At Alexander Cosmetic Surgery in San Diego, facelift is our specialty. The procedure that keeps your face looking younger and vibrant, and we’ve refined our skills to achieve a more natural result. Your friends may not even be able to tell that you had facelift surgery!
As San Diego’s leaders in facial plastic surgery, Dr. Alexander and Dr. Alexander II have a reputation for meticulous attention to detail, quick healing times, and most important, natural results. As leaders in facial rejuvenation, we have performed more facelifts than any other plastic surgeons in San Diego.
Alexander Cosmetic Surgery also is able to perform neck lift surgery. Each person is different, and sometimes your neck can show age even before your face with loose muscles and skin – causing the “turkey waddle” or neck “bands.” A neck lift can enhance the appearance of your neck making the skin and muscles tighter. A neck lift is often performed as part of a facelift procedure using minimally invasive surgery techniques.
- 1 Before and After Photos
- 2 Understanding the San Diego Facelift and Neck Lift Procedure
- 3 Before You Decide…
- 4 The Facelift and Neck Lift Procedure
- 5 Recovery
Before and After Photos
Understanding the San Diego Facelift and Neck Lift Procedure
Facelifts and other facial rejuvenation techniques have been around for over a hundred years. Over this time period, procedures have become more advanced, offering more and more options to those who want to look younger and more vibrant as they age.
If you are bothered by the signs of aging in your face, a facelift may be right for you. Also called rhytidectomy (rye-tid-ek-tuh-mee), a facelift is a surgical procedure to improve visible signs of aging in the face and neck, such as:
- Sagging in the cheek (midface)
- Deep creases below the lower eyelids (tear trough)
- Deep creases along the nose extending to the corner of the mouth (nasolabial folds)
- Fat that has fallen or is displaced that creates jowls along the jaw line
- Loss of muscle tone in the lower face that creates jowls
- Loose skin and excess fatty deposits under the chin and jaw that can make even a person of normal weight appear to have a double chin
A facelift in San Diego doesn’t stop the aging process but will “turn back the clock” on your face and age. Once healed, the face continues to age at a normal pace. If you look ten years younger after a facelift, it will take about ten years or more for your face to return to the preoperative condition.
Procedures often performed in conjunction with a facelift to further rejuvenate the face are a brow lift, to correct a sagging or deeply furrowed brow, an eyelid lift to rejuvenate aging eyes, and chemical or laser peels to smooth sun-damaged skin.
A San Diego facelift can only be performed surgically; non-surgical rejuvenation treatments, such as peels or fillers, are unable to achieve the same results. However, they may help postpone the time at which a facelift becomes appropriate. Thread lifts, also known as feather lifts and contour lifts, have proven to be very ineffective because no skin is removed. These procedures have not stood the test of time and have essentially been abandoned.
Before You Decide…
Choosing Your Surgeon
Several important factors should be considered when choosing a surgeon, including the doctor’s personality, recommendations from friends, physician training and board certification, and experience.
Personality: It is important to develop a good relationship with your surgeon so that communication is easy and trust can be developed. You should feel intuitively that you are in good hands. Bedside manner is important.
Referral from Friends: Many prospective patients find confidence if they have a close friend or other trusted individual who has already undergone a successful procedure by a certain doctor. This is often a good first step in making a decision. In fact, most of our patients are referred to us by a friend who was very satisfied with their results.
Training and Certification: In years past, only plastic surgeons performed facelifts. However, in recent years doctors from many different specialties are more commonly performing cosmetic surgery procedures, including ear, nose, and throat doctors (also known as otolaryngologists and facial plastic surgeons), dermatologists, ophthalmologists, and gynecologists. However, only a surgeon who has been certified by the American Board of Plastic Surgery has received the necessary training to perform cosmetic surgery. There are many boards, and it is easy for patients to become confused or assume that when a doctor says they are “board certified,” it all means the same thing. BE CAREFUL!
Experience: Finally, consider the physician’s experience—the most important factor in making a decision. As with all professions, expertise is directly proportional to experience, meaning the total number of procedures performed. Medical literature illustrates that biggest predictor of success in surgery is volume, in other words, the number of times that a doctor has performed a procedure.
If the doctor is recommending a specific procedure, how many has he performed? Also, how often does he do this procedure?
While board certifications and training are important, a surgeon’s experience with the procedure itself is more important. Don’t hesitate to ask pointed questions about recommended procedures.
To ensure the most natural-looking results, it’s imperative for a surgeon to recommend the procedure that most appropriately matches your needs and offer realistic expectations for post-surgery outcomes. When you meet with a surgeon, you should expect a full discussion of the surgically appropriate options for your face, which is uniquely yours.
In our experience, we have found that most patients are pretty satisfied with how they look—they’re just not happy with the changes to their features that have been caused by age. Patients don’t want to alter the nature of their face; rather they desire to look fresher and younger. In other words, they want to “turn back the clock”. Many patients comment that they look older than they feel, but are wary of cosmetic surgery, especially if they’ve seen poor outcomes in others. We often hear, “I don’t want to look funny, weird, or pulled.”
