What is rhytidectomy / Face lift?
I am glad you asked that question. Simply put, a rhytidectomy is a removal of rhytids, which are the medical term for wrinkles. Most women and for that matter men see themselves aging by looking at the mirror. They see the signs of age and most often people feel the sign of aging is wrinkling. For this reason, one of the most common procedures that individuals undergo for looking younger is a facelift.
The exact procedure involves first understanding the face in three parts. The face is broken down into the upper face, the midface and the lower face or neck. In this way each one of these can be addressed to make someone look younger. The surgery can be and should be tailored to the patient. Some patients really have a sagging neck, while others do not. In this way, the same operation does not necessarily fit for each patient. This being said, a full facelift involves operating on all three of these areas.
First, the forehead is addressed by lifting the forehead and removing 1 to 2 centimeters of skin. This again all depends on how the patient looks and what their needs are. The incision is usually placed immediately at the hairline. Another way of addressing this is to use camera and try to free up the skin of the forehead and tack it up 1 to 2 centimeters higher. However, this should only be done with patients with a low hairline. Otherwise, their hairline is unacceptably retracted.
Once the upper face is addressed, one then looks at the midface. This is the place most patients see and wish to undergo change. Most patients can see how a midface lift can help them by simply looking in the mirror and slowly pulling their skin back towards their ears. The incisions for this operation are placed before the ear, and tend to go slowly behind the ear and they are then hidden mostly behind the ear and in the hairline. Using these incisions, the skin on the cheeks is freed up and is able to be mobilized. The underlying tissue is elevated as well and then supported over the cheeks to give a fuller look. Once the underlying tissue is supported, then the excess skin on the cheeks is removed. This tends to get rid of the wrinkles at the cheeks and at the area between the nose and the cheek. Care must be taken here not to overdue it and so not give the patient a retracted “pulled” look.
The last part of the facelift is the neck lift. This is done so that the neck also is tightened and matches the rest of the face. Neck lifts can be somewhat challenging at times. The neck has to be tightened by using the underlying muscles of the neck and then tying them together in line like a corset. This corseting procedure tends to allow the muscles to smooth out and give a form fitting look. Care must also be taken though to suction excess fat out so that the area does not look plumb. Along with the excess fat, the fatty tissue at the jowl line needs to be removed. This is usually done by liposuction or by actual physical removal. Again, the neck is often an overlooked component but if it is done correctly, it adds tremendously to the facial rejuvination, and the new look.
Is this surgery covered by insurance?
What are the possible complications of a face lift?
Like any surgery, there are risks and complications. With facelifts, the complications can be bleeding, infection, shock, numbness, asymmetry, facial nerve injury, necrosis of the tissues, dehiscence or breakdown. Of these the most often we see bleeding and numbness as issues. Bleeding can be easily managed. More importantly however, bleeding can best be prevented by the patient. Patients need to be off of any type of blood thinners such as coumadin, aspirin, plavix, and must also be off of vitamins and additives for at least three weeks. It may sound strange but many of the bleeding complications seen are due to the use of vitamins. Another complication that is seen is numbness or nerve injury. Many of the nerves to the face are rather superficial. In this way, they are very close to the skin. Other nerves like branches of the facial nerve tend to be in the area of the intended incisions. Because of these two facts, many patients complain of significant numbness in the areas and incisions around the facelift. These then slowly heal and the sensation does return. There are also several places in the face that motor nerves can be injured and cause a functional problem such as difficulty to smile. Again, most of these return. The longest I have seen for this to take and for the problem to correct without an intervention is about 6 months.
How painful is the procedure?
Like any surgical procedure, there is pain involved. Most patients comment that they have a mild to moderate amount of pain. Most of the pain seen with facelifts is usually related to swelling. Most patients complain that they have a tremendous amount of swelling and therefore their faces feel full. This is the cause for most of the angst and not the actual pain level. Most patients do not really complain of pain. Actually most speak about the fact that they are just soar.
To treat the pain, we routinely keep patients on post-operative oral pain medicines. We have many to choose from. Again, like the level of pain that can be related to ones tolerance, the treatment for the pain can be individualized to give the patient the most amount of relief.
How long do I have to take off from work?
Great question. Most often I suggest to patients that they consider taking about 1 to 2 weeks from work. Let me elaborate. Once the operation is completed, the area involved becomes swollen and in many cases becomes extremely bruised. This area then slowly goes through healing. I ask most of my patients to start walking by day#2. I ask them to stay away from exercise at the gym for about 4 weeks. I believe this prevents the development of excessive swelling. As for work though, most patients are fairly comfortable in returning by week 3. However, this does depend on what type of work the patient does.
Can I combine this procedure with any other procedure?
Yes. Like any surgical procedure, there are limits to what can be done and what is safe. As for the yes, it can be combined with some other procedures. Multiple other procedures like a facial peel or laser therapy and ablative facial neck procedures are routinely performed. Any procedure that may be too long or too arduous and place the patient at risk for significant bleeding or significant anesthetic exposure would have to be deferred and done in two stages. Please understand I say this without knowing exactly what you, the patient, may have in mind. I can only speak from my experience.
Am I a good candidate?
Plastic surgery is not for everyone. It involves certain risks like any operative procedure. As long as you are aware of this fact, you can be considered for the procedure. However, in every case, the patient is best served by a thorough evaluation of their history, their body and
their overall expectations. You as the patient have to be realistic and cognizant of what is possible and what is reasonable. Trust me, I am from Beverly Hills and I have had the privilege of working with many of the famous groups of plastic surgeons in LA. I can simply tell you there is no magic. We offer an opportunity to help you with surgical procedures in correcting what you may think is abnormal about your body. Also please understand that for many patients no surgery is needed; just a friendly word of encouragement and confidence from the local plastic surgeon.