It is common for a face and necklift to be performed along with one or more other procedures. This has the advantage of not subjecting the patient to anesthesia multiple times, utilizing fewer incisions, and diminishing overall healing time.
Procedures commonly performed at the same time as a facelift include:
- Eyelid surgery – upper, lower, or both
- Skin resurfacing treatments
- Filler injections or fat transfer to correct contours
- Liposuction to remove excess fat under the chin
- Rhinoplasty (nose surgery)
How is a facelift and necklift performed?
There are many different “types” of facelifts available. Each procedure offers benefits for a specific situation and a specific outcome. It is very important that you talk to your surgeon and work together to determine the best procedure for your needs and for the results that you want to accomplish. Regardless of the procedure you decide to undergo, incisions are either hidden within the existing hairline or camouflaged by the natural creases of your face.
Most facelift procedures are done under general anesthesia in order to keep the patient comfortable even though conscious sedation is a possibility. This is determined by the extent of the operation required to accomplish your goals.
Rejuvenation of the neck is performed through a small and well-concealed incision under the chin. This allows for a conservative removal of excess fat via liposuction, re-approximation of the loose neck muscles (a.k.a. platysmal bands), and re-draping of excess neck skin. To correct loose and sagging cheek skin, well-planned incisions are made around the ears. The supporting, deeper, tissues are then re-suspended into a more favorable position, allowing improved contour while alleviating any skin tension. Wounds closed under skin tension are the source of excessive scarring, ear malposition, and poor longevity of surgical results. While not every facelift surgeon places a surgical drain, Dr. Walker places a small soft drain at the end of surgery for less than 24 hours to prevent any significant fluid or blood accumulation in the face or neck. Typically, our patients have not seen any major side effects or discomfort from having drains in place. Some experts believe that drains help prevent one of the more common complications following facelift surgery: hematoma formation. A hematoma is a collection of blood that usually occurs (if it does occur) the first night after surgery. While hematomas after facelift are not life-threatening, they require prompt attention with drainage in the operating room to reduce local pressure at the surgical site.
Once both sides are completed, a head and neck dressing is applied that is removed and changed to a flexible headband the day after surgery. After awakening from anesthesia and assuring your comfort, you will be able to go home in the care of a responsible adult.
What can I do to decrease the risk of hematoma (blood clot) formation?
- Avoid aspirin, ibuprofen, or naproxen 14 days prior to surgery
- Avoid all fish oil and omega-3 supplements 14 days prior to surgery
- Avoid garlic, ginkgo biloba, ginseng, and vitamin E supplements 14 days prior
- Check your blood pressure 3 times a day for 7 days (at various times of the day). If your pressure is elevated (which is usually without symptoms!!!), please let us know and we will decide what steps to take.
- Consider taking a homeopathic supplement called “Arnica Montana.” You should start 7 days prior to surgery. Some studies suggest taking this supplement may decrease your risk of bleeding and hence hematoma formation.
- Keep pain and nausea well controlled. Poorly controlled pain and nausea can elevate your blood pressure and hence lead to bleeding.
- Continue Arnica Montana (if you started taking it before surgery).
- Consider taking Vitamin C supplementation. Vitamin C is essential during the healing process.
- Consider drinking pineapple juice. Pineapple juice contains bromelain, an enzyme that is thought to be beneficial during the healing process.
- Avoid strenuous activities for 14 days after a facelift.
Recovery time depends upon the particular procedure performed and the overall health of the patient. In general, all bandages and drains are removed the morning after the procedure. Swelling is normal and responds well to cool compresses, head elevation, and adhering to light physical activity. While significant pain is not a usual part of the recovery process, tightness is expected and continues to improve during the first couple of weeks after surgery. All sutures are removed after 1-2 weeks, at which time most bruising has resolved from the face. Usual skin care and light makeup may be worn at 10 days after the procedure. With the exception of overly rotating or extending the neck, normal activities can be re-started after approximately 2 weeks. Patients flying in for their operation should make arrangements to stay in-town for at least 1 week. The final facial and neck contours will continue to improve as residual minor swelling resolves over the first couple of months. The downtime from work, school etc. is usually 2 weeks after facelift surgery.