As we age, the cheeks tend to give in to the effects of gravity and fall lower on our face.  Patients tend to complain that they have a tired or unhappy appearance even when they feel fine.  Proper positioning of the cheeks is an essential component to rejuvenating a face.  Dr. Lopez will often combine a midfacelift with a browlift and/or a facelift to provide a harmonious rejuvenation to the face.

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 facial rejuvenation is that they appear older than they feel. A balanced rejuvenation is an important aspect to providing a natural look that appears non-operated.

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 are not ready for cosmetic surgery and are better served with conservative measures, such as Botox for fine lines and wrinkles or 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 midfacelift with other cosmetic surgery. Eyelid lift, chin implants, facelift, rhinoplasty (nasal surgery), otoplasty (ear surgery) and lip surgery can also be performed in conjunction with a midfacelift.

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 midfacelift. 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.

BEFORE MIDFACE LIFT SURGERY

At your preoperative appointment Dr. Lopez will provide all the instructions for you to follow before and after surgery. A midfacelift takes about one hour depending on the facial structure. 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 three to four hours from the time of admission.

PREOPERATIVE MIDFACE LIFT INSTRUCTIONS

AFTER MIDFACE LIFT SURGERY

When you wake up from surgery you will notice a soft, bulky head wrap dressing.  Following your midfacelift, 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.  You will be asked to return in six to eight days for suture removal.

POSTOPERATIVE MIDFACE LIFT INSTRUCTIONS

Wound care

Keep dressing dry and intact the evening after surgery. Notify Dr. Lopez if the dressings become loose or fall off.  Following dressing removal the morning after surgery, a second dressing will be applied for 48 hours.  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.

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 midfacelift to prevent pigmentation of incision lines.

Final Result

Following a midfacelift, 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 midfacelift 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.

FREQUENTLY ASKED QUESTIONS

1) What is a midfacelift?
Midfacelifts are performed to elevate sagging cheeks. The tissue underneath the cheek pad is elevated and positioned in a more youthful position.  Dr. Lopez will often combine a midfacelift with a browlift to rejuvenate and restore facial harmony.

Midfacelifts are state of the art technology that not all plastic surgeons are skilled in performing. Therefore, it is vital that your screening process includes a review of Before and After Photographs of the doctor's midfacelift results.

2) Am I a candidate for a midfacelift?
Best candidates for a midfacelift are people with hollowed out eyes, sagging cheeks, deep smile lines and a fallen brow. Typically the midface (cheek area) starts to drop in the mid thirties and becomes more apparent in our 40's and 50's. A midfacelift helps Dr. Lopez address the lower eyelid better by padding the bony rim. He removes less fat and is able to remove more skin without eyelid changes.

3) How do I know if I need a midfacelift or a facelift?
Many factors including age, genetics, previous sun exposure, tobacco abuse, skin type and skin elasticity all play a role in assessing if a midfacelift would be the right way to go. The only way to know for sure is a consultation with Dr. Lopez.

4) Where are the incisions for a midfacelift?
Since midfacelifts can be performed endoscopically, incisions measure generally about one half to one inch. These smaller incisions are placed behind the hairline so they are well camouflaged.  If Dr. Lopez feels that a pretrichial browlift is indicated, then the midface lift can be done through the same incision.

5) When can I return to work?
Patients typically return to work and activities anywhere from seven to ten days although restrictions limiting heavy lifting, bending and straining along with aerobic activity remain for two weeks following the procedure.

6) What is an endotyne?
Dr. Lopez uses a state of the art device called a midface endotyne to elevate your cheeks (midfacelift). The endotyne is made of a resorbable material that goes away 6-9 month after placement.

MIDFACELIFT PREOPERATIVE INSTRUCTIONS

7) 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.

8) 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.

9) 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 impetus to quit smoking.

10) 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.

11) 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.

MIDFACELIFT POSTOPERATIVE INSTRUCTIONS

12) What does it feel like 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. We will make sure you are not nauseated or queasy. Our nurses will be right there with you as you wake up from surgery to give you special attention.

13) What do 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 day.   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.

14) Can I do anything to 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.

15) How do I care for the incisions?
The sutures/staples will require some simple care. We will ask you to use a Q-tip to cleanse them 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/staple removal, sutures that have been lubricated glide out easily.

16) When can I shower?
You can shower once the second dressing is removed.  Make sure that you pat dry the incisions well after the shower and apply the antibiotic ointment.

17) 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 - Anti-swelling 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.

18) When do I start taking these prescriptions?
Patients take their pain medication as needed. Begin taking vitamin C 1 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.

19) Are there any foods 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.

20) When is my first postoperative appointment?
You will be asked to see Dr. Lopez on the first day following midfacelift for removal of head wrap dressing. You will need someone to drive you to this appointment.

21) Are there any instructions about 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. If you have little children, bend at the knees or sit on the floor and let them climb on to your lap.

22) How can I minimize the swelling and bruising?
Most of Dr. Lopez’s patients 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.

23) 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.

24) 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.