NYC Facelift

The New York City guide to facelift surgery

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What is a facelift?

A facelift, also referred to as a rhytidectomy, is a popular option for individuals who are bothered by the signs of facial aging. Wrinkles, deep lines, fine lines, and sagging skin are the result of aging and can be best corrected with facelift surgery. As we age, our skin becomes loose and redundant and the soft tissues fall and deflate. The neck and jawline tend to fall causing jowls, loose skin of the neck, plastysmal bands, “turkey neck,” and other unfavorable signs of aging. The midface also falls but at the same time loses volume or “deflates.” This leads to unfavorable signs of aging of the undereye, nasolabial folds, and marionette lines. A modern facelift acts to combat or reverse these changes by a combination of lifting, skin removal, and volume augmentation with fat grafting (autologous fat transfer). If done correctly, a facelift offers a youthful and refreshed look with the stigmata of an operated face.

What are the differences between a facelift, a mini facelift, a short scar facelift, and a necklift?

The terms facelift, mini facelift, short scar facelift, and necklift are often used by patients, the media, and even surgeons interchangeably. That being said, there are many similarities and some differences. In general, a facelift aims to rejuvenate the midface and lower face including the jawline while a necklift aims to rejuvenate the tissue that are loose and hang below the jawline. These two procedures are often done together and referred to as a facelift. The terms mini facelift and short scar facelift are sometimes used to describe a facelift where the scars are only in front of the ear as opposed to scar in front of the ear and behind the ear. As a patient, you should clarify with your surgeon the areas of concern and the areas that you wish to have treated.

Can I have my eyes or other areas treated at the same time as my facelift?

Absolutely. It is common to address other areas of the face at that time of a facelift. In the same operation, other areas of the face can be safely addressed including brows, upper eyes (upper blepharoplasty), lower eyes (lower blepharoplasty), upper lip shortening (lip lift), and autologous fat transfer (fat grafting). A comprehensive facial analysis should be performed in your initial consultation.

Do I need a deep plane facelift or a SMAS facelift?

As a patient, I do not think you should concern yourself with any particular technique that a surgeon uses or advertises. Every patient starts with different anatomy and each technique has pros and cons. There has never been a scientific study to support one technique over another. You should choose a surgeon that you trust and who understands your goals. A modern facelift gently elevates the skin to tighten the tissues underneath (the SMAS) in one of several potential ways (deep plane, SMAS flap, SMASectomy, SMAS plication). The skin is then gently put back down and the excess is removed. This helps to keep tension off the skin and avoid the windswept look of the 1980s and 1990s. I only bring this up to highlight that the modern facelift is more about the surgeon than the named technique.

Am I a candidate for a facelift?

Individuals who are interested in a facelift should be in good health and be fit for elective surgery. Patients should avoid smoking and nicotine-containing products that can affect blood flow and, ultimately, healing. Similarly, patients should avoid intranasal drugs before surgery, during recovery, and after a facelift. In addition to the general health risks of smoking and intranasal drugs, both increase the risk of complications and risk poor healing and tissue loss. In addition, patients with elevated blood pressure deserve special attention preoperatively, intraoperatively, and in the early postoperative period as elevated blood pressure is a risk factor for a hematoma (blood under the skin).

Can I have a facelift in my 40s?

Absolutely. There is no age requirement for this operation. While most patients who undergo facelifts are in their 50s, 60s, and 70s, some patients are genetically predisposed to show the signs of facial aging earlier than others. This is especially true in patients with lower BMI or those who have lost a significant amount of weight. Undergoing a facelift in your 40s while you are healthy can have many aesthetic benefits and does not preclude you from another facelift (or 2) down the road.

How long is a facelift surgery?

A facelift, depending on the complexity, takes between 3 and 4 hours. Additional operative time may be needed for revision cases or when adjunct procedures are being performed. The total operative time may be longer when accounting for anesthesia time at the beginning and the end of the procedure.

What should I expect the first week after a facelift?

A facelift is not a particularly painful procedure. You will have discomfort for several days. You will be swollen and may have bruising. Many surgeons place a headwrap at the time of surgery to assist with compression. This headwrap is usually removed in 1-2 days. It is important that blood pressure is controlled before surgery, during surgery, and after surgery as elevated blood pressure is a risk factor for a hematoma (blood under the facelift skin). Patients usually have sutures that are removed in 5-7 days. The most common complaint during the first week of recovery is that the patient feels like their neck is tight when they move their head side to side. This sensation is generally not very bothersome and tends to get better in the first few weeks after surgery.

What are my limitations after a facelift?

All surgeons have slightly different protocols so each patient should follow their surgeon’s protocols. In general, facelifts should be treated similar to other major surgeries with the avoidance of strenuous activity and exercise for the first 4-6 weeks after surgery. Patients should avoid ranging their neck aggressively during this time as well. Patients should elevate their heads as much as possible to help with the swelling. Patients should sit up while watching TV and use several pillows at night when they sleep.

How long will I be swollen after a facelift?

I tell my patients that they will be bruised and swollen for the first week after surgery. They will be swollen for the 2nd week after surgery, and at the 3rd week, they will still be swollen but they may actually like extra volume as the swelling subsides. Between the 3rd and 4th week a patient will likely feel comfortable enough to be seen at their favorite restaurant. The final result is typically appreciated after 3 months.

How much does a facelift in NYC cost?

There are 3 main costs of a facelift surgery: the facility fee, the anesthesia fee, and the surgeon's fee. Many surgeons also require one night in a hotel with a visiting nurse which adds an extra cost. For the patient, the average total cost in NYC for a facelift will likely be $15,000-$30,000+ depending on the surgeon you choose and if you undergo any additional procedures at the time of your facelift.

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