Pino Surgery > Facial Surgery

Pino Plastic Surgery

Certified Plastic Surgeon

Member American Society Plastic Surgeons

Facelift Surgery or Rhytidectomy

As we age, gravity, the elements and nature, all conspire against us to work unattractive changes in our skin and musculature. Aging changes do not occur suddenly. They happen slowly and involve several components of the face.

As the elastic tissue of the skin weakens with age, lines on the forehead and sides of the mouth deepen. The outer parts of the eyebrows and eyelids sag, making the eye appear smaller. The eyelids become baggy, “crow’s feet” form, and the “double chin” appears. In woman, especially, folds tend to form over the front part of the neck.

For centuries, we have looked to magic cures and creams in vain, hoping to hold Mother Nature at bay. More recently, first for the wealthy and then for the less well-to-do who consider it a personal investment (not a luxury) women and men have turned to the plastic surgeon for a safe, more effective remedy: The Facelift.

Facelift surgery or rhytidectomy is an aesthetic or cosmetic plastic surgery that improves facial appearance by correcting deformed or unsightly features, diminishing the conspicuous marks of aging, excessive wrinkling and over stretched skin folds. Facelifts are the most common facial plastic surgery procedure for reducing signs of aging. It is often performed in conjunction with other procedures such as chemical peel, eyelids surgery and the eyebrow lift.

The facelift generally can be divided into its three components: the neck lift, the cheeks lift and the temporal lift. In some patients, it may be necessary to perform a submental lipectomy to remove excessive fat under the chin (the so called “double chin”). The temporal or eyebrow area may be improved in several ways depending upon the patient’s problem. Some patients especially those with early aging signs, may require only a cheek and neck lift, while others may require a temporal or brow lift done.

How a Facelift is done

To perform a facelift, the surgeon lifts the sagging skin and repositions the underlying muscles of the face. The incision usually begins in the temple hair above and in front of the ear, around the ear lobe, behind the ear, and the backward into the hair of the scalp. For men, the incision line is altered somewhat into the forehead, temples, cheeks, and neck. The underlying muscle and the connective tissues are repositioned. The overlapping skin is removed. Occasionally, it may be necessary to make a small incision under the chin to help with the correction.

Most of the scars will be hidden within your hair and in the normal creases of your

The procedure usually takes between two and three hours. It is performed in our plastic surgery facility, with the most updated equipment and techniques.

Anesthesia in Facelift surgery

Realizing that most patients are apprehensive about surgery, we use an approach to anesthesia designed to make our patients as comfortable as possible before, during and after the operation.

The surgery itself is relatively painless. It is done under “twilight” anesthesia, in which mild sedatives are given orally and intravenously combined with local anesthesia. Because the patient is very sleepy and usually has amnesia to the operating room experience, we call it “twilight” sleep. Generally, anesthesia may be administered if you prefer.

Although most people have amnesia to the operation, they are usually alert upon returning to their room. Our experience with this technique has been that patients are up and around sooner and, we feel, the likelihood of potential complications is reduced.

Facelift with eyelids and forehead lift.

Facelift w eyelids and peeling around mouth.

Facelift with eyelids and foreheadlift.

Postoperative

Despite the long incisions, scars resulting from facelift surgery usually are not noticeable once they have matured. Stitches are removed within one week, and much of the swelling and discoloration that follows surgery will subside in two weeks. It will take six to eight weeks for most of the swelling to disappear and for your face to reach a natural contour, but with appropriate covering cosmetics and hairstyling, you should be able to go out and follow your normal routine after about two weeks.

The results to expect

The elimination of excessive sagging of the facial and neck skin gives the patient a more rested and youthful appearance. Some people are surprised when they receive no dramatic comments from friends. This is usual. Remember, the object of the operation is to produce a natural, more graceful and youthful appearance, not to put on the natural skin so tightly that your face seems mask like or artificial.

Overweight patients do not have as good results as normal weight ones. It could be expected more swelling, more time to heal and to subside, less improvement of the facial appearance and a less lasting result. To achieve a better result, we do recommend our patients to loose weight before the surgery.

The risks

All Surgery Carries Some Uncertainty and Risk
The risks are minimal. There are inherent risks in any surgical undertaking. However, they should be discussed before the surgery. Fortunately many thousands of facelift operations are performed successfully each year. If you are a healthy person, the risks involved in a facelift surgery are minimal.

When a facelift is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable.

Complications that can occur include haematoma (a collection of blood under the skin that must be removed by the surgeon), injury to the nerves that control facial muscles (usually temporary), infection, and reactions to the anesthesia. Poor healing of the skin is most likely to affect smokers.

You can reduce your risks by closely following your surgeon's advice both before and after surgery.

The smoke of tobacco and nicotine alter blood circulation all over the body. Singularly one cigarette causes 90 minutes of vascular spasm which diminishes blood circulation in the skin. Following this principle, it negatively affects scarring process.

Tobacco inhibits the production of a natural blood vessel opener, nitric oxide. Therefore produces blood vessel narrowing in arteries, veins and capillaries. This specific reaction reduces circulation in the regenerating tissues and slows down regeneration.

