| Rhytidectomy - the face lift operation |
| How much improvement to expect and for what duration? |
| After surgery, the first six weeks |,

As health education and modern medicine lengthen the life span, most people feel physically and mentally vigorous and energetic long after their appearance begins to deteriorate by advancing years. Loose skin and sagging subcutaneous tissues of the face and neck are the most obvious signs of aging on display. The face lift operation is designed to remove and tighten the excessive tissues of the face and neck. In addition to the sagging, some faces become etched with numerous fine wrinkles. These are not corrected by a face lift operation. A face peel procedure or laser skin resurfacing are effective in correcting this problem.

The operation is done either to slow down the advance of aging by helping a relatively young individual (about forty), to appear to stay young, or it may have as its purpose, the correction of an already well wrinkled, sagging face of an older person to appear younger and less tired.

Figure 25-a (click image to enlarge)

Figure 25-b (click image to enlarge)

Figure 26-a (click image to enlarge)

Figure 26-b (click image to enlarge)

Figure 26-c (click image to enlarge)

Figure 26-d (click image to enlarge)

Figure 28-a (click image to enlarge)

Figure 28-b (click image to enlarge)

With well designed corrections of the upper and lower face, a great potential for an attractive appearance that existed in this patient was fully realized through surgery.

How much improvement can you expect and for what duration?

If the sagging is marked, the results may be dramatic. In younger patients, where sagging is subtle, the improvement will be less conspicuous but remarks will be made that the face looks more alive and less tired. It cannot be predicted accurately how long the improvement will last. In ideal cases, the duration of the improvement is often from five to ten years. Fat faces will have shorter lasting improvement. The surgery simply "turns back the clock but does not stop it." No operation can permanently stop or prevent aging, but the individual's appearance will always be more complimentary than if the operation had never been done. (Fig.15)

If the patient has had an original face lift operation a "preventive maintenance program" can then be implemented. This is particularly indicated in younger individuals who can maintain a youthful facial appearance for the remainder of their life by having periodic "tuck ups" every few years. This is not uncommon among Hollywood personalities.

Patients with systemic diseases, high blood pressure, heart disease, or obesity are not acceptable candidates for this type of surgery. Patients with a short, stocky neck cannot expect the same amount of improvement as those with more favorable anatomy.

The operation is usually performed with local anaesthesia and sedation. The incisions are made inside the hair line wherever possible but the hair is not cut before the operation. The hair, though, should be shampooed thoroughly before entering the hospital. Infrequently there may be some thinning of the hair for a short distance on each side of the incision line. If this occurs, the thin area can be covered by combing the adjacent hair over it. The site of the incisions will be discussed during the preoperative visit. There is little pain and discomfort following the operation. Remember that the swelling and discolourations are temporary, as are minor changes in the configuration of the hair line which may occur and are usually unnoticed by the observers or even by the patients.

There may be some areas of numbness particularly around the ear which improve to a great extent within three to six months. Some patches of numbness may persist indefinitely.

Closing of the incisions is performed in such a manner as to exert no tension on the lines in front of the ear, where the scars are usually inconspicuous without makeup. The tension resulting from the stretched and lifted tissue is thus distributed to the areas behind the ear and the back of the ear skirting the hair line. These scars are therefore destined to be more visible and have to be camouflaged by combing the hair. At times, they may require a small adjustment under local freezing eight to twelve months after.

 

After surgery, the first six weeks

• Move the head and shoulders as one unit or as though you had a "stiff neck".
• Elevate the head of the bed thirty degrees to forty degrees while you are in the hospital and when you go home.
• Specific medication for pain etc. will be prescribed for you while you are in the hospital.
• I recommend that you remain in bed for the first twelve hours following surgery.
• You are usually discharged from the hospital the following day. If your dressing, which is applied under some tension, begins to feel excessively tight or uncomfortable, report it to me by calling the office at your earliest convenience. You may then sit in a chair, walk to the bathroom or around the house remaining out of bed as much as possible.
• While at home, you will wear a special chin sling for 2 weeks, day and night, for as long as tolerated. The sling may be removed for washing and drying. If you feel comfortable, it will be advantageous to wear the sling for an additional two weeks at night.
• If you live in another city I prefer you stay in town (motel, hotel, or with a friend) for approximately ten days following discharge.
• Enquire about the special suite available for rent in our building upstairs for prolonged stay. This unit is not a part of the clinic but is run by a company well instructed in the needs of our patients following facial surgery.
• Excessive sunning of the face is always harmful to the skin. It should be particularly avoided for the first eight months after the surgery.
• Discolorations can be camouflaged by using thick makeup one week after surgery. A water base makeup may be applied with a moist sponge and after it dries, a second layer may be applied. It can be removed with water. DO NOT apply makeup over the incisions themselves for several days after the removal of the sutures.
• Measure your temperature by mouth daily in the morning and report any persistent elevations above 100.l degrees Fahrenheit or 37.5 degrees Celsius.
• Glasses and contact lenses may be worn as soon as the bandages are removed. If eyelid surgery was carried out at the same time, refer to the instructions pertaining to blepharoplasty. If nasal cosmetic surgery was also performed refer to the instructions under rhinoplasty.
• Returning to work and resuming social activities is usually possible after three weeks. In some cases this period might be slightly extended.
  

AVOID:

• turning the head or bending the neck
• straining at stool and ask for a laxative if you need it
• excessive grinning, smiling and turning, bending and extending the head for two weeks
• foods that are hard to chew; drink through a straw for the first two days
• yawning with the mouth widely open for two weeks

DO NOT:

• apply makeup over the incisions themselves for several days after the removal of the sutures
• use the heat hair dryer, use the cap type
• rest your neck on the rim of the wash bowl in the area of the incisions
• colour the hair until four weeks after surgery
• tweeze the eyebrows for two weeks
• wear clothing that must be pulled over the head until ten days after surgery
• perform athletic activities or exercises that involve turning the head for at least six weeks.

YOU MAY:

• have your hair washed at a salon ten days after surgery
• take a shower three days after surgery
• wash your hair with lukewarm water in the shower and comb it gently with your fingers three days after the operation
• three days after surgery, use a gentle upward motion while washing your face with a mild soap applied with cotton balls
  

Your scars will mature and become less noticeable within one year after surgery. Smoking may result in poor scar quality, the scars being much wider than in non smokers.

Many patients frequently ask whether it would be possible to have more face lifts in the future. They are also under the impression that once they have had a face lift operation, another face lift will become mandatory a few years down the road. Modern techniques used in face lifting preserve a natural hair line, thus allowing for another operation if desired in the future.

There are two reasons for a second face lift:

1. When there are advanced tissue changes, the first operation may not succeed in the degree of the improvement desired by the patient, despite great efforts on the part of the surgeon
2. The psychological effects of face lifting may be so remarkable that after a few years, despite still a relatively youthful look for the patient's age, he/she may wish to experience again the same satisfaction.