Facelift Necklift in Columbus, Ohio

A Rhytidectomy, or facelift, will give your face a more youthful, fresher look and in the process, boost your self esteem. Aging is inevitable. Unfortunately as we age, our skin looses its elasticity. We begin to experience laxity, sagging and thinning of our skin. Heredity, personal habits, gravitational affects and sun exposure all play a role. No where are these aging changes more evident than in our face and neck. While facelift surgery has become the third most desired facial plastic surgical procedures, it is typically one of the least understood.

What is a facelift?

In years past the word rhytidectomy, or facelift, referred to a surgical procedure which corrected skin laxity along the jaw line and neck. Facelift patients often stayed in the hospital for three to four days after surgery, and seemed to drop out of society for many months. Suddenly when they reappeared, the changes were so dramatic that everyone knew they had had plastic surgery. Although the term "facelift" still refers to corrective cosmetic surgery of the jowl and neck, the advancements in facelift surgery in recent years has come a long way. Today's facelift involves lifting and tightening skin, muscle and soft tissue, resulting in a more natural appearance, longer lasting improvement, and in many cases faster recovery. However, as new techniques have developed, there seems to more and more confusion as to what does "facelift" really mean and who is best qualified to perform their facelift or rhytidectomy.

When I am asked to examine someone's face, I like to divide the vertical dimension of the face into thirds. The upper third of the face is that area from the hairline to the eyebrows. Aging in the upper third of the face results in laxity of the forehead, temple skin, or eyebrow hooding. These changes are best treated by a browlift or forehead lift (refer to Browlift). Some individuals refer to surgery in this area as an upper facelift which is a source of some confusion.

The mid-face extends from the lower eyelids to the mid-upper lip. Laxity in this area is often best addressed by a mid-facelift (refer to Mid-facelift) or fat injections (refer to Fat Transfer). The area from the mid-upper lip to the lower neck is simply referred to as the lower face and neck. A lift in this lower one-third of the face is what most of us envision when we hear the word ?facelift? or cheek-jaw-neck lift. But this is probably the region of most confusion because of terminology created by some entrepreneur physicians trying to create a marketing advantage.

I commonly refer to the surgical lift in this area as a lower facelift. A lower facelift will make improvements in four areas: the nasolabial fold (crease between the cheek and upper lip), the marionette lines (crease just below the corners of the mouth), the jowl (sagging along the jaw line), and the neck down to level of the adams apple. Not all patients need improvement in all four of these areas. The beauty of the lower facelift procedure is that it can be customized and almost always is to the individual depending on their specific needs and desires.

Not all facelifts are equal:

The lower facelift procedure has come a long way since 1901 when Hollander devised the surgical "lift" and 1931 when Lexner described the "S-lift". Contrary to those procedures, today?s state of the art facelift or rhytidectomy techniques include tightening of the skin, the muscle layer, and the fatty tissue layer. All of this is done in such a way to give a natural appearance and one that will last for a very long time.

Unfortunately, trademarked facelift procedures have begun cropping up which capture the publics' attention with catching slogans, bold claims, and slick advertising campaigns. The nature of these procedures however is counter to the basic tenants of medicine, which is information sharing and openness so that everyone can benefit. Quite the opposite has occurred and "facelift" is being sold like a McDonald's franchise. These franchises are out there under a variety of names, and although the business models are slightly different, they pretty much work the same way. The corporation identifies a city with appropriate demographics and finds a doctor who is willing to "buy in". The doctor agrees to perform the proprietary technique in exchange for referrals regardless of whether that technique is appropriate for a particular patient. The monetary payback by the physician is substantial for promotion and advertising.

According to Plastic Surgery News (September 2007) the marketing efforts related to these proprietary procedures often target consumers desire for pain-free convenience: minimal down time with no anesthesia, incision, or bandages. However, there is a growing concern that the entire industry of so-called "trademarked quick procedures" may actually compromise patient safety because the surgical methods they employ are often kept secret through licensed confidentiality agreements, which rule out proper testing, study or peer review. When I am asked by my patients about these procedures, my response is always the same. I recall a lesson I learned from my parents long ago "if something sounds too good to be true, it probably is." When searching out any cosmetic procedure these days "buyer beware". Do your homework.

