Facelift
FACELIFT, NECKLIFT & FAT GRAFTING
“Is this the face that launched a thousand ships?”
– Christopher Marlowe –
BEFORE & AFTER (FACELIFT, NECKLIFT & FAT GRAFTING – photos: courtesy of Dr. Minoli’s patient)
THE KEYS TO REASTORATION OF FACE & NECK
Are you looking to restore youthfulness while not wanting to look surgically done? This has been a common echo in modern times.
Every face is different, every neck unique. Aesthetic procedures are chosen based on a person’s anatomy … and their goals and desires as interpreted through the prism of a plastic surgeon’s eye. As we better understand the process of aging, as we advance with safer biologic products & refined surgical techniques, as we learn from the past, we find that results in facial plastic surgery can be remarkable … even exquisite … while also being natural. Overall, it is essential to harmonize the upper, middle & lower thirds of the face in concert with the neck and its décolletage.
Dr. John Minoli offers you years of trusted experience and a range of procedures for beautifying & restoring your face & neck. He is multi-board-certified in aesthetic surgery – with particular expertise in the face & neck; and for decades he has treated thousands of patients, not only in Las Vegas but also in several other regions of the United States.
As modern medicine offers safer operative & non-surgical methods for the rejuvenation of the face & neck, Dr. Minoli continues to adapt his practice accordingly through extensive continued surgical education and experience.A personal consultation with Dr. Minoli may help you further appreciate these highly individualized issues: Is aesthetic facial & neck surgery right for you?
GENERAL THEMES
For your comfort & safety general anesthesia is administered by a board-certified anesthesiologist when necessary, and Dr. Minoli performs these procedures at an accredited ambulatory surgery center nearby. Of course, certain patients are candidates for eyelid lifting (blepharoplasty) surgery or forehead lifting (brow lifting) surgery under local anesthesia in our office. In any event, appropriate prescription medications are provided for preoperative & postoperative home use (e.g., antibiotics, muscle relaxants & pain killers).
BENEFITS
To help ensure patient safety & comfort Dr. John Minoli & his team provide a well-appointed office and a neighboring accredited ambulatory surgery center. Our support staff includes experienced & caring patient-coordinators and a trusted group of board-certified anesthesiologists.
FACELIFT & NECKLIFT TECHNIQUES
A facelift (also called a rhytidectomy) can improve visible signs of aging along the face & neck by smoothing out loose skin, tightening underlying soft tissues, and tailoring the surrounding fat. In general, a face-neck lift improves muscular tone, loose skin, deep facial & neck creases, and excess fatty deposits under the chin and jawline. The results can be dramatic or subtle, depending on how a person looked before surgery. This usually includes a more refreshed appearance; softened fine lines and wrinkles; and a reduction of sagging skin along the cheeks, jowls, jawline & neck.
Of course, a face-neck lift is not a one-size-fits-all procedure. Each patient requires an individually customized treatment plan which may include eyelid surgery, dermal & subdermal fillers, lip augmentation, fat grafting, or even other cosmetic facial procedures such as rhinoplasty of an aging nose. If you have noticed progressive sagging & an overall deflation of your face, brow, eyelids and/or neck, you may be a candidate for face & neck lifting surgery. Dr. Minoli can help guide you in understanding this part of your decision-making.
General anesthesia is typically required and is administered at a first-rate accredited surgical center under the care of a board-certified anesthesiologist … although some mini-face-neck lifts can be performed under local anesthesia in Dr. Minoli’s office setting.
While there are many variations in facelifts – some even sporting commercial names – most facelift incisions are generally camouflaged within the hidden natural contours of the external ear (in front of and behind the earlobe) and perhaps within the hair above and behind the ear itself. There may also be a small incision in a natural, horizontal crease under the chin too. Following surgery, incisions can be easily concealed with hair styling and makeup. Through discreet facelift incisions Dr. Minoli is able to free up facial skin from deeper tissues, the extent of separation depending on the selected technique. After skin has been pulled up and back, excess is removed. Sometimes underlying soft tissues of the face also need to be repositioned – almost a facelift underneath a facelift. Of course, the overall approach may also encompass specific manipulations within the neck. For example, a small incision behind the chin may sometimes be used for removal of excess neck fat or for smoothing of cord-like muscular structures along the center of the neck.
