Facelift Surgery

Facelift Surgery

A Facelift procedure or Rhytidectomy is intended to address the effects of aging in a patient's lower face, neck and jowls. As we age, the factors of time and gravity result in a loss of facial muscle tone and skin elasticity. The cheeks begin to sag creating jowls and distorting the jaw line. Loose skin appears in the neck, often referred to as a double chin or “turkey neck.” Deep creases between the nose and mouth or below your lower eyelid may form. Face lift surgery can “set back the clock” by rejuvenating the face, improving the most visible signs of aging by removing excess fat and skin, tightening underlying muscles, and redraping the skin of your face and neck, thereby restoring your more youthful facial contours.

Dr. Aharonov favors the “deep plane” technique also referred to as a the “SMAS Lift”. Unlike procedures that simply address sagging skin, the deep plane facelift repositions the deeper underlying tissue called the “SMAS layer.” Pulling this layer back to a more youthful state allows the redraped skin to sit naturally in its new position. As both the skin and underlying tissue are lifted together, the tightly pulled windswept look that can accompany a facelift done improperly is avoided. It also alleviates tension on the incision lines which minimizes visible scarring, although the incisions are well hidden within the hairline behind the temples and in the natural contours of the face and ear. A well done facelift scar should be practically imperceptible. In conjunction with a facelift, fat may be sculpted or redistributed from the face, jowls and neck. Skin is redraped over the uplifted contours and excess skin is trimmed away. Sutures or skin adhesives close the incisions. Dr. Aharonov uses the latest advances used by only a handful of surgeons which greatly minimize bruising and swelling, reduces the risk of hematoma (bleeding under the skin), and alleviates the need for drainage tubes. The overall effect is a more natural refreshed appearance than simply having tightened the skin.

During your consultation in his Beverly Hills office, Dr. Aharonov will evaluate your skin, muscle, bone structure, and other specific conditions that may have contributed to your aging appearance, and then tailor the procedure to your individual needs for the best result. A facelift, which primarily address the lower face and neck, is often combined with other facial cosmetic procedures such as a Brow Lift, Eyelid Lift Surgery (Blepharoplasty), Cheek Lift (midface Lift), Neck Lift or chin or neck liposuction in order to achieve your realistic goals. Additional procedures that may further enhance the outcome of a Facelift may  include: Facial implants or soft tissue augmentation to recontour your facial structure, and resurfacing techniques (such as peels) to improve the tone and texture of facial skin.  Wrinkle reduction by Botox or Dysport injection may be recommended prior to your facelift (to help underlying muscles fully relax before repositioning and tightening) or after your facelift surgery to help maintain results. Although a  facelift will not change your basic appearance or stop the aging process, it will restore a younger version that will then continue to age naturally over time.

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Facelift before and after photo. This patient had a facelift and her eyelids done. Click on picture for more pictures. This is about 6 weeks after surgery.

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Facelift Scar Healing

One of the keys to a natural looking facelift result is to avoid the usual surgical signs.  One of these signs is the surgical facelift scar.  The earlobe should never be affected by a good facelift.  It should not seem pulled or stretched in any way.  The scar should heal virtually invisibly and should be very difficult to detect even just a few weeks after surgery.  You should feel comfortable wearing your hair up in a pony tail without worrying about the surgical scar being visible. You will not need to worry about the incision at all when done properly.

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Facelift scar before and after photo. This is about 6 weeks after surgery.

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Facial Fat Grafting in Combination with a Facelift

To fully address the aging process during a facial rejuvenation procedure, fat grafting is sometimes performed in combination with a facelift to achieve a more natural youthful result. The aging process not only affects skin laxity and drooping, but there is a slow progressive loss of fat that occurs as we age.  This may affect different people in different ways.  Some people have more loss of volume around their eyes, temples, cheeks, or jaw.  Look no further than the difference between a child with full cheeks and volume around the eyes, compared to an elderly individual who looks gaunt and hollow.

Each person is treated uniquely in our Los Angeles area office.  Dr. Aharonov will address your individual needs to make sure you have the most natural result.  Fat grafting, when done properly, will last a lifetime, just as a properly done facelift should last a lifetime as well.  Fat is harvested from the lateral thigh area or lower abdomen, processed using advanced techniques to purify your fat, and then injected into your face just like a filler would be.  The extra fat is stored and can be used if needed at a later time just like a filler in the office. During your consultation in our Beverly Hills office you will have a chance to see many before and after photos of patients who had all different types of combinations of procedures.  You are unique, and your rejuvenative solution should be as well.

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Facelift and fat injections before and after photo. This patient had a facelift and fat injections done. Notice the fuller cheeks that is not possible with facelifting alone. Click on photo for more views. This is about 6 weeks after surgery.

