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Introduction: Putting Your Best Face
Forward
Although
I have not had one of these, I am sure I will one day. When my time comes, I'll
be first in line! Many, many, many people -- from late 30's to a 100 or so -- choose to
undergo face lift (Rhytidectomy or Rhytidoplasty) to enhance their features and restore their youthfulness.
Many young professionals undergo this procedure to gain an edge in
their field. It is a known fact that a youthful attitude and appearance is
sought after in the professional world. Remember, this isn't an ideal
world. When in Rome...
What is
a Face Lift?
Also known
as Rhytidoplasty or Face Lift, this operation is designed to reduce sagging and
wrinkling in the lower face and neck. It does not correct problems around the
eyelids, at the corners of the mouth (unless a mid-face lift is used, but there
still is no ideal nasolabial lift) or the creases at the lips. This operation
may be chosen for one of two reasons: to help prevent the advancement of aging,
i.e. to help relatively young individuals (40 and younger) to appear to stay
young, or it may assist one who is already wrinkled or whose skin sags to appear
younger and fresher. The amount of improvement depends upon the degree of
wrinkling and sagging already present. If minimal, then changes may be subtle
but the aging process appears markedly retarded. If the wrinkling and sagging is
great, then the results can be very dramatic.
Understanding
the Underlying Structure of the Face
To better understand what muscles are lifted and what muscles are responsible
for what actions, I have included diagrams for your convenience. They will
each load in a separate window so that you may read the information and view
the diagrams for cross-reference.
 |
 |
 |
 |
 |
facial,
neck & scalp muscles
(lateral view) |
cheek
muscles
(lateral view) |
eye
muscles
(lateral view) |
neck
muscles
(lateral view) |
neck
muscles
(anterior view) |
*these images load in another window
for ease of reference*
Diagram credit: Gray's Anatomy
Discussing the anatomy of the
face, in depth, with English translation in [...].
This will better help you understand what the surgeon wants to do with your
face. Since surgeons seem to speak in another language I have supplied the translations
directly after the words that may be questionable.
"Anatomy:
The SMAS
[Superficial (or Sub-)
Musculoaponeurotic System] is a cervicofacial
[lower facial and upper neck area] layer of
tissue made up of both fibrous and muscular elements that enmeshes and
distributes force among the facial mimetic [simulating the action or effect of;
mimicking] muscles. In the scalp, the galea
[: the
aponeurosis (or : any of the broad flat sheets of dense fibrous collagenous connective tissue that cover, invest, and form the terminations and attachments of various muscles)
underlying the scalp and linking the frontalis and occipitalis muscles (look
at the diagrams, the front top of the head) -- called also epicranial
aponeurosis]
is synonymous with the SMAS. As it proceeds inferiorly the SMAS is made
up of the superficial temporal fascia
[: a sheet of connective tissue (as an
aponeurosis) covering or binding together body structures]
or
the temporoparietal
[: of or relating to the temporal and parietal bones or lobes]
fascia. At the level of the zygomatic arch
[: the arch of bone that extends along the front or side of the skull beneath the orbit and that is formed by the union of the temporal process of the
zygomatic bone in front with the zygomatic process of the temporal bone behind;
zygomatic means cheekbone, in English
 ]
, the SMAS is discontinuous and is not used as a surgical plane because
of risk to the frontal branch of the facial nerve. Below this level however,
the SMAS becomes substantial again, and exists superficial to the parotid
fascia [of or near the parotid gland
[: a salivary gland that is situated on each side of the face below and in front of the ear, in humans is the largest of the salivary glands, is of pure serous type, and communicates with the mouth by the parotid
duct)]
. Anteriorly, at this same level, this layer envelopes the zygomaticus
major muscle
[: a slender band of muscle on each side of the face that arises from the zygomatic bone, inserts into the
orbicularis oris [: a muscle made up of several layers of fibers passing in different directions that encircles the mouth and controls most movements of the lips)
and skin at the corner of the mouth, and acts to pull the corner of the mouth upward and backward when smiling or laughing].
