Facelift

Facelift surgery is the fundamental cosmetic surgery procedure for rejuvenation of the neck and face. Both the facelift and neck lift remain some of the most popular offerings here in our Sacramento cosmetic surgery practice.

When to Choose a Facelift

A facelift is generally chosen to reduce the appearance of:

• Sagging facial skin
• Deep folds and wrinkles
• Loose skin around the neck

There is no "best time" for a facelift. In certain individuals with premature aging changes, a facelift may be indicated at age 35. Most patients are in the age 40 to 65 group. However, assuming good health, there is no upward age limit. Although a greater percentage of facelift patients are women, men have become more and more comfortable with facial aesthetic surgery and are undergoing this procedure. Regardless of gender, the ideal facelift candidate is a healthy patient of normal body weight, with skin laxity of the jowl area and neck.

This procedure will help to recapture a more youthful appearance. But your expectations must be realistic. A facelift is not intended to: make you young again, improve your personal relationships, or improve your career.

Patients who use tobacco products, drink excessive alcoholic beverages, or have had excessive sun exposure in their lifetime have higher rates of complications and may not achieve optimum results.

Facelift Photos

Facelift Pre-Operative Considerations

Before discussing any surgical procedures with you, Dr. McMenamin will review your general health history and current skin care regimen. For patients who have a chronic health problem, we can often work with your doctor to prepare you to safely undergo a cosmetic procedure.

Dr. McMenamin will discuss your particular facial characteristics and your goals for improvement in detail. Facial photographs are an important part of that aesthetic facial analysis. Computer imaging is also helpful to demonstrate to the patient an approximation of the types of changes to be expected. Asymmetries and problem areas will be pointed out to you that you may have been previously unaware of. To meet your described goals, other procedures may be discussed including brow lift, eyelid tuck (blepharoplasty), chin augmentation (mentoplasty), nasal surgery (rhinoplasty), laser/chemical resurfacing, dermabrasion, glycolic acid and Retin A treatment.

The Pre-Operative Visit

Approximately two weeks before surgery, you will attend your pre op visit at our Sacramento office. The doctor or the physician assistant will review your past medical history and perform an appropriate physical exam. You will also be given general information about what to expect the day of surgery and how to take care of yourself post-operatively. Surgical patients are required to discontinue all aspirin products and anti-inflammatories, Vitamin E and C, alcoholic drinks, and tobacco products for two weeks before and after the surgical procedure. Recently, Ginko Biloba, St. John’s Wort, and garlic were added to this list because all of these things can increase your risk for bleeding during and/or after the procedure.

“There’s a beauty ideal that each person holds – how they define beauty and physical appeal for themselves. My patients and I take time in consultation to talk about what looking good means to them.

You have to know what’s going on in a patient’s heart, as well as in their head. My purpose is to understand what they see when they look at themselves and to help them attain the appearance that they personally define as appealing.”

 - Dr. McMenamin

You may be required to have laboratory work (blood and/or urine tests) seven to ten days prior to surgery. Also, depending on your age and health history, you may be required to have an EKG (heart tracing) and/or a chest x-ray. Your personal health insurance will often cover the cost of these tests. It is not included in the surgery fee.

Prior to seeing the surgeon, you will be asked to read the operative consent form that outlines the risks and benefits of the proposed surgery. Dr. McMenamin will review the consent form with you in detail and answer any remaining questions you have.

Antibiotics, a disinfectant soap, and possibly a mild blood pressure medication may be prescribed for the morning of surgery to ingest/use before you arrive.

The Night Before Surgery

It is beneficial to get a good night’s sleep on the night before surgery. Try to spend a quiet night at home. If you must have a pre op "night out," plan this for earlier in the week. We may ask you to shower and wash into your hair with the disinfectant soap that was provided to you. It is important to remember to eat or drink nothing after midnight, including water, for eight hours prior to surgery.

Your Surgery: How the Facelift Works

You will be given a time to report to our facility for your surgery. It is very important to be on time. After changing into a hospital type gown, you will be taken to the operating room and seated in the surgical chair in a semi-reclining position. An intravenous line will be inserted, application of vital sign monitors will be achieved, and sedative medications administered until you are quite comfortable. Your face, hair and neck will be gently washed with a disinfectant solution, and sterile drapes applied. You will not be allowed to touch your facial area once it is prepared for surgery. If you become aware of an itch, ask the surgeon or the assistant to scratch it for you.

Dr. McMenamin will draw the incision lines on your face and chin with a marking pen. He or the physician assistant will numb the area with local anesthetic solution. This process is a little uncomfortable, but you will be well sedated and the process goes quickly. The local anesthetic allows you to be pain free throughout the remainder of the procedure. If at any time you are having discomfort or anxiety during the procedure, tell the surgeon or his assistant so that more medication can be used to alleviate that.

The incision is created with a scalpel blade. It starts in the hair of the sideburn, and continues down just in front of the ear to where the earlobe is attached to the face. Then, the incision turns underneath the earlobe to extend onto the back of the ear, across skin behind the ear, and into the hairline. (Dr. McMenamin will have demonstrated for you where the incisions will be during your pre op.) A scar along this incision line is unavoidable, but most of it will be hidden by the hair and behind the ear. An additional incision is made under the chin to sculpt the neck area. The areas that are not hidden are the just in front of the ear, between the back of the ear and hairline and under the chin. However, these areas usually heal with an acceptable but visible scar.

The neck skin is undermined first from the incision under the chin. Excess fat may be suctioned from the neck and jowl areas and excess tissue will be sculpted. The facial area, one side at a time, is addressed next. Elevation of the skin from the deeper tissues is accomplished, usually extending to the mid cheek area. The facial and platysmal muscle layer (SMAS) is identified. It is undermined and then trimmed of any excess. It is then tightened with sutures to provide better support for the jowl and neck. The undermined skin is then passively lifted up and back. The excess skin is trimmed and removed, and the edges are carefully repositioned and sutured into place.