The facelift consultation:

A rhytidectomy, or facelift, is no different than any other facial plastic surgery procedure in that good health and realistic expectations are a prerequisite. During the initial facelift consultation, your surgeon will examine the structure of your face, skin type, hairstyle and degree of skin elasticity. We all age differently, some faster than others. It is sometimes useful to evaluate your own unique aging experience by examining photographs taken over the last ten to fifteen years. Your facelift surgeon will take a thorough medical history, especially as it relates to blood pressure, scar tendency, smoking, weight, and any deficiency in blood clotting. Safety should always be the number one priority with any elective cosmetic procedure, and facelift is no different. Candidates with chronic medical conditions may be asked to obtain medical clearance from their personal physician prior to undergoing a facelift or rhytidectomy.

Smoking causes the small blood vessels feeding the skins surface to constrict, resulting in less blood flow and possibly poorer or slower healing. It is essential that facelift patients stop smoking for at least one month prior to the procedure. Ideally facelift surgery should be performed when individuals are at their ideal weight. Weight loss of less than twenty pounds usually won't affect the surgical result. However, candidates who anticipate a twenty to twenty-five pound weight loss are advised and encouraged to lose this weight prior to the procedure. Even though the facial skin may appear more lax with weight loss, the ultimate result after a facelift will be better.

During the facelift consultation, your surgeon may notice a fatty collection under the chin or separation of the anterior neck muscle, which results in two long vertical bands extending from the chin to the collar bone. Both of these situations contribute to blunting the angle between the chin and neck or giving a "double chin". Submental liposuction and sewing the muscles back together (platysma plication) may be recommended for a more optimal facelift result.

Chin resorption, or a weak chin, may also contribute to a weak chin-neck angle. Our bony skeleton gets smaller as we age, particularly along the lower jaw bone. Some facelift candidates have always had a weak chin. The facelift result can be enhanced by chin augmentation with an implant at the same time of the facelift surgery.  Chin augmentation is helpful in approximately 20% of my facelift surgeries.

Because a realistic attitude is crucial to the success of any elective surgery, the facelift procedure and what can be realistically expected as a result of this procedure will be fully discussed. There are risks and potentially complications which may occur with any elective cosmetic procedure. The specific risks and possible complications as they relate to rhytidectomy or facelift will also be discussed at the initial consultation.

The facelift procedure:

For optimal facelift results, with current state-of-the-art facelift techniques, general anesthesia is often recommended. However, some patients may be candidates for twilight anesthesia or local anesthesia depending on an individual's medical history and the specific facelift technique which is to be performed. The type of anesthesia will be fully discussed prior to the procedure.

Unsightly facelift scars are devastating and unacceptable. Therefore, incision planning is vitally important to the success of the facelift procedure. Care should be taken to hide the scar in the hairline and along natural creases. For women who like to wear their hair pulled back should expect to confidentially be able to do so after the facelift procedure. The hair should never be shaved for this procedure. The male facelift incision is slightly different than that used in females to accommodate the beard pattern. Shaving after facelift surgery may be altered slightly because a small area of bearded skin may be pulled up behind the ear. However, because of the beard and ruddy skin color in most men, male facelift incisions usually blend in very soon after the procedure.

Every facelift is customized to the individual patients' specific needs. However in general the skin of the face and neck is elevated so that the underlying muscle and fascial layers can be identified. It is the suspension of these deeper layers which act like suspenders to provide a more effective tightening without a stretched or pulled look. Depending on the extent of the surgery, the process can take from two to four  hours. When the facelift is performed with a combination of local anesthesia and a mild intravenous sedation, the patient will experience mild discomfort. A facelift dressing is applied following the procedure and is removed one to two  days later. A small drainage tube may be inserted at surgery. It will also be removed one to two days after surgery. Both the dressing and the drains help to minimize bruising after the facelift procedure.