Because this muscle has cutaneous [: of, relating to, or affecting the skin]
attachments at the nasolabial [those pesky lines fromthe
side of the nose to the corners of the mouth] crease, traction on the
SMAS pulls directly on this crease to actually widen and deepen it. In the
neck, the platysma is the SMAS layer with dehiscences
[: the parting of the sutured lips of a surgical wound]
at the midline and lateral to the angle of the mandible [jaw
bone].
The blood supply to the
flaps [: a piece of tissue partly severed from its place of origin for use in surgical grafting]
elevated in facelift surgery come from branches of the external
carotid arteries [: the outer branch of the carotid artery that supplies the face, tongue, and external parts of the head -- called also external
carotid].
The majority of the supply exists with the branches of the facial and infraorbital
arteries [: a branch or continuation of the maxillary artery that runs along the infraorbital groove with the infraorbital nerve and passes through the infraorbital foramen to give off branches which supply the face just below the
eye].
These are musculocutaneous [: of, relating to, supplying, or consisting of both muscle and skin]
branches. Because dissection [1 : the act or process of dissecting or separating]
is carried out under the fascial layer, it is important to leave fibrous septa
[of the septum] attached to the flap, especially
in smokers. This allows preservation of the septocutaneous vasculature
[the
tissues around the nose and its blood supply] without compromising flap
mobility."
credit: Rhytidectomy; Grand Rounds, Dept. Otolaryngology UTMB, 11/06/96
In English, without all the
medical mumbo-jumbo, that means that the SMAS enables us to be animated and
not all stone-faced. And that when they separate the skin and tissues from the
underlying structure they must be careful -- especially around the nose area (and
definitely in those patients who smoke) -- because quite frankly, necrosis (or
cell/skin death) can occur if the flap (tissue that is temporarily, partially unattached
from your body in order to move it, resituate it or whatever) loses it's
blood supply for very long periods of time, through improper healing, suturing,
swelling or otherwise. Now that that's out of the way let's get down to the
nitty-gritty, shall we?
The
Different Types Of Face
Lifts
There are several available techniques and styles of the face lift --
some correcting or improving all areas of the face and some that were designed
to enhance only specific sections. Unfortunately, it seems that different
surgeons have different ideas of what these following types are. So, I have
included all the types and versions that I know of.
-
Standard,
Conventional or Traditional Lift: Is
designed to lift sagging skin and its deeper structures (sometimes). The
incision lines are usually along or behind the hairline. The skin is excised
and the skin of the face is brought tighter and lifted and sutured. It is
possible that one surgeon may consider a skin-only facelift a traditional while
another may re-suspend the fat and muscle.
-
SMAS
(Superficial (or Sub-) muscular Aponeurotic System) Lift: The
SMAS is responsible for your facial movements. Without it you would not be able
to smile or appear animated. This area is lifted up and out -- diagonally
would be the best way to explain it. This can be done with the Platysma lift
(neck lift) for increased rejuvenation. Read more below.
-
Platysma
Lift (neck lift):
in conjunction with a SMAS lift -- this is the best usually, but most expensive
and a longer operation. With the Platysma lift, the platysma muscles are
tightened and then sutured as well as the hanging skin and excess fat is
removed to result in a more youthful neck, post-operatively. See Diagram
-
S-Lift:
This
procedure was innovated in the late 1960's; although German surgeons further
perfected the procedure before it's transcontinental migration to the US.
This procedure can be performed on patients in their late 30's to even their
80's on upwards. The incision is directly in front of the ear and the layers
are moved and pulled laterally. The lift is for the lower third of the face.
The upper areas and eye wrinkles are not affected. The jaw line, jowls and
neck can be smoothed this way -- all under local anesthetic and oral sedation
I (valium or otherwise).
-
Mini
Lift: Some
surgeons consider the lateral lift with incisions directly in front of the
ear only, a mini-lift of sorts. It can sort of help with nasolabial folds.
-
Mini
Lift (with suture suspension):
although some deem this surgery unethical, this surgery is where sutures
are anchored into the underlying muscle and is suspended by anchoring the
ends with non-dissolvable thread to the frontalis (front-top) of the head.
