What is a Facelift?
A facelift describes a surgical procedure which rejuvenates the face and neck. It does not address the eyes and brows which require different procedures called blepharoplasty (eyelift) or browlift. A facelift should address not only the skin, but the loose muscles and drooping fat in the face in order to last a long time and to look natural. Sometimes a facelift is combined with other rejuvenation procedures such as laser skin resurfacing to improve skin texture and superficial wrinkles or it may be combined with a browlift or eyelift for total facial rejuvenation. A facelift will not stop the aging process, but can make you look younger than your stated age.
How do I choose a qualified Surgeon?
It is important to understand the difference between a Board Certified facial plastic surgeon (www.abfprs.org) and a general plastic surgeon. The facial plastic surgeon specializes in only facial plastic surgery including the face, neck, nose and eyes. The general plastic surgeon does breast and body plastic surgery as well as hand surgery and facial plastic surgery. Facial plastic surgeons spend much more time in their training studying and operating on the face and neck than general plastic surgeons who train in general surgery. Facial Plastic surgeons understand the deep facial and neck anatomy to a greater extent because they do a lot of head and neck surgery during their training than do general plastic surgeons who spend more time doing abdominal surgery. Our doctor is a double board certified facial plastic surgeon with a Park Avenue Practice who also has pioneered his own facelift and necklift techniques and does them every day on a regular basis. Click here to read articles published by Our doctor in Peer Reviewed Plastic Surgery Journals for the latest advances on facelift and necklift surgery.
How do I know if I am a good candidate for a facelift?
The best candidate for a facelift is a person whose facial skin has sagged and who has sagging of the jowls and neck. A strong well defined bone structure is important for a good result. If the bone structure is weak or the patient has a small chin, a chin implant or cheek implant may be necessary. If the patient has a very thin face, fat injections may be necessary at the same time to replenish lost facial volume with the aging process. You are a good candidate if your weight is stable, are medically cleared for the surgery, and do not smoke. A patient has to also have a positive outlook and have realistic goals for improvement in appearance.
How long does a facelift last?
The results vary from person to person, depending on individual skin elasticity, skin tone, history of sun exposure or smoking, etc. However, most people can expect the results to last 8-10 years. Even after these 8-10 years, the patient will still look better than if they did not undergo the procedure. Another tuck up procedure may be required in 10 years.
What anesthesia is given during a facelift?
A facelift may be performed under sedation anesthesia or general anesthesia depending on patient preference. General anesthesia is not necessarily needed but is a very safe form of anesthesia. There have been dramatic improvements in anesthesia care and medications over the last 10 years which have made anesthesia much safer. Patients will require blood work, electrocardiogram (EKG) and a medical clearance from their medical doctor prior to undergoing a facelift operation. Our doctor, a New York City based Facial Plastic Surgeon, puts his patient's safety first and a facelift is a very safe procedure done on appropriate candidates who have been selected carefully and medically cleared.
If I am overweight, should I wait to lose weight before having a lift?
Our doctor states that the facelift should be done when the patient is within 10 pounds of their ideal body weight. If the patient is overweight significantly, they should lose that weight first and then consider the procedure. Our doctor also sees many patients who have undergone gastric bypass surgery and have lost a significant amount of weight and their neck sagged significantly due to their weight lose.
What are the different types of facelift surgery available?