View more before and after facelift surgery photos

Neck Lift Surgery

In most cases a Neck Lift is also necessary. A Neck Lift requires a small incision to be made under the chin in the skin’s natural crease. The muscles underneath the chin (platysmal bands) spread apart over time, giving the appearance of chords or bands beneath the skin. During neck lift surgery, these muscles are tightened and excess fat and skin is removed. In combination with a facelift, a Necklift is effective in helping to restore the jaw line and create a more youthful appearance.

If the patient’s cheeks are not sagging, a neck lift can be performed on its own. Submental (beneath the chin) liposuction can remove excess fat with excellent results. Platysmal bands can be tightened requiring only a small incision under the chin. If loose skin is  present, however, a combination Facelift and Neck lift is likely the best solution.

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Necklift before and after photo. This is about 6 weeks after surgery.

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Chin and Neck Liposuction (Submental Liposuction)

Chin and neck liposuction is a minimally invasive procedure done as an outpatient in our Beverly Hills surgery center. This can be combined with a Facelift, Neck Lift, or done alone. It is a relatively quick procedure without a prolonged recovery period. However, it can make a dramatic difference in your appearance, and is an ideal way to finally eliminate a double chin, despite diet and exercise. A small incision, about the size of a pea, is made in the crease beneath your chin, leaving a virtually invisible scar. When done alone, chin  liposuction (submental liposuction) is an affordable procedure with minimal downtime and impressive results for the ideal candidate.

Chin liposuction is done as an outpatient with local anesthesia and intravenous sedation administered by a physician anesthesiologist to minimize discomfort and maximize patient safety during the procedure. Following chin liposuction surgery, most patients have very little pain, as long acting local anesthetic is given during the procedure. You can return to work within several days after surgery. Initially, you will wear an elastic band under your chin to help minimize swelling, and allow your skin to shrink down to its new more compact contour. Bruising may last up to a week, but is variable between patients. Swelling may last weeks to a month before the final result is seen. There are steps you can take to help minimize the swelling, which Dr. Aharonov will discuss with you during your consultation. Patients from all over the Los Angeles California area are extremely pleased with the results of their chin liposuction procedure.

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Neck and chin liposuction before and after photo. This patient had a rhinoplasty as well as neck liposuction. This is about 6 weeks after surgery.

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Who is a Good Candidate for Face Lift Surgery?

Healthy nonsmokers who are unhappy with the appearance of their face and neck are good candidates for Facelift surgery. Anyone who feels that their outward facial appearance doesn't reflect their inner vitality and youth, and wants to improve the signs of facial aging are good candidates for a Facelift. The best candidates for a Facelift are those persons  with realistic expectations. A Facelift will refresh your appearance, eliminating sagging skin and muscles. It will make you look like a less tired, rejuvenated version of yourself, not like a young version of someone else.


Preparing for a Facelift: Preoperative Information

Dr. Aharonov will most likely ask you to see your primary physician for a physical exam and blood tests. Your medical history, including any medicines that you take should be discussed with Dr. Aharonov. You should stop taking aspirin or anti-inflammatory medicines such as Aleve, Motrin or Advil one week prior to surgery to minimize bleeding during surgery and bruising after your facelift surgery. A list of over the counter medications and supplements to avoid will be given to you during your preoperative consultation. You should avoid alcohol or salty foods for three days prior to surgery to decrease fluid retention and swelling. You should discuss all of the medicines that you are on with Dr. Aharonov. If necessary, you may take your essential medications with a tiny sip of water in the early morning on the day of your Facelift surgery.

Patients who smoke are advised to quit at least two weeks before surgery and after surgery. Smoking inhibits blood flow to the skin, and can interfere with the healing of your incisions. Not only can this lead to unsightly scar formation, but some of the skin and tissue may slough off due to inadequate blood supply. Therefore, it is extremely important to undergo a Facelift procedure only when you are ready to quit smoking.

Although your Face lift is being done as an outpatient in our Beverly Hills surgery center, you should arrange for someone to drive you home after your Facelift surgery, and to help you out for a day or two. Most patients hire a private duty nurse to care for them during the first few days after their Facelift.  If your hair is very short, you might want to let it grow out before your Facelift, so that it's long enough to hide the incisions while they heal.

It is also essential that you disclose any medical conditions such as glaucoma, dry eye, detached retina, thyroid disorders such as Graves’ disease, under-active or overactive thyroid, cardiovascular disease, high blood pressure, circulatory disorders, diabetes, blood clotting disorders, or a history of forming large scars also known as keloid scars.

You should be in the most optimal nutritional state prior to Facelift surgery. An adequate diet with certain vitamin supplements such as Vitamin C is recommended. Dr. Aharonov< can discuss nutritional supplements with you during your preoperative consult.

You will receive a recommended course of treatment based on your physical features, the feature you wish to have corrected, and your realistic goals for improvement. Dr. Aharonov will also answer your questions at that  time. Remember that by carefully following Dr. Aharonov's advice and instructions, both before and after your facelift, you can do your part to ensure the best possible outcome.

Anesthesia for a Face Lift or Neck Lift

Dr. Aharonov performs all facelift surgeries in an AAAHC accredited outpatient surgery center in Beverly Hills. Board certified anesthesiologists, which are medical doctors, perform all of his cases. Dr. Aharonov prefers to have a physician caring for your anesthetic needs during your facelift surgery, as their experience minimizes the potential of unpleasant postoperative side effects. For his surgical cases, Dr. Aharonov uses an extremely safe combination of iv sedation and local anesthetic, not general anesthesia. This technique provides superior operating conditions combined with maximal patient safety and comfort. In all likelihood, you will awaken with very little discomfort, nausea, or anesthetic side effects. In his Los Angeles  area surgery center, all of the appropriate monitoring, medication and emergency  equipment are available at all times. On the day of your Facelift, you will meet your anesthesiologist and can discuss any questions that you may have.

What to Expect After a Face Lift

After a Facelift procedure in our Beverly Hills surgery center, there will be some swelling and bruising in the face, head, neck, or even the eye or cheek area. This can take up to a couple of weeks to resolve, but individuals vary on their recovery time. Facial movements may initially be restricted due to swelling and your facial features may be distorted. Immediately post-op, you should use ice compresses to relieve the pain and swelling. Your head will be loosely wrapped for 3 to 4 days, which further helps to minimize swelling. Dr. Aharonov will want you to keep your head elevated after surgery until the swelling has subsided. You will be given a prescription for pain medicine and antibiotics, although most patients do not require much pain medicine after the first day or two. After 5 days, Dr. Aharonov will remove your sutures in his Beverly Hills office. Your scalp may take longer to heal, and the stitches or metal clips in your hairline could be left in a few days longer. Some numbness on the face is normal after a facelift, and will go away in a few weeks to a month.

In a small percentage of patients, some hair around the incision may fall out and may temporarily be a bit thinner. Normal hair growth will usually resume within a few weeks or months. Permanent hair loss is very rare. You will be able to shower and shampoo your hair within four days, or as soon as the bandage is removed. Your face will be tender, numb and swollen, so you will be given special instructions on how to wash your face and hair. Many patients are healed enough to go back to work after 2 to 3 weeks. At that time, you will be able to camouflage any bruising that remains with cosmetics.

Healing will continue for at least several weeks after your Facelift, as swelling resolves and incision lines continue to heal. You must be very diligent in applying sun protection until the healing process is fully complete. It may take several months for the swelling to fully dissipate. Scars will continue to fade for several months, and will eventually be imperceptible. Life long sun protection will help to maintain your rejuvenated appearance by minimizing photo-aging of the skin. In addition, a healthy lifestyle will also help extend the results of your rejuvenated, more youthful appearance. Our Los Angeles area patients find that the benefits of their Facelift are long lasting, even as they continue to age.

Activity Level After Facelift Surgery

Plan on taking it easy for the first week after your Facelift surgery, but you should be up and about in a day or two. A return to light, normal activity is usually possible within a few days after surgery. Avoid strenuous activity, including heavy housework for at least two weeks. Walking and mild stretching are fine. Avoid alcohol, steam baths, and saunas for several months. Above all, get plenty of rest and allow your body to spend its energy on healing.

For the most part, Facelift incisions are well healed within a week. You will be ready to return to work and light activity sometime between 2 to 3 weeks.

Risks of Facelift Surgery

As with any surgical procedure, there are risks involved. You and Dr. Aharonov will work together to minimize these risks and maximize your results. Follow your surgeon's instructions both before and after your Facelift surgery. Always be completely honest about your medical history and habits including smoking, alcohol or drug use. Be realistic as to your expected outcome.

Risks associated with a surgical facelift include infection, bleeding beneath the skin (hematoma), hair loss at the incisions, facial nerve injury with weakness, facial asymmetry, skin loss with scarring, numbness, and risks associated with anesthesia. These risks are rare, and when they do occur, are usually temporary. Any facial asymmetry may correct itself as the healing process progresses, and rarely is it noticeable enough to require surgical intervention. Both you and Dr. Aharonov can take steps to minimize scarring, and in the vast majority of patients, facelift scars are invisible. These and other potential risks and complications will be fully discussed prior to your consent.