-
SOOF (suborbicularis Oculi Fat) Lift:
Being Updated
-
Temporal
Lift:
(lateral brow lift) Some
like it, some don't. The lift is usually superficially supported by the
skin at the temporal area (above the ears -- your temples). You may
have seen it called the Angel Eyes brow lift. I am getting this one
this year.
-
Subperiosteal
Facelift: This technique was designed to lift the sub-orbital
area as well as the midface. The suspension... "is accomplished by
anchoring mattress sutures to the cut edges of the temporalis fascia on the
flap, and tying them to approximately two cm above the superior incision in
the temporalis fascia. As in a coronal browlift, the appropriate skin
excision is accomplished and the skin is closed. Ramirez felt that in his
series, the perioral and periorbital tissues were rejuvenated by this pull,
areas that the standard lifting techniques could not access. His
complications were limited to a single hematoma that resolved spontaneously,
and the above mentioned frontal branch paresis. Although 20% of the subjects
were smokers, no flap necrosis was seen, likely a result of the flap
thickness." Ramirez O. Subperiosteal rhytidectomy: The third-generation
facelift. Annals
of Plastic Surgery 1992;28(3):220.
-
The
Deep Plane Lift: This
facelift is a relatively new procedure It is performed in a deeper plane
than in the standard face lift. This
procedure is like a SMAS lift with a little extra oomph for the nasolabial
area (those pesky grooves that run from the side of the nose to the lips.
Unfortunately, lateral tension on the SMAS deepens the SMAS so the deep
plant lift was designed with the use of a longer flap elevated with optimal
vascularization. The nasolabial folds will be improved by lifting the sagging fat pad
that causes this fold. At the same time, this pad will be repositioned
upward and backward, improving cheekbone definition. As this procedure is
performed in the deeper plane, there is a higher risk of facial weakness
after the procedure. The benefits to the neck and jaw are the same as with
the standard facelift. "The risk is higher of facial nerve injury,
however. Other benefits, though, include improved rejuvenation of the
nasolabial fold, ptotic malar fat, and sagging orbicularis oculi
muscles." --source:
Rhytidectomy; Grand Rounds, Dept. Otolaryngology UTMB, 11/06/96
Are You A Candidate For
a Face Lift?
If you are in good physical and
emotional/mental health, have realistic expectations, no serious health
threats and have the desire to rid yourself of loose sagging skin of the face
and neck, you may be a good candidate for a face lift. An "ideal" patient would have elastic skin and great underlying bone structure.
Also, if you are considering losing weight you should wait
until after your desired weight is met. You may need additional surgery to
remove the excess skin after you have lost the desired weight which would mean
that the money spent on the previous face lift would be wasted. But it is definitely not unheard of for people to have several
face lifts
in their life.
What To Expect At Your
Consultation
After finding several qualified and skilled surgeons
you will want to schedule consultations with them. These appointments will
give you the opportunity to discuss your needs and have the surgeon tell you, in
his opinion, what it is he thinks you will benefit from. The surgeon or
staff should ask for your
complete medical history. It is advisable to go over any medical records to
refresh your memory prior to your meeting with the surgeon. The surgeon or his
staff should
ask but if he does not, be sure to disclose any allergies that you may have,
disorders, past illnesses and if you are a smoker. If you are, make sure you cease smoking way before your
procedure. Smoking greatly increases lack
of vascularity promoting necrosis (death) of skin, improper healing and excessive
scarring. I am serious. Quit beforehand and stay quit! Be sure to advise him of the
medications, if any, you are taking. This includes, vitamins, herbal
supplements, over the counter medications, etc. You should not take any aspirin
containing products at least 2 weeks prior to any surgery, unless otherwise
instructed. See
Medication & Supplement List. Also, your surgeon may or may not advise
you of the benefits of Arnica montana for swelling and bruising. Would you like
to learn of the benefits of Arnica
montana? Read also about the benefits of Bromelain.
