Facelift is a major surgery whose purpose is to improve the features of your face. The improvement is achieved by stretching your face skin and muscles, if necessary, even removing fat.
The degree of improvement changes from subject to subject and it is influenced by the physical conditions of your skin , the degree of the damage produced by solar radiation, by the underlying bone structures and a variety of other factors .
Preoperative preparation
It is recommended not to take aspirin or medicines containing it two weeks before and two weeks after. Aspirin can cause bleeding thus increasing the risk of complications. It is recommended to stop smoking at least two weeks prior to the surgery. Some studies have shown that the incidence of complications is 10 times higher among smokers than not smokers. If you stop smoking 10 days or more before the surgery, the incidence of complications is equal to that of non-smokers. In the immediate postoperative and in the first following days a liquid diet and soft food are recommended. To patients on oral contraceptives therapy it is also recommended to stop taking these medicines a month prior to the surgery. It is necessary to use an antiseptic shampoo the night and the morning prior to the surgery. Any hair dyes are allowed up to three days before the surgery .
The surgery
The surgery is usually performed under general anesthesia or analgesia. The last type of anesthesia is a combination of intravenous and local sedation administered by intravenous infusion of drugs that induce a mental state of relaxation and calm. The local anesthetic is injected into the tissues of face when the patient is already asleep, so the discomfort of the injection is not absolutely perceived. No pain is perceived during the operation. Sometimes, a general anesthesia is recommended and it can be discussed together with the anaesthetist. In any case, anesthesia is administered by the anaesthetist that is always present during the surgery. All the necessary equipment are ready for use, for the complete safety of the surgery. The duration of the operation is about 2-3 hours, depending on the amount of work necessary in the different areas of your face, neck and scalp. A small strip of hair is removed in the temporal region and behind your ear, and if necessary, a forehead-lift, in the frontal region, further back or to the top. The margins of the wound of your scalp, covered with hairs of normal length, will be pull together with stitches so that the incisions are then hidden. The incisions descend from the scalp to the temporal region in front of your ear, they bend downwards around the ear lobule and they continue in the groove behind the ear upwards, almost to the upper end of the ear and again downward towards the hair of the region of the neck. There is no scar at the base of the hairline and then, if patients wish to wear raised hair, they can do it without having any visible scar. Through these incisions, their skin is lifted and freed from the underlying muscle tissue. It may be necessary to remove some fat from the area below the jaw. The mass of muscles of the expression is unglued as a separate layer and stretched upward and backward, and then the excess is removed and it is sutured. All this takes place under the skin so that it may be wrapped up with a minimum tension above the muscles which are put back into tension so that surgical wounds can heal undisturbed without excessive stress.
The excess skin is removed and the closure is performed with very thin sutures. At the end of the surgery , an abundant soft compression bandage is applied in order to maintain a moderate compression over the entire area of the surgery. This is done in order to obtain a reduction of edema (swelling ) and protect wounds. The face lift is sometimes performed together with blepharoplasty or other types of operation to the face . These can be discussed with patients if they wish further information .
Post–Operative Treatment
The day after the surgery, the dressing is changed, the wounds are controlled and a new lighter and smaller dressing than the previous is applied . The fourth or fifth postoperative day these dressings are removed and also the stitches to the front of the ear will be removed. If a blepharoplasty has been carried out, also the sutures of this operation will be removed . From now on , patients will be able to wash their hair, gently and they do not need any bandages . One week after the surgery , the remaining stitches will be removed from the scalp . Generally and depending on the degree of the operation , patients will normally be presentable within two or three weeks.
Possible complications
In any surgery there is a certain degree of risk. Certainly the administration of drugs of any kind can produce severe and unpredictable results. However, all precautions to prevent such situations will be taken and they will be treated appropriately so as to avoid any consequences, promptly, in case it should occur. The specific risks of facelift are limited and generally rare.
Hematomas. The most common complication, however, extremely rare, is blood clotting or clots below the skin. The clotting is called hematoma. If the hematoma is of such dimensions that removal is required, this can be achieved by means of suction or through the opening of a small part of the surgical wound. This however will not produce negative effects on the final result. In extremely rare cases, it may cause damage of the skin in areas that were generally detached and if that happens, it is in the area in front of the ear. The subsequent healing is got and a generally insignificant scar may be permanent but, if necessary, it can be mended later with a small operation under local anesthesia.
Edema (swelling). Edema is resolved in 2-3 weeks but a modest degree of swelling may persist for several months. This is usually noticed only by the patient.
Bruising (ecchymosis) . Bruises are usually located in the area immediately below the eyes, and in some areas on the sides of the neck. They disappear within a week but occasionally may persist a bit longer and it can easily be disguised with makeup.
What to expect after the surgery
After the surgery there is a certain degree of edema (swelling), erythema (redness) and bruising, but generally the discomfort and pain are modest or absent. After a first enthusiasm for the surgery, before patients can see the result, it may follow a mild depression that is not unusual but it should absolutely not cause any alarm. It usually quickly resolves. It might occur a mild hair loss around the scars. In exceptional cases this may be permanent. The forming of keloid scars on your face is really rare but they can occasionally show up to the back of the ear and can be appropriately managed with excellent results. It may happen that one of the small branches of the facial nerve is damaged. This causes a weakening of some muscles in the small area that can also be permanent, but it is extremely rare.
Resumption of physical activities
The first week after the surgery it is scheduled complete rest. For the first 24-48 hours it is recommended bed rest. Afterwards, it may be possible to get up, but it is not allowed to leave home for the first 5-6 days. During the second or third week normal physical activities will be gradually resumed. During this time it is not recommended to play any sports or to do exercise, but if patients feel able to do so they can go out for not too much strenuous walks and social activities. After the third week any other activity is allowed. It is possible to wash hair , gently, after removing the dressings. Other treatments or dyes can not be performed earlier than 3 weeks after the surgery. Driving a car is allowed after a week as well as sexual activity (moderately). Sun is extremely harmful to your face, particularly following a cosmetic face surgery. Sun is to avoid carefully, limiting exposure to a minimum and using sunscreen in abundance. A hat and sunglasses can be very useful.
Quite apart from the damage to the skin of your face, sun causes redness on recent scars and stimulates the formation of thick scars; it could also stimulate in some areas a more intense colour that will never completely disappear when the tan goes away. There is always a certain degree of reduction of the sensitivity of the front ear and the neck. Although the normal sensitivity tends to resume gradually, a slight degree of hypoesthesia (reduced sensitivity) may persist for several months. Men are advised to be extremely cautious in shaving during the postoperative period. It might be preferable to the use of electric razors. Even the use of heat must be limited (hot compresses on the face, electric hair dryer) as for the reduction of the sensitivity, the skin may be burned without the patient being aware of it.