Dr. Ernst N. Kaplan
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FACELIFTS

Face lift surgery rejuvenates the cheeks, jowls. Not only does a facelift improve facial appearance but also has a dramatic effect on the neck, enhancing its contour and profile. In many individuals, a liposuction under the chin or a platysmaplasty* is an important concomitant surgery to improve neck contour.

The major improvement occurs because of lifting of the deep tissues (cheek fat and neck muscles) as well as by tightening of the skin. The muscle and fat are in continuity with a stronger fascia layer called the SMAS. The tightness of the lift is on the SMAS layer and not on the skin in order to avoid an unnatural tight skin look. A facelift can make a patient look years younger. The facelift also may require surgical correction of the bands (turkey gobbler) under the neck caused by the platysma muscle. This surgery is called a platysmaplasty. A facelift of any type is frequently performed in conjunction with blepharoplasty (eyelid surgery), forehead lift, platysmaplasty and/or liposuction, to create an overall rejuvenation of the face. Facelifts are performed in the outpatient surgical center. Local anesthesia with intravenous sedation or generally anesthesia can be used. General anesthesia is generally not required but can be used if desired.

The alternative methods of facelift:

There are variations of the face lift procedures that can be described in 3 general categories. The classical face lift, the mid-face lift and the minilift. The overall objective is to create a natural more youthful appearance that is pleasing to you. I will discuss which of the different face lift techniques is best for you and what you can expect from surgery.

Classical facelift

Classical Face lift surgery rejuvenates the cheeks, jowls and neck. The major improvement occurs because of lifting of the deep tissues (cheek fat and neck muscles) and to a lesser extent by tightening of the skin. The neck muscle (platysma) and cheek fat are in contact with a strong fascia layer called the SMAS.

Inconspicuous incisions in the temple hairline, against the front and behind the ear are made to access the underlying fat, SMAS and muscle. These tissues are lifted and then sutured in an elevated position. The excess skin is then smoothly re-draped without excessive tension and then is removed. There are numerous variations on this general principle that are chosen to fit you specific circumstance. These technical differences determine which tissue plane is used to lift the tissue, whether the tissue are vertically or obliquely elevated, and positioning of incisions relative to the hairline.


Before & After



Before & After


Midface lift (cheek lift)

The mid-face lift primarily lifts the cheek fat pad, reduces the nasolabial fold (smile crease) and contours the hollows under the lower eyelid. This technique is always performed in conjunction with a lower eyelid blepharoplasty and results in smoothing the lower lid fat pad and reducing circles under the eyelid.

The surgical incision is hidden just below the eyelashes of the lower lid. This surgery is performed by elevating the cheek fat, cheek muscles and lower eyelid muscles at the level against the cheek bone. This technique creates an elevated full cheek and also helps rejuvenate the hollows and fat bulges of the lower eyelid. This surgery has little benefit for the jowls and no benefit for the neck.


Before & After



Before & After


Minilift (limited-incision facelift)

The minilift is also called a limited-incision facelift. It is based on the principles of the classical facelift but only has an incision in front of the ear and none behind the ear. The minilift obliquely elevates the cheek and jowl but has minimal effect on the neck. It is typically used for younger women with minimal neck laxity or for a repeat facelift.


Before & After



Before & After



Post-operative Recovery from facelift: What to Expect

  • The surgery requires 2-3 hours
  • It is necessary to have someone drive you home and stay with you for the first 24 hours.
  • Initially you will have a dressing wrapped around your head. You may have surgical drains attached to bulbs hanging at your neck.
  • You will have a postoperative checkup the next day.
  • Stitches around the ears and the scalp sutures will be removed in 7-10 days.
  • We recommend that you avoid the sun for several weeks after surgery while bruising is present.
  • There is very little pain after surgery. Most patients will take Tylenol or a few Vicodin.
  • Tightness and swelling in your face is normal and will be present for several weeks.
  • There may be bruises low on the neck for about 2 weeks.
  • You can return to work or social activities in 2-3 weeks
  • Numbness or tingling of the cheeks is normal and may persist for several months
  • Postoperative activities should be limited to walking on flat surfaces. Intense exercise should be withheld for about 3 weeks.
  • You must avoid lifting or straining with bowel movements for 3 weeks.

Complications following facelift are rare, but include:

  • Local collections of blood (hematoma). The risk of bleeding is greater if you take aspirin or other NSAID pain medications such as Motrin within 2 weeks of the surgery. Bleeding can also occur because of high blood pressure, trauma or straining with bowel movements.
  • Infection is extremely rare. The risk of wound infection increases in diabetics, persons with a history of radiation, autoimmune and collagen disease as well as in smokers
  • Loss of skin and subsequent scarring behind the ears is almost always related to exposure to cigarette smoke or nicotine in any form. It may also occur with a hematoma.
  • Nerve injury that effects facial movement is extremely rare. If the facial nerve is bruised during surgery, there may be temporary loss of function. However, actual permanent damage to the facial nerve is extraordinarily rare.
  • There may be slight changes in your hair pattern.
  • In the weeks following surgery it is normal to have numb areas of cheek skin and area around the ear. These begin to tingle as nerve regeneration occurs.
  • There may also be some temporary discoloration as healing begins, which may take a few months to disappear.
  • The healing process is gradual, so you will not notice final results for 6-12 months. A single procedure often achieves the desired results. Nearly all patients who have had facelifts are pleased with their new, more youthful appearance.