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Facelift

Photo of 56 year old woman after facelift and browlift
photos

Facelift surgery is one of Dr. Bentkover’s surgical passions. With over 28 years doing facelifts in Worcester and Boston, Dr. Bentkover is constantly honing his skills and evaluating the latest innovations.

Facial Rejuventation as a specialty is an evolving mix of art, science and committment to safe innovation. Each of the facial rejuvenation procedures we perform can compliment other procedures. Whether you choose an office treatment or a surgical procedure, we are committed to recommending for you the procedure or procedures that will most readily and easily achieve your partidular aesthetic goals. If you have considered a facelift, this page and the page on Mini-Facelifts should be helpful.

In this section of our website we try to put it all in perspective. We will discuss the different types of minilifts, and explain how they differ from each other. We will also discuss the traditional deep plane or sub-SMAS full lower facelift and more extensive variations like the triplane facelift.

A facelift can give you back your jawline and your neckline…

Sagging skin, wrinkles and loss of facial volume are the hallmarks of the aging face. Your chronologic age, history of extensive sun exposure, smoking and genetics all contribute to how you look today. The smooth, more rounded faces of children and young adults have more evenly distributed fatty tissues, abundant collagen and tight underlying muscles and deep connective tissues (called the SMAS – subcutaneous muscular aponeurotic system). Over time, the skin and deeper facial tissues loosen. Folds in the chin, jawline and neck become more prominent; and your midface and cheeks may tend to lose volume. Many of our patients say, “I look just like my mother.” Some also say, “My mother has better skin than I do.” You may have the some of same genetic aging factors as your mother that determine volume loss, but maybe mom did not bake in the sun as much as you did. (Baby oil and iodine, anyone?).

Sound depressing? Well, you do have some options…..

There are a number of different kinds of facelifts that can have a dramatic effect on your lower face and jawline, midface, and neck. These procedures can enhance your facial contour and profile.

Only a very few years ago most facelift procedures were basically the same, but today we have many different variations of facelifts that can customize the surgery to your particular needs and your liftstye. The days of the wind swept look should be gone forever.

So, what exactly is a facelift?

Facelift surgery, or rhytidectomy, is designed to restore a more youthful appearance by tightening and lifting the deep tissues of your face. Rhytid means wrinkle, and -ectomy means removal; but the medical term rhytidectomy is actually somewhat of a misnomer. A facelift really does not remove wrinkles. It involves tightening and repositioning the deep facial tissues (called SMAS) and a neck muscle called the platysma, as well as the removal of some excess skin and fat (liposuction).

Removal of wrinkles may require a skin rejuvenation procedure such as a Portrait® Plasma Skin Regeneration, carbon dioxide laser resurfacing, any of a number of facial fillers, or even Botox®. These procedures, some of which can be done in the office, are described elsewhere on this website.

As we have mentioned, today we can offer you a number of different shorter, minilift procedures. Minilifts achieve more limited results but often involve less down-time or quicker healing. However, there are no shortcuts to quality. Properly performed minilifts designed for the best possible longevity and most natural look are just as careful and delicate operations as a full lower facelift or triplane lift. They are best and most comfortably performed with general anesthesia or intravenous sedation.

Facelift procedures performed with only local anesthesia and oral sedatives can seem appealing; but without the comfort and safety afforded the patient with better anesthesia, the surgeon’s ability to effectively tighten and reposition the SMAS layer of the face may be significantly limited.

The most common types of minilifts are as follows:

  • Cheek Lift
  • Neck Lift
  • Submental Plastysmaplasty
  • Mid Facelift

(For even more details on the different types of minilifts, please also go to our section of the website called Mini-Facelifts.)

With advent of so many types of minilifts, the traditional facelift is now commonly called a full lower facelift. It involves tightening of the neck and elevation of the cheek in the proper direction (or proper “vectors”). It is really a combination of two minilifts, a cheek lift and a neck lift.

FULL LOWER FACELIFT = NECKLIFT +CHEEKLIFT

A cheeklift lifts the tissues of the cheeks in a vertical direction to tighten the jaw line and the jowls. In this procedure the SMAS tissue is often cut in such a way as to be able lift a portion of it and place it in a higher position along the cheek. The SMAS tissue that is elevated and repositioned is called a SMAS flap. In an effort to achieve a natural looking, long lasting lift of the cheek and jawline, Dr. Bentkover does what is called a deep plane, sub-SMAS flap lift. The terms S lift and J lift simply describe the shape of the incision in the SMAS tissues and skin. In all these procedures, excess skin is trimmed as needed.