All techniques for facelift surgery need to be customized to each patient. There are many techniques for partial versus full facelifts. Some partial lifts include only the neck if the neck is the only sagging area as seen in some younger patients. Some lifts address the lower face and neck areas only, some address the midface and some address the midface, lower face and neck. Male facelifts are different and focus mainly on the neck and lower face. In facelifts, the best lifts address different structures that age deeper in the face including the loose muscles and fat pads in the face. Skin facelifts alone do not look natural and do not provide longevity. SMAS lifts address the muscles that age in the face and neck. Deep plane facelifts address the loose muscles that age and the fat pads that droop to form the jowls in the face. Mini facelifts may occasionally be needed if there is only skin which is drooping. Shorter scar facelifts are also available and have a place depending on the individual face and neck laxity. Our doctor, a New York based double board certified facial plastic surgeon has pioneered the use of various 3D telescopes to assist in visualizing the internal facial structures through smaller incisions around the ear. This technology is similar to the advent of high definition flat screen TV's versus older television sets and Our doctor teaches instructional courses on the use of this technology to advance facelift surgery into a more precise operation. Our doctor further warns prospective patients to be aware of gimmick "named facelifts" hyped by the media and on the internet as providing a weekend lift with no scars, etc. Be aware that if it sounds too good to be true, it usually is. With Our doctor's rapid recovery techniques you could look presentable in public in 1 week. Weekend facelifts, as advertised are usually either not true facelifts or facelifts that lift only skin. Liquid facelifts are another type of media hyped term but is not a true facelift and is filling the face with fillers.
Do you tighten the muscle?
Our doctor, a New York City based Facial Plastic Surgeon, believes in tightening not only the loose muscles beneath the skin, but also the loose and drooping fat pads in the face which form the jowl and turkey neck. Repositioning the fat pads and tightening the muscles are important components in doing a natural facelift which lasts a long time. If the muscles are not tightened, because of the elasticity of the skin, the face will drop again within 6 weeks. Successful facelift surgery involves tightening the loose muscles, lifting the fat pads and excising the redundant skin. Thread lifts fail because they do not involve skin excisions and are a blind procedure done without a good view of where the deep sutures are placed and can cause deep tissue damage.
Do I need a chin implant?
Some patients need a chin implant to achieve overall facial balance and harmony. This depends on the shape and protrusion of your chin in relation to your lips, mouth, nose and forehead. A qualified facial plastic surgeon can make that determination in your consultation.
I don't want to look "pulled" or too "tight" but I want a dramatic change.
All of Our doctor's patients look natural because he DOES NOT TIGHTEN JUST THE SKIN and does NOT DO THREAD LIFTS which make patients look stretched or pulled. Our doctor tightens beneath the muscle and jowls, not under the skin, and the excess skin is removed once the deeper structures are tightened. This also provides longevity to the procedure. Most patients tell us that their friends make comments like, “You look refreshed like you got a nice haircut or been on a vacation.” This does not mean that the results are not DRAMATIC. A patient could get a dramatic result and a natural result at the same time. Not all results will be dramatic because this depends on what each individual patient starts with and expectations have to be realistic. Younger patients will have less dramatic results but older patients who have let themselves go will have more laxity and therefore more dramatic results. The key to a great facelift, according to Our doctor, is to preserve the unique features of the face that are unique to a person. Patients who want to look like other people should raise a red flag and may require a psychological evaluation prior to a facelift.
How does male facelift surgery differ?
Male patients are mainly interested in their necks and lower faces and are rarely interested in or need a complete facelift, according to Our doctor, who’s New York based Facial Plastic Surgery Practice is comprised of 30% male patients. Male patients have thicker skin and a beard which requires modification of the incisions. Male patients also get a better result in their necks with an additional procedure called midline platysmaplasty where the muscles are sutured together in the middle of the neck while visualizing them with a 3D high definition telescope. Our doctor does this midline platysma muscle binding in the neck with most male patients to achieve a superior result.
Does a facelift get rid of my wrinkles?
The deeper wrinkles created by laxity of the skin and muscles will improve after a facelift, but the finer superficial wrinkles do not improve with a facelift. Finer skin wrinkles may require an adjunctive laser skin resurfacing procedure to improve the more superficial skin wrinkles and improve and rejuvenate skin texture.
Can I have a facelift if I smoke?
