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About Facelift

by Ramtin Kassir, M.D., F.A.C.S.

Want to look as young as you feel? Are you looking for a natural looking facial rejuvenation?

Facelift Surgery is designed to reverse the visible signs of facial aging, including the formation of jowls, which obscure the jaw line, the occurrence of a double chin and the appearance of vertical bands of the skin and muscle in the front of the neck. Dr. Kassir is a leading expert in facelifts in NYC and NJ. Patients travel from national and international destinations for Dr. Kassir's facelifts. Click here to see examples of patients who have had facelifts by Dr. Kassir and their stories.

What is a facelift?

Facelift surgery, also known as rhytidectomy, is a plastic surgery procedure performed to improve the neck laxity, jowls, and the midface. As a person ages, the midface begins to go downhill, producing the smile lines" or "laugh lines. The lower face then begins to show jowling, near the chin and the neck muscles sag, producing banding and redundancy. These three areas can be improved with the facelift procedure. The facelift does not improve the skin texture or quality.

Modern facelift techniques involve resuspending the deep connective tissues of the face and allow the face and neck skin to be elevated and produce a natural rejuvenation. These techniques avoid the "plastic" or stretched appearance so common with facelift surgeries in the past. The surgery is typically performed without the need for general anesthesia and a 1 to 3 week recovery period is usually necessary after the procedure.

What can Facelift Surgery do?

Facelifts, technically known as rhytidectomies, rejuvenate the mid- to lower face and neck. Facelifts are most effective for NJ and NYC patients who want to correct:

  • Midface sagging
  • Deep creases under the eyes
  • Deep creases between the nose and mouth
  • Jowls due to loss of muscle tone
  • Sagging areas of fat
  • Loose skin and fat under the chin and jaw

Are you a good Facelift surgery candidate?

The best candidates for facelift surgery are:

  • Wish to improve one or more of the signs of aging indicated above
  • Are men or women whose faces have begun to sag, but whose skin still has some elasticity
  • Are generally healthy
  • Are considering a facelift for personal reasons to improve their image and appearance

Recovery from Facelift Surgery

The most important thing to remember after a facelift is patience. The body takes time to heal, and your face will look worse before it looks better. Your face may feel tender and tight after the surgery, and there will be discomfort, swelling, and bruising. Dr. Kassir can prescribe painkillers to alleviate the pain, and antibiotics to fend off infection.You should be up and about in a few days, and be sure to walk around 3 to 4 times a day to increase circulation, and prevent blood clots. The bruising and swelling will subside and you should be fine in about 2 weeks. Full recovery however may take 1 to 4 months. Do not bend over or lift heavy objects until Dr. Kassir gives the all clear. Also stay away from saunas, steamrooms, alcohol, aspirin, and ibuprofen. If Incisions were made in the mouth consult Dr. Kassir on what to eat until your recovery is completed. Sleep with your head elevated for example on a pillow, and as still as possible. If you experience any extreme pain, excessive redness, or elevated temperature contact Dr. Kassir immediately.

After your rhytidectomy facelift surgery, Dr. Kassir will wrap the incisions in light bandages. On the next day your hair can be carefully washed and a week later the sutures will be removed.

At first, you may experience swelling, numbness, bruising, and a feeling of tightness or tension in the face and neck. Recovery will be noticed usually within 3-6 weeks, and sensation typically returns to normal within a few months. Scars become less red, raised, lumpy or itchy in time.

Many NJ and NYC facelift surgery patients return to work by the second week and some resume normal activities by day five.

What are the different types of Surgical Facelifts?

The SMAS Facelift is the traditional facelift which pulls up the SMAS layer and is effective for those with jowls and skin laxity.

The Deep Plane Facelift is a modification of the traditonal facelift that works more effictively on the midface areas such as nasolabial folds.

The Endscopic Facelift is a minimally invasive technique using small cameras to guide insturments and allows for lifting the midface and brow.

The Midface Lift is a procudure to specifically targert the areas of aging in the midface; the areas between the cheekbones.

The Mini Faceliift is related to the traditional facelift but involves smaller incisions behind the ear and focuses on adjusting the skin.