A necklift lifts and tightens the neck in a upward and outward direction. First, the area under the chin is tightened through a 1-1.5 inch incision (a submental platysmaplasty). Dr. Bentkover tightens the platysma muscle in this area along with liposuction as needed. If you need a chin or pre-jowl implant, he will do it through the same incision. Next, through an incision that begins in the lower part of the crease in front of the ear and extends behind the ear, he will tighten the back part of the platysma muscle, liposculpt the neck (if needed), and remove excess skin.

A midface lift is a minilift that elevates your cheeks. As you age, the middle of your face generally descends at about a 45 to 90 degree angle. A midface lift elevates this in such a way as to correct the hollows and washed out appearance that can develop in the middle portion of your face (under your eyes and along your nose).

When adding a midface lift to a full lower facelift, it becomes a so-called TRIPLANE FACELIFT, because the operation involves elevation of three separate types (or planes) of tissue, skin, muscle and the coating over the bone (periosteum).

A full lower facelift takes about 3-4 hours, and a triplane facelift takes between about 4 and 5 hours.

All types of facelifts can be combined with other facial rejuvenation procedures such as a blepharoplasty (eyelid lift), liposuction of the neck, laser resurfacing, Portrait PSR3 Plasma Skin Rejuvenation Plasma resurfacing, a brow or forehead lift, cheek augmentation, chin augmentation, or various facial fillers or implants to specific creases and hollows. These procedures add more operating time.

As you can imagine, with the potential for such dramatic results, a full lower facelift is a very technical and exacting procedure. Hence, it often requires 10 to
14 days of recovery time away from work or strenuous activity. Minilifts often require less time to recover.

We have provided a lot of information on this page, but it is unrealistic to think that most people can pick the type of operation they need just by reading various websites. That is where the consultation comes in. Dr. Bentkover will spend an hour with you evaluating your face and discussing your personal aesthetic goals. If need be, he will also “morph” some images of your face on the computer. You will also meet with our aesthetic nurse to get her personal perspective on facial rejuvenation and many of these procedures. In addition, you are welcome to return alone or with family members or close friends for a second consultation at no additional charge.


YOUR PROCEDURE

Before Surgery
Dr. Bentkover’s initial consultation will take about an hour. Hewill carefully evaluate your face and discuss with you what you might realistic ally expect from a facelift. His objective is to create a natural appearance that is pleasing to you, not an operated or overly “pulled” look. He may also take some digital photos of you and simulate a facelift with our imaging software.

Our staff will give you specific instructions on how to prepare for surgery, with guidelines on eating and drinking, smoking and medications. If you smoke, we will ask you to quit for at least 1 month before and after your surgery, since smoking can have an effect on how well you heal. A smoker has a higher risk of infection, swelling and actual loss (slough) of skin near the incisions! You must stop anticoagulant medicationsand herbal preparations such as aspirin, ibuprofen, vitamin E, Gingko, St. John’s Wart, garlic, or Ginseng 10 days prior to surgery. However, we will usually give you Arnica and recommend pineapple juice (for its Bromelein content) before and after surgery. These are herbal preparations that we think decrease swelling and bruising. You will be required to take antibiotics to prevent infection. You should shampoo your hair the night before surgery.

The Procedure

A facelift is frequently performed in conjunction with a blepharoplasty (eyelid surgery), forehead lift, chin augmentation, facial resurfacing, and/or liposuction to create an overall rejuvenation of the face. The procedure may need to be repeated a number of years later, since the effects of aging and gravity continue. You will be the judge of when or if you need further surgery.

Facelifts are most commonly performed in the Same Day Surgery Unit of Saint Vincent Hospital at the Worcester Medical Center. We also operate at the Massachusetts Eye and Ear Infirmary. General anesthesia or local anesthesia with intravenous sedation is required. Dr. Bentkover will make an incision that starts at or inside the hairline at the temple and continues in front of the ear, then around the earlobe and behind the ear, ending at the scalp area. These incisions are placed in such a manner that they generally hide very nicely. Most women can wear their hair up in a few months without worry of unsightly incisions. Excess skin is removed and sagging muscles and connective tissues (called the SMAS) are tightened. Incisions are closed carefully and every effort is made to hide them as much as possible. The procedure may take up to 5 hours, depending on whether any other procedures are performed at the same time.