KEY FEATURES OF FACE-NECK LIFTING SURGERY:
Medications for sedation or general anesthesia are administered for your comfort during a facelift procedure. And appropriate prescriptions are also provided for preoperative and postoperative home medications.
Traditional facelift incisions often begin in the hairline within the temple, then they course in and around the curved, hidden contours of the external ear, and finally they terminate within the hair behind the ear.
In addition to actual skin being lifted, deeper layers of sturdy tissue beneath the skin of the face & neck are commonly lifted too.
Fat grafting is commonly included in the face/neck lifting procedures. The addition of one’s own fat (autologous fat) helps gird depleted and aging facial tissues with one’s own natural substance so that the rejuvenation process is more than a lifting procedure. Depending on the desired results, the facelift may include additional surgical procedures such as eyelid surgery and facial implant surgery.
During facelift surgery skin is re-draped over the uplifted contours, then the excess skin is neatly trimmed.
Facelift incisions are expertly sutured for a meticulous final skin closure.
POSTOPERATIVE CONSIDERATIONS:
In the early stages of recovery (the first 2 or 3 days especially) you will need personal assistance, perhaps even for meals and bathroom visits. And in fact, even facial washings must be done gently during this early period. (Specific instructions are usually reviewed with each patient.) As the 1st postoperative week progresses you will likely be gaining a bit more independence. By the 2nd week driving privileges will likely resume. Of course, Dr. Minoli will help guide you through these milestones. In a broad sense: It takes about 6 weeks after surgery to pass social scrutiny … & 6 months or more before residual lumps & bumps soften & dissipate.
AVERAGE GLOBAL COSTS & AVERAGE RECOVERY TIME:
Face & Neck lifting surgery average global cost range: $ 12,500.00 – $ 15,000.00
Face & Neck lifting surgery average recovery time: 10 days to 2 weeks
FAT GRAFTING
Although the fat injection technique (autologous fat transplantation) is technically a minor surgical procedure, it provides an excellent source of soft-tissue filler material which, to some degree, has a permanent effect. Although the procedure is often done in an operating room as an adjunct to other surgical procedures, it is also quite possible to have such injections done under local anesthesia in an office setting.
Fat injections transfer fat from one part of the body to another – in many cases, helping re-contour a face; diminishing frown lines, crow’s feet & nasolabial folds (smile lines); providing definition to areas such as the cheeks, lips and chin; and even filling out depressed bodily scars. While some fat particles permanently survive the transfer, others do not – so, repeat treatments may be warranted for ideal results.
The fat injection technique can be described as follows. The donor site (for example, the abdominal wall, buttocks, or thighs) and the treatment site are injected with local anesthetic. Intravenous fluids may also be injected into the donor site to facilitate fat collection. Fat is extracted through a specialized needle and processed for the removal of excess fluids. It is then re-injected in multiple thin strands within a desired recipient area. Over-filling may be necessary in order to counter the natural effects of partial fat absorption during the weeks that follow treatment. Fat also can be harvested during liposuction within one area of the body, then re-injected into another desired area. The longest-lasting effects usually involve repeat treatments.
KEY FEATURES OF FAT GRAFTING:
Fat injections are natural and non-allergenic.
Fat injections are from the patient’s own body, so no pre-testing is required. (A person’s own fat cannot be rejected; however, another person cannot donate fat to a given person.)
Fat injections can be performed as an outpatient procedure.
Fat injections cause little down time.
Fat injections cause minimal discomfort which usually can be controlled with oral medication.
Fat injections last several months – and some of the fat injections last permanently.
Fat injections are cost effective if combined with other procedures.
