Facelift If you are considering surgery we want you to be thoroughly informed about this procedure. Reading this information is the first step. However, a personal consultation with your surgeon is the best way to obtain any additional information you need. What is a facelift? As we get older, the effects of sun damage as well as the natural ageing process lead to loss of elasticity and tightness of the facial skin. Gravity can cause sagging particularly around the eyes, cheeks, jowl area and neck. Skin wrinkling is a result of these factors. A facelift also called “rhytidectomy” is an operation designed to correct the effects of ageing in the face. It smoothes the loose skin on your face and neck, tightens underlying tissues and removes excess fat. As a result, your face will appear firmer, fresher and more youthful. It is not usual at the operation to get quite as much tightening as can be obtained with fingers in front of a mirror. It is however possible to produce a significant degree of improvement. After the operation you should not expect to look a different person but to look “well” or “better after your holiday” when seen again by friends. Is facelift for me? Any of the following conditions may make you a good candidate for facelift surgery: • A deep line, or fold, running from the corner of your nose to the corner of your mouth • Jowls, or loss of a well-defined jawline associated with youthfulness • Deep wrinkles in the cheeks and sagging of the “highlight” areas of the cheekbones • Loose skin, wrinkles, vertical folds or excess fatty tissue in the neck A facelift can improve all of these problems. However, it cannot correct conditions such as droopy eyebrows, excess skin and fatty deposits in the eyelids, or wrinkles around the mouth. Your plastic surgeon can provide further information if you have an interest in other procedures to treat these areas. Initial consultation During the initial consultation you will be asked to point out exactly what you would like to see improved. This will help your plastic surgeon understand your expectations and determine whether they can be realistically achieved. You will be asked about your medical history including previous operations, past and present medical conditions and current medications. In order to provide you with the best information and safest options, it is important that you give your surgeon complete information. The medical conditions that may increase risks of surgery include high blood pressure, thyroid problems, diabetes, bleeding problems and smoking. In assessing you for facelift surgery, your plastic surgeon will examine the thickness, texture and elasticity of your skin, and the severity of wrinkles and folds. Your hairline will be examined to determine where incisions can be discreetly placed. All of these factors, as well as your bone structure and underlying tissues, will be considered in developing an individualised surgical plan. Your plastic surgeon may discuss with you additional procedures that can be performed along with a facelift in order to address all the concerns you have identified. For example, a facelift is frequently combined with a forehead lift, eyelid surgery, Botox injections or skin treatments such as laser resurfacing. Your operation Not every person will achieve the same results from facelift surgery due to individual variations. After discussion with you, your plastic surgeon will select the surgical option that he feels will result in the best outcome. Although there are many variations to the facelift operation, incisions are hidden in the hairline of the temple and the natural creases in front of the ear. The incision then curves around the earlobe, behind the ear and is camouflaged in the scalp. www.drmarkkohout.com.au After surgery, incisions can be easily concealed by your hair or with makeup. Through the concealed incisions, the surgeon is able to free the skin from the underlying tissues to the extent necessary for the particular surgical technique selected. The deeper tissues may be repositioned in order to restore a more youthful contour to your face. The skin is then repositioned up and back and the excess is removed. If necessary, a small incision beneath the chin permits the removal of fatty tissue in that area and smoothing of the cord-like structures of the underlying muscle in the neck. How long does the operation take? The operation takes from 3 to 5 hours, depending on the extent of each case. Understanding risks and possible complications of surgery Fortunately, complications from facelift surgery are infrequent. Every year many thousands of operations are performed with no major problems and good results. However everyone considering surgery should be aware of both the benefits and risks. The subject of risks and potential complications of surgery is best discussed on a personal level between you and your plastic surgeon. • Bleeding is the most likely problem that may occur after facelift. It can be problematical in about 2-3% of cases. It is most likely to occur immediately following surgery or that evening. It is possible that return to the operating theatre will be required in order to correct the problem. In this event, this may prolong your admission. Taking Aspirin within two weeks leading up to your surgery significantly increases the risk of bleeding. Do not take any aspirin or medications containing aspirin within two weeks of surgery. • Infection following facelift is uncommon due to the superior healing qualities of the facial tissues. In addition, all patients are given a dose of antibiotics with surgery. If infection does occur it will become evident within a week of surgery. This may require treatment with further antibiotics. In the unlikely event of infection, the ultimate result of the surgery may be adversely affected. • Surgical scars can be expected to be minimal and unnoticeable. However, while great care will be taken to give the neatest closure possible, individual wound healing can be unpredictable and it is possible that they may take up to two years to mature and you may be unhappy with some aspect of your incision line. • It is possible for scarring around the earlobe to result in tightness and tethering. Scarring behind the ear can become lumpy and uncomfortable. Scarring in front of the ear may cause tightness and winging of the tragus (cartilage in front of the ear opening). • The tension on the face and neck is taken in the hairline. The scars in these regions respond by widening and a hairdresser will always be able to detect them on close inspection. The scar behind the ear may be the most noticeable and it is helpful to have a hairstyle that conveniently covers this area. Keloid scars are due to a peculiarity of some patients’ healing process, but are rare. • Skin loss. It is possible to lose small areas of skin, particularly in front of the ear. It is important not to smoke during the early post-operative period. If you are a heavy smoker, facelift may be