Highlighting the Facelift

OP. DR. YUNUS DOĞAN

All about facelifts

You know the phrase “time marches on.” Maybe you feel like it has marched all across your face. You’ve had an entire flock of crows’ feet prance around your eyes. It’s getting more and more difficult to turn that frown upside down. You want to increase your face value? Read on.

Some people have learned to embrace their wrinkles as part of their life’s journey: laugh lines, memories made, blah blah blah. If you’re someone who’s handed your appearance over to Father Time and Mother Nature, your creases aren’t cringy. You’ve earned them! No shade thrown from where we sit. But if you’re aging so gracefully, why are you reading this?

You might have seen ads on social media for plastic surgery alternatives. Our phones are flooded with facial yoga exercises that claim to tighten your muscles without medical intervention. You can try splashing a little of the Fountain of Youth on your cheeks with ultraviolet light, microneedling, or any of the other options that online lifestyle magazine BYRDIE highlights.

In all your research of plastic surgery alternatives, you may read that the results vary and do not last. If you want to put your best (and more youthful) face forward, you might want to consider a facelift. But do you think you’re too old for a facelift?

This article is the sixth in a series highlighting some of the most popular plastic surgery procedures. In the Highlighting series, we tell you ALL the alternative names of the surgery so you learn the medical terminology as well as develop a little street cred with slang terms. We share a little history of the procedure and describe the general process. We mention possible complications and give you an idea of the typical recovery time.

Also known as/similar or related names are:

Face-lift, FaceTite, facial rejuvenation, facial threading, hyaluronic fillers, microneedling, Morpheus8, radiofrequency, rhytidectomy

First recorded facelift

Dr. Eugene von Hollander performed the first documented facelift in 1901. His patient, a Polish aristocrat, wanted her cheeks and the corners of her mouth lifted. Dr. von Hollander removed an oval-shaped piece of skin from around her ears and simply pulled the remaining skin tighter. While this technique was successful in the short term, its results did not last long because the patient’s underlying fat and tissue weren’t manipulated at all. World War I propagated a need for legitimate facial reconstruction, prompting a (pun intended) deeper understanding and manipulation of all the facial layers. In addition to cutting the top layer of skin, surgeons needed to reposition or remove underlying fat, tighten muscles and place sutures to lift tissue and skin.

It wasn’t until World War II, however, that advancements in anesthesia and antibiotics opened up opportunities for these more complicated and aggressive methods. Swedish surgeon Ted Skoog reported the first facelift involving the dissection of the superficial fascia of the face. In other words, Dr. Skoog’s first cut was the deepest known at that time. His technique eventually led to the SMAS rhytidectomy thanks to an anatomical study that renamed the short and sweet “fascia” as the “superficial musculoaponeurotic system.” Saying that 40 times in a row feels like face yoga.

Texas surgeon Sam Hamra introduced his tri-plane rhytidectomy in 1983, which helped improve the neck contouring aspect of the facelift. Several years later he developed other techniques to address different parts of the face, such as the deep-plane and composite rhytidectomies. For more historical details, check out the National Library of Medicine’s article.

General process

Dreaming of a more youthful face? Your actual facelift starts with a nap! Your surgeon will discuss the type of sedation that will work best for your specific procedure. Your options include general anesthesia (where you are completely asleep,) intravenous sedation (also known as twilight sleep,) and local anesthesia with oral sedation.

There are different techniques to choose from but they all share one aspect: an incision around your ear. Traditional facelifts generally start with an incision along your hairline near your temples. This cut will run around your ear and stop in your lower scalp. Your surgeon will do his or her best to place incisions in hairlines and places where scarring will be minimally noticeable.

Remember from the history lesson that skin-deep isn’t enough: we also need to work with fat and underlying tissue and muscle, possibly removing excessive fat to improve large jowls. Your surgeon may place internal sutures to lift sagging muscles.

The American Society of Plastic Surgeons compares the traditional facelift, a limited incision option and a neck lift. Face the facts and talk with your surgeon. Together, you can decide the best option to meet your plastic surgery goals.

What could go wrong?

Complications that may occur include:

• Hematoma - when blood can’t drain properly, it can collect under the skin. A medical professional can remove these collections with a syringe.
• Nerve injury - injury or weakness may occur, involving some numbness or changes in skin sensation. These feelings should be temporary.
• Scarring - if your skin has been broken, it will scar to some degree. Your doctor can advise you on further treatment of noticeable scars.

What could go right?

If your face isn’t too tight, you can smile about:

• Looking younger than your kids. Have you ever been mistaken for your daughter’s sister? It’s only embarrassing for her! Give it a try.
• Seeing that ravishing reflection in every mirror. Lock eyes with that minx looking back at you.
• Keeping that smirk on your face. Nobody needs to know you had plastic surgery. Let them think your new juicing regime keeps your jaw taut.

Recovery time

After incisions are closed with sutures and possibly skin glue, you will experience some swelling and bruising for the first month. You may have drains left in place to catch lymphatic fluids and promote healing. These drains will remain in until the amount of fluid collecting has decreased. Your surgeon will outline your complete post-surgical plan but you can expect a few weeks of keeping your head elevated and your hands free. No bending over or heavy lifting while your new face heals.

The last stitch

Saving face starts well before you get on your surgeon’s table. Prime yourself for optimal results and recovery. Being informed and prepared will help you face up to any necessary but unpleasant aspects of the healing process. Test your plastic surgery knowledge with this fun little quiz. Or maybe save it to read while recovering from fixing your face.