How It's Done
When you arrive at the doctor's office, you'll be given a sedative to relax you, and then you will be injected with tumescent anesthesia if this is used (please see chapter 13 for a description of tumescent anesthesia). Many facelifts are done under general anesthesia, but we prefer tumescent with sedation because the hazard, nausea, vomiting and discomofort associated with general anesthesia is mimimized. There is a shorter recovery from the drugs. By the time surgery begins, you shouldn't be feeling any discomfort at all. You may be asleep or just slightly awake in a "twilight sleep."
Today, careful liposuction may be performed on fatty areas of the face and neck before the rest of the procedure starts. Then, the incision is made around the ears and into the scalp. Sometimes only the part in front of or just behind the ear is treated, depending on the patient. This, however, does not produce results as long lasting or dramatic. But if the whole operation is done, the skin of the face and neck is lifted up from its attachments with instruments or the surgeon's fingers. The deeper layer of tissue located underneath the surface layer is generally tightened with sutures. The excess skin around the ears is then trimmed. Stitches and sometimes staples are used to close the skin. A dressing is applied. This is the traditional facelift.
A newer technique is the "deep plane facelift." This involves going deeper into the face, underneath the muscle, and pulling the muscle up along with the skin to theoretically make the lift last longer. Some studies have shown no difference between the "deep plane" and "classic" facelift results after a year, though the risks and recovery for this procedure are higher than they are for a classic facelift.
Your doctor may choose to laser or chemical peel the surface of the face on the day the facelift is performed, to improve the skin's overall texture. This should be a light treatment only. Anything deeper adds serious, unacceptable risks.
Cheek and Chin implants performed along with the facelift
Cheek implants, placed though an incision in the mouth, and chin implants, placed through an incision either in the mouth or under the chin, are common enhancing procedures used with facelifts. These are made of flexible firm silicone with tapered edges, and are placed under the "skin" of the bone (the "periosteum"). After a short period, these implants feel just like they are a part of your cheek bone ("malar" area) or chin bone (mandible) because they become fixed in place by the healing process. Improvements with these implants are often dramatic, especially if the patient had a weak chin or cheek bone area to begin with. These implants additionally can improve simple aging changes. The maturing face sags partly because fat has been lost. These implants can make up for this in a very pleasing way.
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