You will also discuss the available anesthesia
that will be used for your procedure. Most face lift procedures are
performed under General Anesthesia or Light Sleep Sedation. Either way, discuss
this beforehand. If
you do go under General, you make sure that the anesthesiologist
is certified! Please
read the All About Anesthesia Page -- the risks regarding going
under are a whole different ball game entirely.
Also so you will discuss the complications and
risks of face lift. If he does not discuss with you the risks of your
surgery, you should be very wary. You will discuss where the surgery will be
performed as well as after care and post-operative visits. He will discuss with
you all of the aspects of surgery.
He should advise if he feels as if you have excess fat, skin or
even atrophied muscle that needs to be removed. You will discuss the incision
placement, the realistic expectations you should have and what other options you
may have instead of surgery. You will also discuss fees, medication costs and
any hidden costs that may arise.
Want more
help on Consultations?
Preparing
For Your Surgery
You will be given a pre-operative information packet that explains everything
you should do and know before your surgery date. The packet should include
all the medications you should not take for up to 2 weeks before your surgery.
These medications will include, but are not limited to, aspirin containing
products. Would you like to view a typical Medication
& Supplements List? Also, your surgeon may or may not advise you of the
benefits of Arnica montana for swelling and bruising. Would you like to learn of
the benefits of Arnica
montana?
It is quite possible that you will have
preliminary blood work
performed. This is normally an extra out-of-pocket expense that the patient must
participate in to check your white and red blood cell count (complete blood
count, CBC) which may alert your surgeon to disease or disorders beforehand. You
may also be instructed to have a physical. Please quick smoking at least 2
weeks before your surgery. This will highly reduce your risk of necrotic tissue!
Don't mess around with this. Smoking and major surgery like this can make your scars huge and ugly and not
heal well at all. This is your face and life -- this isn't shopping for shoes.
So many things to do... so little time. Surgery will be here before you know
it so visit the Preparing
For Surgery page and relax. This section contains, printer-friendly pre-op
lists, tips and advice as well as things you must do to prepare for your big
day.
How A
Face
Lift Procedure Is Performed
A face lift normally
takes from 2 to 5 hours to perform. If you are having a Platysma (neck) lift the
surgery will last closer to 5 hours.
Before the surgery begins, your surgeon will mark the incision sites and natural
folds while you are upright with a Sharpie type marker. These incisions
will follow along the natural lines and creases by the ear, neck, wherever and
whatever type pf lift you will be having. All efforts possible should be made in
order to achieve inconspicuous scars.
Anesthesia will be
administered and after it is determined you are completely sedated and your
vitals will be determined as stable and your surgeon will make the required
incisions. First a mixture of Lidocaine (a pain reliever which also
hinders autonomic responses such as rapid heart beat and swelling to the injured
area) and epinephrine (a vasoconstrictor which narrows the bore of the blood
vessels which decreases intra-operative bleeding and hinders the absorption of
lidocaine) will be injected into the incision
areas or possibly into a nerve cluster for regional anesthetic properties.
Your surgeon may also flush the area to be dissected with this mixture as
well.
He or she will then
dissect [: to separate or follow along natural lines of cleavage (as through connective tissue)]
the tissues from your underlying structure, depending upon the type of lift and
desired results. This is like separating the skin and muscle from your skull.
He
will then proceed to either excise excess, loose skin and suction or remove
excess fat manually, or possibly atrophied muscle. Underlying structures are
then suspended by permanent sutures. Some surgeons work on one area at a time,
some like to move back and forth checking for possible asymmetries -- it is
really a matter of preference. The surgeon will then lift your skin to desired
level of lift, possibly insert a drain, and either apply a tissue glue or more
than likely sutures and staples (the latter, if it involves incisions in the
scalp).
Your surgeon will then apply a
bulky dressing to your face and head to protect your wounds, keep the tissue in
the proper place during recovery and possibly as pressure to help with swelling and
prohibit displacement.
You are then
gently awakened and brought into the recovery room where the recovery nurse
will monitor your vital stats until you are ready to be released. This
is dependent upon the individual but may take up to two hours or more.
