Facelift Newport Beach
Faces in their forties and fifties start to show the effects of gravity – more lines, less facial muscle tone and sagging jowls. A good face lift, also known as a rhytidectomy, can easily reverse these signs of aging, leaving your face looking refreshed, healthy and younger. It can make you look and feel five to ten years younger. No wonder it’s the most famous procedure in plastic surgery.
Many people still believe that these procedures don’t work and that having one makes you look plastic and unnatural. Others think they are only for the rich and famous or that the procedure needs to be repeated, over and over again.
With advances in surgical technique, the results of today’s lift procedure lasts a long time, anywhere from five to ten years. Many people have repeat procedures with great success. Surgeons have learned how to tighten not only the skin but the underlying muscle as well, and also know how to remove excess fat from jowls, cheeks, and necks with liposuction.
A basic rhytidectomy surgery in Newport Beach takes four to five hours. It’s done at a plastic surgery center under general or local anesthesia. You can expect to be back on your normal schedule in about a week, although sun exposure should be limited for several months after surgery. Your new face needs about three weeks to heal fully. Some small scars are unavoidable, but they are normally completely hidden and continue to fade over time.
Photos of Dr. Sundine’s face and neck lift patients are available upon request at the time of consultation. To schedule a consultation, contact the practice at 949 706 3100.
Dr. Michael J. Sundine is a renowned facial plastic surgeon, offering a range of aesthetic procedures to help patients turn back the clock. In addition to specializing in facelift surgery, Dr. Sundine is a top Newport Beach rhinoplasty and chin augmentation surgeon. He also performs procedures for the upper facial features such as browlift and eyelid surgery in Orange County.
What is a Face Lift?
In its simplest terms, it’s a procedure designed to restore a more youthful appearance to a patient. Its essential elements include repositioning of deeper tissues and tightening of the skin of the face and neck. In reality, an isolated face lift (only that single procedure) is rarely performed. More commonly a face lift is performed in conjunction with a neck lift procedure.
What are some of the alternatives?
Not every patient is ready for this operation. There are many different alternatives that may be used depending on the age and presenting appearance of the patient. We utilize all of these alternatives to obtain the best results for our patients. These techniques may be used alone or in combination with the other techniques.
Some of these alternatives include:
- Skin care – typically incorporating tretinoin (Retin-A) and hydroquinone or kojic acid
- Neurotoxins-Botox, Xeomin, Dysport
- Facial fillers-Restylane, Juvederm, Radiesse, Perlane, Belotero, structural fat grafting
- Chemical peels
- Laser resurfacing
What are the common reasons why a patient wants a Face Lift?
The aging face is characterized by loss of elasticity of the skin with laxity of the deep tissues and some loss of volume in certain areas of the face. The appearance changes from the heart-shaped face of youth to a more boxy and hardened look. Patients who are good candidates for a rhytidectomy typically have started to develop laxity of the skin of the cheeks and neck along with wrinkles. The creases that run from the base of the nose to the corners of the mouth (nasolabial creases) begin to deepen. The corners of the mouth become downturned, which in women causes lipstick to leak out of the corners of the mouth. Patients start to develop creases from the corners of the mouth down to the chin-so-called marionette lines along with jowls. The neck skin becomes lax and they develop bands of the platysma muscle. The face lift is designed to treat all of these aging changes.
Are there any age restrictions?
These procedures are typically performed in patients and their 50s and 60s but there are no particular age restrictions to the procedure. It is important that the patient be in good general overall health. Any underlying medical conditions such as hypertension or diabetes mellitus should be under control. All patients require clearance from their primary care physician to make sure that it is safe for the patient to undergo the procedure.
What does it treat?
It is important to understand both what the operation treats and what it does not treat. It treats the area from the corner of the eyebrow to the base of the neck. The procedure has many wonderful effects on the face. The outer corners of the eyebrow can be elevated and the crow’s feet can be softened and released. The soft tissues of the cheeks are repositioned back up onto the cheek bones and the jowls are repositioned into the cheeks restoring the heart-shaped face of youth. The bands of the neck can be addressed and the neck skin can be tightened.
What does it not treat?
Sagging of the eyebrows along with creases of the forehead and in between the eyebrows are treated by a brow lift procedure (open or endoscopic). Bags of the upper and lower eyelids are treated with a blepharoplasty. Smoker’s lines require the addition of a chemical peel, laser resurfacing, or dermabrasion for improvement. Atrophy (thinning) of the lips requires the use of fillers or possibly even lip implants. The drooping of the nose will require a rhinoplasty.
