Facelifts
You often hear that 40 is the new 30 and 50 is the new
40, unfortunately external factors such as gravity and
sun exposure continue to negatively effect our
appearance. One of the most common requests Dr. Lopez
hears is "for the outward appearance to reflect the more
youthful energy a person feels inside." Many patients
want to correct the sagging neck skin and hanging
jowls. They desire a smoother contour and tightening of
the jowl and neck area. A facelift is what will in most
cases achieve the desired result.
A facelift (rhytidectomy)
can affect one's appearance as dramatically as any
facial cosmetic surgery. Rhytidectomy is a safe,
effective procedure performed to restore a more youthful
appearance and less fatigued look without compromising
function. Many women and men in today's competitive
corporate workplace are increasingly seeking facelift procedures to restore a younger look that more typifies
their energy level.
When patients come to see
Dr. Lopez seeking facial plastic surgery, it's not
uncommon for them to focus on a single aspect of their
appearance rather than the overall picture. One of the
most common concerns he hears from patients seeking
facelifts is the "turkey wattle," the loose skin
dangling under the chin. Many times patients will
request just a "neck lift." While an isolated
necklift may be appropriate for a male with a
midline excision in the neck, females are poor
candidates for this type of procedure. In order to
address the neck in women, a facelift needs to be
performed.
As Dr. Lopez is a board
certified facial plastic surgeon, trained to perform
plastic surgery exclusively on faces and necks, he knows
that his responsibility is to evaluate not only the
areas of concern but also the motivation behind the
requests. Some patients that are not ready for cosmetic
surgery are better served with conservative measures,
such as
Botox for treatment of fine lines and fillers for deeper
wrinkles. Patients who educate themselves about facial
rejuvenation know when and if the time is right to
proceed.
When discussing
rejuvenation procedures the best place to start is by
looking at
before and after photos to see just what can be
accomplished. As you will see in the photos, patients
often ask to combine a facelift with other cosmetic
surgery.
Eyelid lift, chin implants,
rhinoplasty (nasal surgery),
otoplasty (ear surgery) and lip surgery can also be
performed in conjunction with a facelift.
At your initial
consultation, Dr. Lopez evaluates your bony and soft
tissue architecture of your face and neck. Assessment of
the face and neck provides the basis for what one may
expect from a facelift. Skin type, ethnic background and
age, along with the degree of deformity and function are
important factors influencing the outcome of surgery.
As with all facial plastic
surgery, a thorough health assessment and realistic
expectations are prerequisites. Your understanding of
procedures and routines is essential to a successful
final result. Following your consultation, we continue
our discussion at the preoperative appointment.
At your preoperative
appointment Dr. Lopez will provide all the instructions
for you to follow before and after surgery. A facelift
takes about three hours depending on the facial
structure and amount of excess tissue prior to surgery.
If you are having a combination of procedures your
surgery will take longer. Recovery time from the
anesthetic takes about an hour and you will be
discharged about five to six hours from the time of
admission
PREOPERATIVE FACELIFT
INSTRUCTIONS
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Please avoid any
aspirin, aspirin-containing products, or
ibuprofen (Advil, Aleve, etc.) for two weeks
prior to and two weeks following your surgery.
See our "Medication
List" for products to avoid prior to
surgery. If you are on any medications that
affect bleeding (such as coumadin or warfarin)
please notify the office immediately.
-
Please refrain from
tobacco products for six weeks and alcohol for
one week prior and three weeks following
surgery. Along with delayed wound healing,
persistent skin redness and other complications
may persist when tobacco and alcohol are not
discontinued.
-
Please notify us of
all routine medications and significant health
history. We ask that you remain on your daily
medications unless instructed otherwise. At the
preoperative appointment you will be told which
daily medications to take with just a sip of
water on the morning of surgery.
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At your
preoperative appointment you will be given
prescriptions for use following surgery
including an oral antibiotic, antiswelling
medication, antibiotic ointment and pain
medications. Please obtain these prescription
medications before your surgery so you will have
them ready for use when you return home after
surgery.
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We will ask you to
take Arnica, a natural herb that significantly
decreases bruising, before and after surgery. We
will also ask you to take Vitamin C (ascorbic
acid), which helps promote healing, before and
after surgery.
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You may not eat or
drink after midnight the evening before the
procedure unless instructed otherwise. You may
brush your teeth. Your procedure will be
cancelled if you do not follow these
instructions.
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Remove all make-up
and nail polish before arriving for your
procedure.
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Someone will need
to drive you home after your surgery and stay
with you that evening. Transportation to the
office for dressing removal the day following
surgery is also required.