A good surgeon will go through a series of examinations and observations that are individual and dependent upon your specific situation and goals. Also factored into this process are the doctor’s expertise, training, and experience. If a surgeon specializes in a particular type of facelift procedure, don’t be surprised if it is recommended over other options. Be wary of the “one-size-fits-all” approach.
This is particularly important because, as medicine continues to advance, patients have more options made available to them. The availability and affordability of options in facelift procedures has made it possible for more people to benefit from facial rejuvenation surgery. However, it has also led to many misconceptions in the general public.
The success of your facelift depends very much on your complete candidness during your consultation. We will ask you questions about your health, desires, and lifestyle.
Be prepared to discuss:
- Why you want the surgery, your expectations, and desired outcome
- The options available to you for a facelift and facial rejuvenation
- Medical conditions, drug allergies, and medical treatments
- Use of current medications, vitamins, herbal supplements, alcohol, tobacco, and drugs
- Previous surgeries
We may also:
- Examine and measure your face.
- Take digital photographs for computer imaging
- Discuss your options and recommend a course of treatment
- Discuss likely outcomes of a facelift and any risks or potential complications
- Discuss the anesthesia options available
Other procedures can further enhance the outcome of a facelift. They include:
- Facial implants
- Soft tissue augmentation to re-contour the facial structure
- Resurfacing techniques to improve the tone and texture of facial skin
- Wrinkle reduction through injection
- Shortening of the upper lip
Questions to Ask
- Are you certified by the American Board of Plastic Surgery?
- Were you trained specifically in the field of plastic surgery?
- How many years of plastic surgery training have you had?
- Do you have hospital privileges to perform this procedure?
- Is the office-based surgical facility accredited by a nationally-or state-recognized accrediting agency?
- Am I a good candidate for a facelift?
- What will be expected of me to get the best results?
- Where and how will you perform my surgery?
- How long of a recovery period can I expect, and what kind of help will I need during my recovery?
- What are the risks and complications associated with my procedure?
- How are complications handled?
- How can I expect my face to look over time?
- What are my options if I am dissatisfied with the cosmetic outcome of my facelift?
- Do you have facelift before-and-after photos I can look at, and which of these results are reasonable for me to expect?
Who is a good candidate?
There is no perfect age to have a facelift, no ideal window of opportunity. Some patients prefer to address problems early to maintain a younger look, while others prefer to wait until aging is more noticeable in order to get more out of the procedure. Patients who find themselves looking in the mirror, pulling up their face to see a younger, improved appearance are usually ready for the procedure.
Because every case is unique, the only way to accurately determine which procedure is best for you is to consult with Dr. Alexander.
A facelift may be a good option for you if:
- You are physically healthy
- You don’t smoke
- You have a positive outlook and realistic expectations in mind for the improvement of your appearance
- Feel like you look much older than you feel
- Have significant looseness in the jawline and neck
- Have deep lines around the corners of the mouth
What does it cost?
Cost is always an important consideration in elective surgery. However, when choosing a plastic surgeon for a facelift, remember that the surgeon’s experience and your comfort are just as important as the final cost.
A quote will be provided to you after your consult with Dr. Alexander. We offer patient financing plans, so be sure to ask.
Cost may include:
- Surgeon’s fee
- Operating room and supplies
- Prescriptions for medication
- Medical tests
- Anesthesia fees
To learn more about our partner in payment plans, please visit CareCredit.
The Facelift and Neck Lift Procedure
Prior to surgery, we will have you:
- Take certain medications or adjust your current medications
- Avoid taking aspirin, anti-inflammatory drugs, and herbal supplements as they can increase bleeding
- Stop smoking well in advance of surgery
During a preoperative appointment, usually 1-2 weeks before surgery, we will:
- Get lab testing or a medical evaluation
- Tell you what to do on the night before and morning of surgery
- Discuss the use of anesthesia during your procedure
- Explain post-operative care and follow-up as well as what help you will need after the procedure
Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. We will recommend the best choice for you.
How We Do It
A Facelift typically takes about 3 hours to perform, depending on several surgical and patient variables.
There are four basic steps to any type of Facelift, small or large.
Step 1 – Incisions
A traditional Facelift incision begins in the hairline at the temples, continues in front of the ear and around the back of the ear and ends in the hair of the scalp. The incision is like a seam in clothing. It is impossible to remove the extra skin without an incision. The more skin that needs to be removed, the longer the length of the incision. Incisions typically heal extremely well and are practically unnoticeable.
Usually, a small incision is placed under the chin to remove fat and tighten loose muscle bands.
Step 2 – Undermining, or loosening the skin
Next, the surgeon gently loosens the skin from the underlying muscle (SMAS). The degree of loosening depends on the age of the face and excessiveness of skin. More loosening is required for excessive skin.
Added step: Fat may be sculpted away from the neck and jowls, and fat might be transferred to cheeks or tear troughs.