Smoking affects healing in a negative way. If you are an active smoker, you would need to stop smoking at least 2 weeks before surgery and at least 2 weeks after surgery. Our doctor prefers that you stop smoking all-together as smoking also makes the face age faster by absorption of collagen and destroying the blood vessels which nourish the skin. A deeper facelift is preferred in patients with a history of smoking so as not to further interrupt the blood vessels going to the skin.
How long does it take before I can resume regular activity after my facelift?
1-2 weeks is usually necessary depending on the amount of work done before returning to work or normal activity. Minor swelling will persist for months but is usually not noticeable to others. Avoiding strenuous activity is recommended for 2 weeks after the surgery and avoiding sun exposure is recommended for at least 6 weeks after the facelift. Wearing sun block is recommended if sun exposure is expected for some reason. Out of town patients who travel to New York for surgery cannot travel back to their home state or country for at least 1 week following the surgery.
Can a facelift be done with other facial cosmetic procedures?
A facelift can be performed with a browlift, eyelift, chin or cheek implant or nose job, or it can be performed as an isolated procedure. Laser skin resurfacing can also be done at the same time to improve superficial skin wrinkles or sun or smoking related damage. A patient has to discuss with their doctor what their concerns are and then decide whether he/she would like it all improved together or in stages.
What kinds of incisions are used in facelift surgery?
There is usually an incision around the front and back of the ear and into the hairline. According to Our doctor, the incision in front of the ear is best hidden if it is placed inside of the tragus (cartilage in front of ear). The incisions in the back of the ear are best hidden when placed in the natural ear crease and the hairline incisions should be placed just inside the hairline to hide the scar and not reposition the hairline. Our doctor takes special care not to the remove the hair above the ear in front (called temporal hair) in order to get a natural hairline and avoid the “pulled” look. Our doctor states that the hairline incision length varies depending on the degree of aging and is shorter with the use of the 3D telescope system. In addition, sometimes there is a small scar placed under the chin in a natural chin crease which is used for pulling the platysma muscle together in the midline. For more detail on incisions please read about Facelift Scars.
How much pain is involved?
Most patients who have facelift surgery are surprised how little pain there is. Some discomfort from tightness in the neck is expected. Patients are given prescription pain medicine to alleviate some of the discomfort that they experience. Patients typically complain of this tightness in the first few weeks after a facelift. It is uncommon for patients to report unmanageable pain after surgery.
How about numbness after a facelift?
Numbness near the incisions and earlobe is normal and expected after facelift surgery. It may persist up to 6 months or longer. Permanent numbness is rare. If a patient is undergoing revision facelift surgery, scar tissue may cause more numbness in and around the ear and earlobe.
What are the risks of facelift surgery?
There are risks involved with any surgery such as bleeding or infection. Specific risks involved with facelift surgery include hematoma formation (blood clot under the skin) or seroma formation (fluid collection), which occurs in about 10% of cases and is treatable with removal of the fluid. Our doctor, a New York City Facial Plastic Surgeon, published some articles in peer reviewed plastic surgery journals on how to decrease hematoma and seroma formation (see Media section). Chronic pain after facelift surgery is a very rare occurrence, but may be related to nerve irritation or muscle spasm, and is treatable with medications. Other complications such as nerve injury and scar formation are also mentioned, but are very rare as well. Our doctor, who has done thousands of facelifts, has never had a permanent nerve injury occur after facelift surgery. Scar thickening can rarely occur and may be treated with kenalog injections in the scar, laser treatment or creams.
What are the Non-Surgical options?
A facelift is a surgical procedure. Non-surgical rejuvenation treatments are sometimes labeled “facelifts”, but they are not. Non-surgical treatments such as fillers or Botox may help delay the time at which a facelift is performed and may be used in conjunction with a facelift. Fillers and Botox cannot improve a sagging neck or jowl, but can improve forehead frown lines or crows feet lines around the eyes or a deep nasolabial fold. Fillers may also be used to plump up the lips or cheeks and can usually be used in addition to a facelift as they improve different areas.
When is the right time for a facelift?
