For a successful facelift surgery to be possible, it should involve strict patient selection and surgical planning by a qualified surgeon who has a deep understanding of the aging process and the limits of the underlying anatomies as well.
It has been a year after my facelift surgery and I have no regrets doing the procedure, which has softened my deep wrinkles and contoured my jowl. Now, I look more rejuvenated and happier after my doctor removed the “angry appearance” caused by the loose skin and fat atrophy (shrinkage of facial volume).
While my plastic surgeon has explained to me all the details of my surgery and facelift recovery, I was still caught off guard with the amount of swelling, bruising, and postop blues.
These are the things I wish I knew before my facelift surgery.
- Know how to relax. I have always hated downtime, which is inevitable for anyone planning to undergo a plastic surgery procedure. Take note when I say “downtime” it means no house chores (including the simplest tasks) and work-related undertakings (even answering emails) for at least a week.
During the most crucial time of your recovery, your only focus should be about your wellbeing. Remember that the more relaxed you are, the more efficient your body is able to recover from a surgical trauma.
- There is no shame to ask for help. For at least a week, have a close friend, family member, or nurse to take care of your basic needs. Simply put, let someone pamper you to avoid the stress of your [usual] daily responsibilities at home.
- It’s okay to be afraid of mirror. While my surgeon explained to me that the swelling and bruising would conceal my results initially, I was not expecting that my face would have bruises literally everywhere. In fact, seeing my reflection for the first time after surgery scared the hell out of me.
- Controlling swelling is the key to quick “social” healing. The postop pain was not really the issue during my facelift recovery, but the interruption of my social activities was the hardest part for me. For this reason, I strictly followed my doctor’s instructions to control this symptom—e.g., head elevation, low-sodium diet, cold compress, rest and sleep, etc.
In my experience, most of the swelling was gone about a week, although it took another week for me to look “socially presentable.”
- Camouflage make-up and fashion accessories are helpful. Some cosmetics are specifically formulated to hide bruising and swelling caused by facial plastic surgery, although ask your surgeon first before using them. You don’t want to irritate your incisions, which could lead to unfavorable facelift scars.
Aside from camouflage make-up, large sunglasses and scarves can also help you hide the postop symptoms.
Facelift surgery is not just about lifting the skin and soft tissue of the face; a more important goal is to deliver results that look natural, with no “stigmata” or visible signs of the procedure.
Aside from your surgeon’s credentials—such as his board certifications, plastic surgery affiliations, training, and relevant experience—you should also scrutinize his facelift before and after photos, which will reveal a lot about his artistic skills.
Most surgeons’ who maintain a website also make some of their before and after photos accessible online.
Leading Los Angeles plastic surgeon Dr. Karan Dhir explains the variables that you should look into when gauging the “after” facelift photos.
- There should be no visible scars. The incisions used in any facelift procedure are within the ear’s contour and/or behind the hairline to hide the scars, although excessive tension on the skin and incorrect direction of pull could lead to scar migration.
- The hairline and side burn should look normal. They should maintain their preoperative appearance before the surgery is considered a success.
Meanwhile, the disappearance or distortion of side bun and lack of hairline “continuity” are telltale signs of the surgery that must be avoided at all cost. Should they appear, you may need to undergo hair transplantation, scar excision surgery, or skin flap rotation.
- The ears in the after photos should maintain their original position and appearance. Pixie ear deformity is arguably one of the most blatant signs of surgery since it appears “pulled” inferiorly.
To correct the pixie ear deformity, the earlobe must be released from the lateral cheek and then reattached in a higher position; it is equally important to use a layered wound closure to eliminate or at least reduce the tension on the skin.
In addition, the ears in the after photos should have no excessive fullness in front of the ear canal, which is generally caused by under-correcting the loose, excess skin.
- The overall result should look balanced. A good facelift should also include the neck to achieve a more rejuvenating effect; failure to address the signs of aging in the lower third of the face will make them appear more obvious.
While facelift does not completely eliminate all the signs of aging, the postop appearance of the jaw line and neck area should appear smoother and tighter than the “before” photos.
- The result should look smooth, not overly tight. Nowadays, skin-only lifts are rarely used because they can lead to “surprised” or windswept appearance, flat cheeks, distorted hairline, and slanted eyes.
Facelift surgery is not just about tightening the skin and deeper facial structure to rejuvenate one’s appearance. An equally important goal is to eliminate or at least hide any telltale sign of the procedure through proper scar placement, correct direction of pull, adjunct procedures, etc.
Facelift generally uses incisions behind the hairline that may extend in front, behind, or around the ear, specifically within the natural skin creases to hide the scars.
Around the incisions, temporary hair loss/fall may occur as the hair follicles go into a hibernation phase. For the vast majority of patients this will resolve on its own, although they could “accelerate” the healing process by using topical treatment such as Rogaine.
The general rule of thumb is to wait three months to see if there is any hair regrowth around the facelift scars.
Nonetheless, permanent bald patches do occur after a facelift procedure, particularly if there is an excessive damage to the hair follicles or due to incorrect wound closure. To prevent this complication, the general rule of thumb is to eliminate tension on the wound.
A technique called trichophytic closure is particularly helpful in preventing hair loss or bald patches following a facelift procedure. It involves suturing the overlapping edges of the wound, and removing a small piece of skin at an oblique angle (on one side of the wound), before the adjacent flaps are brought together to close the incisions.
