Facelifts and other facial rejuvenation techniques have been around for over a hundred years. Over this time procedures have become more advanced, offering more and more options to those who want to look younger and more vibrant as they age.

If you are bothered by the signs of aging in your face, a Facelift may be right for you. Also called rhytidectomy (rye-tid-EK-tomy), a facelift is a surgical procedure to improve visible signs of aging in the face and neck, such as:

• Sagging in the cheek (midface)
• Deep creases below the lower eyelids (tear trough)
• Deep creases along the nose extending to the corner of the mouth (nasolabial folds)
• Fat that has fallen or is displaced may create jowls along the jaw line
• Loss of muscle tone in the lower face may create jowls
• Loose skin and excess fatty deposits under the chin and jaw can make even a person of normal weight appear to have a double chin

A facelift doesn't stop the aging process, but turns back the clock on your face and age. Once healed, the face continues to age at a normal pace. If you look ten years younger after a facelift, it will take about ten years or more for your face to age back to the preoperative condition.

Procedures often performed in conjunction with a Facelift to rejuvenate the face are Brow Lift, to correct a sagging or deeply furrowed brow, Eyelid Lift to rejuvenate aging eyes, and chemical or laser peels to smooth sun-damaged skin.

A facelift can only be performed surgically; non-surgical rejuvenation treatments, such as peels or fillers, cannot achieve the same results, but may help delay the time at which a facelift becomes appropriate and complement the results of surgery. Thread lifts, also known as Feather Lifts and Contour Lifts, have proven to be very ineffective, because no skin is removed. These procedures have not stood the test of time and have essentially been abandoned.

There are several important factors to choosing a surgeon, including recommendations from friends, personality, physician training and board certification, and experience.

Referral from Friends: Many prospective patients find confidence if they have a close friend or other trusted individual who has already undergone a successful procedure. This is often a good first step in making a decision. However, not all patients know someone who has had surgery. Most of our patients are referred by satisfied friends who have been our patients.

Personality: It is important to develop a good relationship with a surgeon, where communication is easy and trust can be developed. A patient needs to feel intuitively that they are in good hands with someone they can trust. Bedside manner is important.

Training and Certification: In years past, only plastic surgeons performed facelifts. However, in recent years doctors from many different specialties are more commonly performing cosmetic surgery procedures, including Ear, Nose, and Throat doctors (also known as otolaryngologists and facial plastic surgeons), Dermatologists, Ophthalmologists, and Gynecologists. Only a surgeon who has completed residency training in an accredited training program can become certified by the American Board of Plastic Surgery. There are many Boards, and it is easy for patients to become confused, or assume that when a doctor says they are “Board Certified” it all means the same thing. BE CAREFUL! Learn more about the significance of Board Certification here.

Experience: Finally, consider the physician's experience, the most important factor in making a decision. As with all professions, expertise is directly proportional to experience, meaning the total number of procedures performed. Medical literature illustrates that biggest predictor of success in surgery is volume, in other words, the number of times that a doctor has performed a procedure.

If the doctor is recommending a specific procedure, how many has he performed? How often does the surgeon perform this procedure?

While board certifications and training are important, a surgeon's experience with the procedure itself is more important. Don't hesitate to ask pointed questions about recommended procedures.

Who Is a Good Candidate for The Facelift?
There is no perfect time or age to do a facelift. There is no ideal window of opportunity. Some patients prefer to address problems early, to maintain a younger look. Others prefer to wait until aging is more noticeable, to get more out of the procedure.

A facelift is a highly individualized procedure and you should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image. Patients who find themselves looking in the mirror, pulling up their face to see a younger, improved appearance, are usually ready for the procedure.

Because every case is unique, the only way to accurately determine which procedure is best for you is to consult with Dr. Alexander.

