What Type of Anesthesia Is Used During Facelift Surgery?
A facelift can be performed under local anesthesia with sedation or general anesthesia with supplemental local anesthesia. In our center, we only utilize board-certified anesthesiologists for our patients.
Do I Need to Be Hospitalized for the Procedure?
It is performed on an outpatient basis in a fully accredited outpatient surgery center. We recommend that patients go to an aftercare facility following the procedure for the first evening since the care is usually more than a spouse or friend can provide.
We can recommend recovery facilities or even home nursing care if you require this in the period around the operation.
What Is Involved with a Facelift?
In our experience, no two rhytidectomies are the same, and the procedure is customized to the particular needs of the patient. Clearly, there are some components that are the same in all of the patients. The procedure starts with making incisions in or at the hairline and around the ear. The incisions are designed for minimal visibility after the procedure.
The skin is then elevated from the underlying fat in the cheeks and the neck. We then elevate a deep layer of the face called the SMAS to allow us to reposition the facial fat. The SMAS flap has several effects: it repositions the soft tissues back up over the cheekbones, it repositions the jowl back up into the cheek, it provides hammock support to the neck, it allows for less tension to be placed on the skin giving fine line scars, and it provides for longevity of the lift.
After the SMAS flap has been sewn into position, the neck can be addressed. If there is excess fat in the neck, it may be removed with liposuction or direct excision. If there are bands in the neck, the muscles responsible for the bands may be divided or sutured together. Two drains are placed, and the skin is then tailored and sutured back together.
What About Lunch-Time Lifts, Lite Lifts, and Other Very Heavily Marketed Lifts?
Recently, facelift procedures that are performed under only local anesthesia and take about an hour to perform have become popular and very heavily marketed. However, there are several issues with these procedures.
The procedures are really only applicable to a small percentage of patients who may have some skin laxity but no laxity of the deep tissues. There is still downtime with bruising and swelling in the areas treated. The deep tissues are not treated with these minimal procedures, and there can be no longevity of the results from the procedure.
The lack of longevity is a significant problem with the skin-only type of rhytidectomy. A recent Consumer Affairs report from a study they conducted on one of the heavily marketed lift procedures reveals that the procedure had only a 2% full satisfaction rating with 5 stars, while the dissatisfaction percentage was 76%, earning only one star.
Are There Scars Afterwards?
The incisions used are designed to be well hidden and minimize scarring. The majority of the incision is hidden around the ear. The rest of the incisions are hidden either in the hair or along the hairline and these are also well hidden.
Is a Facelift a Painful Procedure?
The majority of our patients experience only mild pain or discomfort that is easily managed with oral pain medications. Typically, most patients stop taking the medications about three days after the surgery.
What Is the Recovery Like?
Patients go to the aftercare facility directly from the surgical center. They are observed overnight and then brought to the office the next afternoon. In most patients, the drains are removed at that office visit.
We then typically see the patients on postoperative days 3, 5, 7, and 10. On postoperative day 7, the sutures around the ear are removed, and on postoperative day 10, the sutures at the hairline are removed.
Patients can expect some bruising and swelling following the procedure. Bruising is common in the areas near the outer corners of the eyes (because the skin is very thin in this area) and at the lowest point of dissection in the neck. The vast majority of the bruising is gone by about the 10th postoperative day.
Are There Bandages Used Afterwards?
We do not use any bandages, because we are concerned that the pressure from the dressing may compromise the blood supply to the skin.
Will I Need to Take Time Off from Work?
There will be some bruising and swelling following the surgery. This is usually gone by about 10 days following the procedure. We advise patients to plan on about two weeks of social downtime following the procedure.
When Can I Exercise Following the Operation?
Patients can return to some light activity even the first day following the operation. We encourage them to go for light walks. They may go up and downstairs. They may resume full activities at three weeks following the procedure.
Are These Procedures Covered by Insurance?
These procedures are cosmetic in nature and are not covered by insurance.