The Tissue-glue Facelift is a technique that uses fibrin, a safe biological agent, to close inscision as opposed to sutures.

More Facelift Information

One of the most common procedures in plastic surgery is the facelift. According to the American Society of Plastic Surgery 124,000 facelifts were perfomed in New Jersey in 2012, and in New York facelifts were up 42 percent from 2000 to 2011. Our skin is constantly changing, and the older we become the more our skin cells break down, and divide slower. The dermis, or lower layer of the skin, begins to grow thinner as well. The dermis is comprise of different types of tissue, including elastin and collagen. While the elastin provides elasticity for the skin, the collagen keeps the skin taut. Over time these proteins begin to break down, and results in the loss of elasticity in the skin and deeper tissue. The skin begins to sag as well as the muscle and tissue composition under the skin change, and leads to wrinkles. Although a facelift can lead to younger looking face with a better jawline, neck and midface, it cannot completely erase the signs of age, or fix all problems such as sagging eyelids, eyebrows, or skin discoloration. These problems can be fixed with other procedures for example, an eyelift, browlift, or chemical peel. The procedure of a facelift takes time for recovery, and has minimal risks.

Since every patient is different, the procedure will be different for everyone as well. Dr. Kassir will examine the skin, and explain the procedure to you. Smokers will be asked to stop smoking for a week or two before the surgery, and a few weeks after as well. Smoking is not advised since it inhibits blood flow to the skin, and can interfere with the healing process. Patients are also asked to avoid aspirin or other medications that increase bleeding.

The facelift surgery can be performed in Dr. Kassir's office or accredited surgical center. The patient is usually given a local anesthetic or sedative for the facelift procedure. An incision is made around the temple along the hairline, and goes down to the earlobe. An additional incision is made underneath the chin to tighten the skin of the neck. The skin is then separated from the muscle and fat, and the fat may be trimmed or sucked out via liposuction. Dr. Kassir then takes the SMAS (Superficial Musculoaponeurotic System) and repositions it at a higher, more youthful level. Tightening and reposition the SMAS in this manner gives the jawline a sleeker look, and firms the neck. The skin is then pulled back over the area of the incision and the excess skin is removed with a laser or knife. The incision is then closed with stitches, sultures, or tissue glue.The stitches are placed within the hairline so they are hidden. The surgery takes about 2 to 4 hours depending on the extent of muscle and tissue work. There are other methods to achieve a younger looking face, that require less time for recovery, such as the K-lift™ or liquid facelift with restylane, perlane, belotero, radiesse, juvederm, scultpra, artefill, or fat.

Many other types of facial lifts are favorable including the mini-lift due to its short recovery time, the S-lift and the K-lift™ which focuses on the lower part of the face (neck and chin), mid-facelift which includes small incisions in the hairline, above the ear, and inside the mouth, and the Tissue-glue facelift which uses tissue glue to seal the incisions made. Some non-surgical techniques are also available with lower costs and fewer risks. Thermage or thermacool uses radio frequency to activate the body's natural collagen, and causes the skin to tighten and contract. This technique is best used for slight wrinkles, and the results can last from six months to two years. Ultherapy uses sound waves to achieve facial and neck tightening. Another alternative is the ThreadLift or FeatherLift, which involves inserting a needle with a surgical thread (or a non-absorbable sulture) into the skin. The thread is then pulled tight, and the muscle and tissue tightens with it. This technique leaves no scars, and the thread remains in the body. Some risks of facelifts include infection, scarring, reaction to anesthesia, hematoma, damage to facial nerves, necrosis, and alopecia at the incision site. These risks are minimal, and the procedure results in a younger looking you

What Does a Facelift Cost?

The average cost of a rhytidectomy (facelift) can range from $7,000 to $25,000, depending on what's being done and the problems being addressed. The cost of revision and corrective facelifts are higher. This encompasses the anesthesia, the fee for the facility, and the remainder is the surgeon's fee. Having more than one procedure at the same time, such as a browlift or eyelid surgery, may also be cost saving since the cost for the anesthesia and facility are being paid.

Are Facelifts Safe? 