When you wake up from
surgery you will notice a soft, bulky head wrap
dressing. Following your facelift, the nurses will ask
assist you to meet the discharge criteria: to drink
liquids, walk with a steady gait, void, and manage your
discomfort. For patients who have a combination of
procedures such as an eye lift, your vision may be
cloudy from the ointment we place in your eyes at the
time of surgery. The nurses will review all instructions
you will need for care following your facelift.
You will be asked to come
to see Dr. Lopez the following day after surgery for a
dressing change and drain removal (if placed). Although
most patients describe drain removal as discomfort
rather than pain, you are encouraged to take your pain
medication about an hour prior to drain removal. You
will be asked to return in six to eight days for suture
removal.
POSTOPERATIVE FACELIFT INSTRUCTIONS
Wound care
Keep dressing dry and
intact the evening after surgery. Notify Dr. Lopez if
the dressings become loose or fall off. Dr. Lopez
occasionally uses small flat drains that will be removed
the day after surgery. Following dressing removal the
day after surgery, a second dressing will be applied for
48 hours. After removal of the second dressing, you
will wear an elastic wrap for 1 week that can be taken
off to shower. You can shower once the second dressing
is removed. Cleaning the suture with a Q-tip dipped in
hydrogen peroxide once a day and then applying the
antibiotic ointment three times a day is an essential
part of the healing process. Sutures that have been kept
lubricated with ointment are less painful to remove.
Keep elastic wrap in place at all times other than
suture care and showers.
Medications
Most patients complain of
discomfort more than pain. Use pain medication as
directed/as needed. Vicodin and Percocet contain
Tylenol. Do not take additional Tylenol or acetaminophen
while taking Vicodin or Percocet. Do not drive or drink
alcohol while taking pain medication. Taking pain
medication with food helps minimize nausea sometimes
associated with pain medications.
-
Start your
antibiotic (Keflex) when you get home and one at
bedtime. It is not uncommon to have a low-grade
fever for 24 hours following surgery.
Start swelling medication (Medrol Dosepak) when
you arrive home. Then follow package
directions. Take with food.
-
Vitamin C (ascorbic
acid) helps promote healing. Take 1000 mg three
times a day for two weeks following surgery.
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Arnica, a natural
herb that significantly decreases bruising, is
used under the tongue three tabs three times a
day before meals for two weeks.
Diet
Advance diet from liquids
to soft food (oatmeal, French toast, yogurt, soup,
pasta) to your regular diet as tolerated. You have no
diet restrictions. Often the anesthesia you received
can make your stomach feel uneasy for the first 24 hours
so avoid large meals.
Activity
Rest for entire day after
surgery. Sleep with head of the bed elevated or use two
to three pillows for one week after surgery. Absolutely
no bending, lifting or straining. If you have little
children, bend at the knees or sit on the floor and let
them climb on to your lap. No driving for one week
following surgery. 7-10 days off work is recommended.
Bruising can be camouflaged
at one week postoperatively with make-up. Always protect
your face from the sun. At this point, a hat and
sunglasses are a good idea. It is ok to apply sunscreen,
cosmetics or facial creams two weeks after surgery.
Avoid unprotected prolonged sun exposure for three
months following a facelift to prevent pigmentation of
incision lines.
Tearing, bruising,
swelling, eye fatigue and disrupted sleep are very
normal postoperative symptoms and will decrease as the
healing process occurs. Since vision is temporarily
compromised, assistance with daily activities is
recommended.
Final Result
Following a facelift, it
takes time for the swelling to subside and for the skin
to heal. Most patients return to work two to three weeks
following surgery, depending on the degree of privacy
one is trying to maintain. At three weeks
postoperatively, swelling and bruising may be apparent
to you but not to many of your coworkers and closest
friends.
Final results following a
facelift are not apparent for one full year following
surgery. Dr. Lopez will want to see you 3, 6 and 12
months after the surgery to ensure that you are healing
as anticipated.
1) Will I look like someone else after a facelift?
Many of Dr. Lopez's patients report that when they
return to their normal life, their friends comment, "You
look great. Are you getting more sleep?", "Did you
change your hairstyle" or "You look less stressed and
tired". Dr. Lopez will not change the way you look,
just enhance it. A well done facelift will avoid an "operated" look, yet be able to restore the patient's
face and neck to a more youthful appearance.
2) Does Dr.
Lopez tighten the neck muscles?
Yes, the relaxed muscles are "tightened" under the skin
and the excess skin is removed. Tightening the muscles
of the neck eliminates the saggy skin in the midline of
the neck, often termed the "turkey wattle" which results
in a more youthful appearance. Successful facial
rejuvenation involves manipulating both muscles and
skin.
3) How long does a facelift last?
You will continue to age after the surgery, but for
patients who do not smoke, do not abuse the sun, are in
good general health and have good genetics, a facelift
can last upwards of 10 years. For patients who elect to
abuse their skin and body, the improvement one see with
a facelift will not last as long.
4) How can you tell if I need a chin implant?
