The "Facelift"

- What exactly is a Facelift?

This procedure in its most basic form addresses "facial laxity" that quite naturally develops with age. A few particulars:

Facelift involves the dissection of the skin and soft tissue of the cheeks and neck from incisions placed just in front of both ears with extensions into the hair above and behind the ear. An incision may also be made under the chin is fat excision and/or muscle tightening is required. After the dissection is performed the skin/soft tissues of the face and neck are (as previously indicated) re-suspended thereby providing a more youthful appearance. Excess skin is removed from the area in front of the ears in most cases.

A Few More Points

Post-operatively patients will have bruising and swelling that will gradually resolve over several weeks to months. The swelling can take the longest to come down (slowly over a few months) with bruising usually resolving in two to three weeks. Pain is a variable issue but in general is remarkably mild for the extent of dissection. As the operation can take from four to eight hours (some take longer), the anesthesia that accumulates in the patient takes a full day to pass.

Many surgeons recommend (or require) that the patient go to an aftercare facility. These are staffed with nurses that care for the patient while the anesthesia wears off. Afterwards, the patient is pampered for as long as he or she wishes to stay. The stays at these facilities are variable (from 1-4 days). They cost $250 and up per day.

Patients take on average a week off work. Sutures are removed in two to four days. Drains (if required) may be removed in one to two days. These items should be removed by your doctor (or his/her nurse). (This may seem obvious but patients have asked before.)


What can go wrong? Fortunately, here the answer is relatively little and that which can go wrong more often than not gets better with time. The most catastrophic outcome is flap necrosis meaning a part of the skin can die. This is extremely infrequent at less than 1% for the average patient. Smokers are at increased risk as their skin has a less abundant blood supply. I have never seen this and hope not to see a case.

Another poor outcome is facial nerve or muscle paralysis. Some degree may be present in 10-20% of patients. The good news here is that over 95% of these resolve with time, but the time is variable...weeks to 2 1/2 years. The most frequently injured nerve is the one providing sensation to behind the ear. All patients have numbness post-operatively which in most cases (as mentioned) will pass with time.

Asymmetry is always possible and frequently pre-operatively visible. I will discuss with patients pre-operatively that this can be addressed during the operation, but absolute symmetry is impossible and unnatural. This is where patient expectations come in. Those patients will less than realistic expectations are those for which an operation may not be warranted.

Facelift...By Example


© John Di Saia, MD... an Orange County California Plastic Surgeon       John Di Saia, M.D.