A bilateral facelift should aim to rejuvenate the face and neck, without changing the patient’s original appearance. The most reliable strategy to achieve this goal is by surgically elevating the skin of the face and neck and repositioning it. By contrast, attempts to achieve a natural, lasting facelift by tension- producing sutures have not and cannot give comparable results to actual surgery. The techniques of surgical facelift continue to undergo small nuances of change, but patients should have as their first priority a safe and highly reliable result.

I perform facelifting in the hospital outpatient setting or in the accredited surgi-center. Most patients are given a choice of anesthetic, and most choose conscious sedation (intravenous narcotic and sedative drugs) combined with locally injected anesthetic. It is an outpatient procedure that can be done alone or in combination with browlift, blepharoplasty, etc. in a healthy patient.

Aside from eyelid aging effects, the most common early signs of facial aging are the central face and neck (the jowls, deepnasolabial folds and “turkey neck”). A facelift should surely, then, concentrate on improvement of these areas. A “mini-lift”, by comparison, cannot provide lasting benefit to the central facial changes of aging. Normal facial fat moves down and medial during aging, and it also diminishes in volume. A facelift should re-establish the existing fat to its youthful position over the cheekbones and mandible, and also restore lost fat in some instances with fat grafts. The face and neck may deserve different emphasis, but I carefully discuss individual needs and preferences with each patient.

Dressings and drains are removed in the office 2 days after facelifting. Swelling and some bruising is expected, as well as temporary facial numbness and mild to moderate discomfort. All sutures are removed by approximately 1 week. Most patients are doing normal work, limited exercise and some social activities after two weeks. Completion of all healing and recovery continues for 6-12 months. Incisions usually heal rapidly and scars are highly concealed. Complications after facelifting are and should be extremely rare, as it should be with any elective, aesthetic operation. A history of smoking is the biggest risk factor. A lengthy consultation and examination will cover the goals, strategy and risks of the procedure(s) being considered. Patients are invited to return to have a follow-up discussion (without charge), or to confer with other patients who have undergone the procedure. A well informed patient with a natural looking result is the best goal.

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