For patients with weakly projecting chins, a chin
implant can greatly improve their facial harmony and
enhance the ultimate outcome after a facelift. Dr.
Lopez will assess your overall facial anatomy in order
to determine if a chin implant is indicated.
5) I have a double chin and jowls. Can Dr. Lopez
fix them?
Each patient will have different anatomy which dictates
the degree of improvement that is possible: however, the
primary goal of a facelift is to improve the jowls and
the double chin. Neck liposuction is often performed
with a facelift to further improve the neck results.
6) Does a facelift get rid of wrinkles?
The medical term for a facelift is a rhytidectomy which
translates into "removal of wrinkles". A facelift is
performed to lift sagging tissues especially around the
jaw line and neck. There is usually some improvement in
wrinkles; however, facial resurfacing, Botox, and
dermabrasion are more appropriate procedures for
elimination of wrinkles.
7) I had a facelift somewhere else and I don't
like my result. Can Dr. Lopez "fix" it?
Most often the answer is yes. It's not uncommon for
patients who have previously had facelifts to be
referred to see Dr. Lopez for revision surgery. Upon the
initial consultation Dr. Lopez will determine if your
original facelift result can be improved. In general,
patients should wait one full year before undergoing
revision facelift.
8) Why is a revision facelift more difficult?
All surgery causes scar formation. The scarring that
results after a facelift appears as a thick, tough layer
that can be more difficult to work with than tissue that
has not been operated on. Also the original location of
landmarks has been altered such that correcting them may
prove to be difficult. In general, revision facelifts
can take a little longer because of corrections that
need to be made as a result of the initial surgery.
Fortunately, Dr. Lopez is one of a few surgeons in the
country that performs a deep plane facelift. When doing
revision facelifts, this allows him to work in a plane
of tissue that has normally not been dissected.
9) How much pain will I experience?
Fortunately, most procedures on the face cause mild
discomfort. However, Dr. Lopez does provide all
patients with prescriptions for pain medication. Most
patients may use the prescription medication for one to
two days after surgery and then switch to Extra Strength
Tylenol.
10) Will I be awake during surgery?
You will have the choice to have general anesthesia or
IV sedation (medicine administered through an IV) and a
local anesthetic (numbing medication administered in the
operating room). In both situations, patients are
asleep during surgery. Patients do not hear or feel
anything and are comfortable during the operation.
Patients wake up very soon after the surgery is
completed.
11) Do I go home after the surgery?
Yes, most facelifts are done on an outpatient basis.
Because you will go home after receiving sedation, you
will need to make arrangements for a responsible adult
to drive you home, to stay with you overnight and to
drive you to our office for your first postoperative
appointment. Your first appointment is usually the day
after surgery. Patients having surgery must stay in the
immediate San Antonio area overnight.
12) How long should I stay in San Antonio
following surgery?
Most patients stay in San Antonio about seven to ten
days following surgery. After that it's ok to fly or
travel long distances.
13) When can I return to work?
Most of Dr. Lopez"s patients take about two weeks off of
work. After two weeks, most of the residual bruising and
swelling can easily be camouflaged with make-up.
14) When can I exercise?
Dr. Lopez prefers that aerobic activities be avoided for
two weeks after surgery. In addition, heavy
weightlifting or more strenuous workouts should be
avoided for three weeks postoperatively. It' is
extremely important to avoid bending, lifting or
straining during the early postoperative period as these
activities can increase swelling and delay healing.
15) Will I bruise and swell afterwards and how
long will it last?
Unfortunately it is impossible to do surgery without
causing swelling. Dr. Lopez does everything possible to
minimize the amount of swelling that occurs. Generally,
postoperative swelling begins to resolve at the end of
the first week. Bruising is extremely variable.
Patients that have a tendency to bruise will generally
bruise for about 10 days. Patients that don't tend to
bruise may have minimal if any bruising. Complete
resolution of bruising and swelling may take two to
three weeks. However, bruises may be camouflaged fairly
easily at seven to ten days with a concealer stick.
FACELIFT PREOPERATIVE INSTRUCTIONS
16) Should I do anything before to prepare for
surgery?
You will have a preoperative appointment with Dr. Lopez
and his staff to go over the preoperative instructions.
17) Why do I need a preoperative appointment?
This is an essential appointment to prepare you for your
upcoming surgery. Dr. Lopez will take preoperative
photographs at the visit as well as go over the
procedure again to ensure that everyone is on the same
page. All questions that you have will be answered on
that visit as well. You will often times be given your
prescriptions on the preoperative visit day.
18) What else can I do to do to prepare for
surgery?