Facelift surgery or rhytidectomy is a safe procedure if performed by experienced surgeons. Dr. Kassir performs many facelift surgeries per week and also corrects “botch” jobs.  That's why it's so important to pick your surgeon carefully and be an informed consumer. Be sure to direct any questions towards Dr. Kassir. It is normal to feel anxious or nervous about your new look. Afterwards you will have some swelling and bruising, and in a few weeks you will enjoy a rejuvenated look! Be patient. If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment. The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. Be sure to follow Dr. Kassir's instructions on how to take care of yourself after surgery.

Do you Need a Facelift?

Signs of an aging face:

1. Wrinkly skin: Over time your skin's natural collagen and elastin begin to breakdown, which causes wrinkles, lines, folds, and a sagging look. A facelift can help with the sagging skin, but problems such as lines and wrinkles can be better addressed with injectable fillers, and good skin care.

2. Sunken eyes: As fat under the eyes starts to descend, your face develpoes a more sunken look. This looks like a loss of volume around the cheeks, and can be fixed most efficiently with a blepharoplasty, small amounts of fat grafts, or injectable fillers as a non-surgical option. Your blepharoplasty can be performed at the same time as your facelift.

3. A saggy jawline: When the jawbone loses density over time, there is less of a structure for the skin to hang on to, therefore the skin begins to sag. To correct this, the loose skin must be excised and the remaining skin must be tightened by a facelift.

4. Bone changes: With time then density of the bones in the face begin to reabsorb. This makes the eyes appear sunken, the jawline becomes less defned, and the cheeks appear flatter. A facelift can help with these changes.

5. Loss of volume: As your face begins to lose fat, the skin begins to droop. The more fat that is lost, the more pronounced folds and lines are. Fat can be taken from a different areas and added during your facelift to add more volume. Fillers can also be injected either before or after your surgery to gve your face more volume.

What to know before you have facelift surgery:

1. Your facelift expectations need to be realistic: A facelift is designed to make your face look refreshed, younger, and fix any laxity. A facelift can't always eliminate every wrinkle and line, and doesnt mean you will look 20 years old again. Dr. Kassir explains that the goal is to create a younger version of yourself that gives you a "rested" and "natural" look. Dr. Kassir fequently reverses and undo's the "windblown", "pulled", and "Hollywood" look.

2. You will have scars after a facelift: Although techniques have improved throughout the years, a facelift still leaves scars. Dr. Kassir makes incisions along the sidburn and ear so they are hidden by the hair, and inside the ear canal. With most patients, scars improve over time and blend in.

3. There is some downtime after a facelift: It may take 10 days to a couple of weeks until you are ready to resume daily activities, and a few months until all of the swelling goes down. With most patients bruising is slight, and pain is minimal. Most patients report that although they barely have pain, there is a bit of tightness involved that will go away the more you heal.

4. Know what can and cannot be fixed with a facelift: A facelift is meant to restore a youthful shape to your face, but it will not improve the look of brown spots, fine lines, or the position or shape of your eyelids and eyebrows.

You should pick facelift surgery if:

1. You want long-term results: Unlike other age-reversing treatments like lasers and injectables (which don't address lack skin), the results of a facelift are very long-lasting.

2. There is loose skin: Loose skin  at the jawline and on the neck creates the look of a double chin or a "turkey waddle". Microliposuction can eliminate unwanted fatty areas, but loose extra skin needs to be excised.

3. There are lines and folds: Over time facial expressions cause the skin to crease and fold which causes lines. Although fillers can help eliminate these lines and folds, lax skin needs to be addressed with surgery.

4. You imagine how you would look with a facelift : If you pull your skin back and see how it would look tighter, a facelift is the only was to get long lasting, elevated results.

Are you a candidate for a facelift?

If your face is oval, you may benefit from a facelift. Hollowing in the temples and cheeks is common because of extra fat in the cheeks, which dissapates over time. Fillers and/or fat fill out hollowing; a mid-facelift helps with sagging.

If your face is round, you may benefit from a facelift. The cheeks and lower face may sag. A lower facelift, which targets the lower part of the face, is the best option. The cheeks can be resculpted by injecting fat and/or fillers.

