Facelift: 12 things to know
Over time, the face inevitably undergoes changes; the skin may loosen and become wrinkled. Creases may form between and around the eyes and mouth, and jowls may begin to form where the jaw line was once taught. Exposure to the sun, lifestyle, genetics, and gravity all contribute to the aging face. Rhytidectomy, or “facelift”, is a blanket term for several different surgical techniques I perform for facial rejuvenation. When considering undergoing the knife in pursuit of facial rejuvenation, take a few moments to read through the following 12 “truths” you should know.
1. The word “facelift” may not mean what you think it means
This surgery does not, in fact, lift your face “up” to the sky; this procedure actually focuses more on the lower area of your face and neck. Saying “neckandjawandlowfacelift” doesn’t quite have the same sparkle to it. Facelifts can focus on the jowls or cheeks and involve different techniques depending on the targeted area, and how invasive the procedure needs to be to achieve the patient’s desired outcome. Facelift techniques have advanced substantially from several decades ago when patients were left looking windblown. As a double board-certified head & neck and facial plastic surgeon, I have an intimate understanding of the muscle and facial anatomy under your skin; understanding these features will result in the most natural and realistic results for your facial anatomy. However, a facelift alone may not yield the results you’re looking for – the perfect segue into the second point.
2. A facelift may be the main character, but they commonly have supporting characters
As mentioned in the point above, the need for performing multiple procedures at once is because a facelift does not address concerns on the upper part of your face. To achieve a natural, cohesive appearance, I recommend targeting wrinkle reduction on the upper third of your face. The majority of facelift procedures I perform involve one or more other procedures, including fat transfer to restore lost volume, an upper or lower blepharoplasty to promote a youthful and more rested look, and a brow lift to reduce heaviness in the forehead.
3. General anesthesia may not be needed for a facelift
Sedation is the depression of awareness, and occurs when a patient’s response to external stimuli becomes limited, often restricting movement. Sedation is required to perform surgeries to ensure the patient is comfortable, pain free, and the surgeon can perform the case unhindered by movement. There are three basic types of sedation I use to perform surgery: local anesthesia (think of a shot of lidocaine), intravenous (IV) monitored anesthesia care (MAC) or “twilight sedation”, and general anesthesia. Facelift surgery usually takes about six hours and is most commonly performed under general anesthesia. However, you may be a candidate to undergo the surgery under IV sedation; you can still be asleep for the procedure, but don’t have to be
4. The recovery process is a long journey
Healing and the complete resolution of swelling and bruising may take a lot longer than anticipated. Immediately after your facelift, you’ll notice that the contours of your face have already improved, but you may feel a little self-conscious making public appearances, and I recommend a minimum of six weeks before any significant events; bruising is a major part of facelift. You can expect to have 1-2 drains in place overnight which will be removed the next day at your first post-operative visit. Alternatively, we can coordinate an overnight stay in the hospital to provide you with around-the-clock care. Days 2-4 after surgery, you can be up and moving around as tolerated, but should expect to tire more quickly than usual. About one week after surgery you’ll come to the clinic for checkup and suture removal. Bruising may persist for up to three weeks. If possible, consider taking up to six weeks off of work to fully recover. If that’s not reasonably possible, most patients can resume activities at three weeks post-op with minimal visible evidence of surgery. It may take several months for your surgical incisions and facial tissues to fully recover.
5. You may want to avoid mirrors for the period after your procedure
As mentioned above, your facial profile may be immediately more appealing after surgery, but you should expect a lot of swelling and bruising. To minimize bruising, discontinue all aspirin products, including NSAIDS (ibuprofen, Aleve, Motrin, naproxen, etc.) two weeks before your procedure. Tylenol is OK to take and will not cause excessive bruising. Discontinue all vitamins herbal medications (including green tea) for two weeks and discontinue the use of alcoholic beverages five days prior to your procedure. Sleeping with your head elevated on two or more pillows (about a 45-degree angle or your head higher than your heart) can reduce swelling and bruising. Ice compresses will help with swelling and bruising for the first 24-48 hours; at five-days post-op you should switch to warm compresses over bruised areas until the discoloration is resolved. I recommend my patients use arnica or bromeline (found in pineapple and papaya) and tranexamic acid, which is a clotting agent, to help prevent bruising. You may apply makeup to conceal bruising, but be sure to avoid anywhere near the incision lines for at least 10 days after surgery.
