Facelift, or rhytidectomy, is probably the most misunderstood operation in the field of plastic surgery. The word “facelift” conjures images of celebrities with a pulled, operated look that defies any semblance of normal human expression. So it’s only expected that the very mention of this word elicits pure horror amongst my patients. The truth is that this operation is best used in addressing age related changes of the lower face-the neck and jawline. This includes the loose neck skin (a.k.a. the “wattle”), neck bands and the jowls. These are hallmark features of the aging face, and correction of these are pivotal in restoring a youthful appearance. In the lower face, lifting and repositioning of the deep tissues is the critical maneuver in natural rejuvenation, whereas lifting in the midface leads to the undesired “wind tunnel” look. Ultimately, my goal natural rejuvenation that stands the test of time.
How does a facelift work?
With age, the soft tissues-muscle,fat, skin-sag along the jawline and neck droop. The SMAS, or submuscular aponeurotic system, is a muscular sling that is intimately linked to the soft tissues of the face and neck. With time, this sling becomes saggy and redundant like an outstretched rubber band, dragging down fat and skin along with it. The type of facelift employed depends on how the SMAS is handled. In most instances, I prefer using a deep plane approach, in which the SMAS is elevated from the deep facial tissues. From there, the redundant SMAS is trimmed and the SMAS is repositioned to a more youthful position. The facelift is performed through an incision that hugs the nooks and crannies of the front and back of the ear with extension into the hairline. This allows for maximal camouflage of the scar, so that it can be ultimately difficult or one’s own hairdresser to detect it. For those with severe banding and loose skin of the neck, the facelift can be combined with a necklift. In a necklift, a small incision is placed under the chin, the redundant, sagging muscle is trimmed and tightened from below as well. Excess fat in this region can also be removed through this incision as well. The benefit of the deep plane approach is that it maintains the SMAS as the load bearing structure of the facial tissues rather than the skin.
Imbrication, or suture suspension, is the most common type of facelift performed in the United States. This type of lift places tension on the skin which can lead to wide scars, skin necrosis and an overly pulled, unnatural appearance. Few plastic surgeons around the country have the training and expertise to perform a deep plane facelift.
The facelift is performed under intravenous sedation with local anesthesia at our AAAHC accredited surgical center. This mode of anesthesia has the benefit of a more expeditious recovery and less postoperative nausea while diminishing the cardiovascular risks more prevalent in general anesthesia.
Prior to surgery, I spend much time with my patients formulating a customized surgical plan suited to each patient’s unique anatomy and goals. Facelift can be combined with other procedures designed to rejuvenate other parts of the face (e.g. blepharoplasty, browlift, laser resurfacing). All procedures are performed at our surgical center. Contact us today for a consultation.
After having surgery, patients are discharged home with a compression dressing. Cumbersome and uncomfortable drains are not employed. The following day, the compression dressing is replaced with a looser, cotton and gauze based dressing which remains for two days. On the third day after surgery, an elastic band is placed to provide gentle compression for one week. During this week, the band may be removed briefly to shower or if the patient needs a break from dressings. The band is also adjustable as well. I personally do the dressing changes for local patients in the comfort of their own home, as well as out of town patients staying in nearby hotels.
After surgery, patients are prescribed narcotic pain medication. Typically, patients require prescription pain medication for 2-3 days after surgery and are able to transition to over-the-counter pain medications like Tylenol.
Regarding activity, patients are able to start light exercise (e.g. cardiovascular exercise) 2 weeks after surgery. Heavy lifting and bending over may be resumed 3 weeks after surgery. At 4 weeks, most patients feel comfortable being photographed or attending a big event like a wedding or a reunion.
Browse Dr. Bhatt's facelift gallery to see the natural, refreshed results achieved through his skillful approach to Facelift Surgery.