ill advised and this should be carefully discussed with your surgeon before proceeding. The risk of losing some skin varies between _% for the deep (SMAS) facelift to 2% for the superficial facelift. • Hair loss around the scalp incisions is an occasional complication of facelift surgery, occurring in less than 1% of operations. • Bruising and swelling is usual and varies with each patient from being virtually invisible to extensive. Most of the severe cases have settled by about the third week, although some take longer. Swelling of the face can affect contour for some months and during this period of settling, improvement in facial contour can be expected. It is likely that close scrutiny of your face following the procedure may reveal some small irregularity in contour or symmetry. Having expectations of improvement rather than perfection is most likely to result in post-operative satisfaction. • As the final swelling settles, it may appear that the face is beginning to “fall”. This is an inevitable minor consequence of the fact that the skin is stretched by postoperative swelling and is usually complete within about three months. Fine wrinkles may return during this time. • Nerve injury. Facelift involves facial dissection very close to the course of the facial nerve. This major nerve of the face is responsible for movement of the face, particularly around the mouth, nose and eyes. It is possible that some temporary or rarely permanent weakness of a part of the face may result following facelift. It is usual to have some temporary numbness of the cheeks and sometimes of the ears. You can help to minimise certain risks by following the advice and instructions of your plastic surgeon, both before and after your surgery. The risk of such an injury is around 1% for superficial and 4% for deep (SMAS) facelift. It is important to realise that most complications, should they occur, can be corrected. Preparation for surgery Smokers will be asked to stop smoking 3 weeks before surgery. Aspirin and some antiinflammatorydrugs used for the treatment of arthritis can cause increased bleeding, so you should avoid taking these medications for 2 weeks before surgery. If your hair is very short, you may want to let it grow out enough to cover your incisions while they heal. If you plan to lose more than 7 kilograms of weight, you should discuss this with your surgeon as the weight loss may impact on your final result. The day of surgery Your facelift may be performed in a hospital or a day surgery centre. It is usually performed under general anaesthetic, but may be done under intravenous (twilight) sedation. If your operation is done in a day surgery centre, make certain you have arranged for someone to drive you home after surgery and to stay with you at least the first night following surgery. Your anaesthetist will discuss possible discomfort following anaesthesia with you. Any questions you have regarding your anaesthetic would be best answered by your anaesthetist prior to surgery. Various monitors are used during surgery to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood. When surgery is completed you will be taken into a recovery area where you will continue to be closely monitored. A bandage may have been wrapped around your face to help minimise swelling. Small suction tubes are sometimes inserted under the skin to drain away fluids that might otherwise accumulate, but you will not feel these. In fact there is surprisingly little discomfort after the operation. After Surgery It is important to realise that recovery time varies greatly among individuals. The length of hospital stay varies from day only to several days. After surgery you will be asked to restrict your activities and simply relax for a few days. Elevating your head when you sleep will help to minimise swelling and bruising. Remember you must not take aspirin or certain anti-inflammatory medications, and you should not smoke or be exposed to passive smoke for several weeks. Any bandages and drain tubes will usually be removed in one or two days. At that time, you will notice puffiness and discolouration that may be more pronounced in some portions of your face than others. Do not be alarmed by any unevenness or temporary asymmetry caused by this variance in swelling and bruising, which is normal. Generally, the greatest amount of swelling occurs 24 to 48 hours after surgery but it may take several weeks before all puffiness is resolved. Most bruising will disappear within two weeks. You will also experience some numbness in the facial area, which may be present for several weeks or longer. Your stitches will be removed from four to seven days after surgery. When can i resume my normal activities? Considerable bruising and swelling over the first week or so may be encountered. This can be expected to settle rapidly at least by the second week. Straining, bending and lifting should be avoided during the early postoperative period. After a few days you will be permitted to wear make-up which will help to conceal any discoloration. Generally speaking, you will be confident and happy to engage in social contact 3 weeks post-operatively. In many instances you will be able to resume most of your normal activities within two weeks and begin to exercise three to four weeks after surgery. You will be instructed to temporarily avoid exposure to direct sunlight and, for the long-term, to be conscientious about the use of a sunblock to protect your skin. How long do results last? Facelift surgery makes you look more rested, refreshed and alert. Since the healing process is gradual, you should expect to wait at least 6 to 8 weeks to get an accurate picture of the results of your facelift surgery. Incisions will fade over a number of months until they become barely visible. Depending on the extent of the procedure, the result may last 3, 5 or 7 years. The ageing process continues at its natural rate after the surgery and the facial tissues will inevitably descend again. Some patients do request a repeat operation years later - it is usually no more difficult than the first time. Maintaining a relationship with your plastic surgeon Should there be any questions regarding facelift surgery be sure they are answered in advance. Well meaning friends are not a good source of information. Find out everything before proceeding with the operation - a well informed patient is a happy one. After surgery, you will return to your plastic surgeon’s office for follow-up care at prescribed intervals, at which time your progress can be evaluated. Once the immediate postoperative follow-up is complete, many surgeons encourage their patients to come back for periodic checkups to observe and discuss the long-term results of surgery. Please remember that the relationship with your plastic surgeon does not end when you leave the operating room. If you have questions or concerns during your recovery, or need additional information at a later time, you should contact your surgeon.