Face and Necklift Surgery Explained
Face and Necklift Before and After
Face and neck lift:
As we age there are some changes that begin to occur in the soft tissues in the face that make us look older. These include: flattening in the cheeks with a more rectangular appearance to the face, deepening of the nasolabial folds and the formation of marionette lines, hollowing in the temples and cheeks, jowling, and neck laxity. Fillers, laser and ultrasound treatments can help to improve the appearance of some of these issues. But at some point, surgery becomes the only effective way to improve the aging facial appearance. This is with a face and neck lift.
There are many promotions for mini and lunch time facelifts. These procedures may make you look better for a few months, but the results will be “mini” and will not hold up over time. If you decide that you want a facelift, make sure you do this procedure with a surgeon who will address all of your issues, and do a lift that will last for several years. Although it is called a facelift, this will include surgery in the neck to tighten that as well.
Most patients how are interested in a facelift will complain about jowling, neck laxity, and deep nasolabial folds. If they have thin skin they will also usually have a lot of fine lines and wrinkles throughout the cheeks and around the mouth.
A discussion of non-surgical options is always done first, evaluating how much improvement can be obtained with these techniques. Surgical options will then be discussed. This may be limited to just the face and neck, but can also include the brows and lids. The neck is examined to check for fat and banding of the platysma muscle as these must be addressed as they would be in an isolated neck lift. Skin laxity in the cheeks is noted.
If someone has significant hollowing of the face then a fat transfer will also be considered. After going over the surgical and non-surgical alternatives, the patient will then have to decide what they would like to have done.
Unfortunately a face lift will not help with lip lines. If someone has significant wrinkling in this area, laser treatment will be necessary to try and soften the lines.
It is important to know a patient’s health status before making any final decisions. Some patients may be on blood thinners which cannot be stopped, making them ineligible for surgery. There are other health issues which may make them a less than ideal candidate for certain procedures. If a patient is a smoker, they must stop for several weeks before and after the surgery of the wounds may not heal normally.
Photos are taken just before the surgery. Markings are then done on the face to outline where the incisions will be made, and to delineate the areas of dissection. A local anesthetic is then injected into the face and neck.
An incision is then made under the neck to remove excess fat and tighten the platysma muscle. An incision is then made starting just above the ear, going down in front of the top of the ear. The incision then goes inside the tragus so that no external scar will be visible. The incision then extends around the earlobe, up behind the ear, and back into the hairline. The skin is then elevated off the deep tissues. The deep muscle layers are tightened with a series of sutures starting below the jawline and extending up toward the eye. This is done on both sides. The skin is then draped over the ear and excess skin is trimmed. A drain is sometimes placed into the neck. The wound is closed with sutures and staples.
Most patients do a facelift with local sedation anesthesia which is administered by an anesthesiologist. An IV is started to administer the anesthesia. The sedation is helpful to keep the patient from feeling any discomfort during the surgery. It also decreases the anxiety they may experience having the surgery done.
Some patients may also prefer to do this surgery with only local anesthesia. In those cases they receive an oral anti-anxiety medication about an hour before the surgery. They will feel the discomfort of the local anesthesia injections, but once those have been applied they should not feel any pain. Most patients will feel some pressure and pulling, but this should not be painful.
General anesthesia is not needed for this surgery.
The patient is brought to the recovery room for about 2 hours. A dressing is placed around the neck and head for the first 24 hours. This is removed the next day and an elastic support dressing applied. Ice is used for the first 3 days followed by warm compresses. If a drain was placed under the skin this is removed between the first and fourth day. Sutures are removed between day 7-10.
Patients will be bruised and swollen for at least one to two weeks. Much of the bruising will move down into the chest. There is usually not much pain with this surgery, and can be controlled with Tylenol. There will be a tight sensation in the neck when moving the head, and swallowing may be uncomfortable the first couple of days. The sensory innervation to the face is interrupted during the surgery. Over a several month period the sensation will slowly return to the face. Patients may feel some itching and tingling as the nerves regrow.
Some patients may have significant bruising and swelling which can last several weeks. On a rare occasion bleeding can occur in the first 24 hours post-op with a hematoma forming. When this occurs the patient is brought back to the operating room to remove the hematoma and stop any bleeding. This does not affect the final outcome of the surgery.
Some patients may note some relaxation of the lift after a few months. If this occurs, a revision with additional tightening can be done after 6 months.
Some people may also note some swelling in the neck due to the gland under the jawline. We all have this gland, but it may become more noticeable after fat is removed and the skin is tightened. We usually can advise people about this pre-op if they have a large palpable gland. There are some surgeons who can take this gland out if the patient wants this done.
The scars usually heal very well with this surgery. Some patients may develop a hypertrophic scar behind the ears. If this occurs the scar can be injected with anti-inflammatory medications and treated with laser.