Face Lift

THE MYTH OR MISCONCEPTION OF THE FACELIFT - by Alexander Carli, MD
Most Common Questions
A Few Recommendations

THE MYTH OR MISCONCEPTION OF THE FACELIFT - by Alexander Carli, MD

The facelift sounds like the magic “fountain of youth”. Most people anticipate significant changes visible to everyone and a frequent question is, “How much younger will I look?” Usually these women or men are in their forties and need something done for different areas of the face. Aging is becoming a problem and they want to do something about it. In many cases, a facelift is not necessary and other, less extensive procedures can be combined to obtain as good of a result as a facelift.

The facelift does not cover most areas of the face. It usually helps little in the area of the mouth and does not do anything for the texture of the skin. It is an extensive procedure but still limited in terms of rejuvenation. Rejuvenation is a completely different concept. It means a combination of all of the different procedures that can be done to maximize the rejuvenation of the face at any age. The older the patient is, the more procedures need to be combined for the patient to look his or her best. I cannot over-emphasize the need and the necessity to understand the difference between a facelift and facial rejuvenation. The facelift is the most extensive procedure of facial rejuvenation but it still excludes the forehead, the eyelids, the texture of the skin as well as the bone structure of the face and the loss of soft tissue. Rejuvenation is the combination of procedures that specifically addresses the needs of each individual face. It includes improvement of bone structure, liposuction, soft tissue augmentation with fat transplant or other fillers, texturing of the skin as well as usually more surgical procedures such as eyelid surgery—the most common facial procedure in the United States.

The facelift alone cannot accomplish all of these things and, therefore, can only eliminate and tighten up the excess of skin of the cheek and the neck. The tightening procedure is an effective tool of facial rejuvenation but it cannot by itself accomplish facial rejuvenation in most cases. A facelift can be disappointing to patients seeking facial rejuvenation who expect improvements in areas other than sagging of the cheeks and neck. Another cause of disappointment with the facelift can be the skin of the patient. The younger and more elastic the skin is, the better the results will be. Indeed, if the skin has reached a point where it has lost some, or most, of its elasticity the result will not be as good, regardless of the technique and ability of the surgeon. The more the skin loses its elasticity the more it will stretch back after surgery and the results will not be as lasting. The durability of the result varies mostly with the type of skin—the better quality of skin, the more durable the result.

The technique of the facelift is important and within the past 25 years has become more extensive and sophisticated but it cannot compensate for the type of tissue the surgeon has to work with. Besides, though techniques have improved tremendously, they are not perfect tools, hence, we cannot obtain a perfect result. Whenever we consider a facelift in a patient we must consider the needs of the whole face and not just the sagging of the cheek and neck.

We must evaluate the type of skin and tissue as well as the technique for each atient. Practically, in all cases the techniques no longer consist of simply tightening the skin. It includes tightening of the muscle as well some liposuction of areas of the face. The modem facelift is no longer a skin procedure. It treats skin, muscle and facial fat.

All of these considerations should not discourage the proper candidate from having a facelift—for it is an excellent procedure that pleases over 90 of patients nationwide. However, this extensive procedure has to be looked as a tool toward rejuvenation of the face, and cannot be equated with rejuvenation of the face. If patients do understand these different concepts their chances of satisfaction with the result are much better. It is mandatory for my patients to discuss and understand these points that I will clarify as best I can during the 2 consultations we have to cover the procedures, the technique, the risk and the limitations. If the patient does not feel clear about these points, the facelift should not be performed.

It is also a fact that this extensive procedure will require some psychological strength and support. The immediate post-op recovery takes at least a couple of weeks and the end result will take at least 3 months. After the first couple of weeks, people can usually go back to a normal social and professional life by using makeup, modifying their hairstyle and some kind of clothing that will help camouflaging the residual swelling or bruising. The skin of the face that has been lifted in the face and neck area will remain numb for a minimum of 3 months. The sensation will come back gradually, and at around 3 months the sensory is generally pretty good, but for normal sensory to come back it can take over 3 months, in most cases, and in some cases up to a year, as described in literature. For all of these reasons, the patient must be prepared psychologically to go through the post- operative period and usually needs a spouse or a friend for support.