Facelift surgery is a good option for you if:

1. You are physically healthy
2. You don’t smoke
3. You have a positive outlook and realistic expectations in mind for the improvement of your appearance

Consultation
To ensure the most natural looking results, it's imperative for a surgeon to recommend the procedure which most appropriately matches the patients’ needs and to offer realistic expectations for post-surgery outcomes. When you meet with a surgeon, you should expect a full discussion of the surgically appropriate options for your face, which is uniquely yours.

I have found that most patients are pretty satisfied with how they look, they’re just not happy with the changes of age. Patients don’t want to look different, or changed, just fresher and younger. Most just want to turn back the clock several years. Many patients comment that they look older than they feel, but are wary of cosmetic surgery, especially if they've seen poor outcomes in others. We often hear, “I don’t want to look funny, weird, or pulled.”

A good surgeon goes through a series of examinations and observations that are individual and dependent upon your specific situation and goals, but also factor in the surgeon's expertise, training and experience. If a surgeon specializes in a particular type of facelift procedure, don't be surprised if it is recommended over other options. Be wary of the “one-size-fits-all” approach.

This is particularly important because as medicine has advanced, patients have more options available. The availability and affordability of options in facelift procedures has made it possible for many more patients to benefit from facial rejuvenation surgery. But it has also made it possible for candidates considering surgery to form some mistaken impressions about procedures.

What to expect during your consultation
The success of your facelift depends very much on your complete candidness during your consultation. We will ask you questions about your health, desires and lifestyle. Be prepared to discuss:

• Why you want the surgery, your expectations and desired outcome
• The options available to you for facelift and facial rejuvenation
• Medical conditions, drug allergies and medical treatments
• Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
• Previous surgeries

We may also:

• Examine and measure your face.
• Take digital photographs for computer imaging
• Discuss your options and recommend a course of treatment
• Discuss likely outcomes of a QuickLift™ and any risks or potential complications
• Discuss the anesthesia options available

Other procedures can further enhance the outcome of a QuickLift™. They include:

• Facial implants
• Soft tissue augmentation to recontour the facial structure
• Resurfacing techniques to improve the tone and texture of facial skin
• Wrinkle reduction by injection
• Shortening of the upper lip

Prior to surgery, we will have you:

• Take certain medications or adjust your current medications
• Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding
• Stop smoking well in advance of surgery

During a Pre Operative appointment, usually 1-2 weeks before surgery, we will:

• Get lab testing or a medical evaluation
• Tell you what to do on the night before and morning of surgery
• Discuss the use of anesthesia during your procedure
• Explain post-operative care and follow-up, and what help you will need after the procedure

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. We will recommend the best choice for you.

A facelift typically takes about 2-2.5 hours to perform, depending on several surgical and patient variables. There are four basic steps to any type of facelift, small or large.

Step 1 – Incisions
A traditional facelift incision begins in the hairline at the temples, continues in front of the ear and around the back of the ear and ends in the hair of the scalp. The incision is like a seam in clothing. It is impossible to remove the extra skin without an incision. The more skin that needs to be removed, the longer the length of the incision. Incisions normally heal extremely well and are nearly invisible.

Added step: If the neck is a problem or concern, sometimes a small incision is placed under the chin to remove fat and tighten loose muscle bands.

Step 2 – Undermining, or loosening the skin
Next, the surgeon gently loosens the skin from the underlying muscle (SMAS). The degree of loosening depends on the age of the face and excessiveness of skin. More loosening is required for excessive skin.

Added step: Fat may be sculpted away from the neck and jowls, and fat might be transferred to cheeks or tear troughs.

Step 3 – Tightening the Muscle (SMAS)
The muscle layer can be tightened several ways, including:

• Plication: folding, or pleating the muscle layer with sutures
• Purse string plication: tightening the muscle layer with suture loops
• Undermining: lifting the muscle layer up as a second layer, then removing the excess and closing it with sutures.

Some surgeons skip this step, which is called a “simple facelift” or “skin-only” facelift.

