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The FAQ’s on Facelifts

By Lawrence Rosenberg M.D.

faceliftThe response to the previous columns on plastic surgery has been overwhelming. It seems that almost everyone is interested in information on plastic surgery even if they are not considering a procedure for themselves. I have received a large number of general questions regarding the procedures and it was suggested that I use these columns as a general forum for answering some of the most frequently asked questions. Of course more specific questions concerning the individual should be discussed with your doctor. In this issue I will address some of the more common questions concerning facial rejuvenation and in particular facelift. Eyelid surgery and Facelift are the third and forth most common cosmetic procedures performed in the United States, following only breast augmentation and liposuction. Since 1992 the number of patients who had surgery on their eyelid and facelifts grew 102% and 77% respectively according to the American Society of Plastic Surgeons. Later columns will address issues such as breast surgery, body contouring and non-operative procedures. Please feel free to contact me with any suggestions for future columns or questions that I would be happy to address.

Doctor, I am 45 years old and am beginning to develop jowls and loose skin on my neck. Am I too young to have a facelift?

A common misperception of the public is that only persons in their fifties and sixties undergo facelift. In fact the patients who often get the best results are the younger patients in their early forties. In 1998 almost twenty thousand facelifts were performed in patients under 50 years of age. In general the younger you are the more natural the result and the longer lasting the results will be. The skin is more elastic and heals more quickly at a younger age. In this age group several factors can lead to premature aging of the skin. The most common are sun exposure, cigarette smoking and genetics. We can’t control genetics but we can control the other two. Unfortunately by the time a patient presents to the surgeon, the damage is done. Many of the changes associated with aging can be corrected. An important point to remember regarding risk factors is that cigarette smoking can increase your risks of wound healing problems. This can be minimized by stopping smoking for as long as possible preoperatively.

Other options also exist for younger patients depending on the problem. Often a lesser procedure may provide correction, such as liposuction, collagen, or botox alone. Again this is not for everyone and proper patient selection is of paramount importance.

How much younger will I look?

Generally most patients tell me that they feel as if they look seven to ten years younger but the comments that they receive from friends and coworkers are very different. The comments that they receive usually reflect how good they look and how rested and relaxed they look. As if they have just returned from a long restful vacation. Very few patients want to look as if they “just had a facelift”.

How long will my results last?

Facial surgery will turn back the hands of time but it will not stop the aging process. Patients will always look younger than if they never had the procedure done but the signs of aging will recur in usually seven to ten years. The majority of patients only undergo one facelift during their lifetime but a small minority of patients will return in seven to ten years for a repeat facelift.

Will it look natural?

A natural looking result is the goal that the best plastic surgeons always strive for. Techniques have evolved over the past several years to restore a youthful appearance without the telltale signs of surgery. Again younger patients can usually obtain more natural results which last longer. One of the keys to a successful procedure is to stay ahead of the aging process and not let the signs of aging get too severe before pursuing a rejuvenation procedure. In other countries it is very common to have smaller procedures done at an earlier age to keep up with the aging process. Outside the U.S. surgery is viewed more as maintenance than a restorative process.

I am not interested in a facelift. Can I get the same results with a laser alone?

The skin resurfacing laser is a wonderful tool and it allows us to get results that were impossible only several short years ago. However the laser addresses a different problem than the facelift. A facelift can address loose skin and the underlying muscles and fat. A laser only addresses fine static wrinkles, such as occur from aging or sun exposure. It rarely has any significant effect on areas such as the jowls and most surgeons will not use it on neck skin.

What is recovery for a facelift?

Generally I advise my patients to remain at home for approximately one week. At that time most patients feel comfortable making short trips out of the house for example to the supermarket. Occasionally there may be some swelling and bruising at this stage. This can usually be camouflaged with makeup. Many patients return to work at approximately one week. Usually at about two weeks patients feel comfortable enough to spend more time in public such as going out to dinner with friends or returning to work when a lot of time is spent with the public.

Is there much pain involved?

Generally there is very little pain involved with a facelift. There is some discomfort but this is usually controlled with mild pain medications.

Will the scars disappear? Where will the scars be?

Plastic Surgeons are very good at minimizing and hiding scars, but there will be permanent scars, which usually heal as a fine line. The scars are hidden in natural skin creases or folds. The scars can also be hidden within the hairline or in the ear canal as well. Individual healing may vary. Ask your surgeon to see photos of typical scars.

Will insurance pay for my eyelid surgery?

Insurance will frequently pay for the procedure if skin and tissues around the eye actually obstruct or interfere with your vision.

With so many doctors out there how do I choose which is best for me?