As people age, the effects of gravity, exposure to the sun and the stresses of daily life begin to take their toll on the face. Deep creases form between the nose and mouth; the jawline grows slack and jowly; folds, bands and fat deposits appear around the neck.

A facelift is a surgical procedure performed to improve the most visible signs of the aging process, by eliminating excess fat, tightening the muscles beneath the skin of the face and neck, and remove any sagging skin. Many times this procedure is performed in conjunction with eyelid or even forehead surgery. A well-performed face-lift should revitalize the face with distorting or changing one facial feature. A facelift can make you look younger and fresher, and it may enhance your self-confidence in the process. However it can't give you a totally different look, nor can it restore the health and vitality of your youth. Before you decide to have surgery, think carefully about your expectations and discuss them at your consultation.

Am I suitable candidate for this surgery?

The best candidate for a facelift is a man or woman whose face and neck have begun to sag, but whose skin still has some elasticity. There is no need to wait until hanging folds or almost irreversible changes have taken place. While the facelift procedure is probably the most sought after within the over 40's group, increasingly these are being carried out on younger patients. In fact these days, many patients prefer earlier corrections to maintain youthful appearances, and therefore avoid living through a period of looking "old and tired". Although the occasional film star may undergo a celebrated facelift, the vast majority of patients are those normal people who take in their appearance and feel younger than they look.

A facelift has always been regarded as a major surgical procedure. It is important to remember however that surgery cannot erase permanent creases, particularly on the lips, and that it does not stop the aging process. A facelift just "sets the clock back"; it does not stop it running.

At the time of consultation Dr. Loeb will ask you about your general medical history, specifically pertaining to any medical conditions that could cause problems during or after surgery, such as uncontrolled high blood pressure, blood clotting problems, or a tendency to form excessive scars. Slight difference in facial symmetry is normal and will be pointed out as many times these are unnoticed by the patient. It will also be explained that certain areas of the face cannot be helped by the surgery, such as the lines around the mouth, frown, and crowsfeet region. The newer skin resurfacing lasers covered under separate notes best deals with these areas.

If you are a smoker you will be asked to stop smoking well in advance of surgery. Smoking seriously constricts blood vessels and therefore decreases blood flow to a given area resulting in poor healing. Aspirin, certain anti-inflammatory drugs and other medications can cause increased bleeding, so you should avoid these.

If you're contemplating facelift surgery, this information will give you a basic understanding of the procedure. It can't answer all your questions since a lot depends on the individual patient. However, any specific questions should always be addressed at the consultation.

Are there different types of facelifts?

Over the years the classical (skin only) operation has undergone a number of modifications to improve the overall results. These modifications were aimed at lifting not only the skin but also the underlying structures (i.e. muscles), which were equally subjected to the effects of the aging process. By addressing these structures, the face could be lifted to enjoy a longer lasting effect.

The SMAS type of lift is that favored by many competent surgeons although there are now many variations such as the extended skin, SMAS lift, Composite Lift and Sub-periosteal Lift. Each of the above modifications can be tailor made to suit individual needs. It is equally important to remember that different methods do not indicate a departure from any formally established standard. Many times liposuction is carried out during a facelift so as to ensure that the neck and jawline is clearly defined.

IntroductioHow long does a Facelift last?

It is impossible to answer this or generalize, as each individual has different skin quality and texture. However, in one sense, ten years later, you will look better than if you never had any surgery. Remember however your face will continue to age with time. Many patients never have a second lift, while others may desire further surgery seven to 15 years later.

What does the Operation involve?

In broad terms the incision used for both man and women is the same, although there is a slight difference, as result of the hair bearing nature of the male facial skin. Generally speaking the incision starts high in the temple area (hidden by the hair at this point) then courses down in front of the ear, around the earlobe and up behind the ear before curving gently back into the hairline of the neck. It may on occasion, be necessary to add an incision in under the chin.

Using the above incisions the skin is lifted forwards onto the cheeks and down as far as the jawline and into the neck. The underlying muscles are then frequently lifted accordingly. Having repositioned the deep tissues, leaking blood vessels are then sealed with the use of a cautery. Following this, the loose expanded skin is elevated upwards and any overlapping or excess skin is trimmed. The wound is then closed with a combination of fine internal and external stitches. A bandage dressing is then gently applied around your face in order to apply light pressure over the wound area.