Step 4 – Closing
This is the final tailoring step, where the skin is re-draped over the uplifted contours, excess skin is trimmed away, and the incisions are meticulously closed with removable sutures. We use removable sutures to improve the healing process and minimize scarring. No drains are needed.

Pain from facelifts is usually minimal. Patients usually experience tightness in the cheeks and neck, and some soreness in the jaw for the first few days while eating or opening the mouth. Pain pills are provided, but are usually not required after a couple of days. Occasionally patients complain of pain, but this is uncommon.

Important facts about the safety and risks of facelift surgery
The decision to have a facelift is extremely personal and you’ll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable. In general, the overall risks are very small for facelift surgery.

We will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks and potential complications.

The risks include:

• Unfavorable scarring. This is very unlikely with facial surgery, and poor scarring usually improves with time
• Bleeding (hematoma). Occurs <5% of the time, an inconvenience, but does not affect the final result.
• Infection. Extremely rare and usually easily treated with oral antibiotics
• Poor wound healing. Very rare, more common in smokers.
• Anesthesia risks
• Correctable hair loss at the incisions. Rare.
• Facial nerve injury with weakness. We have not seen this in our practice.
• Facial asymmetry. Most faces are asymmetric, and these asymmetries usually persist after surgery.
• Skin loss. Extremely rare, more common in smokers.
• Numbness or other changes in skin sensation. This is normal for everyone and lasts several months. It would be rare to have permanent numbness.
• Fatty tissue found deep in the skin might die. We have not seen this complication.
• Fluid accumulation. Easily treated with a syringe.
• Pain, which may persist. Would be very rare to see persistent pain.
• Skin contour irregularities
• Skin discoloration, sensitivity or swelling. Usually a temporary condition.
• Sutures may spontaneously surface through the skin, become visible or produce irritation that requires removal. This is rare and usually easy to treat.
• Unsatisfactory results may include asymmetry, unsatisfactory surgical scar location, unacceptable visible deformities at the ends of the incisions (It may be necessary to perform additional surgery to improve your results)
• Deep vein thrombosis, cardiac and pulmonary complications. Rare with facial surgery
• Possibility of revisional surgery

Be sure to ask questions: It’s very important to ask your surgeon questions about your facelift procedure. It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with us.

Recovery times vary from patient to patient. In general, the “bigger” the procedure, the longer the recovery time, and the converse is also true. However, within each group of patients, there are individual differences.

Traditional facelift recovery takes an average of 8-20 days. Bear in mind, however, that these are averages. Some individuals may heal much more quickly, while others may take longer to fully recover. A patient who tends to have more bruising and swelling than normal will take longer to heal.

After a Facelift, most patients should allow two weeks before returning to work and other normal day-to-day activities and about three weeks before working out.

Be careful
Following your doctor's instructions regarding medications and other post-operative measures is key to a quick recovery. Herbal medications are available to reduce swelling, bruising, and to speed your recovery.
It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Avoid wearing any clothing that must go over your head. We will give you specific instructions on how to care for yourself.

When you go home
When your procedure is completed, a bandage could gently be placed around your face to minimize swelling and bruising.

It is normal for the face to feel tight. If one side is significantly more painful or swollen than the other side you should call the office. If you experience shortness of breath, chest pains, or unusual heartbeats, call the office immediately. Should any of these complications occur, you might require hospitalization and additional treatment.

You will be given specific instructions that includes:

• how to care for the surgical site
• medications to apply or take orally to aid healing and reduce the potential for infection
• specific concerns to look for at the surgical site or in overall health
• when to return to the office

We will see you the day after surgery, then on the 4th or 5th day to remove some sutures, and again on the 7th day to removed the remainder of the sutures. At one week you can resume normal activities. At two weeks you can begin light exercise, and at three weeks there are no restrictions.

It's natural to feel impatient about seeing the “new” you, but you'll need to be patient as your face heals from the surgery. The visible improvements of a Quicklift™ appear as swelling and bruising subside. It may take several months for swelling to fully dissipate and up to 6 months for incision lines to mature. Once healed, the incision lines from a facelift are well concealed within the hairline and in the natural contours of the face and ear.