If your face is rectangular or square, you may benefit from a facelift. loose skin and sagging jowls on the lower part of the face tend to be the biggest problems. A traditional facelift is likely the most effective solution as it addresses jowling and lax sking.

If your face is heart-shaped, you may benefit from a facelift. The forehead and upper eyes are most affected. Since the cheekbones are higer than square faces with flat cheekbones, hearts-shaped faces tend to ages slower.

Facelift: Questions & Answers

What is the variation in facelifts?

Facelifts tend to vary greatly from doctor to doctor, with less invasive facelifts generally having less downtime and swelling than more invasive ones. Surgeons also have different draining techniques and other small things, so it is best to find the best one for you.

What are some non-invasive procedures for the chin and neck?

To be frank, there are very little procedures, besides the facelift, which can be done for patients demanding significant improvement in the neck area. Certain procedures like liposuction or laser/ultrasound treatment can be somewhat useful, but are very short-term and offer little when compared to a face/neck lift.

Why do my nasolabial folds look bigger post-Endotine lift?

Unfortunately, patients looking to correct nasolabial folds and other problems in this area, the endotine lift is probably not the best option. Revision surgery can certainly be done, but only by a board-certified plastic surgeon (if the patient wants the best results).

Why do I have recurrent swelling which comes and goes post-facelift?

Swelling which arrives and then disappears 18 months after a facelift is not indicative of a typical hematoma, but is more likely the result of a parotid leak. I would recommend a full exam with the surgeon followed by the application of Botox and antisialagogues to the area.

Is nerve damage a risk during a facelift?

Board-certified plastic surgeons must undergo rigorous training and must be extremely familiar with the anatomy of the face to earn this high level of certification. Therefore, if you selected a capable surgeon, you are probably in good hands and need not worry about nerve damage.

What are the pros and cons of a facelift?

Pros: Removal of excess skin, lifting of drooping skin along face, jawline, and neck
Cons: Cost, undergoing surgery, recovery time, scars, swelling/bruising, and risks of surgery

Why can't I smile 2 weeks post-facelift?

Damage to the buccal branches of the facial nerve is generally not a cause for major concern as cross innervation generally allows for full recovery. However, improvement should be seen after 2 weeks. Consult with the plastic surgeon or a neurologist to check for permanent damage.

Can Fraxel treatment damage facelift results?

It is difficult to believe that Fraxel treatment prior to surgery would do anything to contribute to the facelift. I would personally recommend having the procedure done concurrently with the surgery or several weeks post-op in order to hide any possible scars which may develop.

Why is my forehead bulging post-facelift?

A bulging forehead muscle post-op may be the result of an internal fixation device which slipped, but also could be an endotine device placed during an upper blepharoplasty which will eventually dissolve over time.

I have nerve damage on my upper lip more than a year post-op. Is it permanent?

If numbness and other evidence of nerve damage is present 15 months post-op, it is unfortunately indicative of permanent damage to the buccal branch of the facial nerve. Nothing much can be done, sadly, at this point.

What are the side effects of Facetite?

The main side effects of this procedure are bleeding, scarring, and possible nerve injury. It would be best to find a board-certified plastic surgeon and have a consultation to decide whether this procedure is the best for you.

Can I get surgery abroad?

America is not the only country with top-dollar plastic surgeons. However, if patients are going overseas for surgery, they should definitely do their homework on their surgeons, making sure that they are achieving the best results they can for their ideal price. Patients should also plan to stay in the country for an extended period of time in case any problems may arise (since this could be a problem, I would not advise having surgery overseas).

Is it safe to have a Deep plane Facelift at age 55?

The average age of a Deep plane Facelift in NJ and NY is 52-55. Depending on your need you may only require a SMAS lift, or you may even get away with the patented K-Lift™ procedure. You can undergo a Facelift under local anesthesia preferably, or alternatively IV sedation or general anesthesia. If you have any medical problem you should discuss them with your surgeon.

Can deep plane facelifts fix the cheek area?

Generally, deep plane facelifts are good procedures for fixing the cheek and jawline areas as the cheek is usually elevated, creating a higher cheekbone and a well-developed facial structure.

Should I let my surgeon do a deep plane or midface lift?

