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Face Lift
Facelift surgery, or a rhytidectomy, is designed to restore a more youthful appearance by removing major wrinkles and sagging skin. It involves tightening of the facial and neck muscles as well as the removal of any excess skin.
The skin begins to wrinkle and sag as a result of age, sun exposure and genetics. Children and young adults have smooth, round faces due to evenly distributed fatty tissues in facial contours. Over time, the skin sags and folds are the chin, jawline and neck become prominent. Not only does a facelift improve facial appearance but also has a dramatic effect on the neck, enhancing its contour and profile.
A facelift can make a patient look 5 to 10 years younger.
Dramatic as the end results are, this is not a simple procedure. It requires a week to 10 days of recovery.
Before Surgery
We will evaluate your medical history in order to determine your overall health.
Dr. Ayala will discuss with you how your face can look and what you can expect from surgery. Our objective is to create a natural appearance that is pleasing to you. Before and After photographs will reveal what the surgery has accomplished.
Preoperative Instructions: Avoid drugs that contain aspirin several weeks prior to surgery to minimize excess bleeding. You may be required to take antibiotics to prevent infection. You may be instructed to shampoo your hair the night before surgery. A small amount of hair may be shaved around your ears and temples.
The Procedure
A facelift is frequently performed in conjunction with blepharoplasty (eyelid surgery), forehead lift, chin augmentation, and/or liposuction, to create an overall rejuvenation of the face. The procedure can be repeated as gravity continues its effects after the first surgery.
Facelifts are performed in outpatient surgical centers or in an accredited physician’s office. Local anesthesia with intravenous sedation is most commonly used, with premedication to help you relax. General anesthesia is generally not required but can be used if desired.
The surgeon will make incisions inside the hairline at the temple, in front of the ear, then around the earlobe and behind the ear, ending at the scalp area. Excess skin is removed and sagging muscles and connective tissues are tightened. In some cases, fatty deposits are removed from beneath the chin and neck. Incisions are closed with small sutures.
The procedure may take up to 5 hours depending on whether any other procedures are performed at the same time.
Post Operative Care
It is necessary to have someone drive you home and stay with you for the first 24 hours. Initially you will have a large dressing wrapped around your head. You may have surgical drains attached to bulbs hanging at your neck. These will be removed in approximately 24 hours. Stitches around the ears will be loosened or removed in a few days. The scalp sutures will be removed in 7-10 days.
To minimize scarring, the Ayala may remove the sutures in stages. Scarring fades quickly. Swelling and discoloration decrease within two weeks. Tightness in your face will be present for several weeks and there may be slight changes in your hair pattern around the incision.
We recommend that you avoid the sun for several weeks after surgery.
Complications following facelift are rare. These include bleeding, infection, loss of skin behind the ears, facial nerve injury, discoloration of the skin, numbness, asymmetry and scarring. Infection is rare due to the large blood supply to the face. As mentioned, the risk of bleeding is greater if you take aspirin or blood thinners within 2 weeks of the surgery. The risk of wound complications increases in diabetics, persons with a history of radiation, autoimmune and collagen disease as well as in smokers.
By following pre- and post-operative instructions, you will minimize potential problems.
Recovery: What to Expect
In the weeks following surgery, the facial skin and area around the ear may be numb. There may also be some temporary discoloration as healing begins, which may take a few months to disappear. Occasionally, the facial nerve is bruised during surgery, resulting in temporary loss of function or sensation. However, actual permanent damage to the facial nerve is rare.
The healing process is gradual, so you will not notice final results for up to 6 months. A single procedure often achieves the desired results. Most patients who have had facelifts are pleased with their new, more youthful appearance.
Eyelid Surgery
Eyes are a prominent facial feature. It is the surrounding skin, rather than the eyes themselves, that conveys emotion. The tissue, muscle, fat, hair and lashes all contribute to the wide array of expressions. Age, sun exposure and hereditary factors all contribute to wrinkles, deep lines and puffiness around the eyes.
The aging process can cause unwanted changes in expression, causing us to look permanently fatigued and older than we really are. These changes in appearance can cause emotional distress and sometimes even visual impairment. An eyelid lift, or blepharoplasty, is designed to restore a more youthful appearance to your eyes. It may involve the upper lids, the lower lids, or both.
New and Traditional Techniques
Traditional Blepharoplasty: An incision is made in the crease of the upper lid toward the temples. Once healed, it is not noticeable when the eye is open. On the lower lid, the incision is made along the lash line toward the temples, and is hidden by lashes when healed.
The Transconjunctival Approach: This is a newer technique for lid blepharoplasty, involving an incision inside the lower lid. Fat can be removed through this incision, but excess skin cannot be eliminated.
Laser resurfacing of the eyelids is a non-surgical alternative that may delay the need for a surgical blepharoplasty. It results in significant tightening of the skin around the eyes, but will not effect the fat around the eyes and may even accentuate it.
Please ask your doctor if you have any questions about which procedure is right for you.
The Surgery
Local anesthesia is given around the eyes. An intravenous line is started so that sedation may also be given. During the procedure you will be awake but comfortable and relaxed. General anesthesia is rarely used.
This procedure is performed on an outpatient basis at our surgical center. It is important to arrange for care after the surgery. Someone must drive you home and be available to care for you for the first 24 hours.
Complications are unlikely when performed by a surgeon with experience in blepharoplasty. These include: bleeding and swelling, delayed wound healing, infection, drooping of eye upper or lower eyelid, asymmetry, double vision and dry eyes.
Recovery: What to Expect
The area surrounding the eyes will remain swollen in the days following the surgery. It should begin to subside after the first day. Some vision blurring is normal.
The stitches will be removed in 4-5 days. Swelling and bruising will persist for about 10 days, but you can begin wearing makeup to help conceal these concerns. You may expect to resume normal activity within a week to 10 days, and start enjoying your new look within approximately 10-14 days. It may take about 6 months for the scars to lose their redness.
Wrinkling will recur later in life, however it is unlikely that the “bags” will recur because the fat has been removed. Deeper wrinkles around the outer eye extended onto the temple are not greatly affected by the eyelid lift. These areas may be treated with laser resurfacing.
Endoscopic Brow Lift
Dr. Ayala performs brow and forehead lifts to raise eyebrows and reduce ridges and furrows on the forehead, thus creating a smoother, more youthful appearance. This procedure can be performed in conjunction with other surgeries.
An incision is generally made across the top of the head from the front of one ear to the front of the other ear. The forehead and brows are elevated and excess skin is removed. The flap is then sutured. Newer techniques now allow us to perform Forehead Lifting through small incisions in the scalp by using an endoscope and specialized instruments. This accelerates the healing process.
Post-Operative Information
Antibiotics may be prescribed for several days following surgery. Sutures are generally removed within one week. Swelling and some bruising may occur, which should subside within a few weeks. Our doctors will prescribe ice compresses and eye exercises to reduce swelling and regain mobility. Women will be allowed to use eye cosmetics up to two weeks after surgery. You can proceed with your normal daily activities within 1-2 weeks. A final evaluation may occur within several months from the initial surgical procedure.
Insurance
Your insurance company may pay for part or all of the cost of surgery if the procedure is performed as a result of visual impairment. Because every insurance carrier is different, it is recommended that you check with your own insurance company to determine the level of coverage.