A facelift should be a highly individualized and customized procedure according to Our doctor. Many different types of partial facelifts or isolated neck lifts may be more appropriate for younger patients with lesser degrees of aging. Ultimately, the perspective patient needs to look at their face and decide what bothers them before going to the consultation with the plastic surgeon. Younger and younger patients are now doing more minimally invasive facelift procedures to retard the aging process. The advantage to doing it at a younger age is that it lasts longer because the facial structures lifted are stronger.
Do I go home after a facelift?
Yes, facelift surgery is outpatient surgery. You can go home with a responsible adult. Our doctor likes to see his patients and remove their dressing himself the day after the surgery. Most out of town patients who come to New York City to undergo facelift surgery in Our doctor's Park Avenue Center stay in a hotel with a private duty plastic surgery nurse. Our doctor provides all his patients with a nurse which he recommends for the first 24 hours. The nurse goes home with the patient or goes to the hotel with the patient if they are from out of town.
If I am from out of town, where do I stay?
There are many convenient hotels in the area near Our doctor's office on Park Avenue in the Upper East Side of Manhattan, which we recommend. For more questions, please click here.
Usually out of town patients stay in New York City for at least 1 week following the surgery. Many patients come in from other states and countries to undergo facelift surgery with Our doctor.
If I had a facelift somewhere else and I don't like my results, can you "fix" it?
Our doctor sees a large number of patients who request a revision facelift. These patients typically complain of a neck that dropped too quickly or an incision in front of the ear or in back of the ear that is too obvious. Because of scar tissue and the healing process, Our doctor recommends waiting 1 year after your previous facelift for a revision. Other reasons patients seek a revision may include a pixie ear (abnormally attached earlobe) deformity or hairline abnormalities. Recurrence of the neck cords is probably the single most common reason for seeking a revision along with jowling. Our doctor addresses the neck cords from the midline by binding the muscle together in primary and revision facelifts. This is in addition to lifting it sideways behind the hairline. This midline muscle tuck, called midline platysmaplasty is done with a 3D telescope from a small incision under the chin and it is necessary to achieve a more defined jawline. Sometimes patients seek a revision because their face has not been pulled in a natural direction and this may worsen some of the wrinkles around the eyes and pull the mouth sideways. In these patients, the revision facelift involves repositioning the face back to a natural direction.
What is a thread lift, or mini lifts with threading of the muscle?
Many types of thread lifts were being done in the past, where a small incision is made in front of the ear or in hairline and a thread is passed blindly through the deeper muscle and pulled up. These types of lifts fell out of favor due to complications and an unnatural puckering. If the deeper tissue is anchored and pulled without separating the overlying tissue or without removing the excess redundant skin when the deeper tissue is lifted, then an unnatural puckering occurs and the lift does not last. Also, by not creating an incision around the inside of the tragus and ear and making only a tiny incision, the surgeon cannot see what is being anchored and damage to the deep facial tissue has occurred with these thread lifts, necessitating removal of the threads.
When can I go back to work?
Typically between 1-2 weeks most patients return to work.
When can I “work out”?
Light aerobics may be resumed in 2-3 weeks. Earlier resumption of aerobic activity may cause increased swelling. Vigorous activity can increase heart rate, blood pressure and swelling.
How long will bruising or swelling last?
After a facelift, there is minimal bruising in the face. Some bruising may occur in the neck and usually lasts for 1 week. There will be swelling in the face and neck which is imperceptible in 2 weeks following the surgery but minor swelling continues to dissipate over a 3 month period. For more information on preoperative and postoperative instructions for facelift surgery, please see Facelift/Necklift Instructions.
What is the latest laser technology?
Dr. Rizk changes laser technology frequently as lasers advance at a very rapid rate with new technology providing less down time and superior results. The Cortex laser is a combination CO2 (fractionated) and erbium technology that has an average downtime of one week. For more information on this latest addition to Dr. Rizk's practice please click here.
For more questions, please click here.