I see many patients in my plastic surgical practice who are considering surgery for facial rejuvenation. Some of these patients will do well with injectables and/or peels/laser treatments, but many will do best with surgery. As I introduce the option of surgery, a comment that I often hear is, “I don’t want a facelift!” Reasons range from cost to an unnatural look to time off for recovery. What I explain to patients is that there are many different types of facelifts. These would include the full facelift = “the whole enchilada”, full necklift, cheeklift, limited necklift, and limited = mini-facelift. When done properly, none of these will result in an unnatural look. All require 10 – 14 days of recovery, with recovery being defined as being able to drive, exercise lightly, and go out in public. Only the full facelift and full necklift require drainage tubes after surgery and these typically stay in for 2-5 days. In addition, full facelift and full necklift patients usually stay overnight at a recovery center or have a nurse spend the first night after surgery with them in a hotel or at their home.
I am often asked how long the results last? It generally takes 5-10 years for the patient to return to their preoperative appearance, closer to 10 years in patients with good skin elasticity who are typically non-smokers, have avoided the sun, and do not have a history of a great deal of weight change. After surgery patients tell me that they look: #1 – Very natural, and #2 – About as they did 10 years before surgery! They look like themselves, just a younger version.
Let’s consider the differences between these various procedures.
This operation lifts the cheek, jawline, and neck areas. It not only tightens loose skin and muscle, but uplifts drooping fat. This allows for improvement of the jowls as well as the nasolabial folds, those lines on either side of the upper lip that extend to the side of the nose. As the nasolabial folds are lifted, the fat is brought back up onto the cheekbones, restoring a more youthful look. This fat repositioning is done by a tightening of the SMAS, the layer of tissue that covers the facial muscles. The facelift also provides an excellent neck improvement by allowing the surgeon to lift the skin off of the front and side of the neck. He/she can then bring together any muscle bands in the front of the neck and also remove excess fat.
The surgical incision is usually made inside the front edge of the ear, which hides it beautifully. It then passes under the sideburn and up into the temple area. In the temple area the incision can be made along the edge of the hairline or inside the temple hair. If it’s inside the hair, it is hidden completely, but this will cause the hairline to move up and back by up to ½ inch and may also lead to thinning of the temple hair. For this reason most women over 50 will prefer the edge of the hairline incision. There is also an incision made behind the ear and then extending into the hair behind the ear. Great care is taken to precisely align the hairline and hide the scar behind the ear. As a result, after surgery a person can usually style their hair in any way they wish. There is also an incision hidden beneath the chin.
10 – 14 days are required for recovery.
This procedure is identical to the full facelift in its beneficial effects on the neck and jawline. It’s basically the lower 2/3 of a full facelift. As a result, the incision does not need to extend up into the temple area, stopping instead under the sideburn. The incision does hide inside the front edge of the ear and then around to the back of the ear and into the hair. As in the full facelift, the skin of the neck is lifted off of the underlying muscle which allows for treatment of the muscle bands and maximal tightening of loose skin. Again, 10 – 14 days are required for recovery.
A cheeklift can be done so as to lift the cheek only or the cheek plus the jowl. Think of it as either the upper 1/3 or the upper 2/3 of a facelift, depending on which option you choose. In many patients it makes perfectly good sense to do only that portion of the facelift since the neck looks just fine or they want to leave it alone. That is exactly what a cheeklift does!
The incision is like that of a facelift except that it ends at the earlobe and does not extend behind the ear for a significant distance. In most cases there is not an incision beneath the chin. This procedure can be performed under local anesthesia (although some patients may prefer sedation), does not require drainage tubes, and does not require an overnight stay in the recovery center. Recovery is about 10 days.
There are a variety of limited necklifts around, my favorite being a modified MACS-Lift. This procedure improves the jawline and the neck, and in the right patient, is a terrific operation! It works best when there is not a great deal of excess skin or muscle banding in the front of the neck, although it will improve the jawline and neck in anyone who needs improvement. Like the cheeklift, it can also be performed under local anesthesia (although some patients may prefer sedation), does not require drainage tubes, and does not require an overnight stay in the recovery center. Recovery is about 10 days.
How does it differ from a full necklift? The difference is that the skin is not lifted off the front of the neck – the muscle and skin of the front of the neck are tightened from the side. As a result, the incisions around the ear are a bit shorter than those of a full necklift, and only tiny incisions are needed beneath the chin. This makes for a shorter recovery and eliminates the need for drainage tubes in most patients.
LIMITED FACELIFT, ALSO KNOWN AS A MINI-FACELIFT
This procedure combines a limited necklift with a cheeklift. It does an outstanding job of improvement in the cheek and jawline area, and improves the neck to a moderate degree – perfect for someone whose neck only requires a moderate degree of improvement. It can be performed under local anesthesia (although some patients may prefer sedation), does not require drainage tubes, and does not require an overnight stay in the recovery center. Recovery is about 10 days.
Which one of these procedures is right for you? The answer depends on several factors. These include how much improvement you desire or need in any area, the quality of your skin, and your history of smoking/weight loss/sun exposure. It also depends on what type of operation you prefer – under local anesthesia, shorter recovery, less expense. For example – some patients who would enjoy more improvement with a full facelift will opt for a limited facelift because they are not particularly concerned with their neck. “Beauty is in the eye of the beholder!”
Although there is no substitute for an office consultation, I hope that this article will provide helpful information to those patients considering facial rejuvenation.
George Sanders, M.D.