Manuel A. Lopez, MD, FACS

Board Certified Facial Plastic Surgeon

(210) 495-5771 (LPS1)
(210) 495-2367          
Lopez Plastic Surgery
1314 E. Sonterra Blvd, Suite 5104
San Antonio, Texas 78258

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.

Before Facelift Surgery

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

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.

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.

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.

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.

Remove all make-up and nail polish before arriving for your procedure.

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.

After Facelift Surgery

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.

Vitamin C (ascorbic acid) helps promote healing. Take 1000 mg three times a day for two weeks following surgery.

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

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