OTHER CONSIDERATIONS:
There is some swelling and bruising after the injections – mostly within the first three days.
Patients should avoid sun during the early stages of healing.
The longevity of results can vary significantly from patient to patient.
OTHER FACIAL REJUVENATION TECHNIQUES:
EYELID SURGERY, BROW LIFT SURGERY
Facial aesthetics depend upon a consideration of the many separate subunits of the face: The brow, eyelids, cheeks, nose, mouth and jawline are considered individually and in dynamic relationship to one another.
Face & Neck lifting surgery average global cost range: $ 12,500.00 – $ 15,000.00.
Face & Neck lifting surgery average recovery time: 10 days to 2 weeks.
Your consultation likely will include a discussion about your overall goals. What do you wish to achieve through face-neck lifting (rhytidectomy) surgery? You should come to the consultation prepared to discuss your medical history – including any conditions you may have such as diabetes, high blood pressure or heart disease. Dr. Minoli will want to know about your current medications and your previous surgeries & medical treatments. If you plan to become pregnant or change weight in the future, you should discuss this with Dr. Minoli. Complete information is important for proper decision-making.
You will be asked if you had prior surgery of the face, brow, eyelids or neck.
Dr. Minoli will also examine your face, brow, eyelids and adjacent structures. Pre-existing scars will also be evaluated. (Scarring from previous facial, neck and/or eyelid surgery may limit your results.)
Not everyone will achieve the same results. Dr. Minoli will take into consideration your unique features. During the consultation, you will be asked to point out the exact areas you would like improved. This will help Dr. Minoli understand the reality of your expectations.
Any one or a combination of the following conditions may indicate that you are a good candidate for a facelift:
- a deep line or fold running from one corner of your nose to the corner of your mouth
- jowls or loss of a well-defined jawline
- deep wrinkles in the cheeks and/or sagging of your cheekbones
- loose skin, and excess fat within your neck; or vertical cords within your neck
A facelift can improve all of these problems. However, it cannot correct conditions such as sagging eyebrows, excess skin and fat of the eyelids, or wrinkles around the mouth. Dr. Minoli treats these areas too and will provide further information if you are interested in other procedures.
Face-Neck lifting (rhytidectomy) surgery is typically a cosmetic procedure and, as such, is not covered by most insurance companies. However, under certain circumstances, insurance coverage may be available. For example, if a patient has heaviness of the upper eyelids which directly blocks peripheral vision an eyelid lifting (blepharoplasty) surgery – and probably to a lesser extent a forehead lifting (browlifting) surgery – may be be needed. Many factors determine your eligibility for coverage, including the specific terms of your insurance policy. A letter of predetermination may be required by your insurance company prior to surgery. Dr. Minoli & his staff will discuss these matters with you.
Of note, eyelid lifting (blepharoplasty) and/or forehead lifting (browlifting) surgery as relates to this practice does not encompass the breadth of ocular & & eyelid diseases that are more typically cared for by a standard ophthalmologist (eye doctor).
The subject of risks and potential complications of surgery is best discussed on a personal basis between you and Dr. Minoli & his staff. Fortunately, significant complications from face-neck lifting (rhytidectomy) surgery are uncommon – this takes into consideration thousands of procedures worldwide. As benefits are considered, so too are specific risks: These include the possiblity of bleeding, infection, bruising, prolonged discoloration, swelling, numbness, reactions to anesthesia, painful or unattractive scarring, contour irregularities, fluid collections, tissue loss, speech impediment, oral incompetnce, need for further surgery, and unsatisfactory overall results.
Further considerations which pertain to face-neck lifting (rhytidectomy) surgery include the following:
- Following surgery, the body produces a serum-fluid under the skin of the face & neck. In rare cases it can accumlate to such a degree that it needs to be removed. Though uncommon, this process is usually a fairly simple office procedure involving aspiration with a needle & syringe; but sometimes treatment in a surgery center is required. In any event, such a condition may require more than one postoperative visit.
