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Facial Rejuvenation

The facelift continues to be the key procedure of facial rejuvenation for many patients. It counteracts many of the signs of facial aging, but is especially effective in combating the effects of gravity. In particular it improves the appearance of the midface/cheek area, the jowls and the neck, resuspending sagging fat pads, muscle and skin. The procedure is designed to re-establish the natural contours of your skin and facial structures giving a smooth youthful appearance. You, the way you used to look.

Dr. Murphy performs a two layer lift suspending and tightening the deep structures and then re-draping the skin, achieving a natural, aesthetically pleasing and long lasting result. A face lift may be performed alone or as is more frequently the case, combined with other rejuvenation procedures. The procedure is typically performed under intravenous sedation with local anesthetic. Although most patients prefer to go home that night you may choose to stay the night in the hospital.

Am I a good candidate for a facelift?

The best candidates have fairly advanced sagging of the mid-face and lower face structures including excess skin of the neck with some banding of the underlying muscle in the neck. You may have noticed some deepening of the folds along your medial cheek or deepening of the marionette lines. A lot of patients who have facelifts complain of looseness of the skin of their cheeks.

What if I am a smoker?

Typically smoking is a reason not to have the surgery. Patients definitely will get their best result if they are not smoking. Some of the chemicals in cigarette smoke cause the small blood vessels to shrink up which leads to compromised blood flow to the skin flaps created during the procedure. This increases the risk of areas of skin loss and scarring. You want to refrain from smoking for up to 6 weeks prior to the procedure.

Is it safe to have laser resurfacing of the facial skin at the same time as a facelift?

In some patients judicious use of the laser at the same time as a facelift is acceptable. It is quite common to fairly aggressively laser more central areas of the face, such as lip lines or wrinkles around the eyes at the same time as the facelift. Areas closer to the incisions are lightly treated to feather the edges. I use the newest Erbium laser to treat these areas because I can safely determine the depth of the treatment to the micron.

What won’t a facelift improve?

A facelift won’t help at all with eyelid issues of any low position of the brow. Although deeper nasolabial folds or marionette lines will be greatly improved it is not uncommon to add some fat transfer to these areas to optimize the look. Lip lines also require an additional treatment such as resurfacing with the laser, or fat transfer to smooth them out.

What other procedures are commonly performed at the same time as a facelift and is it safe to combine procedures?

The concept of full facial rejuvenation has led to the frequent combination of procedures during one surgical procedure. Commonly performed procedure include brow and eye lifts as well as laser resurfacing and fat transfer. Combining these procedures in an educated and experienced fashion is going to lead to the result which best reveals and restores the patient’s beauty with a sense of facial harmony. Only surgeons as experienced as Dr. Murphy can safely bring together the combinations of procedures ideally matched to meet the desires of the patient.

My dermatologist tells me that I don’t need a facelift, and he can get the same result with a procedure done in his office under local anesthesia with no recovery and for a lot less money. What about that?

This brings to mind the idea that if it sounds too good to be true it probably is. I have spent years scrutinizing each new “non-surgical” facelift that has come out. Certainly some of them have offered a degree of improvement in some patients. You as a patient must also evaluate these offerings. If you are willing to accept a lesser degree of improvement, or in some cases none, then you may want to go ahead. And don’t forget some of these procedures aren’t particularly inexpensive. Many of them cost thousands of dollars and have not been proven by the test of time. As a surgeon I prefer to offer my patients time proven procedures, many with minimal recovery time due to refinements in technique, at reasonable costs. This has led to many happy patients who have returned for additional procedures or have sent in their family and friends. As a respected surgeon in the community I can’t afford to have unhappy patients because they have over-paid for a procedure that didn’t work or offered fleeting improvement in their appearance..

Where are the incisions and will I need to have sutures removed?

Incisions are typically made in the hairline above and behind the ear. Incisions go around the ear and dip inside the ear in the front to help break them up. Occasionally incisions are made along the hair line rather than in the scalp to help maintain as much sideburn as possible. This decision is made based on the anatomy and the desires of the patient. Some patients require an incision beneath the chin to allow access to the neck area to tighten up the muscle in front. Stitches in front of the ear are removed at 5 or 6 days and skin clips in the scalp are removed at 10 days or so.

When will I be back out in public?

The recovery and return to activity after facial is determined by how you look rather than how you feel. There certainly is some discomfort over the first few days but it is quite easily controlled by the prescribed pain medication. Your return to circulation is more determined by swelling and bruising and your threshold of how you want to look as you venture forth. A lot of the swelling has resolved by 8 – 10 days which is when most patients resume more normal activities. Bruising will take more like 3 weeks to fully go away but it can be fairly easily covered with make-up earlier on. Many patients prefer to wait for that 3 week period before attending any major social events or if they want to look their best before being seen by their friends.

Will my friends notice I have had it done?

Dr. Murphy’s frequent answer to this question is, “I hope so.” Of course the degree of change in your appearance after facial rejuvenative surgery depends on how aged your face and skin are prior to the surgery. The ultimate goal is that you look like yourself, just more youthful or rested. Many patients will tell me that their friends tell them that they look rested or rejuvenated.

What are the possible complications?

Infection or bleeding rarely occur, infection being particularly rare. Numbness over the cheek and neck areas is common and usually resolves over a period of months although it is not uncommon to have some fairly minimal permanent numbness along the areas of the incisions. Permanent numbness of larger areas, in particular of the ears, occurs less that 1 percent of the time. Other nerves which can be injured are those that go to your muscles of facial expression. Dr. Murphy has had a few patients over the years with slight temporary weakness of the facial muscles to the upper lip areas which has taken a couple of weeks to resolve. Dr. Murphy’s patients have never had any permanent weakness although it is reported at 1 or 2% in the literature. Smokers are at increased risk of areas of poor healing which may lead to poor quality scars. It is not uncommon to have areas of temporary hair loss around the incisions as the hair follicles go into a resting phase, but the hair regrows over a period of months.

How long will it last?

The length of time that patients enjoy a satisfactory improvement depends on many factors such as the quality of their skin when we start including the degree of sun damage or loss of elasticity. Smokers typically have the worst quality skin. Older patients will see an earlier return of laxity while younger patients will see more long lasting improvement. It is unusual to see a patient back earlier than 10 years.

Are their any differences with men?

Definitely. At the time of surgery we need to take into account a number of anatomic differences between women and men to assure the best result. Due to the vascularity of the beard men are at slight increased risk for bleeding but they also seem to heal a bit quicker with less bruising and quicker resolution of swelling. Incisions need to be different to avoid hairy ears. There are issues regarding shaving after surgery due to mobilization and repositioning of the hair bearing cheek skin. These issues are emphasized during my consultations with men who desire the improvements facial plastic surgery can offer.

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