Facelift in Philadelphia

A person whose face looks overly pulled does not represent a satisfactory result. This undesirable look is many times caused by the direction the skin is tightened during the surgery. By pulling the skin directly back on a horizontal plane, an unnatural result is attained.

The facelift procedure is used to combat gravity. Gravity pulls everything downward; therefore, the proper direction for facial tightening is mainly upwards, with a slight pullback. By using this vector of tightening, the lower facial structures are repositioned to a more youthful level. Such results lead to natural beauty for our patients.

It is not uncommon for patients to have two, or even three of facelifts in their lifetime. As life expectancies continue to increase, more and more patients are visiting the practice seeking to look younger even into their elder years. Many patients begin with a mini facelift in their mid-to-late 40s and return 5-10 years later for a traditional lift in order to look youthful well into their 70s.

Age is not a discriminating factor for surgery. Instead, a patient’s health status is most important. Regardless of age, all patients go through pre-operative screening to evaluate their eligibility to undergo surgery. Many elder patients are in great health and are cleared to have facial rejuvenation procedures and surgery.

The procedure typically takes between 2-6 hours depending on the complexity of the case and if other procedures such as forehead/browlift, blepharoplasty (eye tuck), facial liposuction, chemical peel, laser skin resurfacing, or facial fat grafting are added to further complement the patient’s facelift results. All procedures are performed in a fully accredited outpatient surgery center or hospital.  Procedures which are referred to as “lunchtime lifts” which are many times advertised to take less than an hour result in inferior results, with short-lived improvement.  We never cut corners when it comes to our patients’ faces and take the required time to provide the best results.

The modern-day rhytidectomy involves a “two-layer” approach to facial tightening by addressing the deep and superficial tissue layers. These tissue layers include the SMAS, platysma muscle, and skin.

The SMAS is a connective tissue layer that covers the muscles of the face. The SMAS is one of the most important areas to be addressed in order to achieve long-lasting results. Tightening of the SMAS layer is a key step for a good rhytidectomy.

The platysma is a thin muscle that covers the neck. This area is crucial to achieving good neck rejuvenation. The platysma muscle is tightened both centrally, under the chin, as well as laterally to achieve a firmer neckline.

Once the deep layers of the face and neck have been addressed, the surgeon’s attention is then directed towards the skin. Conservative tightening of the facial and neck skin is carried out to provide a natural look. Overly tightening the facial skin can lead to a “windblown” appearance, which is very unattractive and unnatural.

In an effort to restore facial beauty, other facial procedures may be performed at the same time as the rhytidectomy. These may include the following procedures:

• Forehead/Brow Lift
• Blepharoplasty (Eye Tuck)
• Chin Augmentation
• Neck Liposuction
• Facial Fat Grafting
• Chemical Peel
• Laser Resurfacing

Smoking and all nicotine-containing products will have adverse effects on wound healing. Patients who smoke, use smokeless tobacco, or utilize any nicotine-containing products such as nicotine gum will need to stop before their procedure.

Smoking will cause delays in wound healing, wound breakdown, possible skin death (necrosis), and increased risk of infection and scarring. Typically, patients are asked to refrain from nicotine one month prior to their procedure and remain nicotine free for one month after. Many patients find this to be a great excuse to break their habit, with many patients telling the practice that they have quit for good. It should also be noted that patients should remove themselves from environments with “secondhand smoke,” as this can cause similar problems.

A “turkey neck” deformity usually refers to laxity in the neck region under the chin. Most commonly, this laxity is due to sagging skin or muscle. As we age, our skin loses its elasticity and does not sit as tightly on our neck.

Many times, excess skin alone is what causes the “turkey neck.” In this instance, a facelift will help to remove excess skin and redrape the skin in a tighter position on the neck. If thick bands are present as well, then laxity of the platysma muscle exists. This muscle is present on both sides of the neck and meets in the middle under one’s chin to form a “seam,” like what we see on a pair of pants. As this “seam” separates with aging, the free ends of the platysma muscle become much more visible. Noticeable platysmal bands are seen under the chin.

In order to correct neck banding, a necklift procedure referred to as a platysmaplasty, is performed in conjunction with the rhytidectomy. During this procedure, the free ends of the platysma muscle are brought together and the “seam” is recreated with sutures. After suturing the platysma muscles back together, a tighter, more youthful neckline is achieved. Dr. Corrado will examine your face carefully in consultation to choose which procedures are right for you.

Many patients complain of excess sagging and fullness in the neck area under their chin. Commonly, this fullness is referred to by patients as their “second chin”. It is not uncommon for excess fatty deposits to be present in the submental area, which results in a heavy appearance of the lower face and neck.