- Tissue loss can occur along the edges of the wound. This condition can delay healing & recovery. Of course, the condition occurs more commonly in diabetics and smokers, so these circumstances need special considerations.
Minor irregularities can sometimes arise (e.g., in certain instances when incisions have not healed in an ideal way), but office-based postoperative treatments are usually available to help minimize these problems if they occur. You can help to lessen certain risks by following the professional advice given by Dr. Minoli and his staff.
We want to make your surgical experience as easy and comfortable for you as possible. If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin, certain anti-inflammatory drugs, and an array of supplments (e.g., fish oil, flaxseed oil, garlic supplements, green tea & Vitamin E) can cause increased bleeding, so you should avoid taking these medications & supplements well in advance of surgery. Dr. Minoli and his staff will advise you and provide additional preoperative instructions.
If your hair is very short, you may want to let it grow enough to cover your incisions while you heal.
If you are overweight and have a realistic desire to lose more than 15 pounds, this should be considered as well.
*** Face-Neck lifting (rhytidectomy) surgery is usually performed on an outpatient basis. Some patients are even candidates for minimal face-neck lifting (rhytidectomy) surgery under local anesthesia in our office. Following face-neck lifting surgery you would need to stay in a nearby hotel overnight under nursing supervision. (Dr. Minoli & his staff will help guide you during your preoperative counselling session.) ***
Your face-neck lifting (rhytidectomy) surgery may be performed in a free-standing ambulatory facility, although some patients are even candidates for face-neck lifting (rhytidectomy) surgery under local anesthesia in our office. Medications are administered for your comfort during and after the surgical procedure. Dr. Minoli (and your anesthesiologist if such is the case) will dertermine with you the type of anesthesia to be used – local anesthetic injections, intravenous sedation and/or general anesthesia. For your safety during the operation, various monitors may be used to check your blood pressure, pulse, and circulating oxygen.
Surgical dressings & bandages will likely be placed around your face & neck. Sometimes small tubes will have been inserted beneath your skin to drain away fluid that might otherwise accumlate, but you will likely not feel them.
When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. If you do experience discomfort, this can be controlled by medication which you may continue taking in the days following surgery. After a few hours of recovery room monitoring, you will be escorted by medical transportation after a few hours to stay overnight in a postoperative care setting at a nearby hotel with full nursing supervision. (Dr. Minoli & his staff would help guide you in these preparations.)
You will be returning to Dr. Minoli’s office at regular intervals so that your postoperative progress can be properly evaluated. During the first few postoperative days your face & neck may be tender, but this usually subsides later in the 1st week or so.
In the early stages of recovery (the first 2 or 3 days especially) you may need personal assistance – perhaps even for meals and bathroom visits. This is one of the reasons that overnight nursing care is so helpful just following surgery. Washings must be done in a gentle manner during this early period; and in fact, specific instructions are given to each patient.
In some instances, a small temporary drain tube may be placed along the sides of the neck under the bandages. These drains can help prevent the accumulation of postsurgical fluids under the skin of the face or neck: These drains are usually removed the first day after surgery; but a full shower or bath is not permissible until the drains are gone.
The day after surgery, you will be encouraged to get out of bed for short walks to promote blood circulation. Straining, bending and lifting must be avoided, since these activities may cause increased swelling or even bleeding. You may be instucted to sleep on your back with a pillow under your knees.
As the 1st postoperative week progresses so does one’s sense of independence. External sutures are usually removed in about 7 to 10 days. Bruising and swelling, common during the first few postoperative days, subside during the 2nd week. By the 2nd week driving privileges will likely resume.
It is important to realize that the amount of time it takes for recovery varies greatly among individuals. Straining, bending and lifting should be avoided during the early postoperative period. Depending on the extent of your face-neck lifting (rhytidectomy) surgery … and your general physical condition … you may be able to return to non-strenuous work anywhere from 1 to 2 weeks after surgery. Any sexual activity should be avoided for a minimum of 2 weeks. And vigorous activities should be restricted for at least 2 weeks.