In general, both the deep plane and midface lift technique are done extensively by many surgeon and are both formidable techniques in their own right that can varied from patient to patient. In selecting a surgeon, it is best to evaluate before and after photos in addition to making sure he/she is board-certified.

Does a facelift address the eyes and neck?

Facelifts generally do not include the eyes and neck and instead encompasses the reposition and tightening of facial tissue around the cheeks and the very upper neck. Necklifts and blepharoplasties (eyelid surgeries) are considered entirely separate procedures.

How long do the results of a facelift last?

The first thing to remember is that people continue to age even after a facelift. How long the influence of the facelift last differs from from person to person, and varies based on which type of facelift was performed. SMAS and deep-plane facelifts, which adjust the underlying muscular contours of the face, lead to changes in the structure of the face and are thus longer-lasting than lesser examples like the S-Lift which only deal with the surface skin and surrounding tissues. SMAS and deep-plane facelifts last up to 10-12 years, whereas smaller scale surgeries last around 5 to 8 years. Also important is the patient. Typically, patients who can maintain higher bone densities and have a tendency to maintain taut skin have a higher chance of maintaining the results of their facelift for a longer period of time.

What is the Arasys Perfector Facelift?

As a surgeon, I try to avoid facelift technique which are branded and have official names to them. For most patients, sticking with tradition is probably the best avenue for surgical success

What is the Ribbon Lift?

The ribbon lift is a procedure similar to a thread lift but uses a different device, a collar with spikes of one side. The device is inserted into the platysma muscle and used to pull it back, a procedure which helps with neck lifts, but does nothing for jowls and cheeks. It is a good temporary procedure if done correctly.

How effective is an endoscopic lift vs. midface lift?

Endoscopic facelifts, though not being as mainstream as open surgery, are minimally invasive procedures which presents many advantages to younger people who are not in need of a major surgery. It has a very limited effect on the neck and jowl region, but allows patients to have a lower risk of potential nerve damage and is very effective in dealing with minor facial deformities such as cheek sagging. It cannot, however, be used to perform neck lifts or major operations which would normally require a facelift procedure. Therefore, for people who are in need of a facelift but do not require or want the invasiveness of open surgery, endoscopic surgery is a good option.

Can I have a facelift after Sculptra treatment?

Generally, because having Sculptura treatments can distort the face, it is difficult for surgeons to have a true vision of the patient’s face after they have had these treatments. Therefore, though there should not be a health-related issue, I would not recommend having a facelift until Sculptura treatments are stopped.

Opinions on Acculift vs Fillers?

I remain quite distrustful of these gimmick procedures, especially when they claim to replace the need for fillers and face lifting procedures. Until scientific evidence is provided which shows that these procedures actually have a better effect, I would stick with tradition.

How can loose skin around the mouth be dealt with?

Loose skin around the mouth area, especially for younger patients, is usually best addressed with the use of fillers or fat grafting.

Are there any procedures with minimal scarring?

The amount of scarring which a patient will undergo depends on the genetics of the individual, the surgeon’s placement of incisions and his/her skill, and the tension placed on the skin. There is no definite procedure which provides the least scarring, yet smaller, less invasive procedures (in accordance with popular belief) often have less scarring than other more invasive ones (deep plane, SMAS, etc.).

How do I pay for a facelift?

The cost of a facelift can vary depending on the surgeon’s skill and especially location. Generally, patients will find the money through credit or will have credit from before, but it is best that , if your finances are not up to it, facial surgery may not be the option for you.

When does muscle weakness recover post-facelift?

Generally, muscle weakness, if temporary, takes within 3-6 months to fully recover.

Why do I have beads under my skin post-facelift?

Patients experiencing the sensations of beads under the skin are probably dealing with minor blood clots or sutures. The former problem can be dealt with by massage, but the latter should be taken care of by the surgeon.

Can my muscle spasms affect my facelift results?

Usually, muscle spasms are not attributed to the breaking of sutures or disruption of tissues post-op. Yet, it is not a common problem and should be dealt with at your next follow-up appointment.

What is this hot lump on my face post-facelift?

Generally, patients dealing with major lumps post-surgery are dealing with hematomas where cells break up, releasing salts and drawing fluid to create more swelling. Needle aspiration of the area is usually required to test for infection.

