Patients in the Cherry Hill, New Jersey, and the greater Philadelphia area seeking a consultation for the facelift procedure are concerned about the aging of the lower face. The issues associated with this include sagging cheeks, jowls, and deepened facial folds and wrinkles, as well as excess neck fat and skin.
The onset, degree, and sequence of aging will vary based upon multiple factors. Both intrinsic (related to your body) and extrinsic (related to the world around you) factors contribute to aging. Intrinsic factors include loss of facial fullness, decreased skin elasticity and tightness, and loss of facial bone density. Major extrinsic forces include gravity, hormonal imbalances, diet, smoking, daily stress, and chronic sun exposure. All of these factors in combination allow the face to display the undesirable signs of age.
One must realize that like an individual’s fingerprint, each patient’s face is unique. Therefore, each face provides a unique set of aging issues. In your pre-operative facial consultation, the board-certified plastic surgeon will take the time to personally address your facial aging and formulate a unique plan to restore your youthful appearance.
Historically, facelifts encompassed only “skin-pulling” procedures. Dr. Corrado will employ state-of-the-art techniques to rejuvenate the face. He will not only address the sagging skin but also the deeper facial structures affected by gravity.
By dealing with the descent of the deeper facial structures in addition to the sagging and excess skin, a more natural and lasting result is achieved. This technique allows for extremely natural-appearing results, preventing the classic “windswept” look. Via well-hidden incisions, the surgeon will seek to “turn back the clock” by improving the most visible signs of aging, removing excess fat, tightening the deep facial structures, and tightening the skin of your face and neck; this makes you look and feel more youthful, confident, and fresh.
In an effort to restore facial beauty, other surgical procedures may be performed at the same time as the facelift. These may include forehead/browlift, blepharoplasty (eye tuck), midface lift, facial fat grafting, chemical peel, or laser resurfacing.
Dr. Anthony Corrado Discusses Facelift
Facelift Procedure Facts
To correct sagging cheeks, jowls, deep facial wrinkles, and excess neck fat and skin.
The procedure is performed through carefully placed incisions, allowing the incisions to be well camouflaged. Sagging deep facial structures and skin are tightened. Sagging neck skin and fat are contoured, allowing for a more youthful appearance.
The procedure is performed under oral or IV sedation. General anesthesia is also available at the request of the patient.
Length of Time:
The procedure lasts between 2-3 hours depending on the patient’s rejuvenation needs. Procedures such as forehead/browlift, blepharoplasty (eye tuck), chemical peel, laser skin resurfacing, or facial fat grafting may be added to complement the patient’s lift. All procedures are performed in a fully accredited outpatient surgery center.
After the Procedure:
All patients are sent home the night after surgery and are given a set of post-procedure instructions to follow. Overnight stay at the surgical facility can be provided for the patient at an additional cost if the patient so desires. The patient will follow up the next day for a post-procedure check, and again on the seventh post-procedure day for removal of stitches.
Most patients can return to work in a week. Patients are asked to refrain from physical exertion for a period of two weeks. Swelling and bruising usually resolve by 2-3 weeks. An elastic compression garment may be worn around the lower face and neck for approximately one week. Stiffness in the neck and some soreness are common.
Although a narcotic pain medication is prescribed, many patients report only using it for the first 24 hours, after which Tylenol or no pain medications are needed. (It should be noted that individual recovery time and pain thresholds may vary depending on the patient.)
What is a facelift?
Also known as a rhytidectomy, this surgical procedure seeks to target aging in the lower face and neck area. As we age, the effects of gravity have dramatic consequences for our appearance. The common areas of facial aging are the cheeks, lower face, and jawline, as well as the neck.
Descent of the midface causes accentuation of facial lines and wrinkles. The nasolabial folds, lines which extend down the face from the corner of the nose, are deepened. The marionette lines which extend down from the corner of the mouth are also worsened with gravity and age. The skin along the jawline also sags, causing jowling to occur. Lastly, skin and muscles in the neck also become lax, creating the “turkey neck” appearance. During this surgery, all of these problematic areas are targeted.
How is it performed?
The operation is performed through a planned incision carefully placed in front of and behind the ear. Placement of the incision is critical. The incision follows the natural curves in front of and behind the ear, allowing it to be well camouflaged and not readily visible once healed.
Through this incision, the deep structure of the face, including the SMAS layer, is treated. The key to a successful procedure is to tighten the deep structures – the SMAS – in addition to tightening the skin. This allows the results to be long lasting.
If neck laxity and muscle banding are present, a small incision is made under the chin, and the neck muscles are tightened. Once the SMAS and neck muscles are tightened, areas of excess skin are also removed and tightened.
