The major surgical plan is done well before surgery, with the help of you, the patient. A facelift is done in an operating room setting, either under sedation or general anesthesia. After surgery, you will need help recovering, either with a nurse or with the help of a loved one, so that you will get the best results with the quickest healing possible.
There are several choices to make, including
– placement of incisions
– how to tighten the SMAS
– how to close the incisions
Placement of the incisions generally include an incision made in front of the ear. The bigger choices include whether to follow the curve of the ear or not, as well as how high the incision goes and how far behind the ear the incision goes.
If possible, I try to follow the curvature of the front of the ear, because the scar is very difficult to see. If just a straight line incision is made, that is a little unnatural, and is more visible. The front of your ear is not a straight line, but rather, has several curves.
How high the incision is depends on if you need a forehead lift or not, or whether you need a separate eyebrow/ temporal brow lift. Women typically can get a higher incision than a man, because women have higher sideburns than a man.
If you have alot of neck skin, then the incision behind the ear may need to be longer. If you have less loose neck skin, then the incision behind the ear is more limited.
Once the skin is lifted, then the SMAS is tightened. This tightening will shape your face and eliminate the jowls and loose areas on your face. The SMAS is also what gives the facelift longevity. Just tightening the skin will look good short-term, but will not last that long.
The SMAS (superficial musculo-aponeurotic system) is the clear material that is the supporting framework, or fascia, of the facial muscles. Some surgeons believe you should cut it and tighten it, whereas other surgeons believe that tightening it by imbrication, or folding it onto itself, will give a longer lasting result. There are more subtleties to this difference, but generally, the more maneuvers done to the SMAS, the more swelling you will have afterwards. The SMAS is what gives a facelift the longest lasting overall result, and the amount of laxity is very individual. You should carefully discuss with your plastic surgeon what method is best for you.
The way the incision is closed also affects your overall result. The wind-swept tunnel look has given way to a more vertical or natural look. You should look like yourself, just more rejuvenated. Too much pull to the side of the face makes you look more unnatural. Also, the skin closure should be snug, but not too tight. A very tight closure will result in possible widening of the surgical closure and unsightly scarring long-term.
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