Summary

A patient is rarely a candidate for a facelift only, as most patients that are old enough to have jowls or excess neck skin also have upper facial and skin aging. A facelift is not an operation for wrinkles but loose skin and ptotic tissues. Most facial wrinkles are unaffected after a facelift. A facelift does make the patients look tighter and reverses the gravitational and aging changes in the lower face and neck. To truly rejuvenate (restore the car), concomitant procedures such as brow and forehead lift, blepharoplasty, facial implants, laser skin resurfacing, and fat injections are added. For true facial rejuvenation, patients must be offered a correction of their global facial and neck aging with the discussed ancillary procedures took on the name “full facelift.”

A facelift has more impact than any other surgical procedure. First, the face is our prime identity and our seat of vanity and expression. Even the slightest facial blemishes can keep some people in the house. We are our faces! The other important factor is that you can cover the rest of the body. A patient can hide wrinkles, dark spots, and cellulite on their body but not on their face. Patients can cover poor results or scars on their body with clothes; the face (in most cultures) is exposed for the world to see. Because of this, no other cosmetic procedure carries the physical and emotional prowess of a well-done, natural-appearing facelift. Contrarily, an unnatural or botched facelift may cause a lifetime of problems that are impossible to hide. The word “facelift” is a word that surgeons love and patients hate. No one ever wants to have a facelift; they have it because they feel it is the only choice that will make them look younger. If and when another technology supplants facelift surgery, history will look back upon the facelift as a primitive, aggressive, and barbaric piece of surgical history. Facelift surgery does not make patients look younger. It does make them look tighter and reverses the gravitational and aging changes in the lower face and neck, which are senescent changes that patients disdain.

Even the technical term for facelift “cervicofacial Rhytidectomy” is inaccurate, as it implies that wrinkles (rhytids) are cut out. A facelift is not an operation for lines but loose skin and ptotic tissues. Most facial wrinkles are unaffected after a facelift. Also, high on the list of public fears with a facelift is the possibility of looking unnatural or “done” after facelift surgery. Much of this stems from the poor surgical technique with unnatural vectors of pull, hairline aberrations, and unnecessary surgery. Failure to simultaneously address other aging facial structures, such as blepharoplasty or laser skin resurfacing, also contributes to an unnatural appearance. However, the biggest sin of the past was the failure to discuss the restoration of facial volume.

Surgeons took aging patients with skeletonized faces and pulled their skin-tight. They made patients “tighter, but not younger.” This is a guarantee for an unnatural appearance. Contemporary surgeons realize the absolute need for concomitant facial inflation and volumization with facelift surgery. One only has to Google “bad cosmetic surgery” to see countless images of unnatural-appearing celebrities that violate all common sense of aesthetic balance and surgical skill. People are afraid of facelifts. Reality shows, or what I call “unreality shows,” have also become popular and focus on plastic surgery nightmares.  All the fear appears in the back of the mind of many patients sitting in your office and being told they “need a facelift.” The word “facelift” has transformed with so many meanings that most public is confused about what a facelift is and does. Some patients present and state they do not want a “full facelift.” In the evolution of facelift surgery, I often performed coronal brow lifts in conjunction with facelifts. Many patients had other simultaneous procedures, and the support of one of these ancillary pro­cedures such as blepharoplasty, chemical peel, and facial implants took on the name “full facelift.”

To truly rejuvenate (restore the car), concomitant procedures such as brow and forehead lift, blepharoplasty, facial implants, and laser skin resurfacing are added. A patient is rarely a candidate for a facelift only, as most patients that are old enough to have jowls or excess neck skin also have upper facial and skin aging. For true facial rejuvenation, patients must be offered to correct their global facial aging with the discussed ancillary procedures. Often, a patient ignores this comprehensive approach due to financial reasons or simply because of their conservative attitude.

