A facelift, or rhytidectomy, is a surgical procedure that aims to reduce the signs of aging in the face and neck. During the procedure, the underlying muscle layers of the neck, jowls, and the cheeks are tightened, and excess skin is removed.
One basic principle in facelifting is that the soft tissues of the face (skin, fat, and muscle) have begun to sag and create a deepening of facial creases and descent of fat pads in the cheeks, jowls, and neck. Jowls form along the lower jaw and the tissues of the neck tend to sag as well.
The goal of facelifting is to re-suspend those tissues into the natural position where they started, thereby creating a more youthful appearance. In addition to the effect of gravity and sagging tissue, faces also tend to lose volume as we age.
In addition to the skin, muscles, and fat pads in the face and neck, there is a structure referred to as the SMAS (Superficial MusculoAponeurotic System). This structure serves as the basic underlying structural framework of the tissues of the face. Suspension of the SMAS into a natural position is the key to any successful facelifting procedure. Of note, these procedures address the sagging of tissues.
Over time, many procedures have been developed to improve this aged appearance promising maximum results with minimum recovery time or incisions. More recently, Facial Plastic Surgeons agree that the more extensive the surgery, the more significant and long-lasting the results.
The method by which this is accomplished usually depends on the individual patient–the range of options being tailored to meet a patient’s specific anatomy, preferences, and expectations.
Facelifting techniques differ with respect to the length and design of the incision and the amount of dissection (and therefore the amount of tissue suspended) performed on the deeper tissues of the face, especially regarding the management of the SMAS tissue.
With this technique, a minimum length incision is placed in front of the ear and extends a variable length below the earlobe, behind the ear and into the hairline. Limiting the incision length also limits the amount of dissection of the soft tissues of the face, including SMAS, thereby limiting the amount of lift that may be achieved.
Some of these procedures do not include any suspension of the SMAS and are essentially just a lift of the skin. When performed in this manner, it may provide for a quick recovery but limits the long-term results, and, more importantly, may result in wide, highly visible scars.
Depending on each patient’s anatomy, a shorter scar may be possible while still allowing for adequate exposure to address the areas needed to provide for the patient’s best possible result safely.
The traditional approach to a facelift employs an incision that begins in front of the ear with extension into or around the sideburn and extends below the earlobe, behind the ear, and into the hairline posteriorly. Dissection is performed with the skin elevated and the SMAS is suspended via one of several techniques.
The deep-plane facelift is an extension of the traditional facelift dissection of the deep tissues into the cheek. By performing a more extensive dissection, there is a more complete lift that is able to be performed with longer-lasting results. This procedure may be associated with a longer recovery and has an increased risk of nerve weakness or paralysis of the facial muscles that are almost always temporary but in a small percentage of cases, can be permanent.
Correction of sagging tissues in the neck is performed through a limited facelift incision. It can correct mild to moderate jowls as well as sagging skin and excess fat in the neck. In some patients, sagging muscle produces a characteristic “turkey gobbler” appearance. This may be able to be corrected via a small incision hidden beneath the chin or may require a limited facelift incision as well. In some younger patients, it can achieve a significant improvement in neck contour, especially when seen from the side view.
Liposuction of the neck and face is often combined with some of the above procedures in order to achieve a more complete rejuvenation. This is performed through the same incisions as described for the facelift and/or neck lift.
Another key issue in most aging face procedures involves the restoration of facial volume with Facial Fillers and Injectables and Facial Fat Transfer. These are often performed concurrently with some of the lifting procedures.
A liquid facelift or non-surgical facelift is a procedure performed with injections to rejuvenate the face. It usually consists of Botulinum toxin to improve the wrinkles in the upper third of the face (e.g., crow’s feet, horizontal forehead lines, and glabellar or frown lines). Dermal fillers are then used to elevate the cheeks and smooth the nasolabial and marionette folds. The limitation of a liquid facelift is that it does not treat the sagging neck or heavy jowls.
During your consultation, Dr. Pero will ask you about your concerns about facial aging, whether the onset was slow over time or recent in the last few years. He will also ask you about your facelift surgery goals.
Following that discussion, Dr. Pero will perform a thorough physical,
Information gathered from this consultation (a lengthy discussion, including intraoperative details and post-operative care and expectations) will help to formulate an ideal treatment plan tailored to your specific needs and aesthetic desires.
Initially, you may not see the full results of the surgery until several months later. Once you are completely healed, however, you can expect the results to last up to 10 years.
Up to 70 percent of facial swelling subsides within 3 weeks after surgery. The remaining swelling may take up to 3 months to resolve.
Patients should refrain from any strenuous activity up to 3 weeks after surgery.
Patients may return to work and daily activities within 2 weeks after surgery.
You will have nearly imperceptible scars after facelift surgery, as Dr. Pero hides all incisions inside the hair, behind the tragus (post-tragal), and in facial creases. He uses a technique that places the pull and tension on the deep tissues rather than on the skin itself, which yields a better result.
As with any surgery, there are always risks with anesthesia. Other risks may include a hematoma (a collection of blood under the skin) or infection. A hematoma can be drained in the office and infections can be treated with an antibiotic. To decrease the risk of infections, patients are given an antibiotic before and after surgery.
The facelift surgery takes about 3 hours to perform and may take longer if there are added on procedures.
Dr. Pero performs the facelift surgery on an outpatient basis under general anesthesia.
Dr. Pero requests that his patients obtain pre-operative labs several weeks before surgery. Other requirements may include
Also, be sure to arrange for someone to drive you to and from surgery and to stay with you for at least the first night following surgery.
Most patients choose to have facelift surgery in their mid to late forties (or later) when they see the first signs of facial aging. Others may choose to have it done at a younger age due to premature facial aging, poor congenital neck contour, or after excessive weight loss.
Before having facelift surgery patients should have a clear understanding that it “does not stop” the aging process, but rather “turns it back.” The natural aging process continues after the procedure.
Patients should also understand that there are sometimes limitations to what can be achieved. If you have poor skin laxity in the neck, for example, your surgeon may not be able to produce a tight neck contour.
To avoid any misunderstandings or misconceptions, clear communication with your surgeon during your consultation is very important.
If you are interested in discussing facelift surgery with Dr. Pero, please call (214) 382-5100 to schedule a consultation.
11970 N. Central Expressway
Suite 410
Dallas, TX 75243
Legacy Medical Village
5425 W. Spring Creek Parkway
Suite 145
Plano, TX 75024
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