In many instances, you can resume most of your normal activities, including some form form of mild exercise, after a few weeks. You may continue to experience mild periodic discomfort and swelling during this time, but such feelings are normal. Severe pain should be reported. In general, the timing of your recovery depends largely on the extrent of your surgery and your individual healing capacity.
You will be instructed to avoid exposure to direct sunlight during the early postoperative phase – and for the long-term, to be conscientious about the use of sunblock to protect your skin.
Bruising & swelling, common during the 1st week, begin to subside noticeably during the 2nd week. In a broader sense: It takes about 6 weeks after surgery to pass social scrutiny … & 6 months or more before residual lumps & bumps soften & dissipate. Incisions will initially be red or pink in color: They will remain this way for many months following surgery – and may even appear to worsen before they fade. There may also be numbness in some areas, it may take months before feeling returns. Of course, Dr. Minoli will help guide you through these milestones.
You should be up and gently about during the first few days following surgery; but without strain. After surgery, you will be asked to restrict your activities and simply relax for a few days. Elevating your head when you sleep will help to minimize swelling and bruising. Remember, you must not take aspirin or certain anti-inflammatory medications, and you should not smoke or be exposed to heavy secondary smoke for a while.
Your dressings will be removed in the days following surgery so that Dr. Minoli can examine the treated areas. He will probably suggest that you shower starting on the 3rd postoperative day. Stitches will be removed in 5 to 10 days, depending on their nature. If present, drains and their associated sutures are typically removed usually on the 1st postoperative day.
- Additional notes about early healing:
During the early stages of healing you will notice puffiness and discoloration which may be more pronounced in some portions of your face than others. Do not be alarmed by any unevenness or temporary asymmetry caused by this variance in swelling and bruising; it is perfectly normal. Generally, the greatest swelling occurs 24 to 72 hours after surgery, but it may take several weeks, or even months, before all puffiness resolves. Mainly though, most bruising will disappear within 2 weeks; and usually during the 2nd week following surgery you will be permitted to wear makeup to help conceal discoloration. You will also experience some numbness in the facial area, which may be present indefinitely. Your non-dissolvable stitches are removed usually 4 to 8 days after surgery.
It is important to realize that recovery time varies greatly among individuals. Please remember that the relationship with our staff does not end when you leave the operating room. If you have any questions or concerns during your recovery, or need additional information at a later time, please contact us.
The results of your face-neck lift may be dramatic or subtle, depending on how you looked before surgery as well as the specific goals that you and Dr. Minoli establish. Since the healing process is gradual, you should expect to wait at least several weeks before being able to appreciate your “new look.” Modest changes may continue to occur over several months.
When healing is accomplished, face-neck lifting (rhytidectomy) surgery will have enhanced and refreshed the appearance of your face. It may take some time to adjust to your new facial image, but you are likely to feel a boost in self-confidence as you progress in your healing. Still, it is important to remember that various healing factors may prolong the final result. Fluid retention and prolonged swelling are typical in the months following surgery. The healing process is gradual, so you should expect to wait a while before fully enjoying the outcome. Nevertheless, the results of your surgery should be long-lasting.
Scars will fade over time; but no matter what, incisions create scars – and scars are permanent. Most incisions heal nicely; but some scars are more noticable. Fortunately, face-neck lifting (rhytidectomy) surgery scars are usually concealed by natural facial creases. Occasionally, a touch-up revision may be desired to further improve a contour or a scar. The additional treatment can usually be performed under local anesthesia in Dr. Minoli’s office.
You will return to Dr. Minoli’s office for follow-up care at prescribed intervals, at which time your progress will be evaluated. Please remember that the relationship with Dr. Minoli and his staff does not end when you leave the operating room, but continues.
(Dear reader, please note: Aging, gravity & weight-fluctuation can take their toll. If your face, brow & eyelids change even after surgery, secondary procedures are still available.)
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