Upon completion of the procedure, a thick, gauze dressing will be applied. This applies gentle pressure to the surgical area to reduce the risk of bleeding. It is normal to have a small amount of blood or secretions during the first night. The dressing will help absorb that. You will remain in the operating room or the recovery area until you are sufficiently alert and ready to go home. Upon discharge, pain medication will be provided. Also, verbal and written instructions will be reviewed for your home care with you and your caretaker. A responsible, adult friend or relative must drive you home and attend to you the first 24 hours after surgery. Under NO circumstances will you be allowed to drive yourself home.

The Evening of Facelift Surgery

You may feel drowsy for several hours following surgery until the sedatives completely wear off. Also, pain medication can make you drowsy. You will have noticeable swelling especially in the cheek and eye area because those areas are not compressed. This swelling may make wrinkles around the mouth and eyes less apparent. Unfortunately, most of those wrinkles will return as the swelling subsides. You may notice some bruising at the base of the neck.

Keeping your upper body elevated in the days after surgery will minimize swelling and promote faster resolution of any residual swelling (Figure 2). You must stay in a near sitting position for 24 hours a day for the first 10 days to reduce swelling, bruising, and to minimize discomfort. A recliner chair, a cushioned outdoor lounge chair, or a sofa with several pillows to prop you up will work nicely.

Ice applied to the surgical site(s) will also decrease swelling. You should apply ice packs to the face/neck areas 20 minutes out of every hour for the first 72 hours (3 days), then 12 hours out of the day for and additional three days. Continue as needed if swelling or discomfort persists. In general, the discomfort following a facelift is mild and usually felt most along the sides of the face and neck. Tylenol should be taken as directed on the bottle in the first 24 hours. The pain medication supplied to you should only be taken as needed after the first 24 hours. The pain medication, usually Darvocet, should be taken on a full stomach to avoid severe nausea and vomiting. Most patients have very little pain and Tylenol can suffice. Any occurrence of sudden, severe, and persistent pain or swelling is an indication of a problem and should be immediately reported to your surgeon. This may mean that a hematoma (blood collection under the skin) has occurred and will require immediate attention. It is not unusual to have minor bleeding after a facelift. This will often show through on the bandage but should not soak the dressing. If you have a questionable amount of bleeding, call Dr. McMenamin.

Do not drink alcohol, smoke, take aspirin or anti-inflammatory compounds, or Vitamins E or C in the two weeks following surgery. Excessive bleeding under the skin may occur. Straining on the toilet due to constipation or forceful vomiting can increase the blood pressure in the blood vessels to the head and cause marked post operative bleeding. A rapidly acting laxative (i.e. Milk of Magnesia) or anti nausea medication will be recommended.

It is normal to feel apprehensive about what you are experiencing after surgery. Even those patients who are veterans to surgery experience some level of anxiety. Remember that we are here to answer your questions to relieve your anxieties. Don’t hesitate to call us if you need reassurance.

After Your Facelift in Sacramento

You will be given an appointment for the day after your surgery. Your gauze dressing will be removed, the surgical areas will be examined, and then a new dressing will be applied. Any questions you have will be answered. Be aware that swelling, bruising, skin discoloration, and noticeable sutured incisions will be visible. Do not be alarmed. This is normal for this stage and will rapidly improve.

The gauze dressing must be worn for approximately five days. The pressure it applies will greatly decrease your risk for complications. Swelling and bruising usually reach their peak at approximately five days. Each day after that, you should note a gradual improvement. Bruising is the result of blood infiltrating the soft tissue as the result of trauma. It routinely is most visible along the jaw line and the base of the neck. It will go through a number of color changes from purple to yellow or green before finally disappearing, usually by the end of the second or third week.

After the gauze dressing is removed, you will be provided an elastic compression facial garment. It must be worn for 24 hours a day for the first two weeks, then as much as possible the second two weeks. After that, you will wear it only at night. You will be instructed on wound care using hydrogen peroxide and/or Bacitracin Ointment on the incision lines twice a day.

Remember that during surgery, the skin of your face and neck is lifted completely away from the deeper tissue. It is extremely important that your skin reattach smoothly and snuggly. You can facilitate the best possible result by keeping the face quiet and the dressings in place as directed.

Suture removal will begin around post operative day 5 – 7. The first sutures to be removed are immediately in front of the ear and under the chin. The remaining sutures will be removed about two to three days later. You may CAREFULLY wash your hair 24 to 36 hours after ALL the sutures are out. Do not use a hot hairdryer, curling iron, or hot rollers until the feeling is back in your skin sufficiently to avoid burning yourself.

You may begin resuming your normal activities, excluding exercise, approximately two weeks after surgery. This amount of time is necessary to allow sufficient healing for your face to appear “normal” cosmetically, and also to allow you to recover your strength. Occasionally, patients require a longer period of time.

Evaluating Your Facelift Results

At first, patients are often concerned about what their family, friends, and co-workers will think or notice. You may wonder, "Can they tell that I've had a facelift?” or "Can they see my swelling, incisions, and bruising?" We have found that most comments, if any, tend to relate to how well you look, how rested you look, or “Have you lost weight?” It is unlikely that they will know the real reason you look so good – unless you tell them. They won’t hear about it from us. Our Sacramento cosmetic surgery office maintains strict confidentiality about any care that we deliver to our patients.

We are excited to help you through your facial plastic surgery. Please call our Sacramento cosmetic surgery practice at (916) 564-8888 if you have any other questions or would like to schedule a consultation.