Recovery: What to Expect

You will be given explicit pre- and post-operative instructions. By following these instructions you will minimize potential problems. It is necessary to have someone drive you home and stay with you for the first 24 hours. There is also a hotel across the street from the hospital that is very accustomed to hosting our patients. Initially you will have a large dressing wrapped around your head, and your neck will feel very tight. You might have surgical drains. These will be removed in approximately 24 hours. Often there are no drains. Stitches around the ears will be removed in a few days or dissolve on their own. The scalp sutures or staples will be removed in 7-10 days.

Generally scars fade satisfactorily over a number of weeks, but maximal fading may take a few months. Most swelling and discoloration generally decreases within two to three weeks, but some in some areas it may take months to subside. You are usually “presentable” in 2 weeks. If a midface lift is also performed, the mid facial swelling will persist longer. Tightness in your face and neck will be present for several weeks, and there may be slight changes in your hair pattern around the incision. Dr. Bentkover will discuss all these details with you and show you the location of the incisions. If you have had a facelift previously, your hairline may be a bit high at the sideburn area. Dr. Bentkover may need to alter the incision to prevent further elevation of you sideburn.

We recommend that you avoid the sun after surgery. Also, remember that one of the major factors that led to you having the surgery was probably sun exposure. In order to preserve the results of your surgery and prevent unwanted thick scars, we actively discourage excessive sun exposure and encourage high SPF sun protection. SPF 45-75.

Complications following facelift are veryrare but can happen. They may include bleeding, infection, loss of a small amount of skin nearthe ears, facial nerve injury, discoloration of the skin, numbness, asymmetry and excessive scarring. Infection is rare due to the large blood supply to the face. The risk of bleeding is greater if you take aspirin or blood thinners within 10 days of the surgery. The risk of wound complications is higher in smokers, diabetics, persons with a history of radiation and autoimmune or collagen diseases.

The healing process is gradual, so you may not appreciate the final result for up to 6 months. A single procedure usually achieves the desired results. Most patients do not have another facelift later in life, but the number of patients having second facelifts is definitely growing. Most patients who have had facelifts are pleased with their new, more youthful appearance. They appreciate the return of a more youthful jawline and neckline.


FAQ

How long will my facelift last?

Everybody ages a bit differently; but, generally speaking, a successful facelift may not need to be repeated for 8-12 years.

Why can’t I have a full facelift under local anesthesia?

Remember from our discussion on the previous pages that a full facelift = a cheek lift + a neck lift. Dr. Bentkover believes that it is not realistic to believe that a full facelift or a well done minilift can be performed as effectively and as safely under straight local anesthesia as it can under local anesthesia with sedation or general anesthesia.

So, can I just have my cheek lift (minilift) under straight local anesthesia?

“Facelifts” done with only straight local anesthesia are generally limited procedures that usually involve just tightening sutures placed in the deep tissues (the SMAS) in front of the ear. They are usually a form of a minilift, specifically a limited cheeklift. Dr. Bentkover does not believe that just placing tightening sutures in the SMAS is sufficient, even for a minilift. For the procedure to be as long lasting as possible and as effective as possible, he believes that the operation must include elevating the SMAS tissue as a flap (see Full Facelift/Overview) and repositioning it. This is called a sub-SMAS dissection. To do an effective minilift on the cheeks for the purpose of lifting your face in front of you ears and your jawline, Dr. Bentkover believes that the surgeon should elevate the same sub-SMAS cheek flap that he/she would in a full facelift. (The only differencefrom a full facelift is that the necklift part of the procedure is not performed). While this could be done under local anesthesia, it would not be as comfortable for the patient or as safe. You can place tightening sutures in the deep tissues (SMAS) under straight local anesthesia, but Dr. Bentkover does not believe that this will last as long and be as effective as the sub-SMAS flap procedure that he performs. To do the sub-SMAS dissection safely and comfortably for the patient, he believes that intravenous sedation or general anesthesia is advisable.

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