Finally, the word “facelift” has become a blurred definition. What used to be called an operation of skin dissection and tightening by excess skin removal is now characterized by filler injection (liquid facelift), platelet-rich plasma injection facelift, nonsurgical facelift (radio wave and ultrasonic skin tightening), numerous suture suspension “facelifts,” and even massage devices and creams; all these are referred to as “facelift” procedures. Patients and consumers must understand the difference between the proven safe and effective technology versus a corporate or self-serving substitute. Internet technology has ushered in frauds of all types and proportions, and I must educate patients to separate the wheat from the chaff. Unfortunately, like many surgeons, I see patients regularly who became the victim of some shortcut or publicized “facelift” technique that fell short in result, longev­ity, and sometimes safety. It is the job of the credible, ethical, and academic surgeon to steer patients away from proce­dures that do not live up to what they purport.

In cosmetic facial surgery, procedures can be mastered and reproduced, being always predictable and rarely challenging. On the other hand, there are procedures such as rhinoplasty, Otoplasty, and facelift surgery, which still present new challenges and room for improvement, and excel­lence in these is a journey and not a destination. As in any side of life, some do something and are satisfied with the average and those who are continually searching for a better, safer, faster, and more reliable result.

When to Consider Surgical Face and Neck Lift Surgery?

• If you feel that your face does not show your youthful spirit and energy level
• If you decide that your facial sagging and excess skin is a social or career obstacle
• If you show signs of facial aging but still have some skin elasticity
• One day you look in the mirror and realize that time, gravity, sun exposure, and heredity have taken a toll, and you do not look like yourself anymore.

Some patients might find that they can make their cosmetic goals with a non-invasive procedure, such as a chemical peel or microdermabrasion. Others may be happier with their results if they combine facelift surgery with other methods, such as a neck lift or forehead lift (also known as a brow lift). Patients who understand both the possibilities and limitations of facelift surgery tend to be more pleased with their results.

Am I the Right Candidate for Surgical Face and Neck Lift Surgery?

The following are some common facial characteristics that make you a proper candidate for a facelift:

• Sagging skin in your midface and jawline
• Deep creases extend from your nose to the corners of your mouth (nasolabial folds)
• Lines extending from each corner of your mouth down your chin (marionette lines)
• Facial fat (volume) that has fallen or is displaced
• Sagging and loss of muscle tone in the lower face, resulting in jowls.
• A double chin, resulting from loose skin and excess fatty deposits under the chin and jaw
• Creased and sagging skin in your neck

The best facelift candidates have realistic expectations and are willing and able to follow the pre-and postoperative instructions provided by their plastic surgeons.

Who is The Good Candidate for Face and Neck Lift Surgery? (Doctor Opinion)

After a one-on-one consultation, the doctor can recommend a patient whether they are the right candidate for a facelift or whether an alternate procedure might be preferable. Ideal candidates for facelift surgery share certain essential traits.  The following is a list of factors that can affect whether an individual is a suitable candidate for facelift surgery:

Skin Elasticity

A right facelift candidate will have skin that keeps some of its natural suppleness and flexibility. This is important because, during the procedure, the surgeon tightens the facial skin to reduce wrinkles. Successful healing with the best results depends on having skin that can conform to its new, improved contours.

Strong Bone Structure

Ideally, a facelift candidate will have a well-defined underlying bone structure to support and give satisfying results. Patients with more minor distinct features may help from facial implants as an alternative or addition to a facelift.

Realistic Expectations

A candidate should understand what facelifts can carry out and the limitations of facial plastic surgery procedures. Consulting with a qualified cosmetic c surgeon can help a patient get the information needed to make the right decision about surgery.

Good Overall Health

A right facelift candidate will be healthy and tell their surgeon of any – medical conditions well in advance. A facelift is an invasive procedure that needs significant healing and recovery, so the patient must be physically ready for surgery.

Loose skin on the face or neck

Facelift candidates typically want to remove excess skin from the face or neck, tightening skin and reducing the appearance of wrinkles simultaneously. The surgeon trims the loose skin during the procedure.

Face and Neck Lift Surgery for Men

Facelift surgery isn’t just for women. Men can also turn to Rhytidectomy to erase the signs of aging and do a younger, rejuvenated look. The procedure steps are typically the same for both sexes, and both men and women can enjoy outstanding cosmetic results.

