A facelift is the classic surgery performed by James M. Shaw, MD to elevate and tighten loose and sagging skin on the lower face and neck. Facelift is often chosen by patients who are healthy and active, and when they look in the mirror see someone older than their lifestyle indicates. Common references are made by patents that they feel energetic and youthful, but feel that their appearance is more suited for their mother, aunt or grandmother. They just want to look more like how they feel.
A facelift cannot make a 55-year-old look 35 and it won’t make you look like someone else. The goal is for you to look like a more rested and rejuvenated version of yourself. Even though there is elevation and tightening, this one surgery does not reverse all of the effects of aging. Addressing surface texture changes and wrinkling, uneven pigmentation and loss of facial volume will require additional procedures. Laser resurfacing and volume replacement using fat transfer or injectable fillers are often needed as well.
Facelift surgery will address the area from the cheekbones down to the front of the neck. The strongest tightening will be along the jaw line and under the chin. Higher on the cheek, care must be taken to decrease the degree of pulling. It is important not to distort the outer portions of the mouth, nose and eyelids.
The forehead is not treated in a facelift. This can be addressed with a forehead lift (or brow lift). In addition, the eyelids, the skin around the mouth, and volume loss in the face will not be improved. These all require different approaches specific to that area.
One way to consider facelift vs. laser resurfacing is to compare to a suit or other clothing item. If the suit is too large and needs to be altered, that is like a facelift. If the suit is wrinkled and needs to be pressed, that is like laser resurfacing. Most patients have some degree of both needs and along with Dr. Shaw will decide which one needs to be addressed first.
There is no specific age for seeking a facelift. Around age 50 is the most common time frame. Facelift patients can range from the late 30s to around 80. The most important factor is when the looseness or drooping start to become a problem to the patient. One advantage to having something done sooner is that the before and after change is less pronounced and can look more natural.
The onset of facial aging is a combination of accumulated sun exposure, history of smoking or exposure to cigarette smoke, and genetics. In addition to accelerating the facial aging process, smoking increases the risk of healing problems after surgery. Smokers are encouraged to choose options other than facelift or completely avoid all sources of nicotine for at least three weeks before and three weeks after surgery.
There are several less aggressive options to having a facelift. However, there is no substitute for a facelift and it is not possible for these more conservative approaches to provide the same degree of improvement one gets from a facelift.
The facelift surgery is performed by Dr. Shaw in an operating room with either general anesthesia or IV sedation. Most patients benefit from liposuction under the chin and below the jaw line at the same time. If muscle bands are present on the front of the neck, these can be repaired through a small incision at the base of the chin. The skin incision starts above the ear and continues immediately in front of the ear. It then curves around the earlobe and up toward the hairline behind the ear.
Due to bearded skin, male patients have a bit of a disadvantage compared to female patients. The narrow bridge of skin between the front of the ear and the sideburn area usually is eliminated with a facelift. This leaves bearded skin immediately next to the ear. Sometimes it is necessary to do laser hair reduction to achieve a more natural distribution of the bearded skin.
Pain is usually not a big concern following a facelift. A strong pulling sensation or tightness under the chin is more common. This is because the strongest pull from the surgery is in this area. Swelling and bruising are normal and unavoidable. The amount of each varies greatly between patients. The tight sensation can limit wide mouth opening and the ability to move the head from side to side. All of this begins to resolve after a few days. Ice packs can be used as much as possible for the first several days. Keeping the face elevated higher the heart level is very important to help manage swelling. This position should be maintained both day and night for the first week or so.
Swelling and areas of temporary numbness are common and usually not the same on each side. Showers are okay on the day after surgery. It may be helpful to wash the hair with conditioner first. This will to soften and remove any dried blood that may be along the hairline.
Activity should be minimized during the first week after surgery. Increasing your pulse or blood pressure will increase facial swelling. Numbness around the ears is normal and typically begins to improve after the first week.