Your eyes may feel tight, "hot" and quite tender as the anesthesia
wears off. If you feel any discomfort you may want to ask for a pain
reliever which you will more than likely have been asked to bring with you.
You may even feel emotional or upset -- this will depend upon your
body's reaction to anesthesia. You may also experience
"rigors" or shivering. This may feel uncontrollable and is
usually from the medications - more than likely epinephrine that is used as
a vasoconstrictor -- and the cold saline which will have been introduced
into your system for the last few hours, and still may be. The fact
that the operating room is usually very chilly, surely does not help matters
in this regard. The recovery nurse usually has wrapped you in a warm
blanket but if not, request one. It certainly makes things more
tolerable. You may even be lucky enough to have heating lamps!
Some surgical "theaters" are more like the dollar theater ass than
IMAX -- so ask first.
If you do not stay over night in
the hospital, you MUST have someone to drive you home after your procedure.
It
is dangerous to drive oneself home, not to mention illegal. You should
also have someone present to care for you at least for the first 48 to 72 hours.
This
is very important should you have a medical emergency or feverish spike
that you are unable to wake up and take medications or drive your self to the
hospital should you need emergency care.
The Road To Recovery
You may get sick on the ride home
from the surgical center or hospital so have a bucket or can with a lid as well
as water and some unsalted crackers. Bring pillows and a blanket if need
be. If you hurt take your pain relievers. There is simply no reason
to suffer. Studies have shown that patients with increased pain heal
slower than patients who are not in pain.
You won't usually be extremely
swollen until late that night or the next day and then the third is by far
usually the worst. Don't worry, it is all a part of the natural healing process.
You shouldn't really look at yourself in the mirror, but rather have your
partner or nurse care for you instead (even take photos if you wish
it). Make sure you take your medications! This is important. Your
antibiotics keep infections at bay. Your drain (if applicable) will be removed
on either day two or three. You must sleep with your head elevated (at least 2
pillows) for 3 weeks and for the first few days. A recliner is the best for
this. KEEP YOUR HEAD STILL. Do NOT turn your head from side to side. MOVE YOUR
WHOLE BODY, if you must move.
Your back may more than likely
cramp up from not being able to lie completely stretched out and flat on your
back so some patients prefer heating pads or hot water bottles. Remember not to
SLEEP while using any of these devices. This can result in severe burns.
You may also wish to have your surgeon provide you with a prescription for
valium or other muscle relaxers to obviously relax muscles and assist in
sleeping.
Also you will go in the next day
more than likely for your first post-operative visit. The surgeon may change your
bandages or may wait until the end of the week -- depending upon the seepage or
the extent of work. Your sutures won't be removed until day 5 or 7 and your staples
in your scalp (if applicable) not until around day 10. Your scalp takes longer
to heal.
Your skin will be numb -- don't be
afraid or worried, this is quiet normal, remember your nerves and all have been
partially separated from their source. Give them time to recuperate
-- just as you, yourself, need time to heal. Don't mess around here!
You must take it
easy and try not to do too much, too soon. You should be up and about in the
first few days but don't feel guilty if you don't. Listen to your body.
This
isn't a race. Keep your activities to a minimum. No
sex, exercising or strenuous housework (make your spouse do it!
)
for several weeks (at least 3 weeks). Go easy!
A face lift is a serious
surgery so avoid contact sports in the weeks and months ahead. Although I find
it hard to believe someone at the age of wanting a face lift goes around playing
tackle football or hockey; but if you do -- don't. Many surgeons
advise NO steam rooms, saunas or face masks or products containing Niacin, Niacinamide or
Niacinamate (they make your face red); NO
anything to promote major flushing of the skin.
Please avoid alcohol and aspirin containing
products for several months as this has anti-platelet properties and could cause
bleeding. But ask your surgeon if the needs arises to take such, always
obey your surgeon. Also you are going to be bruised and swollen for quite some time.
