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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 jaw line 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.
If you're considering a facelift, this brochure will give you a basic understanding of the procedure when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on the individual patient and the surgeon. Please ask the surgeon about anything you don't understand.
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The best candidates for facelift
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 the surgeon.
All surgery carries some uncertainty and risk
When a facelift is performed by a qualified plastic surgeon, complications are infrequent and usually minor. At the Riley Surgery Center, we boast an excellent staff of experienced doctors and nurses, as well as a state-of-the-art Surgical Suite. 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 the 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.
The surgeon will 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 the 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, the surgeon will explain the techniques that will be used. The procedure is done under general anesthesia and will be performed at the Riley Surgery Center. Also, the risks and costs will be discussed. 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
The 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. Pre-operative administration of anti-bleeding medication and a night-before shampoo with an anti-septic soap (prescribed) are standard, as is a pre-operative evaluation by our anesthesiologist. Carefully following these instructions will help your surgery go more smoothly. In any case, a checklist is provided to you to ensure you do not forget any details and close companionship with our clinic manager is appreciated. 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.
Your facelift is being done on an outpatient basis (you do not stay overnight) and you should arrange for someone to drive you home after your surgery, and to help you out for a day or two if needed.
Where your surgery will be performed
Your facelift will be performed in our state-of-the-art Surgical Suite at the Riley Surgery Center. It's done on an outpatient basis using general anesthesia. You do not stay overnight. A same night visit at your home or hotel by our anesthesia nurse is standard (included in the price) to check on you. Any complications can be dealt with swiftly or any questions answered at that time. Also, ambulatory nurse care (optional) can be provided by the Riley Surgery Center. Certain conditions such as diabetes or high blood pressure should be monitored after surgery and this can also be done by our ambulatory nurse service.
Types of anesthesia
Facelifts in the Riley Surgery Center are performed under general anesthesia (you'll sleep through the operation), although local anesthesia combined with a sedative to make you drowsy could also be used on indication or request. You'll be awake but relaxed, and your face will be insensitive to pain. (However, you may feel some tugging or occasional discomfort.) In any case, an anesthesiologist and anesthesia assistant are present to ensure that discomfort is kept to a minimum and that safety is never a question.
The surgery
A facelift usually takes several hours-or somewhat longer if you're having more than one procedure done. For extensive procedures, two separate sessions may scheduled.
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. The exact placement of incisions and the sequence of events depends on your facial structure.
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. If the muscle of the neck (platysma) is severely lax, this may also be plicated (tightened) trough the small incision under the chin. Stitches secure the layers of tissue and close the incisions; metal clips are used on the scalp.
Following surgery, a small, thin tube is temporarily (usually one or two days) 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. Also, a compressive, elastic facioplasty support girdle is fitted on (provided) which should be worn for ten days or so following surgery.
After your surgery
There isn't usually significant discomfort after surgery; if there is, it can be lessened with the pain medication prescribed by the 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. Strenuous activity, such as aerobics, working out, but also sexual activity which heightens blood flow to the face, should also be avoided for some weeks following surgery.
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 ten days. Your scalp may take longer to heal, and the stitches or metal clips in your hairline are left in a few days longer.
Getting back to normal
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. Avoid strenuous activity, including sex and heavy housework, for at least two weeks (walking and mild stretching are fine); avoid alcohol, steam baths, direct sunbathing and saunas for several months. Above all, get plenty of rest and allow your body to spend its energy on healing. Bruising can be combated with special crèmes and the surgeon will advise you to use moisturizers.
Be prepared for an emotional rollercoaster: a facelift more than any other cosmetic procedure may produce emotional upsets ranging from depression (direct post-operatively due to the puffy appearance) to exhilaration (on seeing the contours of the final result) to back to normal again after about a month or so. Also, your partner and family should be prepared for this. In any case, discuss these feelings with the surgeon who has dealt with these on many occasions and you may find this comforting. Sometimes, a relaxant like xanax or anti-depression medication will be prescribed to help you deal with these emotions.
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 two to four weeks after surgery. If you need it, special camouflage makeup can mask most bruising that remains.
Your new look
The chances are excellent that you'll be happy with your facelift-especially if you realize that the results may not be immediately apparent. 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, and you may want to repeat the procedure one or more times-perhaps five or ten years down the line. But in another sense, the effects of even one facelift are lasting; years later, you'll continue to look better than if you'd never had a facelift at all.
The costs
Facelifts at the Riley Surgery Center have an all-inclusive price of US$ 5000,00. This includes peri-operative consultations and companionship, pre-operative anesthesia consult, operating room, anesthesia fee, same night anesthesia nurse visit, surgical facioplasty support girdle and before and after photos (which can also be e-mailed to you). Operation report and a cost breakdown are provided on request free of charge. The listed price does not include additional procedures, such as adjuvant Botox rejuvenating wrinkle relief, eyelid surgery or rhinoplasty. If additional surgery is needed, these will be quoted separately, although significant reductions apply due to the fact that not everything is paid twice (such as anesthesia and operating room). Initial consultation (US$ 50,00), ambulatory nurse care (US$ 30,00 per visit) and all prescribed medication are excluded.
Financing is available. In addition, quoted prices are subject to discounts if you are local or medically associated.
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