With this wound closure, a piece of scalp tissue lies beneath the other, allowing the hair follicles from both flaps to grow and conceal the facelift scars. This technique is also helpful in hair transplant surgery.
To further eliminate any telltale sign of facelift, such as frontal hairline distortion or weird-looking sideburns, the direction and amount of pull should also be taken into account. The idea is to eliminate or at least minimize tension on the skin by contouring the SMAS (deeper facial structures) and not just the skin alone.
Should permanent bald patches occur after facelift, hair transplant surgery is the only permanent solution. This involves collecting hair follicles from the back of the scalp, grouping them together, and implanting them into the area that requires some coverage.
Most Los Angeles plastic surgery experts suggest waiting at least a year before considering hair transplant since hair regrowth is possible with time, or the patient could find hairstyle options that may hide their small bald spots.
Facelift surgery comes in several techniques and terminologies, which differ from surgeon-to-surgeon. Nevertheless, good results are only achieved by customizing the surgery based on the patients’ cosmetic goals and their underlying anatomies such as skin quality and bone structure.
A standard facelift primarily targets the sagging cheeks, jowling, and turkey neck appearance. It has no effect on the upper third of the face, which requires a different procedure called forehead lift. Meanwhile, combining these two surgeries or other techniques that aim to rejuvenate the entire face, or at least most of its area, is called full facelift.
On the other hand, a mini lift procedure is a very broad term that may describe a mid facelift, lower facelift, brow lift, forehead lift, or short-scar lift. But despite the confusing terminologies, it is generally used in patients with early features of facial aging or “isolated” problems such as sagging cheeks, jowling, neck bands, or laugh lines (nasolabila folds).
Also, a mini lift typically uses shorter incisions than a standard or full facelift wherein the scar lies behind the hairline near the temple and then goes around the ear, specifically within its natural skin creases to hide any telltale sign of the surgery.
In mini lift, a scar is typically hidden just behind the ear or around it.
While a mini lift procedure can deliver impressive results, it is only suitable for patients who have maintained a good amount of skin elasticity, with just mild changes in the lower third of their face, specifically the jaw line and neck area.
Performing mini lift surgeries on individuals who have more noticeable signs of facial aging is like under-correcting the problems. In worst case scenario, it leads to unfavorable scarring or skin asymmetries, which are telltale signs of plastic surgery. Simply put, proper patient selection is crucial to achieve impressive results from any type of facial rejuvenation surgery.
Regardless of the facelift technique used at the time of surgery, it is always crucial to go deeper into the facial structures to achieve more rejuvenating effects and longer lasting results. The idea is to lift the SMAS, which is a layer of skin where the soft tissue and muscle are attached, and not just the skin alone.
A skin-only lift, while it provides immediate rejuvenating effects and shorter facelift recovery, almost always leads to short-lived results because the skin will eventually sag due to the “weak” or loose SMAS that has not been reinforced.
A successful facelift surgery result not only looks more youthful and refreshed. An equally important goal is to create a natural-looking visage, with no telltale signs of the said procedure, as suggested by Los Angeles plastic surgery expert Dr. Tarick Smaili.
Simply put, the result of facelift should not “scream” plastic surgery.
Dr. Smaili explains the four most common telltale signs of facelift surgery and the “principles” he uses to avoid them.
1. Weird-looking ears. Most facelift techniques involve an incision that runs around the ear, particularly within the natural folds of skin to hide the scars. This will allow the surgeon to remove some excess skin, tighten the deeper facial tissue, and pull the skin to reduce the saggy appearance.
However, excessive tension on the skin and incorrect direction of pull could lead to pixie ear deformity in which it appears too elongated. Raisin-like wrinkles in the earlobe, meanwhile, are often caused by poor wound closure.
Avoiding excessive skin tension and incorrect wound closure can prevent wrinkly or elongated earlobes. For this reason, it is crucial to reshape the deeper structures of the face so the new contour will have a stronger support, with no or very minimal strain on the superficial layer.
2. Weird facial expression. The late Joan Rivers has been the poster child of botched facelift surgery because of her perennially surprised visage.
A “surprised” and “windswept” appearance is often caused by incorrect direction of pull and/or excessive tension on the skin. To avoid this look, the leading Los Angeles plastic surgery expert advocates the use of three-dimensional facelift approach in which fat grafting or dermal filler injection is used to create a more natural visage.
The idea is to restore the facial volume and rely less on skin pulling, which if done aggressively can backfire, Dr. Smaili warns.
3. Poorly placed scars. Facelift scars are positioned behind the hairline and around the ears to hide them. However, problems can arise when they migrate due to excessive skin tension, or thicken due to incorrect wound closure or because of the patient’s susceptibility to keloids.
Aside from minimizing skin tension during surgery, Dr. Smaili says proper wound care also plays a crucial role. The idea is to avoid infection, pressure, and other factors known to inhibit healing and lead to aggressive scarring.
But if the facelift scars remain persistent, Dr. Smaili recommends steroid injections, laser treatments, silicone tapes, or scar revision surgery.
4. Hair loss. Incisions are typically positioned behind the hairline so the scars remain hidden. However, incorrect or aggressive wound closure and failure to elevate the facial skin could lead to hair loss and unnatural hairline.
To avoid the aforementioned problems, the hair follicles and the surrounding blood supply should not be exposed to excessive trauma at the time of surgery.