When is the minimum age for a facelift?

A facelift is not done based on age, but rather based on the symptoms of a patient. Generally speaking, skin laxity is the number one issue for which a facelift is necessary, an issue which is rarely present in younger patients (who more often have problems relating to volume loss).

Can I have a facelift with a heart condition?

It is probably best for surgeons to avoid taking any unnecessary risks when doing surgery. People with coronary heart disease are probably not good candidates for full facelift procedures but may, depending on cardiologist-led examinations, be eligible for cosmetic surgery.

Can a MACS Lift be done with Fraxel repair?

The MACS Lift, a treatment used for sagging facial tissues, muscles, and jowls, can indeed be done with the Fraxel treatment, which repairs aging skin. Both procedures are relatively non-invasive and can be done in conjunction.

Can I do laser resurfacing and a rhinoplasty with my facelift?

All of these procedures can generally be performed concurrently as long as an MD anesthesiologist is available and is fully consulted with prior to surgery.

Is blinking difficult after a facelift?

It shouldn’t be. Patients having trouble with the eyelids or lips following surgery may have sustained temporary damage to the facial nerve. It is important that, for the time being, the patient makes a sustained effort to keep the eye lubricated and consult with a specialized neurologist in order to pinpoint the extent of possible nerve damage.

What Can I do about the laxity under my eyes?

Two good options to address laxity under the eyes while avoiding changing eye lid shape are the Lower Lid Lift, and Cheek Lift. The Lower Lid lift is a procedure that removes excess skin, and the Cheek Lift actually lifts cheek tissue. You can also address it with injectable fillers (Perlane, Restylane, Radiesse), energy devices (Ulthera, Thermage, Radiofrequency) and lasers (CO2 laser resurfacing like Fraxel).

I have bulging and itching of the eyeball post-facelift. Is this a problem?

Problems with the eyelid post-op can be serious and usually call for additional consultations with the surgeon. Itching in the eyes is normal, but bulging of the eyeball can be related to internal bleeding or excessive scar formation.

How is aging affected post-facelift?

The extent to which aging increases/decreases post-facelift depends on the way the surgery was performed. Generally, if performed adequately, the surgery should not cause any changes in skin texture or blood supply to the skin, meaning that aging should not be affected generally. The point of a facelift is not to alter the aging clock, but simply to reverse it temporarily. A facelift, if done correctly, should be followed by normal aging without any facial distortion.

Should I do fractional laser resurfacing before or after a facelift?

Patients deciding between doing either one of these procedures before the other can do any of these first, as long as the two procedures are separated by a period of 6 months. Laser treatment should probably be done later though as a way of combating the wrinkles which may appear after the facelift.

Can the greater auricular nerve be damaged during a facelift?

Compression or injury to the greater auricular nerve during a face lift or neck lift will result in numbness to the ear lobe and a small area of the neck just below the earlobe. To be frank, this nerve is purely sensory and cannot be treated if damaged, except naturally. Usually, it will heal after 12 months.

Is scarring visible post-facelift?

Though surgeons are generally trained to minimize scars as much as possible, scars will be present. Surgeons will usually attempt to place incisions in areas that are hidden or in areas where it may look like natural wrinkles (ex. Hairline, behind the ear), but, particularly in Hispanic or African-American patients, there is an increased risk of “hypertrophic” or “keloid” scars.

What is the SMAS layer?

The main area affected during a facelift is the SMAS layer which is a layer of fascia under the skin which is tightened during the procedure as a way of avoiding direct tension of the overlying fat and skin.

Why do I have ropey fullness on my neck post-facelift?

Ropey fullness on the neck tends to be the mark of fluid collection which can easily be aspirated by a surgeon. Even untreated, the symptoms will eventually begin to heal on their own. Consult your surgeon to check it out.

Where is scarring for a facelift, blepharoplasty and a subnasal lip lift?

Facelift scars generally fall behind the outline of the ear along the edge of the hairline. Blepharoplasty scars fall in the natural crease above the eye and just below the eyelashes on the lower lid. Finally, the subnasal lip lift is marked by an incision under the nostrils.

