Facelift

A facelift at its core simply means the mobilization of facial tissue into an improved position with the goal of restoring a more youthful look. The name is an oversimplification since “lifting” is not a sole component of a facelift, and even lifting usually involves simultaneously lifting in several directions. In addition, restoring volume is a key component of a good facelift, as well as improving the skin quality, and most importantly, obtaining a natural “nonsurgical”-looking result.

Dr. Shai Rozen, an experienced facial paralysis surgeon and board-certified plastic surgeon at the University of Texas Southwestern Medical Center, performs facelift surgery in Dallas to help patients with and without facial palsy look younger and feel more confident.

What is a facelift?

A facelift is a procedure that involves moving several different layers of the face into a position that will result in a more youthful appearance. These layers involve the skin and the SMAS (superficial muscular aponeurotic system). A facelift sometimes even involves refined manipulation of both facial and neck muscles and the submandibular gland to optimize results in some patients. More frequently than not, these different tissue layers need to be manipulated in different directions in order to achieve optimal results.

Are there different types of facelifts?

Yes. Initial concepts of facelifts started as skin stretching procedures. Because of their limitations in durability as well as unnatural-looking results (earlier facelifts gave the face a stretched appearance), additional techniques evolved using a deeper facial layer, the SMAS, providing more durable results and the ability to more effectively move volume that has sagged over the years.

Over the decades, there has been an increasing appreciation of the importance of facial volume in achieving a youthful look and recognition that with age, we experience volume loss. Therefore, as part of the volume restoration strategy, fat injection techniques and injectable fillers were introduced as either a standalone or an adjunct to facelifts.

What are the goals of a facelift?

The real goal of a facelift is to obtain a more youthful appearance that looks natural, not operated on, and makes the patient not only look better but also feel better.

In the setting of facial paralysis, the same principles are applied to the injured side and, if patients wish, can be performed on the healthy side to provide overall improved symmetry and facial harmony.

What are the key components of a good facelift?

The key surgical components of a good facelift are effective and long-lasting repositioning of facial structures that have sagged over the years, volume restoration, reproducibility, and safety. But the importance of skin care, including sun protection, maintaining skin moisture, cessation of smoking, and healthy eating, cannot be overemphasized.

Additionally, it is important to assess other facial structures such as the forehead, brow, eyelids, and neck and their relationship to the mid-face. Treating one area of the face without treating others if needed will create a disharmonious and suboptimal result.

Will a facelift eliminate all facial wrinkles?

A facelift can decrease but not eliminate all facial wrinkles (rhytides). To further decrease skin folds, additional adjunct interventions may be needed, such as BOTOX® Cosmetic injections, filler injections, and skin resurfacing procedures such as chemical peels or laser treatments.

How long should I expect to maintain the results of a facelift?

The longevity of results may vary between patients depending on factors such as age, quality of skin, weight, and surgical technique. But as a general statement, a well-performed facelift should provide a lasting effect of close to 10 years. Patients who continue healthy lifestyles, maintain their weight, avoid smoking, and practice good sun protection, may only benefit and enhance the results.

Can a facelift be performed without a brow lift, neck lift, or eyelid surgery?

A facelift alone usually addresses the midface (the facial part between the lower lid and upper lip) area and, to some extent, the lower face (from lower lip to jawline) and but not the neck or brow (forehead). High SMAS techniques can improve cheek volume and achieve a smoother transition between the cheek and lower eyelid, improving a youthful appearance.

Therefore, when considering a facelift, the face should be evaluated as a whole, and any areas needing improvement should be considered for treatment in order to achieve a harmonious result. Dr. Rozen often combines facelift surgery with one or more of the following procedures:

• Neck lift
• Brow lift
• Eyelid surgery

What is a high SMAS or a composite lift technique?

Both of these techniques incorporate the mobilization of the deeper SMAS layer of the face. There are several advantages to these techniques. Both can mobilize or carry volume with them during the lift into areas where volume is needed, such as the cheek (malar) area, and reduce volume where it is less needed, such as in the jawline (jowls). The specific technique should be chosen based on the patient’s needs.

Another advantage is that both techniques reduce the tension on the skin in the area of the incision so patients don’t have an unnatural stretched (windswept) look, and the scars heal better. In the long term, if 10 to 15 years later a patient wants another facelift, it can be done safely while further reducing the risk of the “stretched look.”

What are the risks of a facelift?

Probably the most feared risk for both patients and surgeons is injury to the facial nerve and partial facial paralysis. Other nerves can also be injured, most commonly the great auricular nerve in the neck area, which may result in permanent numbness in certain areas of the ear skin.

Other complications can involve hematoma (bleeding after surgery), wound healing problems, and mild infections.

How can I decrease the chances of complications from a facelift?

To decrease the chance of nerve injury, it’s important to choose a surgeon with:

• Experience in facial surgery
• Knowledge of the facial nerve anatomy and the facial anatomy in general
• Good surgical technique

To decrease wound complications, avoiding smoking is essential. If you have diabetes, good sugar control is important. To decrease the chances of hematoma (bleeding), control of high blood pressure before, during, and after surgery is important.

What happens if the facial nerve is injured?

This is uncommon, but if this is noticed during surgery, the best approach is the immediate repair of the injured branch. The type of repair depends on the area and mechanism of injury. Most surgeons who are well trained and adept in facelifts should be able to recognize and perform the repair. In cases when there is suspicion of a more complicated injury, it is advised to see a facial nerve surgeon.

What if I have a facelift and wake up with weakness?

If there is post-operative weakness but still some degree of motion, near-complete or complete healing is the rule. This is usually caused by neuropraxia (reversible injury to the facial nerve) and recovery should be expected usually within 6 months. If no signs of recovery are observed within 3 months, consultation with a facial nerve surgical expert is advised.

What if I have bleeding after a facelift?

If a small amount of bleeding occurs, the surgeon may aspirate it in the clinic and follow it closely. If a large bleed occurs, evacuation of the blood and control of any bleeding vessel should be performed in the operating room as soon the bleeding is identified.

What if I have any wound healing problems?

Most healing problems will resolve with conservative treatment. Most patients do not require additional surgery. The main treatment involves applying ointment and changing the dressing.

What should I expect after a facelift and what is the recovery time?

Initially, every patient has some degree of swelling and bruising. One or two small drains in the neck area sometimes help, and if placed, are usually removed within days after surgery. Sutures in front of the ear and neck (if a neck incision is used) are removed after 5 to 7 days, and sutures behind the ears in the hairline area are removed in 7 to 10 days.

Usually, within 2 weeks, most of the bruising is gone and anything remaining can be covered with a small amount of makeup. Remaining swelling will decrease gradually over the following 3 months. Some degree of numbness in the cheek and ear areas is expected, and sensation will usually return to normal within 6 months after surgery.

When should I expect to see the more final results of a facelift?

Usually, the more final results are seen about 6 months after surgery. At this time, swelling is gone and skin sensation returns to normal. You should expect to enjoy your results for the next 10 years or more. Remember that avoiding smoking and sun and living a healthy life, including maintaining a balanced diet and regular exercise, will help maintain your appearance for years to come.