The process of aging is one of those universal bonds connecting all people. It is inevitable and perpetual. Starting in the 30s and 40s, this process hits us where it hurts the worst: the face and neck. It is the epicenter and without intervention, it is overrun by loose skin, unwanted fat, deflated cheeks, worsening wrinkles and lost definition.
Even though you can’t stop aging, it is possible to weight the scale in your favor. In our Denver clinic, a truly unique approach has been implemented for our patients. After we maximize life style, genetic and health related factors, a comprehensive treatment plan, or beauty ‘pro forma’ is created. This is a road map to attaining natural beauty. It ensures the best results and establishes real goals for treatment. Technology is stressed and surgical intervention is the last option in a long line of treatments. Everything is fully integrated into our Aesthetic Wellness program.
When surgery is necessary, all forms of face and necklift procedures should be considered. These are the most common type of procedure I perform on a weekly basis and involve every aspect of plastic surgery that I enjoy: anatomy, technique, artistry and technology. The newer techniques that I use have little relationship with the procedures of the past. The days of windblown, pulled and unnatural results have been replaced by procedures that balance and truly enhance one’s beauty. Therefore, our outcomes are natural and tailored to each patient’s specific facial features. There is an emphasis on restoration and less invasive approaches. Volume losses are addressed and combination treatments with lasers are now the norm. Overall, the results give a subtle rejuvenating effect to the face that is unparalleled by any other treatment or procedure. With the addition techniques like Smartlifts, technology is now front and center. It is a great time to one of these rejuvenating procedures and turn back the hand of time.
Click below to read a more detailed breakdown of my patients by groups to make it easier for anyone interested to better categorize themselves. The 3 groups are listed below:
Minimal jowling (excess skin and fat on the jawline), loose skin on the neck and fine wrinkles
A patient with complaints of mild jowling, loose neck skin and fine wrinkles is an excellent candidate for a short incision (mini) facelift. These patients are generally 40 to 60 years old, active and desire a pre-emptive rejuvenating procedure.
A few key points are listed below that are important understand about this procedure.
- The incisions for this procedure can be easily camouflaged around the ear allowing for any hairstyle, including having the hair pulled back tightly. I often use a retrotragal approach, which ensures that a patient will have no visible scars in front of the ear.
- As this procedure is much less invasive than a standard facelift, the recovery time, including bruising and swelling, is drastically reduced. In most cases, the patients are able to return to normal activities, including work, within 7 to 10 days. Exercise is initiated 2 weeks after surgery.
- I often combine these cases with an ablative laser treatment (fractionated or non fractionated) and autologous fat grafting at the time of surgery. The laser addresses the residual wrinkles (especially around the mouth and eyes) and the unwanted changes in the skin from cumulative sun damage. The autologous fat grafting utilizes a patient’s own fat to subtly improve the areas of the face that have lost volume with age.
- Contrary to common claims in the aesthetic industry, NO current device can accomplish the necessary skin and soft tissue tightening that is achieved with a short incision facelift. I do believe that these technologies will arise but this is many years down the road. This includes the SmartLift procedure which I complete on a regular basis.
- For patients with unwanted fat on the neck, combining a short incision facelift with a neck liposuction is enormously beneficial. In my office this is often combined with SmartLipo™ and VASER® Lipo.
Moderate jowling, loose skin in all areas and wrinkles
This group of patients has complaints of moderate jowling, loose skin in all areas and wrinkles. These patients are generally 50 to 70 years old, active and desire a natural, age appropriate improvement.
- A majority of these patients can be treated with a short incision (mini) facelift. If a necklift is also required, the incisions are easily hidden within the occipital (behind the ear) hairline. The benefit of removing the unwanted skin and fat of the neck is far outweighed by having an imperceptible scar along the occipital hairline that fades within the first 6 months after surgery.
- For a full facelift/necklift, recovery time is 14 days on average. The bruising is more substantial than a short incision (mini) facelift but is generally limited and resolves within 10 days. If a neck lift is completed, attention must be given to keeping your neck in an extended position to avoid creasing.
- A majority of these patients are good candidates for a more aggressive laser treatment of the facial skin. Fractional lasers are an excellent option for treating the mild to moderate wrinkles of the facial skin and the results are potentiated when combined with a facelift.
- Correctly addressing the SMAS layer with these types of procedures will drastically improve the definition along the jaw line, the nasolabial folds (the crease from the edge of the nose to the edge of the mouth) and the cheeks
- These patients are usually good candidates for autologous fat transfer to the face. In this subset of my patients, over 50% also include fat transfer in their procedure. This will increase the post-operative bruising and swelling but is the only permanent way to restore lost volume in the face that is not improved with a facelift.
Moderate to severe jowling, unwanted fat in the neck and loose skin and deep wrinkles in all areas
The patients in this group are in general 60 to 70 years old or in select cases, younger and with a history of weight loss. Due to the amount of wrinkles and hanging skin, these patients are rarely candidates for short incision (mini) face and necklifts. They often require simultaneous eyelid rejuvenation and autologous fat grafting to areas of the face deficient in volume. Overall, these cases have the most transformative results of all the patients I treat for facial aging.