Because I have worked with so many patients, I can look at someone relatively early in their recovery and say, "You look great," even though that patient can only see how they look that day — not how they will look a few weeks later. Your final result should not only restore a more youthful and rested appearance, but also help you feel more confident about yourself.

After a few months pass it is not uncommon for patients to become so used to their new appearances that they barely notice the change. This is similar to when you get a new haircut and can't help but notice your reflection every time you pass a mirror. After a few months, your self-image resets, and you may not recall how drastic the change is until you happen upon an old photograph.

The same phenomenon occurs with facial rejuvenation, and is one of the main reasons we take “before” pictures. Patients quickly forget how they used to look! For the first few months after a procedure, the change is dramatic, and the mind is constantly noticing and comparing the younger look to the older face. After a few months, the mind has reset the new look as the new self-image. Once this becomes the new norm, it is easy to look in the mirror and still see some signs of aging. However, when the patient looks at old pictures, they are often surprised they have forgotten what they used to look like, and how much they have improved.

If our patients tell us they’re receiving a lot of compliments, but nobody knows they’ve had surgery, we feel like we’ve achieved our goal. And one of the ways we do this is by keeping things very simple and conservative. Some surgeons overplay their artistic ability and make recommendations that really change a person’s face and make them look quite a bit different than they used to. Our goal is to not change a person’s face, just to give them a better version of what they already have.

In general our patients are very pleased with their Quicklift™ results. The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure. Another surgery may be necessary.

Continuing a Skin Care program can help maintain your result and help keep your skin young and healthy. We offer a complimentary facial after your procedure to introduce you to our Aesthetician, Leanne, and our Physician Assistant, Joanna, in our excellent Skin Care Clinic.

Life-long sun protection will help to maintain your rejuvenated appearance by minimizing photo-aging or sun damage. In addition, a healthy lifestyle will also help extend the results of your rejuvenated, more youthful appearance.

How much will facelift surgery cost?
A quote will be provided to you after your consult with Dr. Alexander. Cost is always a consideration in elective surgery. We offer patient financing plans, so be sure to ask.

Costs include:

• Surgeon’s fee
• Operating Room and Supplies
• Prescriptions for medication
• Medical tests
• Anesthesia fees (if not done under local anesthesia)

• Local Anesthesia: the surgical area is numbed up, but the patient is awake. Sometimes a patient will be given an oral medication, like Valium, to help with relaxation.


• Sedation (Twilight) Anesthesia: the patient is given an iv, and is made sleepy with medications given through the iv. The level of sedation can be adjusted, from barely sleep to very sleepy. Sometimes sedation is given by the surgeon, and other times it is administered by an Anesthesiologist.


• General anesthesia: the patient is asleep, requiring that the airway be protected, either by a standard breathing tube, or by a laryngeal mask (LMA), an inflatable mask that goes in the back of the throat but doesn’t go down the trachea. Through the airway, an anesthesiologist gives gases to put the patient asleep. Drugs may also be given through the iv.


• Tear trough:A groove below the lower eyelids extending from the nose across the upper cheek.


• Nasolabial fold:The crease that extends from the side of the nose to the corner of the mouth.


• Mesolabial fold (marionette lines): The crease that extends from the corner of the mouth down the side of the chin.


• Jowls:Soft bulges that sag along the jaw line, usually caused by loss of muscle tone in the lower face.


• SMAS:the Superficial Muscular Aponeurotic System, the superficial layer of muscles in the face just below the skin and subcutaneous fat.


• Hematoma: An unwanted collection of blood under the skin.


• Hypertrophic scar:a hyperactive, usually temporary scarring process that makes a scar raised and red, sometimes called a “baby keloid.” More common in patients with pigmented complexion and more common on the chest, trunk, and shoulders. Very uncommon on the face and neck.