Are There Age Restrictions for Face and Neck Lift Surgery?

Age is not the most critical factor in determining candidacy for facelift surgery; skin elasticity and overall health have far more bearing on a patient’s ability to undergo this procedure. Most patients who undergo Rhytidectomy are between the ages of 40 and 70 years old. However, people older than 70 can benefit from the surgery, as well.

Face and Neck Lift Surgery for Seniors

More people over the age of 50 are turning to cosmetic surgery to improve their appearance. The doctor will consider each person’s circumstance, including age, before approving cosmetic surgery. Seniors undergoing surgery should understand that they will not look 20 years younger, although they will look more youthful.

Your Initial Consultation For Face and Neck Lift Surgery

First, Prof Moawad will decide whether a facelift is a suitable procedure, considering health history, skin type, and goals for treatment. It is essential for a patient to be honest with their doctor, especially about health history. Certain medical conditions, such as autoimmune disorders or heart disease, can increase the risks of plastic surgery. Although not all underlying conditions will prevent a patient from receiving a facelift, the surgeon needs to know about these concerns to take necessary precautions. At the first appointment, Prof Moawad may also address the issue of smoking. Again, the patient should be upfront, as smoking can raise the risks of plastic surgery and slow healing. Although this habit does not automatically keep someone from qualifying for a facelift, they will need to stop smoking for at least two weeks before and two weeks after the surgery, if not longer.

Planning the Procedure of Face and Neck Lift Surgery

After determining that a facelift is a practical solution, Prof Moawad and the patient will work together to create a personalized treatment plan. They will decide:

• The type of facelift
• The type of anesthesia
• The location of the incisions
• How the doctor will close the incisions
• Which procedures, if any, should be combined with the facelift
• The about recovery times

One of the most critical components of the first consultation is determining the correct type of facelift. With so many options, choosing the right kind of facelift surgery depends on more than just budget. It is crucial to consider the specific areas a patient wants to target, the length of recovery, and their expectations for their post-facelift appearance. Treatment options include:

Traditional Full Face Lift

A complete facelift offers the most comprehensive results. With this procedure, the doctor can address deep creases below the eyes, sagging around the cheeks, lines around the mouth, excess fat and skin under the chin, jowls, and more. Because it targets a larger area, the treatment needs a longer incision. As described above, it usually runs along with the temple, around the ear, and down to the neck. Full facelifts can address the most dramatic signs of aging, and, thus, they are popular among patients in their 50’s and 60’s.

Mid Face Lift

A surgeon can lift and tighten the tissues under the eyes and around the cheeks during a mid-facelift. The doctor will create incisions during the procedure like those used in a traditional facelift, but they will typically be deeper. This technique allows him to lift the muscles that are usually untouched by a conventional facelift. He may also use fat grafting or facial implants to enhance contours and create more defined cheekbones. Because this procedure does not address all the signs of aging, it is often suitable for men and women in their 30’s and 40’s who are only looking to rejuvenate their appearance.

Mini Face Lift

Mini facelifts involve smaller incisions and a shorter recovery time, which is why this procedure is sometimes called a “weekend facelift.” As with the mid-facelift, this surgery targets a smaller area, primarily treating the jaw, lower cheeks, and neck. The doctor will usually find the incisions along the hairline and behind the ear. Through these incisions, the doctor will lift the muscles, remove fat, unwanted fat deposits, and cut excess skin. Many surgeons perform mini facelifts using endoscopic techniques. Like mid-facelifts, this procedure is standard among younger patients who are showing the first signs of aging.

Lower Face Lift

As the name implies, lower facelifts target the bottom third of the face. This procedure can be an excellent way to cut jowls, reduce deep nasolabial folds, lift the sagging corners of the mouth, and enhance the jaw. The process itself is like other facelifts, and the doctor will create incisions along with the patient’s ears and hairline. Lower facelifts are suitable for patients of all ages who want to decrease the signs of aging and enjoy a more youthful appearance.

How do I Prepare for Face and Neck Lift Surgery?