Who Is a Candidate?
- Patients who have facial wrinkles and skin laxity
- People who have developed deep nasolabial creases (the crease between the base of the nose and the corners of the mouth), downturned corners of their mouths, and marionette lines (the crease running downward from the corners of the mouth to the chin)
- Patients who have developed jowls
- People who have vertical bands in their necks or who have a poorly defined neckline
- Patients who have a tired appearance
- It is important that the patient is in good general overall health. Any underlying medical conditions such as hypertension or diabetes mellitus should be under control.
Intended Results
- Change the boxy and angular appearance of the aged face and restore the heart-shaped face of youth
- Soften the deep creases running from the base of the nose to the corners of the mouth (nasolabial creases)
- Remove or soften the creases running downward from the corners of the mouth to the chin area (marionette lines)
- Remove the jowls by repositioning them back upwards into the cheeks
- Restore a refined jawline
- Remove the vertical lines in the neck and restore a youthful convex configuration under the chin
- To remove any excess skin and improve the wrinkles of the face
- The overall goal is to restore you to an appearance about 15 years earlier
Procedure Description
- The procedure begins with incisions within the hair in the temple area or at the temple hairline. The incision is then hidden around the ear. The incision then follows the hairline behind the ear for a short distance and then goes into the hair. Frequently a small incision is made behind the crease under the chin.
- The skin of the face and neck is then elevated up from the face and the neck.
- A deeper layer (the SMAS) is then elevated repositioned upward and posteriorly. The importance of elevating this layer cannot be underestimated. The SMAS layer repositions facial fat upwards and restores the softness over the cheekbones. In addition, the SMAS also repositions the jowls back up into the cheeks. The use of the SMAS also reduces the amount of tension on the skin and prevents a tight and wind-blown look seen in skin-only lift procedures and helps to form fine line scars. Finally, the use of the SMAS improves the longevity of the operation.
- The excess skin is then trimmed and sutured back into position.
Recuperation and Healing
- There is little discomfort associated with the procedure, which is easily managed with oral pain medications. Typically, most patients stop taking the medications about three days after the surgery.
- The sutures that are placed during the procedure are removed on postoperative days 7 and 10.
- There will be some bruising and swelling after the operation. This is usually gone by about 10 days following the procedure.
- Patients may begin light exercise such as walking on postoperative day 1.
- Full exercise may be resumed three weeks post-operatively.
- We recommend patients plan on about two weeks of social downtime following the procedure.
Other Options
- Skin care-typically incorporating tretinoin (Retin-A) and hydroquinone or kojic acid to improve fine wrinkles and even out irregular pigmentation
- Microdermabrasion-to remove the outer layer of the skin improving fine wrinkles and pigmentation
- Neurotoxins-Botox, Xeomin, Dysport-to soften crow’s feet and soften creases between the eyebrows and forehead
- Facial fillers-Restylane, Juvederm, Radiesse, Perlane, Belotero, Voluma, Sculptura-to fill in deeper creases and help to fill areas of facial fat atrophy
- Chemical peels-to tighten skin and even out pigmentation
- Laser resurfacing-to tighten skin and even out pigmentation
- Structural fat grafting-to help to replace volume loss and fill in deep creases
What is the Cost of a Newport Beach Facelift
The cost of the surgery can vary. During your consultation, Dr. Sundine will go over his recommendations and pricing.
Insurance Guidelines
- A rhytidectomy is a cosmetic procedure and is not covered by insurance. Frequently the preoperative workup and laboratory studies can be captured as part of an annual visit on their insurance plan.
Note: Be wary of heavily marketed procedures that promise to achieve in an hour over lunch with no downtime. These procedures cannot achieve any significant correction and will not produce a lasting result. A recent Consumer Affairs report from a study they conducted on one of the heavily marketed procedures reveals that the procedure had only a 2% full satisfaction rating with 5 stars, while the dissatisfaction percentage was 76%, earning only one star.