How long does it usually take to perform?
It generally takes several hours to perform. If more extensive procedures are performed this may add additional time. In rare cases it may be necessary to perform the procedure in multiple stages.
What type of anesthesia is used during Face Lift surgery?
It 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 Face Lift?
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 reposition the facial fat. The SMAS flap has several effects: it repositions the soft tissues back up over the cheek bones, 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 “face lift” 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 procedure is really only applicable to a small percentage of patients who may have some skin laxity, but not laxity of the deep tissues. There is still down time with bruising and swelling from the areas treated. The deep tissues are not treated with these minimal procedures and there can be no longevity of the result from the procedure. The lack of longevity is a significant problem with the skin-only type of rhytidectomies. 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 it 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 day 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 down stairs. 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.
- Patients 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.
- Patients who have vertical bands in their necks or who have a poorly defined neck line.
- Patients who have a tired appearance.
- It is important that the patient be in good general overall health. Any underlying medical conditions such as hypertension or diabetes mellitus should be under control.
- Intended Results?
- To change the boxy and angular appearance of the aged face and restore the heart-shaped face of youth
- To soften the deep creases running from the base of the nose to the corners of the mouth (nasolabial creases)
- To remove or soften the creases running downward from the corners of the mouth to the chin area (marionette lines)
- To remove the jowls by repositioning them back upwards into the cheeks
- To restore a refined jaw line
- To 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
- 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 from 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.
- There will be some bruising and swelling after the operation. This is usually gone by about 10 days following the procedure.
- The sutures that are placed during the procedure are removed on postoperative days 7 and 10.
- Patients may begin light exercise such as walking on postoperative day 1.
- Full exercise may be resumed three weeks postoperatively.
- We recommend patients to 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
- 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.
- 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.
Facelift Surgery After Care Instructions
- After surgery, go home and relax. Take your medications as directed. You will be given a prescription for pain medication (generally Vicodin), 24 hours of antibiotics (generally Keflex), and antinausea medication (Zofran). You may expect minor bruising around your eyes that may last 1-2 weeks.
- Patient is not to turn neck from side to side, but is to move shoulders and neck as one unit. Avoid yawning, smiling is okay. Avoid chewing gum.
- Patient is not to have a pillow behind head, but is to use a small pillow or towel rolled up and placed behind the neck. The chin angle should be greater than 90 degrees. Patient is not to eat in bed, but may eat from a coffee table with one elbow on the knee.
- Diet: Liquid or soft diet with small bites for 10 days.
- Bathroom privileges with assistance. Remove area rugs. Keep floors clear.
- Ice filled gloves or frozen bag of peas covered with a towel to eyelids and crow’s feet areas for 20 minutes every hour while awake.
- Send patient to 1st postoperative appointment with ice gloves or frozen bag of peas covered with a thin towel.
- Empty Jackson-Pratt plastic bulb drains at 12:00 midnight and at 8:00 AM. Note amount of drainage and restart bulb suction.
- Shampoo hair after the drain is removed and continue shampooing as per patient’s usual routine. You may use conditioner. It is not necessary to use the Betadine shampoo after surgery, unless instructed to do so. Water may run over the incision sites, including the eyes. You may gently blow dry the hair with low heat.
- If patient had dermabrasion of the upper or lower lip apply bacitracin ointment on lips or treated area at least four times daily until the area is completely healed.
- Make sure that you do not become constipated from the pain medications. Take Colace (docusate sodium) twice daily- this is an over the counter medication.
- No driving for 10 days after the operation.
- Immediate postoperative follow-up appointments will generally be on days 1, 3, 5, 7 or 8, and 9 or 10 following the surgery.
- No hair tinting for three weeks after your surgery.
- Avoid strenuous activity or getting overheated. Patient may begin short walks on postoperative day 1 following the surgery. NO SMOKING or exposure to second hand smoke.
- After a face lift, you must apply sunscreen for at least 6 months when outside.
- If excess bleeding, fever, excess swelling, difficulty breathing, or any other distressing problem develops, call the doctor immediately.
- A copy of these discharge instructions is to be given to patient by post-op care nurse.
- Post-op nurse for the 1st night must call Dr. Sundine at 9 PM to update progress of the patient.
- If you wear eyeglasses, remove one ear piece to prevent any compromise to the blood supply of the skin flaps.
For any postoperative problems telephone:
Dr. Sundine 949-677-5845 (cell) 949-706-3100 (office)