Marisa Marques

Facelift

(usually two days of hospitalization)

Facelifting addresses ptosis and atrophy of facial tissues. Deep creases, such as the labiomental creases, may be also improved by facelifting.
However, this procedure, does not address, and has no effect on, the quality of the facial skin itself.
Consequently, facelifting is not a treatment for wrinkles, sun damage, creases, or irregular pigmentation. Fine wrinkles and irregular pigmentation are best treated with skin care and resurfacing procedures such as dermabrasion.

The facelift is the single most important and beneficial treatment for most patients older than age 40 years who wish to maximally address facial-aging changes.
Aging results in jowls and a rectangular lower face. A facelift lifts the jowls back into the face, augmenting the upper face and narrowing the lower face, producing the “inverted cone of youth.” This change in overall facial shape from rectangular to heart-shaped is subtle but real, and is a benefit that no other treatment modality can provide.

Aging changes in the face: 1) Forehead and glabella creases; 2) Ptosis of the lateral brow; 3) Redundant upper eyelid skin; 4) Hollowing of the upper orbit; 5) Lower eyelid laxity and wrinkles; 6) Lower eyelid bags; 7) Deepening of the nasojugal groove; 8) Ptosis of the malar tissues; 9) Generalized skin laxity; 10) Deepening of nasolabial folds; 11) Perioral wrinkles; 12) Downturn of oral commissures; 13) Deepening of labiomental crease; 14) Jowls; 15) Loss of neck definition and excess fat in neck; 16) platysmal bands.
 
Postoperative care
Patients are instructed to rest with the head elevated for the first several postoperative days. The drains are usually removed on the first or second postoperative day.
Pain medication is usually required, especially at night, for several days. Oral antibiotics are generally prescribed. Swelling and bruising are variable. Depending on the ancillary procedures performed, patients look reasonably acceptable after 1 week, good with makeup after 2 weeks, and able to attend social functions after 3 weeks. An occasional patient will have prolonged bruising that may limit activity for a longer period of time.
 
Complications
 
Acute complications
Hematoma: Hematoma is the most common complication of facelifting, and most major hematomas occur during the first 10 to 12 hours postoperatively. The history focuses on factors that predispose to postoperative bleeding. Surgery is not performed until the patient has been off of aspirin for 2 weeks. Facelifting is probably contraindicated in patients on warfarin or clopidogrel, even if they are allowed by their physicians to stop these medications. At the very least, facelifting on such patients is performed with extreme conservatism and only after every possible means of eliminating the effects of these medications has been pursued. Hypertension is probably the single factor that most closely correlates with postoperative hematomas, thus blood pressure must be under strict control.
Skin Slough: Cigarette smoking increases the risk of skin slough, the second most common complication after facelifting. Patients are encouraged to quit smoking permanently. At the very least, patients should cease smoking 2 weeks prior to surgery. It is important that smokers know they will never become “nonsmokers;” that is, the effects of smoking never totally disappear, and are certainly not gone in 2 weeks. The most common location for skin slough is in the retroauricular area where the scarring is less visible.
Infection: This complication is rare.
Pain: Pain following face lift is quite unusual. Disconfort, such as a feeling of tightness when turning the head, is not uncommon during the first few days or weeks after the operation.
 
Chronic complications
Pigmentation: Hyperpigmentation owing to the formation of iron pigments may occur in the facial skin over sites of postoperative ecchymosis. The degree of pigmentation is apparently related to skin type, and patients with darker complexions tend to have greater degrees of pigmentation. Telangiectasia of the facial skin may be aggravated during face-lift surgery.
Hair loss: Can occur in the temporal skin flap or adjacent to the incisions in the hair-bearing scalp. It is most often found in patients with thinning hair and tendency toward alopecia. Temporary loss is more common than permanent loss.
Scars: Scars of facelift are, in the majority of cases, almost imperceptible.
Hypertrophic Scarring: Hypertrophic scaring is most often attributable to excessive tension on the incision closure. Some patients, however, develop hypertrophic scars despite the best efforts of the surgeon. As with skin slough this usually involves the retroauricular area, which is less visible, but can occur in the preauricular area where it is a bad complication. An occasional patient will get true keloids of the facelift incisions, which are difficult to treat.
Nerve Injury: Injury to a branch of the facial nerve is the complication most dreaded by patients. Motor nerve injury occurs in 0.9% of patients who receive subcutaneous undermining. Many nerve injuries are temporary, presumably the result of traction or cautery. A nerve that has been transected will not recover function. Transient numbness of the cheeks and neck skin is a result of interruption of the small sensory branches during skin undermining and is unavoidable. Sensibility always recovers although it may take months to do so. Injury to the treat auricular nerve is another matter. It is a large sensory nerve, as described under “Facelift Anatomy,” and transection will result in permanent numbness of half of the ear and in some cases a painful neuroma. The nerve is quite superficial on the surface of the sternomastoid muscle especially in thin patients and is easily transected.


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