• Your surgeon will give thorough preoperative instructions, answer any questions you may have, take a detailed medical history, and do a physical exam to decide your fitness for surgery.
• I may also need you to get medical clearance from your personal, family physician, or internist.
• Preparation for surgery begins after the surgeon examines you and discusses the details of the procedure. If he recommends that you stabilize your weight before surgery or make other lifestyle suggestions, do your best to follow them to ensure the best results and lower complications.
• Patients should also prepare for their surgery by mentally preparing for the downtime and deciding on transportation and after-care. Most people should plan to take one to two weeks off from work, although specific time will vary, depending on the procedure they select.

In advance of your procedure, your surgeon will ask you to:

• Stop smoking six weeks before your surgery to promote better wound healing and reduce scarring. Smoking also increases your risk of serious complications.
• Avoid taking aspirin, nonsteroidal anti-inflammatory medications (NSAIDs: Advil, Motrin, Aleve), and vitamins/homeopathic regimens. These can increase bleeding.
• Regardless of the type of surgery to be performed, hydration is vital before and after surgery for safe recovery.

Your facelift may be performed in a hospital or an MSI outpatient surgical facility. If it is outpatient, be sure to arrange for someone to drive you home after surgery and stay with you for the first twenty-four to forty-eight hours, unless you and your surgeon have decided on other postoperative recovery options.

What Can I expect on the day of Face and Neck Lift Surgery?

Facelift surgery requires at least several hours to complete, though more extensive procedures may take longer. The goal of your aesthetic surgeon and the entire staff is to help you do the most beautiful and natural-looking results and to make your surgical experience as easy and comfortable as possible.

• You will receive medications to keep you comfortable during the surgical procedure.
• Local anesthesia combined with sedation is used during facelift surgery, though general anesthesia can be used instead. An anesthesiologist or nurse anesthetist may be present to administer sedatives (or general anesthetic) and aid in monitoring.
• For your safety during the surgery, I will use various monitors to check your heart, blood pressure, pulse, and the amount of oxygen circulating in your blood.
• Your plastic surgeon will follow the surgical plan discussed with you before surgery. Once the operation has begun, they may combine various techniques or change a method to ensure the best result. It is vital that you feel comfortable and trusts your doctor to make these decisions.
• After surgery, I will take you into a recovery area where I will carefully check you.
• Your incisions will likely be covered with bulky bandages that give gentle pressure to decrease swelling and bruising. A small tube might be placed under the skin behind one or both of your ears to drain any excess blood or fluid.
• Before leaving for home on the day of surgery, you or someone looking after you should feel comfortable emptying and resetting the drains.
• You may choose to go home on the day of surgery or spend the night with an official consultant or nurse unless you and your plastic surgeon have made other plans for your immediate postoperative recovery. Under no circumstances will you be allowed to go home alone.

How I Will  Look During Recovery?

After surgery, you and your caregiver will receive detailed instructions about your post-surgical care, including information about:

• Drains, if they have been placed.
• The typical symptoms you will experience. Your surgeon will discuss how long it will be before you can return to your average activity level and work.
• Potential signs of complications

Immediately after your facelift surgery

• You may be placed in a compression garment or wrap at once after surgery. Wear this exactly as directed. Remove it only as directed for cleansing incisions or showering.
• To reduce swelling, recline, and not lie down. This will be more comfortable for you and can reduce swelling. Always keep your head raised. Do not bend forward or over.
• You will have a mild to moderate amount of pain and discomfort. This should be easily controlled with oral medications. If it is not, call your surgeon.
• The discomfort and pain should begin to decrease within forty-eight hours after surgery. If you have a significant increase in pain after this period, call your plastic surgeon. Severe pain is rare; if you experience this, call the doctor at once.
• Expect bruising and swelling. These symptoms will peak within the first thirty-six to forty-eight hours after surgery and gradually subside over ten to fourteen days. To reduce swelling, sleep with your head raised for a couple of weeks after the surgery.
• It is not unusual to have some slight drainage for the first forty-eight hours. A bulky cotton compression dressing with drains will cover your scalp and face from one to two days to help prevent blood collections under the skin.
• In the weeks and months following a facelift, patients should attend all follow-up appointments with their surgeons. They should also carefully check their progress and alert their doctors if they notice the signs of post-surgical complications. It may take several weeks for patients to see the results of their facelifts. Nevertheless, as recovery progresses and swelling subsides, patients should begin to enjoy a younger, more alert appearance.