What can I do about lip asymmetry post-facelift?

Asymmetry in the lips due to a neurological issue can be easily corrected with Botox, fillers, and additional revision surgery.

How does skin reattachment work during a facelift?

During a facelift procedure, it is not truly the skin itself which is altered, but the SMAS layer under it. The SMAS layer is tightened and reattached to the underlying tissue by the use of sutures, after which the skin is trimmed and reattached using stitches. Soon after, the body produces new collagen which causes the skin to adhere better to the underlying tissue.

Are there volumizers that are non-surgical and don't use needles?

Unfortunately, without surgery and without fillers and fat grafts, it is impossible to add volume to the face where it is needed. Facial exercises may exacerbate volume loss, but again the best treatments are fillers.

What do I do about volume loss post-facelift?

Patients desiring a more “baby face” look following a Facelift will probably want to use volume fillers like Scuptra Esthetic or perhaps utilize fat grafting and fillers depending on what is desired. Consult with the plastic surgeon to find the best options for your individual case.

Can I a have True Facelift after having a Thread Facelift?

The fact is that Thread Facelifts only yield temporary results, and tend to be overpriced for the results they give. Clinically there shouldn’t be any reason why a patient can’t have Traditional Facelift (SMAS, deep plane, etc) after a Thread Facelift.

Is getting a facelift early detrimental?

Though patients should not get facelifts until they are truly ready, there is no harm in having one early under the hands of an experienced and capable surgeon. Especially if early signs of aging are present, treating them earlier may help create more long-lasting results. But consult with your plastic surgeon about this.

Can suturing be done along the hairline behind the head?

It is common for sutures to be placed in this location because it allows for trimming of neck tissue to be easily hidden within the hairline.

Is residual distortion normal post-MACS Lift?

Unfortunately, as I have stated before, the MACS Lift is a surgery which works well for some patients and not so well for others. Patients in the latter category, because of the rather limited nature of the MACS Lift, may need to undergo secondary facelift or mini-lift surgery to achieve optimum results.

Can I travel for a facelift?

If patients are more comfortable traveling for surgery, this can be done. However, they should arrange for a ride and a stay at a nearby hotel post-surgery.

Is Beverly Hills the only place to get quality plastic surgeons?

Though it may seem like all the best plastic surgeons are in the Beverly Hills area, there are plenty of other surgeons throughout the country who can probably do the same work for a cheaper price. Most board-certified plastic surgeons are perfectly capable, but patients must make sure to check credentials and certifications beforehand.

Will more facial work mean more swelling?

Patients who have major facial work done, meaning several major procedures done concurrently, should expect a great deal of downtime AND a longer period of swelling and bruising as they are dealing with internal and external healing. Optimal results may be in store if the patient is willing to wait up to several months.

Is there an advantage to stem cell facelifts?

The problem with the stem cell facelift is that it is not really a facelift in the true sense, but rather a modified method of fat grafting. Studies have shown that it really does not do more for the patient than simple fat transfer which can last for several years.

What is the pros vs cons of an extended MACS facelift?

The problem with the extended MACS facelift is that, though it is a vertical facelift and the results look more natural than most others, it does not address lax skin on the neck and definitely does not target fat and banding around the platysma muscle.

Can I have a facelift at an outpatient center?

Generally, if outpatient surgery centers are located adjacent to a hospital, patients will want to look at the credentials of the outpatient center alone. Unless the outpatient center is hospital-owned, they are usually on their own, so having one that is AAAHC certified is probably the best option.

What does nicotine do during a facelift?

Doctors will recommend that a patient quit smoking prior to and after the surgery because nicotine causes the constriction of blood vessels which can result in scarring and dead skin cells.

Can rosacea present a problem during a facelift?

Facelifts are generally not meant to address the skin, but rather for deeper muscle layers and tissues. Therefore, redness and pimples on surface skin should not present a problem during the procedure.

What are the basics of facelift surgery?

An incision is made along the hairline, that extends around and behind the earlobe. Skin and muscle are pulled towards the incision, trimmed appropriately, and are sutured/clipped/glued closed. The various /procedures can take from 2 to 5 hours, with a minimum recovery of 2-3 weeks.

