How Do Facelifts Work?

There are many types of facelifts as well as a lot of different names that are applied to them in the medical world and in the public eye. A lot of people have one view of what a facelift is while a plastic surgeon might have another idea of what a the procedure is about, so it is important to have a thorough consultation with a surgeon before committing to the actual operation.

Typically, a facelift involves tightening the structures of the face. This includes the mid-face, lower face or the neck area. Sometimes the facelift is combined with other procedures like a lifting of the forehead or eyebrows or eyelid surgeries. It can also be combined with volumizing procedures like fat transfers to the face or laser resurfacing of certain parts of the face. The type of facelift can be tailored to fit the patient’s desired goals as well as what the physician wants addressed by the procedure.

DIFFERENT FACELIFTS

As mentioned earlier, there are different types of facelifts and some of them include:

• The lunchtime lift which is a skin only type of lift that simply tightens the skin.
• There are some SMAS tightening procedures. SMAS stands for the submuscular aponeurotic system which is the muscle that is continuous with the platysma muscle in the neck. The SMAS muscle is in the face and this is a muscle tightening procedure.
• There are also procedures that go basically right on the bone. They go underneath the muscle and lift up and are associated with a little bit more swelling.

Since there are different types of procedures, some surgeons might do all of them while others might do only one type of facelift. Typically, the skin only ones have a quicker recovery but they are not going to last as long. Tightening the muscle is kind of like treating the foundation on the face so it gives a lengthier duration of effect.

MINI-LIFT

One of the main types of facelifts is the skin only type of facelift that is often called a lunchtime lift or a mini-lift. Patients need to focus on the concerns they have and if the procedure addresses these concerns. 

Does the patient need the skin or the muscle tightened?  Is it a minimal incision? Is it a mini-lift? What do those terms mean? A mini typically refers to a minimal incision that is less than the typical facelift incision which starts in the hairline, goes inside or around the ear and then back and behind the ear. A mini-lift only involves a portion of that scar and is typically from the top of the ear to the bottom of the ear. In general, a mini-lift has a minimal incision scar. The minimal incision scars can still tighten muscles but they do not always have to do that. Patients have to be careful when picking what type of mini-lift to achieve their results.

Plus, it is very hard to remove a lot of excess skin in the neck through a minimal incision. Where is the skin going to go? It has to be removed somewhere so doing a minimum incision in front of the ear is probably not going to address much of the neck. Quite often, some of the heaviness of the neck is coming from excess skin in the neck as well as excess skin in the cheeks that have fallen down.

NO COOKIE CUTTER PROCEDURES

There are many different facelift procedures and the doctor has to determine what is best for the patient. There is no cookie cutter procedure that is best for everybody. For example, a patient might have jowls or cheek muscles that are sagging and need to be tightened. Another patient might have a problem with loose neck skin and the neck needs to be tightened up. A problem with neck muscles means the procedure has to tighten the platysma bands. A doctor cannot do a cookie cutter procedure because not everybody has a problem with the neck or the mid-face. It depends on what the patient is trying to accomplish. Patients need to focus on their concerns and what option is going to treat their issues.

TURNING BACK THE CLOCK

In general, a facelift turns back the hands of the clock. If somebody comes in and they are 70 but they want to look 20, it is not a realistic goal. They do not have the collagen or the skin make-up to accomplish that goal. The surgeon can tighten and rejuvenate and lift to set things back a little bit but setting the clock back the entire way is impossible. The collagen is not as good as a person gets older. The elasticity of the skin is not as good so the results will not last as long. It is always better when somebody starts younger rather than waiting too long.

Once a person has really deep lines established, it is much more difficult to get rid of them. Pulling on them and putting them in a position where the skin does not normally fold may look unnatural. The skin no longer has that elasticity so it does not go over the bones the same way to revolumize some of the tissue. There are certain things that change within the bony structure of the face from the ages of 20 to 70. The volume of the soft tissue changes over the top of those bones so the distance from the eyebrow to the eyelashes shortens and gives a different look.

LIMITATIONS

Patients have to be realistic about their expectations. They have to be in good health and ready for some downtime because it does not heal overnight. It takes about a month for the swelling to go down. With any procedure, a facelift will not change who a person is and make them happier. It will just turn back the clock a little bit and make a person feel more confident.

RECOVERY

Typically, patients cannot do anything strenuous for a couple of weeks after the surgery. They have to wait until all of the swelling and bruising is gone. There can be some numbness after the surgery but that is only temporary.

There can be drains left in place depending on the type of procedure. If there are drains, they are normally taken out the next day. There is usually a compression wrap that stays on for about a week. There are stitches that stay in for seven to ten days.

LINES AROUND THE MOUTH

Some patients ask for laser resurfacing along with the facelift, especially around the mouth area, because facelifts typically do not address the lines around the mouth. There are limited things that can be done in the area around the mouth and they include laser resurfacing, Botox, and fillers.

These treatments are done at the same time as the facelift. Most patients do not complain about any pain from the treatments. Usually, people complain about tightness around the neck and some difficulty swallowing because the muscles are tightened up. They feel like they cannot open their mouth the whole way for a couple of weeks. It is simply tightness that will loosen up as the swelling and everything else goes down.

RISKS

Patients that are not healthy should not have a facelift. Ideally, people should be healthy and non-smokers. Smoking can kill off the blood supply to the skin and cause the skin to die off. Patients should quit smoking at least six weeks before the procedure.

There is also a risk of bleeding, blood clots, problems with scarring, and a rare possibility of nerve damage.

SCARRING

The amount of scarring does not vary between the different facelift techniques. The length of the scar varies depending on what is done by the surgeon. If the procedure is on the neck, the incision is behind the ears. If the procedure is on the face, the incision is in front of the ear or inside the ear to some degree. Typically, the incision will be around the ear.

There are certain things doctors can do to make the scar less visible. However, it is not entirely up to the surgeon. It is up to the patient, their collagen, and their genetic makeup as to how well they heal. Some people keloid while others have hypertrophic scarring. Some people scar extremely well. Things that can be done afterwards to help with the scarring include scar gel, silicone scar gels, massages, steroid injections, and laser treatments.

MAINTENANCE

The things a patient can do to help extend the results include maintaining a healthy lifestyle, staying at a stable weight, exercising, eating properly, and following a good skin care regimen. Good skin care includes sun protection, avoiding smoking, and using a good skin care protocol that is backed by medical science.

Whenever a patient gains weight, it stretches out the skin so it fills up the face. A patient that loses weight will see a shrinking of volume and an increase in laxity. Sun exposure causes sun damage and smoking decreases oxygen and blood flow to the skin.

FINAL THOUGHTS

One of the most important steps before a facelift surgery is determining if the patient is a good candidate for the procedure. There are people in their late 30s who want a mini-facelift procedure. This is a possibility for some patients because they genetically age faster and already have jowls. At the same time, patients have to be careful they are not coming in with unrealistic expectations. If somebody comes in and they barely have any jowls, but they want a facelift to get rid of them, the surgeon needs to set realistic expectations. A consultation with a board-certified physician is important when it comes to patient selection and qualifying any patient for a facelift.

Written by Cosmetic Town Editorial Team- MA

Based on an exclusive interview with Mark Blake, MD in Milwaukee, WI