How Long Will Face and Neck Lift Surgery Results Last?

Your genes, skin quality, and maintenance routine are essential factors in the longevity of your facelift. Still, the facelift technique is the number one factor in determining how long the result will last.

• Mini-facelift, or ‘S-Lift,’ refers to a facelift with a small amount of skin undermining with limited SMAS (muscle/fascia) mobilization. With this technique, recovery is fast, and results can last up to five years.
• Complete or standard classic facelift: There are many versions of the operation that fall into this class and can be called SMAS platysma, SMAS-ectomy, SMAS imbrication, deep plane, composite lift, or subperiosteal. These all require extensive rearrangement of the underlying facial tissues as well as significant skin undermining. The recovery is longer (two to four weeks), but the results can last over ten years.
• Minimal facelift techniques with fast recoveries will last the least amount of time.
• The more extensive the procedure, the longer the recovery period, and the longer you enjoy the results.

What are the Limitations and Risks of Face and Neck Lift Surgery?

Fortunately, significant complications from facelift surgery are infrequent. This surgery stays the gold standard for facial rejuvenation and is usually performed without any significant problems. I should discuss the risks and potential complications of surgery during your consultation. The chances in most operations are similar such as:

• Poor reactions to anesthesia
• For most patients, anesthesia is extremely safe. However, there may be some risk for heart attack, stroke, and other severe complications for patients with underlying health conditions.
• Infection
• All surgeries pose some risk of infection. However, when doctors and surgical centers follow proper sanitation protocol, this risk is shallow.
• Hematoma:
• Hematoma is the most common post-facelift complication, affecting 1 to 3 percent of women and 7 to 9 percent of men. While the risk is higher for men, other factors that may raise a patient’s chance of developing a hematoma include smoking, the use of NSAIDs or aspirin, and high blood pressure. Patients who combine a facelift with a specialized neck lift procedure known as anterior platysmaplasty also have a higher risk for this complication. Bleeding under the skin can cause immense discomfort, as well as swelling and skin discoloration. Surgery is the only way to repair this problem.
• Nerve damage:
• A nerve may be cut, nicked, or cauterized in rare cases, causing numbness or facial paralysis. Nerve damage, the most dreaded complication of facelifts, is the second most common risk of this surgery. Even so, the rates are still reassuringly low, occurring in a mere 0.5 to 2.6 percent of all facelift patients. Sensory-motor damage, which can cause reduced sensation in the face, is more common, occurring in up to 7 percent of all cases. Fortunately, when this does happen, the damage is not always permanent.
• Visible scarring:
• Although there will always be some scars still being after a facelift, usually, they are hidden. Occasionally, some faint marks may not be concealed behind the ear or in the hair.
• Only two other side effects have a high enough occurrence alopecia, or hair loss affects 0.2 to 1.8 percent of all facelift patients.

Othe Combined Procedure with Face and Neck Lift Surgery

In some cases, additional treatment can help to augment or enhance facelift results. These treatments may include further surgery, or a doctor may recommend a non-invasive skin treatment for a more youthful appearance. Cosmetic surgeries frequently combined with facelift surgery include:

• Chemical peels, laser peel, and microdermabrasion to improve skin appearance and texture
• Botulinum toxin and fillers
• Lipo-transfer and implant insertion to restore lost volume
• Eyelid lid surgery or blepharoplasty
• Eyebrows and forehead lift
• Lips augmentation
• Rhinoplasty
• Liposuction (Face and Neck)

Notes

I can determine the specific risks and the suitability of this procedure for a given individual only at the time of consultation with your cosmetic surgeon. Minor complications that do not affect the outcome occur occasionally. Significant complications are rare.

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