Don't
be sad, this is normal. Go in to this procedure knowing all of what you should
know. There is no fear with full knowledge of the possibilities. If you smoked
before the procedure you REALLY should not start back up. Smoking greatly
increases lack of vascularity promoting necrosis (death) of skin, improper healing
and excessive scarring. I am serious. Quit beforehand and stay quit!
This procedure takes quite a bit
of time to begin seeing definition in your face again. You will be puffy and
slightly swollen for months. It will abate.
Risks
& Complications
Of Face Lift
There are quite a few risks of Face Lift.
First and foremost there could be an allergic reaction to
the anesthetic. The most common
are complications are due to hemostasis
[1 : stoppage or sluggishness of blood flow]
or "overextensive undermining of flaps." Although
extremely rare, it is possible to bleed post-operatively resulting in another
surgery to control and drain the collected blood. Another
possibility is hematoma (a collection of blood, some report 8.5% but
usually is in the 5% range),
seroma (a collection of the watery portion of the blood) and
thrombosis (abnormal clotting). Loss of sensitivity is
common, although temporary. Permanent sensation loss in the cheek
or chin
area or in general, can and may happen. Then there is always a risk
of excessive scarring or inner scar tissue.
Although greatly
feared, nerve injury is rare -- 0.4% and 2.6%. Out of the nerves of the face, the
frontal branch
[: a branch of the ophthalmic nerve supplying the forehead, scalp, and adjoining parts]
is most
commonly injured. The reason it is vulnerable to injury during
dissection is due to its path over the zygomatic arch
[: the arch of bone that extends along the front or side of the skull beneath the orbit and that is formed by the union of the temporal process of the
zygomatic bone (English translation: cheek bone) in front with the zygomatic process of the temporal bone behind]
The mandibular branch
[: the one of the three major branches or divisions of the trigeminal nerve that supplies sensory fibers to the lower jaw, the floor of the mouth, the anterior two-thirds of the tongue, and the lower teeth and motor fibers to the muscles of mastication]
can be injured during dissection below
the platysma (neck muscle) at the mandibular angle (angle of the jaw).
There is the possibility of buccal
[1 : of, relating to, near, involving, or supplying a cheek
<the ~ branch of the facial nerve>]
injury which can happen when deep
dissection is carried out medially in the mid-face section. The greater
auricular nerve is injured more than the facial nerve due to the postauricular
[: located or occurring behind the auricle of the ear <a ~ incision>]
flap
[: a piece of tissue partly severed from its place of origin for use in surgical grafting]
being elevated off of the adherent subcutaneous tissues.
As far as hematoma is concerned,
"The pathophysiology
[: the physiology of abnormal states; specif : the functional changes that accompany a particular syndrome or disease;
in English this translates to the "reason" or "cause"]
behind this problem is that the flaps are
separated from the deep tissues, limiting the blood supply. Additionally,
tension is placed on the flap as the skin expands to accommodate the underlying
volume. Skin necrosis routinely follows unrecognized hematomas. Expanding
hematomas must be addressed by opening the incisions and obtaining hemostasis
[1 : stoppage or sluggishness of blood flow].
Smaller ones may disappear with serial evacuations. Meticulous hemostasis,
judicious flap dissection, and attention to postoperative pain are the best
defense against this common complication." source: Rhytidectomy; Grand Rounds, Dept. Otolaryngology
UTMB, 11/06/96
If too much skin is
removed or if inadequate incisions are placed, a rhytidectomy can suffer
greatly. You see, excessive tension can widen scars (as talked about in the Temporal
lift) Hypertrophic scarring is possible, especially in individuals who are
prone to such (ethnic patients). If this happens these scars can be
treated with repeat injections of
triamcinolone [: a glucocorticoid drug used esp. in treating psoriasis and allergic skin and respiratory disorders,
such as Kenalog or Kenocort:] every month.
T hese injections help calm
down inflamed tissue and break up the excess collagen causing the excessive
scarring.
Another possibility is
tissue necrosis (skin death) or skin sloughing [: dead tissue separating from living tissue; esp : a mass of dead tissue separating from an ulcer]
. Topical and oral antibiotics will help but the necrotic tissue must be debrided
[: the surgical removal of lacerated, devitalized, or contaminated tissue].
