed, more youthful look for your age. The effects of the face lift may be present for up to 5-10 years, but eventually the aging process will cause a recurrence of the original condition.
ALTERNATIVES TO THE PROCEDURE
Face lift surgery is an elective procedure designed to help reverse some signs of facial aging. Without the surgery, the face will continue to age as expected. In certain instances, a full face lift procedure may not be required to affect significant improvement. Chemical peels, laser treatment or suction lipectomy without face lift surgery may be alternatives in some patients.
SURGICAL TECHNIQUE / ANESTHESIA / RECOVERY
Face lift surgery is generally performed through incisions in front of and behind the ear which extend both into the temporal hairline and the posterior neck hairline. Through these incisions the skin of the cheek, jawline and neck is elevated from the underlying supporting structures along with, in some instances, elevation of the deeper supporting layers. The skin and underlying supporting layers are then pulled upward and fixed in place with sutures. This results in a tightening of the skin and facial structures. In addition, obvious fat pockets overlying the jawline and underneath the chin are frequently tightened in the midline to sharpen the chin and jaw angle. Excess skin is then removed and the incisions in front of and behind the ear are closed with sutures. The procedure is usually performed under general anesthesia, but in certain instances can be performed under local anesthesia with heavy intravenous sedation. The procedure can be combined with upper face procedures such as forehead lift or eyelid surgery. The procedure may be performed in the hospital or in a surgical center. An overnight stay is usually recommended to observe the extensive areas of dissection for possible bleeding. The facial sutures are usually removed around 1 week after surgery. There is considerable swelling and bruising of the facial tissues resulting in black and blue marks and facial distortion. The swelling will greatly subside within 10 days to 2 weeks, although there may be some residual swelling for several months following the surgery. It is generally recommended that at least a 2 week absence from work be expected. In addition, physical activity particularly bending and vigorous exercise be curtailed for 3 to 6 weeks following surgery. Bandages are usually placed around the head the first day and evening of surgery, but are removed within a day or two of surgery.
It is possible to wash one’s hair 24-48 hours after surgery. Makeup can be worn starting 8-10 days following surgery. The entire surgical procedure takes approximately 4 hours. Blood loss is generally minimal and a transfusion is rarely required.
RISKS / COMPLICATIONS
Surgical complications accompanying this procedure include bleeding or fluid collection underneath the skin flaps which may necessitate a return to the operating room for removal. Bruising and discoloration of the facial skin along with swelling as far down as the clavicles or upper chest is not unusual following this procedure and is not considered a complication. However, occasionally small pockets of fluid accumulation occur for several days to several weeks following surgery which require needle drainage in the office. Because of the extensive dissection underneath the skin, in rare patients, a portion of skin will be injured due to vascular interruption and may actually be lost. In such instances, a long healing period may be expected and the resulting scars may require secondary scar revision or skin grafting. Occasionally, the scars in front of the ear or behind the ear are reddened or thickened and may require secondary procedures as well.
There is usually a change in the hairline which is generally subtle, but in some patients may be obvious. In men, the beard pattern around the ear may be altered. In patients of both sexes there may be hair loss in the temporal area or behind the ear. Numbness of the earlobes may occur as a result of the dissection in the neck. There is usually numbness of the facial skin for a period of two weeks to months following surgery which improves with time. As the nerves return, it is common to experience a tingly or irritating sensation in the facial skin. In some instances, the nerve branches which innervate the muscles of the cheek or around the mouth may be traumatized during surgery resulting in weakness of the muscles. This is generally a temporary condition and usually corrects itself within three to six months. In very rare instances, permanent nerve damage may occur with alterations of facial expression. Some patients experience a period of psychological depression following surgery in that their expectations for an improved facial appearance are not immediately evident due to the expected and normal postoperative swelling and bruising. This temporary psychological alteration improves as the facial appearance improves. There may be areas of lumpiness or irregularity in the skin for several weeks to months following surgery which again generally resolves as healing progresses. Return to work can be anticipated within 2-3 weeks of surgery and full normal activities within 4-6 weeks of surgery. Even though the risks and complications cited above occur infrequently, they are the ones that are peculiar to the operation or of greatest concern -- other complications and risks can occur, but are even more uncommon. Any and all of the risks and complications can result in:
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Additional surgery
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Hospitalization
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Time off work
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Expense to you
On occasion, surgical revisions may be indicated following the original surgery. If planned or performed within one year after the original surgery and if insurance does not cover these revisions, there will be no charge by the surgeon, but a facility fee will be charged by the hospital for use of the operating room, as well as a fee from the anesthesiologist. NO GUARANTEE -- The practice of medicine and surgery is not an exact science. Although good results are expected, there cannot be any guarantee nor warranty expressed or implied by anyone as to the results that may be obtained.
COMMENTS
If a smoker -- must be off cigarettes for 3 weeks before surgery and 3 weeks after surgery. There is a much greater risk for scarring, poor healing, hair loss and skin loss in smokers. Must be off all aspirin containing products for 3 weeks before and after surgery. You must stop all herbal medications 2 weeks prior to surgery. (Check all medications with us. Some medications, such as Motrin and Advil may also affect clotting.)
If there is any item on this consultation sheet that you do not understand, mark it and call the office. An explanation or additional information will be provided. Share the information that we provide to you with interested family members and/or friends. Our aesthetic coordinator, Connie Chudoff is available for any questions at 856-325-6768.