These fatty deposits can be corrected during a facelift with liposuction. A small incision no longer than a half inch is made in the crease under the chin, and a small suction cannula is used to gently suction out the excess fat.

The best procedure for correction of jowls is a lower facelift.  Jowls are formed due to descent of sagging tissue in the face along the jawline. 

During a rhytidectomy in Philadelphia, the jowls are addressed by tightening and removing excess tissue and skin. The SMAS layer is addressed first. SMAS plication involves placing sutures in the SMAS to tighten it. This portion of the procedure provides a firm and refined facial foundation onto which the skin can be redraped. The skin is then tightened and areas of excess skin are removed. This leads to a refined jawline and a more youthful profile.

As we age, our skin loses its elastic properties. With decreases in facial collagen and elastin, two key components to youthful skin, the skin begins to sag and overall skin quality is worsened. 

The main purpose of a facelift is to “lift” and remove sagging skin along the face and neck. It is a procedure used to combat the effects of gravity. Because the facial skin is tightened, as a result facial wrinkles do appear to be improved as well. This operation is NOT the procedure needed to combat wrinkles. Instead, other procedures exist to eliminate wrinkles.

Deep static wrinkles on the face require fillers to smooth out deep crevices. Juvederm, Restylane, and facial fat grafting are three procedures which are effective in eliminating deep facial wrinkles. Fine lines and wrinkles are best treated with either laser resurfacing or chemical peels. Both procedures help to eliminate wrinkles, improve overall skin quality and complexion, and provide a mild degree of skin tightening.

Lastly, wrinkles caused by muscle overactivity are best treated with Botox. Facial wrinkles in the regions of the crow’s feet, forehead, and “11″ lines between the eyebrows can be eliminated with Botox®.

Most patients only require a mild prescription pain reliever the first 24-48 hours after surgery. After this time, most patients require no pain medications at all. For those that do require relief after the first 24-48 hours after surgery, Tylenol typically is more than sufficient.

All patients’ bodies are different, and all patients tend to heal at different rates. Generally, bruising can take approximately 2-3 weeks to resolve. Patients differ regarding the degree of bruising they display. At no point after the procedure should the face be completely covered with bruising, as this can be a sign of a complication such as a hematoma.

Many steps are taken to limit excess bleeding in surgery and subsequent post-operative bruising and swelling. Patients are given an extensive list of all prescription and over-the-counter medications that have blood-thinning properties. There is also an extensive list of herbal and vitamin supplements that need to be avoided because of similar effects. Such medications are usually stopped for two weeks prior to surgery and for up to two weeks after surgery. Dr. Corrado will tell you which medications to avoid at the time of your pre-surgical consultation.

Our office will also provide patients a supplement to take prior to surgery called Arnica Forte. Arnika Forte consists of a combination of Arnica Montana and Bromelain, which have been shown to speed healing allowing for faster recovery from bruising and swelling.

Every patient is unique. Therefore, all patients’ recovery periods differ slightly as well. As a general estimate, at 3-4 months after the surgery, 80-90% of the swelling should be resolved. You should not appear to have facial swelling to others that see you. Patients themselves look at their faces regularly and therefore will pick up on small changes in their facial appearance, such as residual swelling. Patients will continue to see subtle changes in the mirror each day of the recovery period.

I tell patients that generally by 6 months after surgery, all swelling should be gone. We suggest to all our rhytidectomy patients to begin herbal therapy with Arnica Forte prior to their procedure. Dr. Corrado finds that this helps to minimize post-operative swelling.

Cold pack therapy in the immediate pre-operative period will also help. Dr. Corrado will provide thorough instructions for your care after your procedure.

Dr. Corrado has his patients refrain from all strenuous activity for 3-4 weeks after surgery. Strenuous activity refers to heavy lifting, aerobic exercise, and strength training, as well as all other activities which may raise a patient’s heart rate. By partaking in such activities immediately after surgery, a patient would put themselves at high risk of complications such as bleeding, hematoma, and delayed wound healing.

Dr. Corrado does want his patients to partake in light activity, as lying in bed all day will not help one’s healing or raise a recovering patient’s spirits. For the first three weeks after the procedure, patients may take short walks, as long as they keep themselves protected from the sun and do not exert themselves. At the three-week follow-up appointment, Dr. Corrado will assess a patient’s healing and typically clear them for participation in their normal activities.

Unfortunately, there is no "fountain of youth" and no way to completely halt the aging process. Your face will continue to age following the operation. It will, however, help to "turn the clock back" and allow you to look younger. Most patients say they look 10 years younger following this operation. A patient can prolong the results of their procedure by using a proper skincare regimen, avoiding the sun, not smoking, and maintaining an overall healthy lifestyle.