Many forms of debridement exist but the most common is manual with an acidic
pack. The least common being maggot therapy debridement [: use of sterile maggots from the blue bottle
fly].
A very common after
effect is Alopecia [: loss of hair, wool, or feathers : BALDNESS]
along the incision lines and even hair of the head n general or facial hair,
such as eyelashes or eyebrows sometimes because of the anesthesia and medications
such as antibiotics and pain relievers. Only about 1% (source:
Rhytidectomy; Grand Rounds, Dept. Otolaryngology UTMB, 11/06/96) report
permanent Alopecia. This may be from individual bodily reactions, circumstances
or excessive tension. Sometimes a scar excision is suitable, sometimes this will
only create further tension.
Another
major risk is facial weakness or paralysis. This can be from necrotic muscle
tissue or surgeon area in detaching the flap of muscle for too long of a period
of time and then the flap is traumatized. Resulting in necrosis at worst, as
well as dysfunction. Another is attached earlobe, also called Pixie Ear
Deformity [:drawn
down or attached earlobe due to excessive rotation of the flap and auricular
regions].
The Least You Need To
Know
-
What: Also known
as Rhytidoplasty, this operation is designed to reduce sagging and
wrinkling in the lower face and neck. It does not correct problems around the
eyelids, at the corners of the mouth or the creases at the lips.
-
Why: This operation
may be chosen for one of two reasons: to help prevent the advancement of aging,
i.e. to help relatively young individuals (40 and younger) to appear to stay
young, or it may assist one who is already wrinkled or whose skin sags to appear
younger and fresher.
-
When: commonly
late
thirties to eighties.
-
Who: Research
your doctor very well! He should help you decide which technique would be
best for you and discuss this openly. You may not need a complete or full
face lift or you may not need a face lift at all. Lasers may work for you
instead.
-
Where:
Accredited Surgical suite or hospital
-
Risks:
READ THEM
-
incisions/scars:
depending
upon technique or type, usually within the hairline, behind the ears, under
the chin or in front of the ears.
-
Anesthesia: IV
Sedation (Light Sleep) or General. Read
All About Anesthesia
-
Duration:
2-5 hours, depending upon extent of ptosis (sag) and type of lift.
-
Pain
Factor: Mild to medium, pain meds should alleviate any
discomfort.
-
Swelling:
Medium - depending upon
individual; I suggest arnica montana and bromelain.
-
Bruising: Medium - depending upon individual; I suggest
arnica montana and bromelain.
-
1st Pre-op
visit: 1-2 days after procedure the bandages will be changed and
your incisions checked in-office by your surgeon.
-
Cosmetics:
May be worn 1-2 weeks post-operatively but check with your surgeon!
-
Return
to Work: Some have returned to work in 5 days but you may not
want to leave the house until about 2 weeks due to your appearance - you will
be quite swollen.
-
Activity: No exercise until at least 3 weeks post-operative. Check with your
surgeon!
-
Sun
exposure: use an SPF 30 or higher to
prohibit UV exposure or to at least keep it to a minimum. UV light may cause
hyperpigmentation in some patients, especially around the incision lines.
-
End result:
Anywhere from 4 months to a year, depending upon technique or type.
-
Loss
of Sensitivity: Expect numbness under the chin, around cheek area
and in front of ears. Long term or permanent loss of sensitivity is
possible.
-
Anything
else? Possible eyebrow and eyelash loss from medications
-- also
scalp hair loss around incision lines. Possible asymmetry as well.
-
Longevity: Anywhere from 2 to 10 years.
-
But Wait! There's More!
Visit other sites, this is your life! Research as much as you can on the subject.
