Facelift

The typical age to have a facelift is 45-65 years and is very dependent on the individual’s facial aging characteristics. All of our faces age at different rates depending on many factors including genetics and environmental factors such as smoking and sun exposure. When you begin to notice sagging skin in the neck and jowl area you may wish to consult with a surgeon to discuss timing. Read our blog entitled Facelifts for Younger People for more information. 

Chronological age is not nearly as important as biological age. Many patients in their 60’s, 70’s and even 80’s can have a very nice result from facelift surgery. Be sure your medical conditions are well investigated and controlled before considering elective surgery. Older skin has less elasticity and tends to sag earlier than younger skin, so a tuck up procedure is more common with an older patient.

The “pulled” appearance that you see in some celebrities is likely due to having had repeated facelifts over time. Almost all patients will have a natural look after one or two facelifts, but the more times you pull the skin tighter, the more likely it is that you will begin to look overly tightened.

There are many variations on the techniques used for lifting sagging skin and soft tissue of the face. The major differences in these two types of facelifts are the incisions used to lift the tissue to remove the excess skin. The “mini-lift” or “short incision” or “short scar” type uses a shorter incision that
does not extend as far behind the ear as the traditional facelift technique. It is best for correcting the sagging jowl area, but less effective for significant sagging neck skin and muscle. It typically produces a very natural look with less healing time. The ideal candidate for a short incision facelift is typically a bit younger and has less sagging skin than someone who would benefit from a more standard approach. The bottom line is that you should consider what the surgeon recommends as the most effective technique for your situation so that you have the best chance at achieving the improvement you are looking for. All surgeons want their patients to have a more youthful, rested appearance and to avoid the over-tightened, pulled look that is sometimes seen in older patients, or celebrities (you know who they are!) who have had multiple facelifts.

A full facelift, in our opinion, includes facial enhancement of the cheeks, jowl and neck areas, but not the eyelids or forehead. Those areas are rejuvenated by upper and lower blepharoplasty and brow lift, respectively.

A liquid facelift is the injection of a large volume of filler at multiple locations over the face to achieve a degree of improvement and give the appearance of a facelift. It can be effective for the right patient. It is rather expensive ($2000- $5000) since multiple syringes of filler are required (4-10) and only lasts for a year or less. It does not actually tighten or lift skin, but by the expansion of the upper face it gives the appearance of lifting.

There are no truly effective non-surgical procedures that offer the same improvement as a facelift. Thread-lifting is undergoing a resurgence, but has quite a few issues still. Skin- tightening devices are not as effective and not predictable. Laser liposuction can help tighten loose neck skin and fat, but is not effective for jowl improvement and does not give the degree of improvement seen with facelifting. Injectable procedures like BOTOX^® and dermal fillers are non-surgical anti-aging treatments that are suitable for certain patients but are also not a replacement for a facelift. 

A stem cell facelift is the injection of purported stem cells into the face to attempt to rejuvenate the facial tissues. This assumes that stem cells are actually being harvested (typically via liposuction of fat), isolated by some process, and injected in a way that the cells remain alive, all of which are large assumptions. There is no doubt that fat contains stem cells, but the ability to selectively remove them from the fat and then inject them while they remain alive is the, as yet, unproven question. This is a procedure that has a lot of hype attached to it and one should proceed with caution, in our opinion, whenever this happens in medicine.

A SMAS facelift is a very common technique that tightens and lifts the “Superficial Muscular Aponeurotic System” or “SMAS” of the face. This is the layer of tissue and muscle under the skin of the cheek and upper neck that is lifted and suspended in order to reverse the effects of gravity on the facial and neck skin and tissues. It typically is seen as a safe and effective technique that can be carried out under local anesthesia and mild sedation in an office setting. Your surgeon can best inform you as to whether or not you are a good candidate for this type of facelift.

Upper and lower eyelid surgery, browlifting, cheek and chin implants and rhinoplasty are commonly done along with facelift surgery. You have to consider the additional time under anesthesia when combining procedures as this can increase the risk of complications.

Many patients incorrectly assume that facelift procedures always require general anesthesia.

Patients undergoing multiple surgeries, such as cheeks or chin implants at the same time as their facelift, will benefit from general anesthesia. While healthy patients undergoing traditional or mini-facelifts are often operated on under just oral or intravenous sedation, at Faces, we typically use sedation by mouth supplemented with Nitrous Oxide (laughing gas) and local anesthesia. This combination is safer than general anesthesia and allows the patient to recover very quickly while avoiding nausea and fatigue associated with general anesthesia.

When performed as a single procedure, a traditional facelift can take anywhere between 2 to 3 hours. If the patient is getting other procedures at the same time, this time can extend to six hours, depending on the surgeon and the procedures being performed.

Revision facelift surgery is very common and constitutes about a third of all facelifts we do. A second facelift is a very viable option and excellent results are typical. We also specialize in improving scars and other problems from previous facelifts such as elongated earlobes and poorly placed incisions.

Smoking does not mix well with surgery in general and it is particularly bad for facelift surgery. Nicotine causes decreased blood supply to the skin, which is essential for healing. Because the skin is lifted with this procedure, this is especially dangerous and can lead to death of the skin, resulting in severe scarring over the cheek in front of the ear and the neck behind the ear. We will not perform facelift surgery on someone who is actively smoking. We require patients to stop smoking for at least 30 days before surgery and 30 days afterwards. There are many programs available to help you stop smoking, please ask us if you would like a referral to one.

