The goal of the modern facelift is to “reestablish the facial contours one had at an earlier period in life,” says New York plastic surgeon Sherrell Aston, MD. While a full facelift classically takes aim at sagging cheeks, droopy jowls, neck laxity and banding, limited lifts can target specific areas of concern. Unlike nonsurgical procedures, the facelift delivers a dramatic and lasting improvement, but it can’t permanently stall the aging process: “We can only turn back the clock with a lift,” says New York plastic surgeon Lara Devgan, MD; “we can’t stop it from ticking.”
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Over the years, as plastic surgeons have shifted from simply tightening the face to more wholly and consistently restoring its shape, they’ve allowed us to recapture a more youthful look while avoiding the distortions associated with facelifts past, notes Miami plastic surgeon James Stuzin, MD. Today, the facelift has become a routine three-hour affair delivering appreciable but natural results with generally undetectable scars and a manageable recovery. Average treatment cost $7,500–$18,000
What to Expect
In the two weeks leading up to your procedure, avoid taking anti-inflammatories, aspirin, ibuprofen, and certain herbs/ supplements/vitamins (namely fish oil, vitamin E, ginkgo biloba and willow bark), which can increase your risk of bleeding. (Your doctor will give you a list of things that are off-limits both pre- and post-op.) Your physician may also suggest that you take certain vitamins and homeopathic remedies, like arnica and bromelain, before your facelift to help prepare your body for surgery and aid in healing.
Facelifts can be performed under general anesthesia, or local paired with twilight sedation, depending on patient and surgeon preferences and the patient’s medical history. Doctors may also prescribe oral medication before surgery to help induce relaxation.
You’ll go home with a private-duty nurse or supervising adult, and may have a dressing around your head for two to five days to reduce swelling. Stitches come out after a week or two. Recuperation time can vary. Following a full facelift, expect at least 10 to 14 days of downtime. Significant swelling, bruising and stiffness can last up to four weeks. To hasten recovery, stay hydrated, minimize salty foods and sleep on your back with your head elevated on two pillows, says Dr. Devgan. “I advise patients not to exercise, have sex or get sun exposure for three weeks after their surgery,” says La Jolla, CA plastic surgeon Robert Singer, MD. It can take months for swelling to subside completely, and up to a year for scars to fully mature and fade—topical scar treatments can help expedite the process.
The 3 Main Types of Lift
You and your doctor will decide together which one is right for you.
The Full Facelift
The most comprehensive way to address laxity and sagging in the midface, along the jawline and throughout the neck, the classic lift allows for fat redistribution, muscle repositioning and removal of excess skin. Surgeons hide the incisions in the contours of the ears, around the earlobes, and/or in the hairline. A fine-tuning of the platysma muscle of the neck usually comes standard with a facelift to achieve a balanced result. Surgeons can often address the neck through incisions around the ears, but will sometimes make a short incision under the chin if fat needs to be removed.
The Mini Lift
“Mini, midi, short-scar, modified—these are all variations of limited facelifts, differing in terms of the area to be corrected and the location of the incisions,” explains Dr. Singer. These procedures zero in on a single region, like the mid-face or temples. Ideal for younger patients with early signs of aging, mini-lifts are less invasive than classic lifts, and typically use abbreviated incisions that give surgeons restricted access to muscle, fat and excess skin. Incisions are commonly placed behind the hairline at the temples, or hidden inside the front of the ears.
Denver plastic surgeon Brent J. Smith, MD treated this 62-year-old patient with a necklift and facelift with fat transfer, which firmed sagging skin in her lower face and restored lost volume in her cheeks.
The Neck-Only Lift
“We can do a full necklift without touching the face,” says Dr. Singer, but only in those without significant jowling to avoid the risk of a wobbly jawline contrasting a sleek neck. Small incisions are placed under the chin and/or behind the ears. “We open under the chin to let the neck skin re-drape smoothly. If we need to tighten the platysma or remove fat, a chin incision makes everything a lot easier,” says Corona Del Mar, CA plastic surgeon Val Lambros, MD. Patients with greater laxity may require a longer incision behind the ears through which to tailor out excess skin.
The Minimally Invasive Facelift
While the surgical facelift is deemed the gold standard for hoisting and shaping facial tissues into a more youthful position long-term, thread lifts (aka absorbable suture suspension lifts) can offer a very temporary fix for those with less severe skin laxity. Here’s what you need to know:
New and Improved
In 2015, Silhouette InstaLift spearheaded the shift from permanent, polypropylene threads to dissolvable, poly-l-lactic acid (PLLA) sutures, which are completely reabsorbed by the body after nine to 12 months, says Chicago plastic surgeon Julius W. Few, MD. Brands such as Nova Threads and MINT have also introduced similar versions made of polydioxanone (PDO), a material that’s been widely used for thread lifting in Asia for years.