Dr. Lopez likes to have patients that have well
controlled blood sugar to drink three eight ounce
glasses of pineapple juice for at least one week before
surgery. Pineapple juice can help minimize the
postoperative swelling. Patients that use tobacco will
be asked to stop for six weeks before and six weeks
following surgery. Tobacco has properties that impede
wounds from healing. Dr. Lopez will encourage tobacco
users to not resume smoking at all after surgery; in
fact many of his patients have used the surgery as their
motivation to quit smoking.
19) What about my daily medications before
surgery?
In general you will be allowed to take most of your
daily medications. Medications that thin the blood such
as ibuprofen, vitamin E, and herbal supplements need to
be stopped two weeks before surgery. You can continue
to take a multivitamin. Aspirin needs to be stopped
three weeks before surgery. Dr. Lopez will provide a
"Medication List" that reviews all medications and
supplements to avoid prior to surgery.
20) Do I need any special prescriptions before
surgery?
Dr. Lopez will generally give you a prescription for an
antibiotic, a pain medicine, antibiotic ointment, as
well as an anti-swelling medication. He also asks you to
start taking Vitamin C 1 gram per day for 1 week before
surgery to continue for 2 weeks after surgery.
FACELIFT POSTOPERATIVE INSTRUCTIONS
21) What will I feel when I wake up from surgery?
Most patients report only mild to moderate discomfort
associated with some tightness or pulling. This pulling
sensation, most noticeable under the chin, subsides
after about three weeks. Dr. Lopez will make sure you
are not nauseated or queasy.
22) How will I look like when I wake up from
surgery?
Following the procedure, you will have a soft head wrap
around your head and under your chin. This helps
minimize swelling. The head wrap will be removed in the
office the following morning. A second dressing will be
gently applied for 48 hours to minimize swelling. You
may have some bruising, however, this typically is more
pronounced 24-48 hours after the procedure.
23) How can I prevent bruising?
Most patents will have a little bruising. We can try to
minimize bruising by using Arnica before and after the
procedure. Arnica is a natural "herb" that helps prevent
bruising.
24) How do I take care of the incisions?
The areas that are sutured will require some simple
care. Dr. Lopez asks that you use a Q-tip to cleanse
the sutures with peroxide once a day and apply an
antibiotic ointment three times a day to keep the
sutures soft. In six to eight days, when the time
arrives for suture removal, sutures that have been cared
for will slide out easily.
25) When can I shower?
You can shower 48 hours after the surgery. Make sure
that you pat dry the incisions well after the shower and
apply the antibiotic ointment.
26) What medications do I take following surgery?
Dr. Lopez will ask you to take the following medications
starting the day of surgery:
1- An antibiotic - generally Keflex for one week
2- Pain medicine - Vicodin or Percocet to take as needed
3- Antibiotic ointment- to place on the incision sites
at least three times a day
4- Antiswelling medication- for patients that are not
diabetic a Medrol dosepak will be given
5- Vitamin C 1 gram for 1 week before and two weeks
following surgery to promote healing
6- Arnica- place under the tongue three tabs three times
a day before meals for two weeks.
27) When do I start taking these prescriptions?
Patients take their pain medication as needed. Begin
taking vitamin C one week before surgery. You can begin
taking Arnica the day before surgery. The antibiotic
and swelling medications begin when you arrive home
following surgery. Unless you are notified otherwise,
resume all daily medications when you arrive home from
surgery.
28) Are there any food to avoid following surgery?
No. Dr. Lopez encourages you to eat a well-balanced
diet. You may notice that saltier foods can cause you
to swell for a longer period of time.
29) When is my first postoperative appointment?
You will be asked to see Dr. Lopez on the first day
following facelift for removal of head wrap dressing.
You will need someone to drive you to this appointment.
30) What about my regular daily activities?
Sleep with head of the bed elevated or use two to three
pillows for one week. Absolutely no bending, lifting or
straining for two weeks. If you have little children,
bend at the knees or sit on the floor and let them climb
on to your lap.
31) How can I minimize the swelling and bruising?
Most of Dr. Lopez's patents will have a little bruising.
He minimizes bruising by having patients stop all blood
thinners well ahead of surgery as well as using Arnica
before and after the procedure. The cold packs around
the eyes should be used every 20 minutes while awake
after surgery to help prevent swelling and bruising.
The cold packs should be used for the first 72 hours.
You do not need to wake up to use the cold packs. A
good night's sleep is vital to healthy healing.
Patients are also asked to sleep with their head at
least at 45 degrees to minimize the swelling.
32) When will I look normal?
You will be presentable at two to three weeks. You will
look great at six weeks and even better at six months as
things settle and expressions become more natural. At
three weeks you know you are well on the way to recovery
and most patients resume routine activities around two
to three weeks following surgery. Final results are
evaluated at one year.
33) How often do I need to return for
postoperative visits?
Dr. Lopez likes to see his patients 3, 6, and 12 months
after the procedure to ensure that the healing is going
as expected.
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