What type of anesthesia is used and how long does the surgery take?

A facelift is performed with a local anesthesia and intravenous sedation by an anesthesiologist. You are not aware of the surgery. A facelift can take between 2-3 hours, although this takes longer when combined with additional surgery like eyelid surgery.

What happens after the surgery?

Bandages are removed two or three days after surgery. Over the next few days you hair should be washed with a gentle shampoo, obviously exercising care in the suture area, stitches in the skin. You will be provided with full postoperative care instructions, which you are kindly asked to follow.

You will also experience a feeling of numbness and tension in the neck and cheek areas as well around the ear. This is a result of small sensory nerve fibers in the skin being separated during the operation. Sensation usually returns to normal but may take anytime up to 9 months.

What kind of after effects should I expect?

Following surgery you will experience swelling and bruising of the face to varying degrees, which can last up to 3 weeks. Occasionally, isolated bruised and hardened areas can take up to two months to resolve. The appearance of tiny thread veins on the cheeks can rarely occur. Swelling may produce some temporary lag in the normal motion of the facial muscles but this should be gradually subsiding without permanent change.

You will also experience a feeling of numbness and tension in the neck and cheek areas as well as around. This is a result of the small sensory nerve fibers in the skin being separated during the operation. Sensation usually return to normal but may take anytime up to 9 months.

It is important that both men and women alike are aware that the position of the hair in front of the ear is altered, and may be elevated for 1-2 cms. In men the beard may be repositioned underneath and behind the ear, necessitating in these areas.

What the scars like?

A scar will obviously form at the incision sites. This is always red and slightly lumpy in the first few months following surgery. One must remember, it is always impossible to ultimately predict how any individual's scar will appear. However, behind the ears, and rarely in front of them, scars of certain skin types can stretch.

These skin types cannot be identified prior surgery. Often, these are easily hidden by longer hairstyles but may become visible if the hair is cut short of lifted. Occasionally a bald strip can develop adjacent to the scar that is suitable in the temple area.

Is it painful?

You will experience a tight feeling around your face following surgery as a result of the bandages used. However it is safe to say that the majority of patients experience a surprisingly small amount of discomfort following a facelift. In fact most patients experience a numb sensation once the bandages are removed. This of course improves with time.

What could go wrong?

All surgery carries some uncertainty and risks. When a facelift is performed by a qualified Plastic Surgeon, complications are infrequent and usually minor. Still individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable. Conditions such as high blood pressure and smoking increase the chances of complications and therefore will be discussed in greater detail at the consultation.

Complications that can occur include hematoma(a collection of blood under the skin that must be drained by the surgeon), injury to the nerves that control facial muscles(usually temporary and less than1% chance), infection, delayed wound healing and skin lumpiness or distortion(usually temporary).

You can reduce your risks by closely following Dr. Loeb advice both before and after surgery.

How long before I can get back to normal?

You should be up and about in a day or two, but plan on taking it easy for the first week after surgery. Be especially gentle with your face and hair, since your skin may b both tender and numb, and may not respond normally at first. Avoid strenuous activity, including sex, and heavy housework, for at least three weeks. Mild stretching and walking are fine. Above all, get plenty of rest and allow your body to spend its energy on healing.

At the beginning your face may look and feel rather strange. Your features may be distorted from the swelling, and your facial movements may be slightly stiff and you'll probably be self-conscious about your scars. It's not surprising therefore that some patients are disappointed and depressed at first. However by the third week, you'll look and feel much better. Most patients are back at work from about ten days to two weeks after surgery. If you need it, camouflage make-up can mask bruising that remains.

Summary

The chances are excellent that you'll be happy with your facelift. In the properly selected individual it is likely to boost ones self-confidence and self-image.

The results of any properly carried out facelift should be lasting but remember the procedure cannot halt the aging process. The clock can be turned back but you cannot stop it ticking. However, it is reasonably safe to say that the delay in aging made available to average facelift patient is sufficient for their adjustments to various changing social pressures and can therefore be recommended as a solution to many of the aging signs that some individuals find objectionable.