-
Average
Prices for Rhytidectomy: minor:
$4,293. - $7,000.; major: $5,000. -
$15,500.
with necklift: add $4,000. - $7,500.; S-Lift:
$4,500 - $6,000
Related Links (these links will launch a
new window)
Rhytidectomy, Deep Plane Facelift
Rhytidectomy, SMAS Facelift
Rhytidectomy, Subperiosteal Facelift
References
Owsley, J. Q., Jr.; UPDATE: SMAS-Platysma Face Lift,
Reprinted from Plastic and Reconstructive Surgery, Vol. 71, No. 4, April 1983
Owsley, J. Q., Jr.; Face Lifting: Problems, Solutions, and an Outcome Study
Friedman, C. Jeffrey, The Face Lift, Interview
& private practice brochures/info. 1999
Owsley, J. Q., Jr., MD; Platysma fascial rhytidectomy.
Plast. Reconstr. Surg. 60: 843, 1977.
Millard, D. R., Garst, W. P., Beck, R. L., and Thompson, I. D. Submental and submandibular lipectomy in conjunction with a face lift, in the male or female.
Plast. Reconst. Surg. 49: 385, 1972.
Millard, D.R., Garst, W. P., Beck, R. L., and Thompson, I.D. Submental and submandibular lipectomy in conjunction with a face lift, in the male or female.
Plast. Recronstr. Surg. 49: 385, 1972.
Connell, B. F. Contouring the neck and rhytidectomy by lipectomy and a muscle sling.
Plast. Reconstr. Surg. 61: 376, 1978.
Peterson, R. The role of the Platysma Muscle in Cervical Lifts. In D. Goulian and E. Courtiss (Eds.),
Symposium on Surgery of the Aging Face. St. Louis: Mosby, 1978. P. 115.
Weisman, P. A. Simplified technique in submental lipectomy. Plast. Reconstr. Surg. 48: 443, 1971.
Horton, C. E., Adamson, J. E., and Carraway, J. H. The Cervical Lift. In D. Goulian and E. Courtiss (Eds.),
Symposium on Surgery of the Aging Face. St. Louis: Mosby, 1978. P. 95.
Rees, T. D., Lee, Y. C., and Coburn, R. J. Expanding hematoma after rhytidectomy.
Plast. Reconstr. Surg. 51: 149, 1973.
MacGregor, M. W., and Greenberg, R. L. Rhytidectomy. In R. M. Goldwyn (Ed.), The Unfavorable Result in Plastic Surgery. Boston: Little, Brown, 1972. P. 335.
Ellenbogen, R. Pseudoparalysis of the mandibular branch of the facial nerve after platysmal face lift operation.
Plast. Reconstr. Surg. 63: 364, 1979.
Owsley, J. Q., Jr. SMAS-platysma facelift: A bidirectional cervicofacial rhytidectomy.
Clin. Plast. Surg. 10: 429, 1983.
Owsley, J. Q., Jr. Mechanical properties and microstructure of the superficial musculoaponeurotic system (Discussion). Plast. Reconstr. Surg. 98: 71, 1996.
Owsley, J. Q., Jr. SMAS-platysma face lift. Plast. Reconstr. Surg. 71: 573, 1983.
Hamra, S. T. The deep-plane rhytidectomy. Plast. Reconstr. Surg. 86: 53, 1990.
Owsley, J. Q., Lifting the malar fat pad for correction of prominent nasolabial folds.
Plast. Reconstr. Surg. 91: 463, 1993.
Owsley, J. Q., and Fiala, G. Update: Lifting the malar fat pad for correction of prominent nasolabial folds.
Plast. Reconstr. Surg. 100:715, 1997.
Chris Thompson, M.D. , Karen H. Calhoun, M.D., FACS , Francis B. Quinn, Jr., M.D.
RHYTIDECTOMY; Grand Rounds, Dept. Otolaryngology UTMB, 11/06/96
Ramirez O.
Subperiosteal rhytidectomy: The third-generation facelift. Annals of Plastic
Surgery 1992;28(3):220.
Diagrams,
Henry Gray - Anatomy of the Human Body
Webster-Merriam
Medical Dictionary
Cardenas-Camarena, Lazaro M.D., Gonzalez, Luis E. M.D. "Multiple, Combined Plication of the SMAS-Platysma Complex: Breaking Down the Face-Aging Vectors"
Plastic & Reconstructive Surgery; September, 1999, Volume 104, number 4
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