Aging affects us all, and nowhere are these changes more obvious than in the face. Some of the first changes we can see are in the skin which thins and stretches as well as developing lines and wrinkles. However the face ages in all its layers; nothing is spared. Some bone is lost, muscles become lax and, most importantly, there is loss of fat which plumps up the youthful face. In the lower portion of the face, fat often accumulates, contributing to jowls and a fuller neck.
A facelift is a procedure designed to correct aging changes in the deep layers of the cheek, the neck and along the jaw line. Through mostly hidden incisions, the deep tissues of the face can be elevated, the muscles can be tightened, and fat can be redistributed. The success of modern facelift surgery depends on the repositioning of deep tissue (muscle and fat), the removal of fat where it is excessive and the addition of volume where it has been lost. Changes in the skin are best treated with other technologies such as resurfacing, fillers, and botulinum toxin.
The end result of a facelift should be a more rested, youthful looking face which appears natural.
If you are considering surgery, you can request a consultation with Richard J. Warren, MD. A staff member will contact you to discuss the procedure, Dr. Warren's availability, and additional scheduling information.
Frequently Asked Questions
Planning is done before the surgery, when surgical marking on the face can be done with the patient sitting or standing. The face looks very different when a person is lying on their back as is the case during surgery.
The actual procedure is performed at the Vancouver Plastic Surgery Center, under a light anesthetic administered by a certified anesthesiologist. Well concealed incisions are made around the ear, and the skin of the cheeks and neck is raised, giving access to the underlying fat and muscle. Depending on the unique situation for each patient, the deeper tissues of the face are repositioned, excess fat is removed from the lower face, and fat is added to the mid face. It is usually necessary to harvest fat from the abdomen in order to have enough volume to re-fill the face to a more youthful appearance.
Once that has been completed, the skin incisions are then closed with miniature stitches, and the face is wrapped in a dressing. The procedure normally takes about 3 hours.
A facelift can be performed under sedation, heavy sedation with airway protection, or general anesthetic. In my facility, a Royal College Certified anesthesiologist is in charge of that decision. While many surgeons prefer to do their own anesthesia, I have come to the conclusion that a person having a facelift deserves 2 doctors – one to concentrate on their face, and the other to care for the rest of their body. This is much safer for the patient, and it allows me to put every ounce of my energy into doing the best surgery possible.
I modify my facelift incisions depending on the individual situation. Someone with loose cheeks and a firm neck may be a candidate for a "short scar" incision. This starts above the ear in the scalp of the temple, goes down inside the ear (behind the tragus), around the earlobe and ends behind the ear. If that same person has a high hairline, the incision will not start at the temple, but rather, will follow the hairline across the base of the sideburn, then angling vertically back into the sideburn hair. If the skin on the neck needs tightening, I typically will use a standard incision, which is like the short scar, but extends further behind the ear into the scalp. I rarely use an incision down the hairline of the neck because of the potential for a visible scar.
A number of different terms have been introduced to describe shorter incisions; most of these refer to the same procedure, and the different names are primarily used for marketing reasons. The "short scar" incision is also called a mini-lift, or an S-lift. They all amount to the same thing. In fact, the skin incision is the least important part of a facelift. What really matters is what, if anything, is done to the deep tissues of the face.
Building up bone, injecting fat, or removing fat are minor procedures and can be performed independently or in conjunction with a facelift. However, to reposition heavy, deep tissues in the jowls and neck, we need to get under the deep fat of the face, release it from its moorings, and move it back up where it came from. This requires some type of "deep plane facelift," examples of which include the SMAS lift, the extended SMAS lift, and the SMASectomy – to name a few. Other less invasive procedures depend completely on stitches to hold up the deep tissues – these include the MACS lift and SMAS plication. I have tried every conceivable variation of deep plane face lifting, and will use any one of them depending on the circumstance.
The method I usually use is one which I devised myself around 1996, called the "Oblique SMAS and Malar Fat Lift," and it combines the advantages of several different procedures. I have found it to be very successful at lifting the malar fat pad (cheek fat), the jowls, and the neck. There are numerous advantages to operating on the deep tissues of the face: patients look younger naturally without looking "pulled" and the results of the surgery last much longer.
Combined procedures are very common. At the same time as facelift, I can perform any of the following: a browlift, blepharoplasty, upper lip shortening, lip augmentation, or peri-oral dermabrasion. Also, for especially challenging necks, I will add an incision under the chin to access neck tissue directly.
Studies have shown that deep plane surgery will last at least 10 years, which means that a patient can expect to be back where they started in about 10 years. The good news, though, is that instead of looking 10 years older, you'll look the same as you did 10 years ago. So there is some permanent effect when ongoing aging is considered.
A facelift performed on younger people, such as the mid-40's appear to look better and last longer. Whether or not such surgery actually helps prevent some of the changes which occur with aging is unknown. The advantage of waiting longer is that more problems have developed and the surgical results tend to be more dramatic.
After your surgery, you will be kept in the recovery room for about 4 hours, before you are discharged to an overnight facility. You will be watched over by a nurse through the night who will make sure your head remains elevated and cold packs are kept on your face. The following day, the dressing will be removed, and suction drains are removed. This is a painless procedure, and is done in your bed. You may then go home, although some patients choose to stay in the overnight facility, without a nurse, to be close to our clinic. The first night after surgery there is usually little to no pain. Instead, you may experience some numbness because we fill the face with long lasting local anaesthetic which functions for 12 to 24 hours. You will then be given specific instructions about what you can do and not do, and when you may shower.
The following day after the dressing is changed, you may return home or stay in a local hotel. You can shower and wash your hair by 5 days post op, and all stitches will be removed by 7 days after the procedure. You will then be allowed to travel if you wish, but you but you may not feel comfortable socializing for about 3 weeks. For the first few months, the neck tends to feel tight and the cheeks remain somewhat numb. These things gradually resolve on their own. The last thing to come back is feeling in the cheek, which takes about 6 months. We normally see people for their last visit photographs by 6 months after the surgery.
It is impossible to cut through the skin and not leave a scar behind. Fortunately, the incisions for a facelift can be hidden in the hair and around the ear. If placed carefully, they won't be visible to the average person.
Side effects – things which are expected to occur – include bruising, swelling, numbness of the cheek and tightness in the neck. Also, the hairline at the base of the temple often shifts slightly. The commonest medical complication is hematoma – a condition where blood collects under the skin of the cheek, usually in the first 24 hours after surgery, and requires a small surgical procedure for corrections. The most feared complication is nerve damage. Infections have been known to occur but are extremely rare.