Skin necrosis in a heavy smoker after a facelift surgery.

Several investigations have proved that smoking leads to a greater frequency of scarring problems in the areas behind the ears in facelift patients.

“While there is usually a relative minimum of pain, incapacity, and discomfort following a facelift surgery, one must be prepared to accept what little there is”.

Perioperative smoking results in significantly higher complication rates (specifically, wound healing complications) that are unrelated to the number of cigarettes smoked.

Our experience has shown that we cannot turn a smoker into a nonsmoker. Our experience, however, suggest that extreme discretion should be exercised when offering plastic surgery procedures to smokers.

Smokers must know about their possible higher risk for wound healing problems.

As we perform the operation we try to be more conservative, mobilize less, remove less tissue, and immobilize the patient in the critical first 3 days to prevent them from smoking. With reference to our anecdotal evidence, we have since noticed a significant reduction in the incidence of wound healing problems.

Facelift--Forehead lift--Eyelids

Post-Operative Instructions

Every operation, no matter how minor, is accompanied by swelling. The amount varies from person to person and it is difficult to predict. Swelling or inflammation is a natural body reaction. It is due to the new tissue fluids brought into the surgery area to promote healing.

Swelling may become greater after the first or second day. It is generally worse in the mornings when you wake up, especially along the eyelids and the jaw line. This is not serious or an indication that something is wrong with your operation. It is normal. In most patients, 80 to 90 percent of swelling will be gone in 3-4 weeks. The rest could take 9 to 12 months and sometimes more.

To obtain a satisfactory recovery, follow carefully these instructions:

1. Stay up as much as possible (sitting, standing or walking around).

2. Avoid bending over or lifting heavy objects for ten days.

3. Avoid hitting or bumping your face and neck. It is advisable not to pick up small children, play ball or contact sports for one month.

4. Sleep with the head of the bed elevated for one week. To accomplish this, place two or three pillows under the mattress at the head of the bed.

5. Cold packs are recommended during the first two weeks. Dip a face towel in a bowl of ice water and apply it over the swollen areas several times a day. DO NOT APPLY ICE DIRECTLY TO THE SKIN.

6. Avoid sunning the face for two months.

7. Avoid using a hair dryer for two weeks.

8. Avoid “pull-over clothing” during the first two weeks. Wear clothes that fasten in either the front or the back.

9. No swimming, strenuous athletic activity or exercises that involve turning the head for one month.

10. Try to keep the face and neck stiff. Do not move the face and neck excessively. Try to turn the head, neck and shoulders as a unit for two weeks.

11. Avoid excessive use of face and neck muscles for two weeks. No chewing gum or chewing hard foods. Avoid talking too much, yawning with the mouth widely opened, grinning and smiling.

Daily Post-Operative Care

From the following day of surgery, you must take a shower twice a day during the first week. Shampoo your hair with a baby shampoo. Scrub gently the wounds especially behind the ears. Don’t be afraid to get wet the sutures around the eyes when showering.

1. After the shower, clean the suture lines with hydrogen peroxide on a Q-tip. This will help to remove the scabs and secretions from the wounds. Apply Neosporin ointment or another. antibiotic ointment over the wounds.

2. If bleedingoccurs, lie down on a bed. Apply a cold compress with continuous pressure over the bleeding area for 20 minutes. It is normal to have some bleeding from the incisions during the first days.

3. Hair cannot be tinted or colored for three weeks.

4. Make-up may be worn on the face from the day after surgery. But, not over the incisions for 10 days.

5. Smoking is known to delay healing. When you smoke the blood supply to the skin is reduced. To minimize possible complications such as skin loss, lack of healing and bad scarring, smokers must refrain from using tobacco one week before and two weeks after surgery.

Convalescent Period

The following post-operative conditions are normal and should not cause alarm:

a. The entire face and neck will be swollen. This will start reducing after the second day. About 80% will be gone in 3-4 weeks. The rest will take 9 to 12 months and in a few cases more. Swelling will be asymmetric and changeable. The face will look deformed and irregular.

b. Bruising, black and blue, although generally localized, may be distributed throughout the face and neck. Usually it lasts 1-2 weeks. The color may be purple, green or yellow.

c. Numbness is customary around ears, cheeks and under the chin. The feeling or sensation will return slowly over several months.

d. Dimpling of cheeks and neck occurs. You could feel small “lumps” and skin irregularities. Theyusuallydisappearwithin 4-6 weeks.

e. Pain on the neck and around the ears, especially on pressure, may persist for several weeks.

f. A feeling of tightness behind the ears and upper neck will last a few weeks. The neck may feel firm. It will eventually soften. This tightness usually peaks during the second or third week.

The convalescence period varies from person to person. Although most bruising disappears in a few weeks, residual swelling may last for months. Your appearance generally will be presentable in 4- 6 weeks, but healing continues for up to one year or more. Months after surgery , you may suddenly experience some swelling in certain areas. Healing is not completed as long as there are swelling and sensitive areas. Thus the final appearance has not been achieved. The best treatment is patience. Be patient and wait for the results.