A facelift is a surgical procedure designed to rejuvenate the face and neck. The
operation consists of removing the excess skin and fatty tissue and to lift the
sagging deeper tissues.

What are the limitations of the procedure?

Facelifts are not effective for correction of generalized fine wrinkling. Skin
rejuvenation is best treated with dermabrasion, chemical peels, laser or Visage
resurfacing. This is particularly true for the fine wrinkles of the lips. It also cannot
remove the wrinkles caused by facial animation when muscles contract. It should
be noted that after a facelift the aging process does continue at the normal rate.
The procedure can be repeated if the rejuvenated look is desired to be
maintained.

Is there any preparation required?

There is always a possibility of excess bleeding during or after the operation
therefore it is essential to avoid taking aspirin, anti-inflammatory drugs, or similar
medication for two weeks before and after the procedure. No smoking, use of a
nicotine patch or chewing gum one month prior to surgery or 3 weeks after
surgery is needed to prevent these toxic substances from depriving the skin of
sufficient blood and oxygen causing skin tissue death and bad scar formation.

How is a Facelift Performed?

The basic operation is designed to lift; stretch and remove the excess skin, and
re-support the underlying facial muscles where necessary. There are many
variations on the basic procedure. The standard incisions starts within the temple
hair, proceeds out into the natural skin fold in front of the ear and then down
around the earlobe, in the crease behind the ear, and then back into the hair of
the nape of the neck (see diagram). The skin of the cheek, upper neck and
behind the ear is separated from the underlying tissue and stretched in an
upward and backward direction. The excess skin is then removed. The muscle in
the upper neck (platysma) is tightened. Fat beneath the chin if present is
removed through an incision beneath the chin and liposuction resulting in a small
scar in this area. The skin is then sutured, using a combination of dissolvable
and removable sutures.

The "Short Scar" technique face lifting is a newly developed evolution of the
standard facelift procedures. This differs from the standard procedures in that
there are not any incisions behind the ear. The advantage of these techniques is
one can wear their hair up without revealing the scars behind the ear.

It is frequently combined with the endoscopic browlift in which through small
incisions in the scalp an endoscope (a small camera in a tube) connected to a
TV screen is introduced to loosen and then lift the eyebrows and to smoothen
the forehead. The forehead deep tissues are moved upward and fixed to the bone.
The frowning muscles between the eyebrows can be removed. The chief benefit
of the procedure is that scars are minimal in the forehead when no strip of scalp
is removed and sensation to the top of the scalp is for the most part maintained
unlike the older procedures.

The Recovery Period

There is some pain or discomfort for a week or two following surgery and usually
requires use of medication for the first few days. Most patients notice a dull,
muscular-type ache or a burning sensation. Numbness or discomfort may be
experienced for varying periods of time. You will experience some mild bruising
for two to three weeks and swelling that usually subsides in six to eight weeks.

Most people return to work in about 2-3 weeks, depending on the extent of the
surgery and the type of work they perform. The majority is back to most activities
within 4 to 6 weeks.

What about the scars?

Surgery is not possible without scars but the incisions are carefully planned and
located so they lie in normal skin folds or are hidden by the hair or ear, making
them as inconspicuous as possible. The individual genetic characteristics of
natural healing are the main factors in determining scar appearance. In some
patients the scars may widen particularly behind the ear. Thick, raised, red,
"keloid" scars can occasionally occur.

What are the more common complications?

A facelift is a low risk procedure, but as with any operation, there are certain
potential problems. Nerve damage can occur which might cause a varying
amount of facial weakness or paralysis of the muscles that elevate the eyebrow,
close the eye or affect the smile. This can be temporary or permanent. As in all
surgery, problems such as infection (requiring antibiotics) or bleeding can occur
and require appropriate treatment including possible surgery. At times fluid or
blood may accumulate in the operative sites, which may require aspiration,
drainage, or removal by surgery. There may be blistering, crusting, or skin tissue
death (necrosis) with delayed healing in areas where the skin has been lifted and
pulled tightly. This can result in prolonged recovery and exaggerated scarring.

There may be scattered areas of numbness over the face, forehead, scalp, neck,
ears, and face following the surgery which may persist for an indefinite period of
time. Rarely these sensory nerves may cause persistent pain in the skin or scar.
Abnormal earlobe positioning can occur. Temporary or permanent hair loss
around incisions may occur. Facial asymmetry can occur. Eyelid malposition
may occur. Occasionally the scarring of the lower eyelid can pull the eyelid down
and away from the eyeball (ectropian). Dry eye syndrome may occur. Any of
these complications may cause permanent disfigurement and/or require
subsequent surgical treatment.