My goals in performing facelift surgery are two-fold: 1) to get the very best possible result I can achieve for my patients, and 2) to get my patients back to their normal life as quickly as possible. The dressing, drains, and several prescribed medications help in this regard.

Because post-operative bleeding is always a concern following facelift surgery, patients remain in the recovery area for one to two hours after the procedure for observation.

After your facelift:

Most facelift patients experience little if any pain after surgery. However pain medication is often prescribed, just in case, before surgery. Frequently patients find that Tylenol or Extra Strength Tylenol is helpful if they need mild pain relief. Of course, Aspirin, Advil, Motrin, and any other medications which might interfere with blood clotting, are avoided before and after facelift surgery. Some degree of swelling and bruising is unavoidable and expected. Ice and head elevation can be quite helpful to minimize both. Exertional activity should be avoided for four to five days. Patients frequently begin light walking at this time.

All sutures are removed within seven to eight days of a facelift. At this time, make-up can be applied to this incision for camouflage. Most facelift patients can confidentially resume work and social activities within seven to fourteen days after facelift surgery. Full physical activity can be resumed in two weeks.

Our bodies only know one way to heal and this takes time. Facelift patients look good at ten days to two weeks. Every day thereafter, facelift patients will see improvement. However, it will take four to six months before the final surgical result is ultimately experienced.

Facelift surgery makes it possible to correct many facial flaws and signs of premature aging that can undermine self confidence. By changing how you look, cosmetic surgery can help change how you feel about yourself.

Frequently Asked Questions (FAQ) about Rhytidectomy:

What is the typical age of a facelift candidate?

We all age at different rates. This is often dictated by the genes we inherit from our parents, the effects of gravity, environmental damage from the sun, smoking, and fluctuations of weight. However, most facelift patients present in their forties to seventies. During these years the skin usually continues to have good elasticity which is essential for a natural and lasting facelift result. Patients with thin skin and less elasticity are still candidates for facelift surgery; however the result may not last as long. These patients may experience some premature looseness of the facelift result, which can be recaptured by a minor touch-up procedure within the first one to two years.

Will the benefits of facelift surgery be permanent?                                                           Cosmetic surgery doesn't stop the biological clock of aging, it merely resets the clock. The face continues to age after facelift surgery. However, state-of-the-art techniques give a longer lasting improvement. Patients are typically pleased with the results for eight to twelve years. In addition, the effects of even one facelift will continue to be noticeable; you'll look younger than if you had never had a facelift at all. These days it's not uncommon for patients to have a second or sometimes a third facelift in their lifetime. The key however is proper planning and the performance of the initial facelift procedure.

What are the risks and potential complications with facelift?

Risks and possible complications can occur with any type of surgery, including facelift surgery. By choosing a Facial Plastic Surgeon that performs facelift surgery frequently, you will minimize these risks as much as possible. Bleeding is a concern with facelift surgery. Everyone will experience a little bleeding, which will result in mild bruising. However, when more than the expected amount of bleeding occurs after surgery, it may develop into a hematoma (a collection of blood under the skin). This is not life threatening, but can slow down the healing process and result in considerable bruising. Treatment involves opening the skin to evacuate the blood. Smokers and patients with uncontrolled blood pressure are at increased risk for bleeding after facelift surgery. Dressings, drain tubes, ice, Vitamin K, and bruise cream are all recommend to decrease the likelihood of bruising after facelift surgery.

Temporary numbness around the earlobe is an expected side effect with facelift surgery. Normal sensation should return in three to six months. The facial nerve is important for facial expression. Facial nerve branches are at risk with facelift surgery. Fortunately these nerve branches are much deeper and are rarely injured. Infection is a concern, however occurs infrequently. Prophylactic antibiotics are always prescribed.

What is the next step?

If you are interested in exploring the possibility of a rhytidectomy, call The Sullivan Centre, central Ohio's only free standing ambulatory surgical facility dedicated to cosmetic surgery at (614) 436-8888.