6. You may experience facial numbness for up to six months post-op
Numbness, tingling, hardness, tightness, and bumpiness of the surgical area are common occurrences. If any of these things do occur, they will gradually subside over several months. Patients report that the numbness or tingling is not painful, but just a strange sensation. Your skin may feel tight or uncomfortable to the touch, so applying moisturizer might feel bizarre. Most commonly, the numbness is around the front of your ear, near the surgical incision site, so it might be weird to be talking on the phone but not feel it pressed against your face. The numbness should subside within three months on average, but may take up to six months to fully subside.
7. You may experience altered moods after surgery, sometimes feeling depressed or anxious
Some patients may feel overwhelmed in the first few days, post-operatively. You may ask yourself why you underwent the surgery in its immediate aftermath while the swelling is at its height. Most commonly, patients report feeling varying degrees of anxiety and/or depression. Thankfully, most patients report the resolution of these mood changes within the first week after surgery. You may experience a second bout of mood changes about three to four weeks after surgery. At this point, the sutures will be removed, you’ll have stopped taking pain medication, but you may not be back to your pre-operative routine or energy just yet. Expect to continue feeling more tired and need more calories and more rest as your body recuperates from the trauma of surgery. It will take several months to fully recover, which can be frustrating for some patients. Rest and good nutrition are important healing factors, especially during the first 6 weeks.
8. Be prepared to wear a compression garment known as a “jaw bra” during the beginning of your recovery
You might feel like a wrapped up mummy for the first few days after surgery. Expect to have bandages covering your incision lines along with 1-2 drains in place overnight, which will be removed the day after surgery at your first post-op checkup. You will also be provided with a machine-washable compression garment, known as a “jaw bra”, that I recommend you wear as much as possible during the first week. You’ll also layer on ice packs on the sides of the face and under the chin continuously for the first 48 hours (on for 20 minutes, then off for 20 minutes). You’ll also want to avoid turning the head from side to side as this can cause tension on suture line and bleeding under the skin; you’ll want to turn head and shoulders together for the first ten days.
9. Get ready for some quality binge watching
If you don’t already enjoy binge-watching your favorite TV shows, you’ll want to learn quickly. Most patients indicate that resting post-operatively is one of the hardest parts of the recovery process. You should expect to be taking it easy for the first two full weeks after surgery; I recommend no heavy lifting or strenuous exercise for that time. After two weeks, you’ll be out of the window for bleeding under the skin, so you may feel up to walking or light physical activity. You might feel up to getting back into an exercise routine, but find yourself tiring more easily; this is completely normal during recovery. Avoid any rigorous exercise or contact sports for six full weeks after this facial surgery. Rest and good nutrition are important healing factors, especially during the first six weeks. Depending on your occupation, you may be feeling up to returning to work after that first week.
10. The post-op pain you anticipate may end up not being as bad as you think
Thankfully, most patients report that the pain and discomfort immediately following surgery dissipates within just a few days. Most patients will take prescription pain medications for 2-3 days after surgery, followed by over-the-counter Tylenol for pain management for the next few days. With any surgery, there are risks, including but not limited to: infection, bleeding, swelling, scarring, numbness, skin discoloration, asymmetry, fluid collection, delayed wound healing, displeasure with the cosmetic outcome, and allergic or other negative reactions to one or more of the medications or substances used in the operation. My incredible team ensures that you have an open line of communication for any post-operative questions or concerns; we have surgeons on-call 24/7 for any medical emergencies.
11. Surgical scars are easily concealed, so don’t consider having scars a dealbreaker
In general, all facelifts involve an incision in front of the ear hidden behind the tragus and under the earlobe. This incision allows me to separate the skin from underlying anatomy to remove excess tissue. I work very precisely to hide the incision in the patient’s hairline or behind the tragus of the ear canal. The incision lines are closed very precisely with small sutures and are well-hidden in the natural folds of your facial anatomy. I recommend applying Vaseline/Aquaphor on the incision line for two weeks, then switching to an over-the-counter scar gel with silicone. Incisions may need a full year of recovery. I also perform a variety of skin resurfacing techniques or scar revision that can aid in optimally concealing the surgical sites.
12. Get ready for a faster morning routine
The beauty of facial rejuvenation is enjoying the benefits of having a more rested and youthful appearance. You may find that you no longer need the same morning makeup routine, and can even give up those biannual appointments for filler or Botox. In the vast majority of patients, the desired aesthetic result is readily achieved. After your facelift, you may feel like a walking Instagram filter.