Finally, the incisions are delicately sutured to allow for the best possible healing. A light dressing is then placed on the cheeks and neck to allow for gentle compression in these areas. This dressing will be removed the following day during your first post-operative visit.
How long does it take to perform this procedure?
Generally, it takes about 2-3 hours to perform. In cases such as a mini facelift, the operating time may be as short as 1 ½ hours, while in more difficult cases, operating times may be extended. Many times, additional procedures are performed in conjunction with the procedure. Commonly performed procedures include blepharoplasty, browlift, facial fat grafting, laser skin resurfacing, and chemical peels.
Where is the facelift performed?
It can be performed in a hospital or outpatient surgery center. In either case, patients are sent home the night after surgery. There is usually no need for an overnight stay in the hospital following surgery.
What type of anesthesia is used for it?
Typically in my practice, IV sedation is the preferred anesthesia. This type of anesthesia provides patients the most comfort during their procedure and allows for less anesthetic side effects in the immediate recovery period. Smaller mini facelifts can also be performed under local anesthesia in the right patient. Some patients will require general anesthesia; this is a decision made by their primary physician and anesthesiologist based on their medical history.
Who is a good candidate for this procedure?
A good candidate is any healthy female or male who is starting to become self-conscious about their facial aging, and who desires rejuvenation of the lower face and neck. During your consultation, a detailed medical and surgical history will be taken. A careful physical examination will also be performed. Social habits, as well as goals and expectations, are also discussed. Following evaluation of “the whole patient,” a final decision is made regarding a patient’s candidacy for the operation.
What are the realistic expectations for a patient having a rhytidectomy?
In my practice, our surgical philosophy is to strive for natural-appearing results. I do not like an overdone or overly “surgerized” look. I want my patients to appear well rested and refreshed. Specifically for this operation, I seek to allow the patient to appear more rejuvenated without the tell-tale signs of a facelift, such as the overly pulled or “windswept” appearance seen in some cases.
How long is the recovery?
Generally, the initial healing process takes 7-10 days. During the first 7-10 days, a majority of the swelling and bruising subsides. A majority of the sutures are removed at 7 days after surgery, with the rest being removed at 10 days after surgery. Most patients return to work at about 10-14 days after their procedure and begin exercise at 3 weeks post-op.
Will I have noticeable scars afterwards?
One of my main goals in performing your surgery is to allow you to heal without noticeable scars. There are two ways that this goal is achieved.
First, proper placement of the incisions is a must! Care is taken to place the incisions in specific locations that follow the gentle curves of the ear, making the incisions less conspicuous post-operatively. I use a post-tragal, which helps to further hide the incision, instead of the traditional incision, which is placed completely in from the ear.
Second, I take much care not to close the skin incision under tension. By addressing and tightening the SMAS layer first, I am able to close the skin incisions with virtually no tension on them. Without tension, incisions heal extremely well without scarring. Tell-tale signs of this surgery are wide, thickened scars, which are a result of closing the incisions under tension.
Will I be in much pain after my rhytidectomy?
Most patients only require a mild prescription pain reliever the first 24-48 hours after surgery.
Are the results permanent?
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 skin care regimen, avoiding the sun, not smoking, and maintaining an overall healthy life.
Which structures are “tightened” with this operation?
The modern-day version of this procedure 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 results with regard to neck rejuvenation. The platysma muscle is tightened both centrally, under the chin, as well as laterally to achieve a firmer neck line.
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.
What kinds of incisions are necessary?
Incisions consist of both the “pre” and “post” tragal approaches. The tragus is the small triangular structure that sits in front of the ear canal. It is a cartilage structure covered with skin.
Traditional incisions typically employed the pre-tragal approach, an incision placed in front of the tragus, leaving a noticeable vertical scar. Today, more physicians employ the post-tragal approach, which allows the incision in front of the ear to be broken up and hidden behind the tragus. The remaining incisions, which occur in front of the ear in this approach, are fashioned to follow the gentle curves of the ear. This allows the incision to be much less noticeable post-operatively.
The remaining incisions are placed behind the ear in the post-auricular crease and then extending along the natural hairline. Incisions in this area do not cross into the hairline, preventing a noticeable “stepoff” along the hairline, a telltale giveaway for a rhytidectomy. Sometimes, a hairline incision may not be necessary and the incision can end in the post-auricular crease, as seen in popular procedures such as the mini facelift and S Lift.
What can I do if I have noticeable scars from a prior rhytidectomy?
“Hypertrophic scars” refers to wide, thick, and raised scars along the incision lines. Many times, these scars occur because the incisions are not sutured properly or the incision sutures are placed under a lot of tension. Multiple treatments exist to correct this type of scarring, and the treatment choice usually depends on the extent of the problem.
