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Facelift (rhytidectomy) is a surgical procedure performed to improve visible signs of aging of the face and neck. As individuals age, facial skin and fat becomes loose and begins to sag. A facelift enables repositioning of sagging structures and removal of excessive skin. Most patients appear approximately 7 to 10 years younger, though individual results vary.

A facelift cannot stop the process of aging or remove all facial wrinkles. The best candidates for facelift have some sagging of the face and neck but retain reasonable skin elasticity and bone structure. Most facelift patients are 40 to 65 years old.

A facelift is frequently performed in conjunction with surgery of the upper eyelids, lower eyelids, and/or brows.

Dr. Friedman performs these procedures under general anesthesia. The procedures are performed in his AAAASF-accredited surgical facility, the West Plano Plastic Surgery Center, which is located on the campus of Texas Health Presbyterian Hospital of Plano. He strictly uses physicians—not nurses or technicians—to administer your anesthesia.

There are several types of facelift. Dr. Friedman generally performs a MACS lift (Minimal Access Cranial Suspension), a technique that originated in Europe and is growing increasingly popular within the U.S. The technique involves placement of permanent sutures in the fascia (fibrous tissue just above the muscles) to lift the cheeks, jowls, and neck. Relying on fascia (rather than skin alone) for the lifting tends to improve the longevity of results. The incisions are hidden in front and in back of the ears and within the sideburn. Tightening is done with care to avoid the overdone, "pulled" look. If necessary, excessive fat beneath the chin is removed by liposuction.

Patients are monitored overnight by two medical personnel, a Registered Nurse and her assistant, in Dr. Friedman’s surgery center. Pain is usually mild and well controlled with prescription pain medication. Small, temporary drainage tubes are usually removed within 48 hours. Compressive dressings are removed 3 days after surgery. Most patients return to light activities within 3 to 5 days. Stitches are removed 10 to 14 days after surgery. Bruising resolves in about 2 to 3 weeks. Heavy straining should be avoided for about 4 weeks. The scars are generally well-camouflaged and inconspicuous.

When you visit our office, Dr. Friedman will discuss your specific concerns. He will outline the available procedures and will help you decide which one(s) may be most appropriate for you. We will also show you a variety of "before and after" photos of facelifts performed by Dr. Friedman. If you wish to speak to other patients who have undergone these procedures, we will be happy to provide phone numbers.

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Q & A: Facelift

Will I look “pulled” or “artificial” after facelift?

All facelift patients look swollen and tight immediately after surgery. This gradually improves over the first few weeks after surgery. Dr. Friedman makes every effort to provide natural-appearing results following surgery, since virtually all patients simply want to look better, not different. Most patients feel comfortable in social settings within 2 to 3 weeks of surgery.

I want to look better, but I’m not ready for a facelift. What do you recommend?

You may wish to consider non-surgical procedures to improve facial aging, such as Botox, Restylane, Juvederm, and microdermabrasion. Botox improves frown lines between the eyes, forehead creases, and crows’ feet wrinkles. Injectable fillers (Restylane, Juvederm, and Perlane) improve creases and lines around the mouth, inner cheeks, and chin. Microdermabrasion and skin care products improve skin tone and clarity.

Keep in mind, however, that none of these procedures will tighten a sagging neck or jowls. This is best accomplished by a facelift.

Which kind of facelift is best?

There is no single best facelift procedure. Procedures fall into one of three categories:

  1. Skin lift: These used to be quite popular, as they are easily done and have relatively little downtime. However, relying on skin tension to hold up the face is probably unwise. If the skin stretched out once, putting more tension on it will probably make it stretch out again.
  2. SMAS lift: Most surgeons, including Dr. Friedman, perform some form of SMAS lift. The SMAS (superficial musculoaponeurotic system) is the fibrous tissue between the subcutaneous fat and the facial muscles. The SMAS bears the tension of the facelift, thereby increasing its longevity over a skin-only lift.
  3. Deep-plane lift: This procedure also provides good results but is less popular due to increased swelling, recovery time, and risk of injury to the nerves that control facial movement.
Does Dr. Friedman do “mini-facelifts”?

Mini-facelift is a great marketing term, but facelifts should be classified based upon the plane of elevation (see previous question) and the length of the scars. Dr. Friedman performs a SMAS lift, generally using a “short-scar” technique. Unlike traditional facelifts, short-scar lifts do not require incisions along the scalp behind the ears. Calling this a mini-lift would be misleading, as the results and recovery time are similar to a traditional lift. Caution: some mini-lifts provide results that last only long enough to allow your check to clear.

How long will a facelift last?

Most patients look about 7 to 10 years younger after facelift. You will continue to age at a normal rate following surgery, though you may never “catch up” to your chronological age.

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Facelift: Instructions

One week before surgery

  1. Do not take aspirin-containing products, as these may increase your risk of bleeding. Use extra-strength Tylenol for any headaches or other minor pains.
  2. Please notify Dr. Friedman's staff if you become sick with a fever, significant cough, etc. If necessary, your surgery can be rescheduled to a time when you are feeling better.
  3. Do not smoke at all or use a nicotine patch for at least four (4) weeks prior to surgery and 4 weeks after surgery. Smoking interferes with wound healing and increases your risk for anesthetic and surgical complications.
  4. Arrange to have a relative or friend drive you home the morning after surgery and stay with you for the day. You cannot drive yourself home.