We can compare the facelift patient to a dental patient who goes to the dentist for the first time after 40 years old. The older we are when we go to the dentist the first time, the more work we will need done on our teeth. The younger we go, the less work is needed, and the better the result. As we know, going to the dentist later in life is always a necessity and we always get an improvement, but our teeth are fixed with tools and techniques that cannot restore a perfect look.

Talking about teeth, it should be emphasized that the facelift like facial rejuvenation in general, does not require reaching a certain age. It should be started when the face starts aging—for some people it will start earlier than for others. Like with teeth, we treat a condition and not an age.

If we wait until age 50 to go to the dentist for the first time, we could never get the same improvement as we can by starting earlier, as a problem occurs. The analogy between teeth and skin is real. People need to treat a problem when it develops, and not wait for an arbitrary age, letting the problem go without treatment and allowing it to get worse. Plastic surgery, like dental care, is not age related but condition related.

An example is skin care, which has allowed, with the advent of different Skin Care Treatments and the laser, preserving and improving skin in way that was never possible before. However, that type of aggressive skin care must be started early in life to minimize or reverse the aging of the skin. In other words, like with teeth, we have to start taking care of our face early in life if we want to look our best as we age. The time for a facelift is when the cheek and the neck start sagging.

Most Common Questions

1. How much younger will I look?
It cannot be determined but we can guess that usually you will look younger.

2. What about the scars?
This depends upon the way you heal and how extensive was the surgery. As a rule the more skin removed the more extensive the scar will be. They usually fade away within 4 to 6 months after your surgery but will never disappear completely.

3. How long will the result last?
On the average, 5 to 10 years depending upon your age and the quality of your skin.

4. Will I have a natural look?
A facelift gives a fresher younger look and not an unnatural look. This has been my experience with the technique I use.

5. Anesthesia, Should I be put under?
I do my facelift under general anesthesia. It is better for the patient. There is no pain or discomfort and no risk of claustrophobic reaction during the procedure. Indeed, it is a long procedure.

6. Does laser resurfacing substitute a facelift?
No. The laser can only improve the texture of the skin, the fine wrinkles and small scars such as acne scarring. It will also cause a light tightening of the skin. That tightening of the skin cannot get rid of excess of skin. Skin excess can only be eliminated by surgery whether it is a facelift, forehead lift or eyelid surgery. The laser is an excellent tool but it only complements the result of the facelift. The facelift lifts and tightens up the skin whereas the laser improves its texture. Both can be done at the same time in some cases. Usually they are done separately because lifted skin may not sustain a laser resurfacing if it is deep. However, in all cases, a partial laser can be performed at the time of the facelift safely.

A Few Recommendations

Take advantage of our esthetician consult at no charge.
Please no makeup on at the time of your second visit and on the day of your surgery.
Do not choose a time of crisis or depression to have your surgery.
Shampoo your hair the night before and the morning of surgery with hibiclens.
Make sure you have good psychological support from your spouse or a friend.

Once Again,

The scars will fade within 4 to 6 months usually, but will remain permanent, though practically not visible.
The more skin to remove the longer the scar. The length of the scar is not the main problem. The position and the shape of the scar are more important than the length. A long scar behind the ear can be virtually invisible as long as it's positioned well within the fold behind the ear. In the rare case of conspicuous scar if it is well positioned it is usually easy to do a scar revision and practically get rid of the scar. I rarely have to do it. It is a simple procedure without down time and I do not charge for it.
The 2 sides of the face do not look alike. It is visible pre-operatively and to the patient it might become more visible post-operatively because usually the patients look at themselves much more closely after the surgery than before. However, that difference we can notice in everybody is usually so subtle that it is not noticeable.
After a facelift the face will look better and fresher, although a little different but in no case you will look like a different person. The technique I use is extensive but it will not give you a mask or surgical look. Your face will feel tight for a while but should not look unnatural.
Most importantly, you need to understand the difference between facelift and facial rejuvenation. I covered that difference above and I reiterate the need to understand it. If you want or need a facelift only.. .great! But it only corrects the sagging of the cheeks and neck. It doesn't mean facial rejuvenation which entails the other aforementioned combined procedures.