Step 3 – Tightening the Muscle (SMAS)
The muscle layer can be tightened several ways, including:
- Plication: folding, or pleating the muscle layer with sutures
- Purse string plication: tightening the muscle layer with suture loops
- Undermining: lifting the muscle layer up as a second layer, then removing the excess and closing it with sutures.
Some surgeons skip this step, rendering the procedure a “simple facelift” or “skin-only” facelift.
Step 4 – Closing
This is the final tailoring step, where the skin is re-draped over the uplifted contours, excess skin is trimmed away, and the incisions are meticulously closed with removable sutures. We use removable sutures to improve the healing process and minimize scarring. No drains are needed.
Pain from a facelift is usually minimal. Patients usually experience tightness in the cheeks and neck and some soreness in the jaw for the first few days while eating or opening the mouth. Pain pills are provided but are usually not required after a couple of days. It is uncommon for patients complain of pain.
The decision to have a facelift is extremely personal, and you will have to decide if the benefits will achieve your goals and if the risks are acceptable. In general, the overall risks are very small for Facelift surgery.
We will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo including the risks.
- Scars. Facelift scars vary from person to person, but QuickLift™ incisions heal extremely well and are usually very difficult to see
- Hematoma (collection of blood under skin)
- Slow healing
- Bruising and swelling
- Temporary numbness
- Possibility of revisional surgery
It’s very important to ask Dr. Alexander questions about your facelift procedure. It is natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with us.
Important Terms to Know
- Anesthesia—General: The patient is asleep, requiring that the airway be protected either by a standard breathing tube or by a laryngeal mask (LMA), an inflatable mask that is placed in the back of the throat but not down the trachea. An anesthesiologist releases gases through the airway which put the patient asleep. Drugs may also be given through the IV.
- Anesthesia—Local: The surgical area is numbed up with an injection, but the patient is awake. Sometimes a patient will be given an oral medication, like Valium, to help with relaxation.
- Anesthesia— Sedation (Twilight): The patient is made sleepy with medications given through an IV. The level of sedation can be adjusted, from barely sleepy to very sleepy. Sometimes sedation is given by the surgeon, but most of the time it is administered by an M.D. Anesthesiologist.
- Hematoma: An unwanted collection of blood under the skin.
- Hypertrophic Scar: A hyperactive, usually temporary scarring process that causes a scar to be raised and red; sometimes called a “baby keloid.” More common on the chest, trunk, and shoulders and in patients with a pigmented Very uncommon on the face and neck.
- Jowls: Soft bulges that sag along the jaw line, usually caused by loss of muscle tone in the lower face.
- Mesolabial Fold (Marionette Lines): The crease that extends from the corner of the mouth down the side of the chin.
- Nasolabial Fold: The crease that extends from the side of the nose to the corner of the mouth.
- SMAS: The Superficial Muscular Aponeurotic System, the superficial layer of muscles in the face just below the skin and subcutaneous fat.
- Tear Trough: A groove below the lower eyelids extending from the nose across the upper cheek.
Recovery times vary from patient to patient. In general, the “bigger” the procedure, the longer the recovery time, and the converse is also true. However, within each group of patients, there are individual differences.
Compared to a QuickLift™, a traditional facelift recovery takes about twice as long, an average of 8-20 days. Bear in mind, however, that these are averages. Some individuals may heal more quickly, while others may take longer to fully recover. A patient who tends to have more bruising and swelling than normal will take longer to heal.
After a facelift, most patients should allow two weeks before returning to work and other normal day-to-day activities and about 3-4 weeks before exercising or participating in any other strenuous activity.
Following our instructions regarding medications and other post-operative measures is the key to a quick recovery. Herbal medications are available to reduce swelling and bruising and to speed the healing process.
It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Avoid wearing any clothing that must go over your head. We will give you specific instructions on how to care for yourself.
You will need someone to drive you to and from surgery and to stay with you for at least the first night following surgery.
When your procedure is completed, a large bandage will be gently placed around your face to minimize swelling and bruising. Although a bandage is not absolutely necessary, it greatly decreases swelling and speeds your recovery time. It will also be a reminder to take it easy for the first day or two. It is normal for the face to feel tight.
You will be given specific instructions that include:
- How to care for the surgical site
- Medications to apply or take orally to aid healing and reduce the potential for infection
- Specific concerns to look for at the surgical site or in overall health
- When to return to the office
We will see you the day after surgery, on the 4th or 5th day to remove some sutures, and again on the 7th day to remove the remainder of the sutures. At one week you can resume normal activities, at two weeks you can begin light exercise, and at four weeks there are no restrictions.
It’s natural to feel excited about seeing the “new” you, but you’ll need to be patient as your face heals from the surgery. The visible improvements of a facelift appear as swelling and bruising subside. It may take several months for swelling to fully dissipate and up to 6 months for incision lines to mature. Once healed, the incision lines from a facelift are well concealed within the hairline and in the natural contours of the face and ear.
Because we have worked with so many patients, we can look at patients relatively early in their recovery and tell them they look great, even though they can only see how they look that day—not how they will look a few weeks later. Your final result will not only restore a more youthful and rested appearance but should also help you feel more confident about yourself.