The evening before surgery

  1. Do not eat or drink anything for at least 8 hours prior to your scheduled surgery time.
  2. Make some jello and/or soup for after surgery. Have some juice in your refrigerator.
  3. The anesthesiologist will contact you by phone to discuss your medical history and to answer any questions.

Day of surgery: before you leave home

  1. Remember not to eat, drink, or smoke. This includes no chewing gum, mints, etc.
  2. Make sure someone is available to drive you home the following day. Put a pillow and blanket in the car.
  3. Wear loose, comfortable clothing. Avoid heavy make-up, jewelry, or contact lenses. Please do not use any lotion, baby oil, perfume or powder. LEAVE ALL VALUABLES AT HOME!

Day of surgery: at the facility before surgery

  1. Dr. Friedman will talk to you before surgery to answer any last-minute questions. He will mark your face and neck to help him accurately plan your surgery.
  2. You will meet the anesthesiologist and surgical nurses.

Day of surgery: at the facility after surgery

  1. You will be taken to the recovery area to wake up after surgery. Dr. Friedman will go to the waiting room to speak to your family/friends.
  2. Approximately 1 hour later, your family can visit you. You will stay overnight in our facility where you will have a Registered Nurse and her assistant caring for you—and only you—all night. Dr. Friedman will see you the following morning. If appropriate, he will remove your drains. You will go home with the compression dressing.

At home after surgery

  1. Have someone stay with you for the first few days.
  2. Take the antibiotics, steroid pills (to reduce swelling), pain medication (as needed), and anti-nausea medicine (if needed) that Dr. Friedman has prescribed for you.
  3. Sleep with your head elevated. If available, a recliner is quite helpful.
  4. Keep your compression dressing clean and dry; do not remove it. You may use soap and water to wash your face. You may shower your body (but not your face).
  5. Take at least 10 deep breaths every hour. This will help keep your lungs expanded.
  6. Do not be a couch potato. To reduce the risk of blood clots in the legs, have someone help you to get up and walk anytime you need to eat or use the bathroom. While you are in bed, repeatedly flex your ankles (moving your toes up and then down) and/or have your family massage your calves.
  7. If you experience a prolonged fever (oral temperature greater than 101), contact Dr. Friedman. Feel free to call our office or to page Dr. Friedman for any other problems or concerns.

Instructions for your first postoperative visit (about 3 days after surgery)

  1. Activity level

    1 week after surgery: you may resume casual walking but must not engage in vigorous exercise that increases your blood pressure or heart rate. You may resume driving once you are off of your pain medication. Avoid freeways until you are comfortable with city driving.

    3 weeks after surgery: you may gradually resume regular exercise.

  2. Sleeping position

    Please sleep with your head elevated. You may sleep on your back or part way over (pillow under your shoulder and hip). Do not sleep on your side until about 3 weeks after surgery.

  3. Incision care

    You will use Bacitracin (over-the-counter) antibiotic ointment over your stitches twice daily after washing your face with a gentle soap and water. We will remove your stitches about 10 to 14 days after surgery. A few days later, you may begin scar massage with Mederma twice daily. Mederma is available at our front desk or over-the-counter at your pharmacy. If you prefer, you may use Vitamin E or Aloe Vera. Continue scar massage for about 3 months.

  4. Compression garment

    If liposuction and/or muscle tightening was performed beneath your chin, you must wear a neck compression garment all day and all night (except for showers and massage) during the first two weeks. Wear the garment on an intermittent, tapering basis for the second two weeks. This will reduce the swelling under your chin.

  5. Massage

    You should begin gentle massage to the face and neck one week after surgery. This will help smooth any irregularities and areas of firmness. You may apply lotion to your hand to massage and/or you may use a vibrating massager. Massage in an up and back direction.

  6. Water exposure

    You may begin light showers but should avoid scrubbing your incisions. Avoid immersing your face in a pool, lake, or ocean for 4 weeks.

  7. Medications

    One week after surgery, you may resume use of any medications or supplements that you discontinued prior to surgery. However, for at least 3 weeks, you should avoid Motrin, aspirin, and any other product that may thin your blood.

  8. Smoking

    Do not smoke for at least one month (and preferably much longer) after surgery. Smoking may increase your risk of infection, lung problems following anesthesia, and wound healing problems.

  9. Tanning

    You should avoid unprotected sun exposure to your incisions for at least 6 months. You may use a high-SPF sunscreen (30 or greater). Premature tanning of the incisions may cause them to darken permanently.

  10. Sex

    You may resume intercourse about 3 weeks after surgery.

  11. Makeup

    You may begin use of make-up one week after surgery. A camouflage makeup (available at most department stores) is helpful to hide bruises. Do not place makeup directly over your incisions until 3 days after the stitches are removed.

Please feel free to ask Dr. Friedman or his staff about any additional questions or concerns.

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© 2018 Ronald M. Friedman, M.D., P.A.

Contact Us At 469-467-0100

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