Short- and Long-Term Gains
Modern thread lifts provide more than just an immediate boost. “With Silhouette InstaLift specifically, because the sutures are largely composed of PLLA—the same material used in the dermal filler Sculptra Aesthetic—a bio-stimulatory effect occurs in the skin with the production of both Type 1 and 3 collagen,” explains Washington, D.C. dermatologist Tina Alster, MD. “This collagen increase can lead to a volumizing effect that continues for up to two years, enhancing the quality of the skin in the long run.”
To address early signs of aging like sagging jowls, loose skin and volume loss, this 59-year-old patient underwent a Silhouette InstaLift procedure with New York dermatologist Marina Peredo, MD.
The Right Fit
“The best candidate is someone in their 30s, 40s or early 50s with mild-to-moderate sagging,” says New York plastic surgeon Z. Paul Lorenc, MD. “For patients in their mid-50s and older, we can still see some good results, but they’re much less predictable.”
According to Dr. Few, downtime following Silhouette is generally minimal with little swelling and/or bruising. Many of his patients have gone to big events 24 hours later where no one noticed, although he stipulates this may not be the case for everyone.
Unlike a surgical facelift, which “pulls the deeper layers of muscle and fat up with the skin, says Eugene, OR plastic surgeon Mark Jewell, MD, sutures elevate only the skin, “so the lifting effect isn’t nearly as profound.” Dr. Singer notes that those with significant laxity, loss of elasticity or sun damage “are generally best-suited for a facelift,” adding that “patients need to be educated on the differences between the two procedures.”
Because facelifts don’t correct tone or texture; address the eyes or brow; or restore lost volume, “combination procedures are now the norm,” says Dr. Singer. Consider tacking on one of these treatments, then maintain your results with a quality skin-care regimen.
“To me, autologous fat grafting is an essential part of modern facial rejuvenation,” says Dallas plastic surgeon Rod J. Rohrich, MD. Conservatively filling the cheeks and nasolabial area can soften a facelift, and reduce reliance on fillers in the future.
“A facelift can’t fix aging eyes, so it’s very common for patients to do an upper and lower blepharoplasty with their facelift,” says Dr. Devgan. The popular pairing brings harmony to the entire face.
Some plastic surgeons perform ablative laser treatments during surgery, attacking barcode-like lines above the lips, crow’s-feet at the outer eyes and glow-obscuring sunspots.
Intended to elevate the eyebrows to a more youthful position, most contemporary browlifts are performed endoscopically via small incisions hidden in the hairline. The procedure can also smooth forehead lines and crow’s-feet, and diminish upper-lid hooding to an extent. If you have a low forehead or deep sagging that can’t be corrected without removing skin, a traditional browlift, which requires an incision across the crown of the head, may be in order. Swelling and bruising usually subside within 10 days. Some complain of mild headaches post-op, but these typically relent after a couple of weeks.
To give this 58-year-old patient a new and improved look, Pasadena, CA plastic surgeon Martin A. O’Toole, MD performed a facelift, a necklift, a limited-incision browlift, and an upper and lower blepharoplasty.
Plastic surgeons share their facelift predictions for 2019 and beyond.
“People have been talking recently about taking the nerve supply away from the medial platysma, [as] this part of the muscle does nothing except make obnoxious bands in the neck,” says Dr. Lambros. “There’s some very interesting research on ways to selectively clip the nerve responsible without compromising motion. By doing so, we can probably reduce considerably the number of recurrent bands in the neck, which is one of the most common things patients complain about. This is still being studied, but it could be very promising.
“Total facial rejuvenation without any incisions or recovery!” says Dr. Rohrich. “Once we unlock how to safely and reliably tighten skin and remove neck fat nonsurgically— while continuing to fill the face in an artistic manner—the traditional facelift will be history. I truly see this on the horizon; it’ll be here in five years or less.”
“The future in facelifting may focus on the addition of growth factors and other innovations in regenerative medicine, such that the elasticity of aged soft tissue and skin is improved, allowing us to provide better aesthetic control in facelift techniques,” says Dr. Stuzin. “We’re seeing some of these effects now as we combine nanofat grafting with the facelift in patients with sun-damaged skin, as the nanofat contains both growth factors and stem cells. Nonetheless, the development of these types of procedures is only in its infancy.”
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