- As these procedures are usually more involved, the recovery time is around two weeks and a return to normal activities is within 3 weeks.
- Bruising and swelling is common with a full face and necklift but limited primarily to the first week after surgery. In our office, we have a comprehensive post surgery protocol to reduce bruising and swelling. This includes homeopathic medications and LED light therapy. With this protocol, the degree of swelling and bruising can be reduced by 50%. Combining these protocols with the more advanced surgical techniques that I commonly use makes bruising and swelling a non factor in almost all cases.
- Unlike less invasive procedures (e.g. short incision (mini) facelift), surgical drains are often necessary. These are removed between 12 to 48 hours after surgery and the use of long acting local anesthesia minimizes any discomfort from the drain site. I place surgical drains on a case to case basis so don’t be mislead by claims of a drainless facelift. This has more to do with marketing and less to do with actual procedures.
- It is appropriate for the front part of the neck to feel a little tight after these cases. This last around 2 weeks and resolves within 4 weeks.
Frequently Asked Questions
1. What are the new advancements in facelift surgeries?
The field of aesthetic facial surgery has progressed immensely in the past decade. This progression is in part due to improvements in technology and an increase emphasis on minimally invasive procedures. The most obvious improvement is a trend toward shorter incisions and less traumatic surgery. This is largely made possible by the combination of these procedures with full face fractionated laser treatment and autologous fat grafting. Although some surgeons understandably stick to the “tried and true” surgeries of the past, the paradigm has clearly shifted. Patients now actively seek out less invasive procedures with the added benefits of combination treatments. In my practice, 90% of my facelift procedures utilize shorter incisions and/or combination treatments. As we are now pushing the envelope with the addition of techniques like Smartlifts, the future should be very interesting.
2. How much recovery time and discomfort is associated with a facelift surgery?
In general, total recovery time is on average 14 days and is lessened when a shorter incision procedures is utilized. Swelling and bruising is in most cases minimal by post-operative day #10. Therefore, work duties and social activities are usually resumed at that time. If eyelid rejuvenation or fat grafting is included, swelling and bruising may persist for up to 14 days. For most patients, there is not much pain associated with this procedure. The swelling can cause some discomfort but this is short lived (3 to 5 days). Most of my patients are surprised how little pain they have through the recovery period and often return to normal activities sooner than they had planned.
3. Are drains required for this surgery?
Operative drains are placed on a case by case basis and I often complete short incision facelifts without operative drains. If drains are placed, they will be removed within 12 to 48 hours. Furthermore, the addition of a long acting local anesthetic around the drain site, minimizes any discomfort that may occur. Drains are useful in some cases to avoid unwanted fluid collections in the operative site that can negatively impact the final results of the surgery.
4. Are scars after a facelift surgery obvious?
One of the biggest concerns for patients who are considering a facelift surgery is the potential for post-operative scar formation. This is a reasonable concern as I often see patients for a second opinion who are unhappy with their scars after a facelift with another physician. If a patient chooses a reputable surgeon who has a primary focus of facial aesthetic surgery then undesirable scar formation will be extremely rare. Techniques during surgery and strategic placement of the incisions around the ear and hairline can make the scars nearly imperceptible after complete healing has occurred. Activities after surgery like smoking and sun exposure can wreak havoc on scar maturation. If the recommendations are followed and the surgeries are completed competently then the potential for unwanted scar formation is negated.
5. Do patients look ‘different’ after facelift surgery?
If a facelift surgery is done correctly, patients do not look ‘different’ after the procedure. In its basic form, this surgery is meant for rejuvenation. Therefore, these procedures should restore the facial characteristics that were desirable during the younger years while not drastically changing ones appearance. This is essential for any successful facial aesthetic procedure and is the primary emphasis for my practice. Successful facial aesthetic procedures should stay true to a patient’s historical appearance. It should build upon the basic foundation (bones and muscles) of a patients face and add volume only where volume is needed. Surgeries that deviate from this tenant will be unsuccessful, causing an abnormal appearance. For a patient considering these procedures, education regarding these surgeries is imperative. When choosing a surgeon, the surgical plan should be clearly outlined, before and after pictures should be thoroughly examined and other patients who chose that surgeon for the procedure should be contacted about their experience. This is critical as the results are not just dependent on a surgeon’s technical abilities but they are equally dependent on a surgeon’s judgment. This is a very important decision and a patient must feel comfortable that their surgeon will understand their expectations and maintain a natural aesthetic. A majority of my consults regarding facial rejuvenation are spent discussing expectations, self-perceptions, life stressors, relationships and a host of other non surgical issues. This allows me to understand a patient’s motivations thus ensuring that we are a good fit. As I tell my patients, “In my hands, the surgery is the easy part. The hard part is making sure everyone is on the same page.”