Facelift (Facial Rejuvenation)

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Facelift is a major surgical procedure whose purpose is to improve the appearance of the face. This improvement is achieved by redraping the face skin and muscles and, where necessary, even by removing or injecting fat tissue. The improvement level is different from patient to patient and it is influenced by many factors, such as: skin condition, sun damage and underlying bone structure.

ANESTHESIA:
local + sedation or general
TREATMENT LENGTH:
2 to 4 hours
STAY IN HOSPITAL:
none or 1 day
RECOVERY TIME (BACK TO SOCIAL LIFE):
2 weeks


The procedure

The procedure is normally performed with general anesthesia or analgesia (a combination of intravenous sedation and local anesthesia).
Through an intravenous injection, sedation drugs are administered that produces a relaxing and calming effect. Local anesthesia is injected when the patient is already sleeping, so that the punch is not giving any nuisance. The patient will feel no pain during the operation. In some cases, general anesthesia is recommended. Anyhow, the choice can be discussed with the anesthetist. Anesthesia is, anyhow, administered by the anesthetist, who is present in the surgery room for the whole surgery time. For safety reasons, all equipment required for the procedure is prepared before the operation.


The procedure length is 2 to 4 hours, depending on the extent of the area to be treated: face, neck and scalp.
A small strip of hair is removed in the hairline at the temples and behind the ears and, if the procedure includes also a forehead lift, n the forehead or even further backwards. The wound margins in the scalp will be closed by sutures and, as a consequence, the incisions will be hidden and, anyhow, well concealed within the hairline
The incision, started in the hairline at the temples, continues around the front of the ear, turns downwards around the ear lobe and upwards around the auricular sulcus reaching almost the upper edge of the ear and, then, downwards again and, finally, along the hairline in the nape area. There will be no visible scars at the base of the hairline and, as a consequence, the patients will be able to have their hair rolled back without showing any scar.
Thanks to these incisions, the skin is lifted and gently detached from the underlying tissues. Sometimes it is necessary to remove fatty tissue under the inferior maxillary bone (jawbone). The subcutaneous connective tissue ("fascia") is stretched upwards and backwards and then sutured in this position. All this occurs under the skin, in a way that it can be redraped with minimal tension on top of the muscles; consequently, when the muscles will be tense again, the surgical wounds will not get excessive strain and will be able to heal normally.
Excessive skin will be removed and incisions will be closed with very thin sutures, after placing subcutaneous drains, which will be removed within 24 hours. At the end of the procedure, soft compression bandage is applied, in order to keep a moderate compression all over the treated area. This helps keeping the edema (swelling) under control and protects the wound.


Facelift is sometimes combined with Blepharoplasty or other face procedures (such as lipofilling to fill up the cheekbones that have lost their original volume). This can be discussed with the patients in case they wish to have further information.

Preoperative Preparation

The patient will be asked to stop taking aspirin, or other drugs containing it, 2 weeks before and 2 weeks after surgery. Aspirin can cause bleeding and, as a consequence, increase the risk of complications.
The patient must stop smoking for at least 2 weeks before surgery. Some research studies have shown the risk for complications becomes 10 times higher if you smoke. If the patient stops smoking at least 10 days before the operation, the risk of complications will be the same as for non-smokers.
It is recommended to female patients taking oral contraceptives to stop taking them one month before surgery.

It is absolutely necessary to apply Antibacterial Shampoo the night before and the morning of the surgery day. Hair color can be used until 3 days before the procedure.

Post-operative care

The day after surgery the dressing is changed, the wounds are checked and a new softer and smaller dressing.
After surgery and for the first few days after surgery, a diet consisting of liquid and soft food is recommended. Starting from the third day after surgery, the patients can gently wash their hair and no dressing will be needed anymore.
On 7th day after surgery the stitches in the front of the ear will also be removed. If the procedure has been combined with Blepharoplasty, the stitches related to it will be removed at the same time.
Two weeks after surgery, all the remaining stitches in the scalp will be removed. As a rule, yet depending on the extent of the procedure, the patients will look presentable within 2-3 weeks.


After the procedure

After surgery, some edema (swelling) will occur, together with erythema (redness) and ecchymosis (bruises), but normally there no or very little pain and discomfort. After the first enthusiasm just after surgery, and before the patients can see the final result, some depression might occur, which is normal and gives no reason to worry. This is normally over in a short time.
A limited hair loss might occur around the scars. In some exceptional cases, this condition can become permanent. Keloid scars are very rare in the face, but, occasionally, they might occur behind the ears. When they occur, they are anyhow minimal and can be easily treated with excellent results. It might happen that one of the small branches of the facial nerve is damaged. This can cause muscle weakening in some areas, which might also become permanent. This is, nevertheless, extremely rare.

Possible complications

Specific risks related to facelift are limited and as a rule rare. Hematoma. It is the most common complication, but extremely rare. It consists of a localized subcutaneous collection of blood or blood clots. This collection is called hematoma. If the size of the hematoma makes it necessary to remove it, this can be performed by aspiration or by re-opening a small part of the surgical wound. This will anyhow not affect the final result.
In extremely rare cases, the skin might get damaged in the areas where it had been detached and, if that happens, the damage will be only in the front of the ear. This might imply a permanent scar, yet, not a significant one and, if necessary, it can be improved with a small outpatient surgery with local anesthesia later on.

Edema (swelling). Edema will disappear within 2-3 weeks, but a minimal swelling might stay for a few months. This is anyhow normally noticed only by the patient himself/herself.

Ecchymosis (bruises). Ecchymosis is normally limited to the area immediately under the eyes and in some areas beside the neck. Anyhow, it normally disappears within a week, but occasionally it might stay a bit longer; if this happens, it can be easily hidden with make-up.

Recovery time (back to the social life)

The patient has to avoid any significant strain for a week after surgery. During the first 3 weeks after surgery, normal physical activity can be gradually resumed. During this period, it is recommended not to practice any sports or physical activity, but if the patients feel like it, they can go out for short walks or social activities that are not strenuous. After the third week, all physical activity can be resumed.
It is possible to wash your hair gently after the dressing removal, on the third day after surgery. Other hair treatment or coloring cannot be done before 3 weeks after surgery.
Driving can be resumed one day after surgery, as well as sexual activity (within reasonable limits).
Sun exposure is extremely dangerous for the face, and even more after a Face Cosmetic Surgery procedure. As a consequence, sun exposure must be very limited for at least 3 months, and plenty of sunscreen lotions must be used. Hats and sunglasses can also be useful. Apart from the direct damages on the face skin, sun exposure can cause redness of the scars and it also makes the scars thicker; it could even make the skin color darker in some areas, which would not disappear when the suntan goes away.
Some loss of sensitivity in the front of the ear and in the neck might also occur. Even though the sensitivity will slowly go back to normal, a little Hypoesthesia (partial loss of sensitivity) might stay for a few months. Men are recommended to be extremely careful when shaving during the post-operative period. An electrical shaver might be preferable. Heat on the face, such as warm compress and hair dryer, must also be limited, since the patient could burn the skin without realizing it, because of the loss of sensitivity.

 

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