Minor thickened scars can many times be treated with steroid injections, which allow the scars to gently smooth and fade. For more moderate scars, laser resurfacing can be used. Fractionated CO2 laser resurfacing provides a means to smooth out thick, raised incisional scars. For major scarring, many times surgical treatment is necessary. Surgical treatment involves removal of the thickened scar tissue and repeat suturing of the incision site.
What types of rhytidectomy procedures are good for my age?
Many times, patients ask “what is the right age to have this procedure?” Ultimately, there is no right answer. I suggest to patients to entertain the possibility of having this surgery when they are unhappy with what they see in the mirror.
That being said, one must have realistic expectations of facial beauty and understand that facial aging is unfortunately a natural part of life. Although we perhaps cannot look like a teenager again, this operation can provide a means to turn the clock back by about ten years.
The purpose of a rhytidectomy is to provide rejuvenation to the lower third of the face, specifically the neck and jawline.
Different techniques exist based on age and, more importantly, the degree of aging present. Beginning with patients in the early 40s, it is common to have complaints about mild sagging of the neck skin and the early formation of “jowls. These patients are usually excellent candidates for a mini lift.
A mini lift will provide patients with rejuvenation of these problematic areas with a shorter recovery and usually at a lower cost than a traditional rhytidectomy procedure. Those in their 50s and beyond may complain of marked jowling and sagging of the neck.
Why do I need to quit smoking before the surgery?
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, 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.
How do I get rid of my “turkey neck”?
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, this operation 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,” similar to 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 this problem, a necklift procedure 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.
How can I get rid of my “double chin”?
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 to the lower face and neck.
These fatty deposits can be corrected during a lift 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. After fat removal, the skin is able to redrape in the neck, resulting in a more slender neckline.
How long does it take for all of the swelling to subside afterwards?
Every patient’s body is different. 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 Montana prior to their procedure. Dr. Corrado finds that this helps to minimize post-operative bruising and swelling.
How long will it take for the bruising to go away?
All patients’ bodies are different, and all patients tend to heal at different rates. Generally, bruising can take approximately two weeks to resolve. Patients differ in regard to 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 discuss with you which medication to avoid at the time of your consultation.
Patients are suggested to begin Arnica Montana supplements prior to surgery to help reduce swelling. Patients are instructed to apply Arnica Montana to areas of facial bruising in the post-operative period to help speed up its resolution. Cold pack therapy in the immediate pre-operative period will also help. Dr. Corrado will provide thorough instructions for your care after your procedure.
Will this operation correct my jowls?
The best procedure for correction of jowls is a lower facelift. This targets sagging skin and muscle along the jawline and neck. Jowls are formed due to descent of sagging tissue in the face along the jawline.
During this operation, these areas are addressed by tightening and removing excess tissue and skin. The SMAS layer is addressed first. SMAS plication, placing sutures in the SMAS to tighten, is performed first. This portion of the procedure provides a firm and refined facial foundation onto which the skin can be redraped. The skin is redraped onto the new facial foundation. The skin is then tightened and areas of excess skin are removed. This leads to a refined jawline and a more youthful profile.
What will my activity level be like afterwards?
Dr. Corrado has his patients refrain from all strenuous activity for three 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.
Why do some patients look like their faces are pulled too tight or look “windblown”?
My practice philosophy is to provide my patients a natural-appearing result. A patient should not immediately be asked by a friend or relative if they had a lift. Instead, my patients commonly say that they are asked if they changed their hairstyle, if they lost weight, or that they look so well rested. These are the compliments given to a good rhytidectomy result.
A person whose face looks overly pulled is not satisfactory. This 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 pull back. 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.
Does the procedure correct wrinkles?
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 decreased. Many patients come in for the procedure, and in addition to complaints of facial and neck laxity, they also complain of fine lines and wrinkles. They seek a way to improve skin quality, in addition to correcting the effects of gravity.
The main purpose of this operation 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. Although this is the case, 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.
If I have had a rhytidectomy from another surgeon and I am not happy, can I have a revision?
Yes, Dr. Corrado has much expertise in revision rhytidectomy surgery and has helped many patients achieve the look they were hoping for. Dr. Corrado routinely consults with patients who have had prior procedures and are not happy with their results. He routinely performs revisions in order to correct complications from prior procedures, or for patients who have continued to age and require another rhytidectomy.
This revision surgery requires the expertise of a facial surgeon who has performed many of these procedures and is knowledgeable of the nuances associated with revisional surgery. Dr. Corrado routinely suggests that patients wait for a least one year after their initial surgery before having a revision. The face takes a full year to fully heal after the procedure, and the true results cannot be evaluated until complete healing has taken place.
Can I have more than one rhytidectomy in my life?
It is not uncommon for some patients to have two, or even three of these 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.
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: