Facelift (Rhytidectomy)

Contents

Philosophy
Facelift Anatomy
Good Candidates for a Facelift
Your Facial Rejuvenation Consultation
Computer Imaging for Facial Surgery
The Facelift
The Week After a Facelift
Preserving the Natural Contours of the Face
Facelift Techniques
Complementary Cosmetic Procedures

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Philosophy about Facelifts

Facial plastic surgery can make you look years younger by reducing the appearance of wrinkles and lines, sun damage, and skin laxity that can make you appear upset or tired. Dr. Bennett customizes the lift for each patient based on their individual needs to achieve a natural and long lasting result with techniques that allow patients to recover quickly. Dr. Bennett performs many different types of facelifts to maintain the unique beauty of every face.

As we age, muscles become loose and drop, pulling the skin with them. Dr. Bennett addresses the deeper tissue by going under the muscle and sliding it into its original youthful position. This technique results in less bruising and swelling since he lifts deeper beneath the muscle. Skin heals better because there is no tension on superficial layers. The face reclaims a very youthful and natural look. The skin is smoother, leaving the soft glow of a rejuvenated face. Scars disappear inside and behind the ear which allows wearing hair up after surgery. Most patients resume their normal routines within seven to ten days of surgery. Younger patients with less aging may need shorter lifts and have an even more rapid return to normal activity. Dr. Bennett uses the combination of vitamin C, arnica montana, and probiotics to expedite healing and keep the body in balance during recovery.

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Facelift Anatomy

Understanding the facial structures that have been changed by time and gravity can give insight into treatments that are effective. The key to a natural look is preserving normal anatomy. The major areas that are corrected by a facelift are addressed below.

Jowls are the tissue that settles on either side of the jaw line making the face look squared-off from the front. The lower cheek fat pads and facial muscles are constantly stretched and pulled downward. Repositioning the deeper structures of the lower face will return tissue to a more natural position and create a more pleasing rounded appearance.

Jowls - Before and After

Neck banding is caused by tightening of the neck muscles. This creates the vertical folds of tissue on either side of the neck. Bringing these bands together will form a smooth line under the chin.

Neck banding - Before and After

Skin laxity of the face, forehead and neck is corrected by repositioning the deeper facial structures and then removing extra skin. No tension is placed on the skin resulting in a rested but not operated on appearance.

Skin Laxity - Before and After

Submental liposis is caused by fat in the neck and under the chin and can be inherited from our family or may occur as we gain or lose weight and age. Removal of the fat followed by pulling the neck skin laterally will improve this area. Younger patients may benefit from liposuction of the fat alone.

Submental Liposis - Before and After

Midface sagging occurs when the soft tissue of the midface descends and flattens the cheek area creating folds of skin in the lateral face. Correction by lifting this tissue upward will make cheeks fuller and more youthful. Occasionally, cheek implants will also be used to add volume to this area.

Midface Sagging - Before and After

Nasolabial folds are the deep creases between the cheeks and the nose and mouth. They are formed when gravity pulls the cheek tissue down and toward the mouth. Bringing the deep tissue upward and backward will help smooth out this area. Fillers may also be used to soften the folds.

Nasolabial Folds - Before and After

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Good Candidates for a Facelift

Facial aging, lines and laxity can occur very rapidly in just a year or two. The youthful features we remember may be hidden by sagging of jowls or banding in the neck. Realistic expectations are very important with respect to what a facelift can do for you. The best candidates for rhytidectomy:

– Have one or more of the aging features shown above
– Are generally healthy
– Do not smoke
– May be men or women
– Have realistic expectations
– Would like to look as good as they feel
– Desire a facelift for themselves and not to please another person

Patients want facelifts for many different reasons. If you feel that the above describes you then you may be ready for a facelift.

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Your Facial Rejuvenation Consultation

Dr. Bennett individualizes every patient’s care. A minimum of an hour is needed to get a complete history and evaluation of your face and to fully understand your expectations. Knowing what to expect will make the entire experience more pleasant and increase your satisfaction with the surgical results. Dr. Bennett will discuss your facelift and other procedures in detail to make sure all of your questions are answered.

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Computer Imaging for Facial Surgery

Reviewing photographs of your face from several different angles gives you the opportunity say what you like or dislike about your features, and what you would like to change. Computer imaging gives an additional step where we can agree on a final goal for the procedure. Computer imaging is not a guarantee of outcome and individual results may vary.

Computer Imaging

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The Facelift

Knowing what to expect will make for a smoother and more enjoyable experience. The procedure is performed at Lenox Hill Hospital or at The Center for Specialty Care, an Upper East Side state of the art ambulatory surgical facility. You will arrive two hours before your case is scheduled and will speak to a nurse. Dr. Bennett will discuss your treatment and goals with you again before you receive any medications. You will then receive some medicine to relax you followed most times by a general anesthetic. When you awake several hours later from your procedure you will speak to Dr. Bennett again who will have already spoken to the person taking you home. You will leave the ambulatory center with your escort about an hour after surgery. Dr. Bennett’s techniques minimize the recovery period and allow most patients to return to a normal routine the week after surgery.

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The Week After a Facelift

A light pressure dressing is placed that Dr. Bennett will remove the next morning. Dr. Bennett spends extra time during the surgery to control bleeding so drains and the discomfort of their removal is not needed. You will spend the night in a local hotel with a sitter to take care of your needs and allow you to rest. You will be given some prescription pain medicine although most patients just have one dose and then switch to Tylenol. The neck feels very tight for a few weeks which is very good because there will be some relaxation of the neck in the first year. You may have bruising and swelling of the neck and lateral face that will start to resolve within a few days. Most swelling resolves in a couple of weeks but subtle changes in the face can continue for a year or more. You will return to the office at one week and then as needed to have your healing followed. It is important to avoid strenuous exercise for 3 weeks for best results.

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Preserving the Natural Contours of the Face

The key to a natural looking lift is a combination of well placed incisions and not placing tension on the skin. Incisions are hidden in naturally occurring creases. The incision is camouflaged behind the tragus and in the natural contours of the earlobe and helical root. The incision continues in the crease behind the ear and along the hairline. Skin is draped without tension to prevent a “pulled” look.

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Facelift Techniques

Facial rejuvenation should be individualized for every patient. Patients have different cosmetic concerns and show aging in different ways. Each facelift is customized and will contain the techniques needed to obtain the best results for you. Dr. Bennett employs many different surgical techniques to sculpt an attractive and natural appearing face with a rapid recovery. These concepts are the basis for an excellent long-term outcome. Addition of a chin implant or cosmetic filler may also be discussed to achieve additional improvement.

Deep-Plane Facelift

Incisions are hidden around the ear with precise placement and planning to preserve normal anatomy. The incision continues around the back of the ear and fades into the hairline. The deeper tissues of the face are repositioned and tightened. Excess skin is removed and the skin is draped without tension. The deeper structures are repositioned so the skin does not get that windblown look. Neck liposuction is often performed. A small incision may be hidden under the chin to tighten the neck muscles.

Short-Scar Facelift

This is a very similar procedure to a deep-plane facelift except that the incision behind the ear does not curve into the hairline. This is an ideal lift for patients with little neck laxity. Poorly chosen patients will have visible folds of skin behind the ears and in the lateral neck that may flatten out over time.

Endoscopic Facelift

The use of thin tubes containing high definition cameras allows smaller incisions to be made with minimal scarring. The improvement in the face is still dramatic. This technique will target problem areas especially under the neck or toward the nasolabial folds.

Skin Lift

Sometimes the facial structures are in good position and there is extra skin especially noticeable when lying down. Conservative removal of the skin can tighten these areas. This is a useful method for removing scarring from previous facelifts and can be performed in the office under local anesthesia.

Lunchtime Lift

The theory is that these can be done rapidly with very little downtime. They are performed using lasers that are touted to tighten the face or using barbed fishing line on needles to support the facial structures. Local anesthesia can be used for either. Both will cause some swelling and many times when the puffiness resolves so will the results. The strings can also cause dimpling of the skin and results are usually gone within two years. There is a trend away from these styles of “lift”. Although Dr. Bennett is certified in these methods he does not endorse them.

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Complementary Procedures

Adjunctive procedures may improve the results of a facelift but will certainly not be appropriate for all patients.

Rhinoplasty, especially with a nose that is drooping, can enhance a facelift. Facial features that are out of balance may seem more noticeable to patients after the rest of their face looks refreshed and rejuvenated.

Browlifts will open the eyes if the eyebrows are very heavy or blocking vision. This can be performed endoscopically with no visible scar or using incisions that allow extra forehead skin to be removed. There is a trend towards a fuller and heavier brow at this time and more conservative brow elevation if any is generally appropriate.

Temporal lifts raise the extra skin that hoods over the lateral side of each eye. The outside of the eyebrow becomes more elevated and the eyes appear healthier and more rested. The incisions are hidden behind the hairline.

Chin implants can give definition to the jaw line and will make the neck appear tighter. An additional benefit is that chin implants create the illusion that a nose is smaller.

Cheek implants can give definition to the upper face and elevate flattened cheekbones. They will also slightly tighten the skin lower and lateral to the eyes.

Eyelid tightening (upper or lower eyelid blepharoplasty) will remove the excess skin and fat that can block vision or make eyes appear tired or puffy.

Lasers will soften fine wrinkles around the mouth, eyes, or the entire face and can reverse sun damage. The fractionated CO2 laser gives great results and the skin looks refreshed in only a week.

Fillers like Restylane and Juvederm can plump the areas that have deeper folds. This can improve facelift results.

Botox Cosmetic will relax the superficial muscles and allow the skin to heal with less creasing. This can be performed at the time of surgery.

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