Lifting the Face, Part Three

In previous posts I discussed when a facelift is helpful, and briefly the differences between types of facelift procedures. Here in Part Three I will discuss the practical aspects of undergoing a facelift, including preoperative, operative, and post-op aspects. Buckle up, here we go.

The Consult

The road to a facelift starts with your consultation (your free consultation, if you see me at Gallatin Plastic Surgery!). During your visit we discuss your goals, concerns, and medical history. The idea is to understand specifically what you are hoping to accomplish, make sure your goals fit with what can be reasonably achieved surgically, and make sure that there are no medical issues that will place you at a higher risk for complications. Also during your consultation, standardized photographs are taken and a very detailed discussion takes place where the risks, benefits, expected recovery, scars, and other important parts of surgery are discussed with you. You are also provided with a detailed quote which describes the total cost of surgery.

Preoperative

After you decide to schedule surgery a preoperative appointment is made with our nurse. Although we like to see you again face-to-face before surgery, for patients who have to travel a long distance, we will perform a phone preop. I try to be available during preop appointments so that I can answer any remaining questions directly (otherwise I’ll answer them by phone before surgery). Oftentimes we order lab work to make sure there are no surprises during surgery, and sometimes an EKG (these tests are ordered based on accepted guidelines predicting the risk of finding problems, or if there is a personal or family history of specific diseases). Your postoperative medications are ordered for you at this point so that you have them ready for surgery.

On the night before your operation the anesthetist will contact you and make sure the instructions on when to stop eating and drinking are clear, and to answer any questions that you may have about anesthesia. After (hopefully) getting a good night’s sleep, we will see you in the morning on the day of surgery. I recommend that patients who live a long distance away spend the night before surgery in Bozeman. After getting checked in and settled, I will mark your planned incisions and answer any additional questions before your nap.

Surgery

Most facelift operations in my practice are performed under general anesthesia (“going to sleep”). There are some exceptions, but the reason for this is mostly the length of time it takes and how extensive surgery must be to achieve a long lasting, natural-appearing result. Once again, beware of “mini” operations– although there may be less cost and recovery time, there also tend to be “mini” improvement and “mini” duration of results. Once under anesthesia, you will be unaware of discomfort and the time that your operation takes.

During your operation a continuous incision is made, camouflaged along your hairline and physical facial features. Skin and underlying tissue (SMAS– see Part Two) are released in a controlled way from the surrounding tissue. This allows improvement in wrinkles and skin texture (by removing excess skin) and improvement in facial shape (by repositioning facial fat pads via the SMAS). Skin has a covering function and not a supportive one, and it is critical not to try to make the skin perform both roles– this leads to an “operated-on” look, and disappointing results.

Once reshaping is complete, a drain is placed to improve swelling and bruising and the incisions closed with very fine dissolving sutures (the visible sutures are about the same diameter as your hair). A gentle compression wrap is placed. When you wake up, the operation is done! Recovery in the operating suite usually lasts a few hours, and you are discharged to your caregiver with detailed care instructions.

Postoperative

After surgery it is helpful to sleep in a propped-up position (either with pillows or a recliner). This allows extra fluid to be captured by your drain. The drain connects to a bulb that is emptied at least twice daily. I see you the next day in the office to make sure that you are doing well. The next time you are seen is in one week for drain removal, followed by 1-2 weeks after. It is helpful to note that some swelling occurs right after surgery and may last for up to two months postoperatively, although most of it is gone within 2 weeks (the approximate duration of “social recovery”). I will also see you two months, six months, and one year postoperatively to make sure that your results and recovery are optimal. You are not charged for these visits or any other visits you need after surgery.

Results from more extensive facelift operations (such as those that I prefer to perform) should provide up to 10-15 years of improved youthfulness. Scar care and sun avoidance are important to optimize appearance. Fat or filler injections may be recommended with your surgery to provide the best outcome.

Epilogue

I hope that you have enjoyed my series on Lifting the Face! Please call to schedule your consultation for more information and a personalized plan.

Dr. Jarred McDaniel
Board Certified Plastic Surgeon
Owner, Gallatin Plastic Surgery