Each patient will experience recovery differently, but it’s common to see the results of your facelift within a month of your procedure. You’ll likely see improvement for up to a year as your muscles heal and your skin tightens.

You can expect to look more rested with a tighter neckline and less jowl. Ideally, your friends will not know you have had something done, just that you look better! Some things are not improved by a facelift. The deep folds alongside the nose will not typically improve very much, nor the wrinkles around the lips, mouth, and eyes. These are better treated with a skin resurfacing procedure such as a deep chemical peel or laser resurfacing.

You will never look as old after a facelift as you would had you not had one, but you will still age of course. Face-lifting just turns the clock back but it does not stop it. Most patients feel that the benefits of a facelift last about 10 years, and turn the clock back 7-10 years. The older you are when you have a face-lift, the faster the skin will stretch back out due to the loss of elasticity with aging. Many older patients will need a tuck up procedure at 2-3 years.

Most patients will be up and around the evening after surgery. Light activity is advisable for the first week, but most patients can go out socially at 10-12 days depending on the degree of bruising. Swelling decreases over 2-4 weeks and the incisions are still pink for several months. Many patients look their best at about 3 months. Patients should avoid jogging or any other exercise that causes a pounding motion for the first 3 months as this may loosen the skin prematurely.

Most people can return to work at about 10 days, although we have had some return as early as 3 days! We don’t advise this.

For the first week after your facelift, you may engage in light activity such as walking around the neighborhood. You should avoid jogging or other activities, such as high impact aerobics and tennis, that create a bouncing or pounding motion for a full 6 weeks. You can introduce weights, 10 lbs. or less, the 2nd week with light, low impact aerobic activity. You should also limit neck stretching or twisting movements up to 4 weeks. At that point you can introduce up to 20 lbs of weights with full aerobic activity (swimming and cycling), minus the bouncing and pounding.

Most people do very well with facelift surgery, but some discomfort, swelling and bruising are typical. About half of patients say they experience very little or no pain. Bruising is highly variable with some patients experiencing none and others extensive. Significant bruises, if they occur, will last about 2 weeks. Blood that accumulates under the skin (a “hematoma”) may need to be removed with suction during the office visits in the days after surgery to help reduce bruising. We use medications to help reduce bruising in all our patients. If there is a large accumulation of blood, some of the sutures may need to be removed in order to do this. As mentioned under the section on smoking, skin loss and poor healing can occur, mainly in smokers but rarely even in non-smokers. Numbness of the ear and earlobe is typical and usually returns to normal over the next few months. Permanent weakness of the facial nerves from nerve damage is very rare, less than 1%, but temporary weakness is more common and around 5%. Early recurrence of sagging skin occurs in older patients who have more skin sagging and loss of elasticity from the start. A “tuck-up” procedure may be required at 1-2 years in 5-10% of patients over the age of 60. 

Depending on the type of facelift you choose, incisions will be made at different locations on your face.

For traditional facelifts, incisions are made along the hairline around the temples, extending down the front of the ears, beneath the earlobes, and finishing by running up along the back of the ear before turning into the lower scalp.

For mini-facelifts, incisions are kept around the front of the ear down under the earlobe, and end in the crease behind the ear.

Visible or unsightly scars are very rare after any facial surgery because of the rich blood supply to the face and neck therefore healing is quick and predictable.

Think about what you want to improve and what you are willing to go through in the way of downtime and surgery. Read any material that the surgeon has sent to you. Have a list of questions for the surgeon as it is difficult to remember everything during the initial office visit. Be sure you list all your medical conditions, medications that you take, any allergies and any previous facial surgery on the medical forms given to you. Consider bringing a friend to help listen.

Get a good night’s rest and follow all the instructions that we give you. Bring a reliable adult to drive you to and from the office or surgery facility. You should have a responsible adult stay with you for at least the first night after surgery. We can help you arrange this if needed. Arrive at the time you were given by our office staff. Only eat or drink as instructed after midnight. You will be instructed on the medications to take before you arrive.

We do offer virtual consultations. However, this should not be considered a substitution for an in person visit because it is very helpful to be able to touch and manipulate the facial skin in order to assess what can potentially be accomplished with surgery.

Choose a surgeon who is Board Certified – this is the very basic credential that you should look for. Talk to friends who have had cosmetic procedures about their experiences. Look at online reviews and facelift before and after photo galleries on websites. Hairdressers and aestheticians can also be good resources.

For Facial Plastic Surgeons- go to: https://www.abfprs.org/certified/index.cfm.

For Plastic Surgeons- go to: http://www.abplasticsurger.org/public/verify-certification/VerifyCert?section=SurgeonSearch

We have many years experience performing facelift surgery and take pride in producing natural looking results, whether it is an initial or revision procedure, that avoid the signs of having had a facelift. Dr. Jordan is Double Board Certified in Facial Plastic and Reconstructive Surgery. Also, we offer a caring and relaxed experience in our office that is conveniently located in the Madison-Ridgeland area.

Dr. Jordan specializes in facelifts, and most are performed at our clinic in Ridgeland, Mississippi. A patient’s health and preferences for comfort are always taken into consideration. Should Dr. Jordan determine that it is in a patient’s best interest to have the procedure elsewhere, it will be performed at Merit Health Hospital in Madison. The costs for procedures in a hospital or outpatient surgery center are typically higher than in an office surgery setting.