Will the procedure for anesthesia (breathing tube) disturb dental work?

Patients concerned about displacing or fracturing existing dental work with general anesthesia should not worry too much as anesthesiologists take care for these concerns. LMA or Combitube can also help for patients with concerns.

When can I see the earliest results from a deep plane facelift?

Typically, improvement from a facelift should be seen after 1-2 weeks when examining before and after photos.

What is the longevity of Smart Lift results?

Again, due to the low invasiveness of this procedure, there is a much shorter longevity for these procedures when compared to other procedures. Often, a mini facelift can be substituted with fillers, Botox, and other skin care methods that would be less invasive and probably more effective.

Why do I have bruising and bunching of the skin post-MACS Lift?

Bruising following a MACS Lift may be completely normal, but could also be the result of hyperpigmentation which can be treated with hydroquinone or glycolic peels. Bunching of the skin, however, must be treated surgically with a redraping of the skin.

Can I use Ice to help with swelling after a facelift?

Patients should expect the most swelling the first few days after a Facelift and a significant decrease over the first 2 weeks. Ice can help reduce the swelling, but using it too much can damage the skin.

When can I use Radiesse?

Quite often, fillers rather than facelifts are the ideal procedure for solving certain facial problems. Fillers like Radiesse or fat grafting can be used to fill depression, while facelifts can be used in concurrence to treat jowl formation.

Is the facelift procedure different for a patient with sleep apnea?

Patients who have severe sleep apnea and require a CPAP machine should be monitored 24 hours in a hospital following the facelift to avoid a severe apnea episode.

Can nerve damage occur from a facelift?

With an experienced surgeon, it is very unlikely that injury to the facial nerve will occur during surgery. Again, many surgeons are certified by the American Board of Plastic Surgery and are often trained to avoid such complications. Therefore, the risk is relatively low (around 1% or so), even if a small cyst is removed. However, if doctors are removing large objects like a tumor, the chance for nerve injury increases, so take care to select a surgeon with great medical skill.

When are sutures and staples removed after a facelift?

Sutures can be removed from incisions in front of the ear about 7 days post-op while staples and sutures behind the ear or in the scalp can be taken care of after about 2 weeks.

How do I find the best facelift surgeon?

Patients looking to find the best doctor to treat them should generally look for ones who are board certified in plastic surgery or facial plastic surgery. Evaluating before and after photos and evaluating if they are a good fit for you is another thing which a patient can do prior to undergoing surgery.

Why is my facial surface so uneven post-MACS facelift?

Uneven surface features following a MACS Lift can be attributed to an attached pursestring suture, tethered tissue underneath the skin, etc. Yet, many of these issues can be corrected with revision surgery and the same scars can be reopened.

What is a Mini facelift and what is the recovery like?

A Mini Facelift is done by first creating an incision behind the earlobe and then pulling the skin of the face towards that point. A Mini Facelift does not address underlying muscle issues such as the SMAS group. A Mini Facelift recovery time is about 2 weeks, and the results last for about 1 year.

Is tightness associated with nerve damage?

Generally, tightness around the ears several months post-op should not worry patients as it is not associated with permanent nerve damage but rather with inflammation associated with healing. Here, nerves are just beginning to recuperate after the trauma of surgery but may take a while to adjust themselves.

Do I need General Anesthesia for my facelift?

Statiscally general anesthesia is for the majority of Facelift procedures done in America, however it has no direct bearing on the results of the Facelift. General anesthesia primary functions to eliminate of patient anxiety during a procedure so that they can tolerate the operation. Surgeons using Local anesthesia take just as many precautions to minimize the risk of surgery, and can achieve the same results. We prefer twilight anesthesia, referred to as IV sedation, which is much like the anesthesia for colonoscopies.

I have banding almost a year 6 months post-op. Why?

Generally, by this time, the face should be relatively healed. Muscle tightness may persist for several months, but banding calls for an additional consultation.

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Dr. Ramtin Kassir © 2017

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Disclaimer: This site only provides information about cosmetic surgery and this information is not meant to be taken as medical advice. For more information about plastic surgery, contact Dr. Kassir.

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