With age, the effects of gravity and repetitive muscle contraction, changes occur to the soft tissues of the face, giving one a tired appearance. Skin becomes loose, fat pads descend, and muscle banding occurs in the neck. Wrinkles appear in the skin along with other qualitative changes, signaling a mature countenance.
A facelift is done to reverse many, though certainly not all, of these changes that occur with aging. Through inconspicuous incisions around the ears, the tissues of the face can be accessed, repositioned, and excessive skin removed. By its very nature, facelifts only "set back the clock"; the constant pull of gravity cannot be stopped.
The facelift may be combined with other procedures, such as eyelid surgery (blepharoplasty), forehead lifting (browlift) , fat grafting (injecting the patient’s own fat from one area of the body into deflated areas of the face, or chin augmentation. These other procedures can be done either at the time of the facelift or in a staged approach.
The Consultation / Our Comprehensive Approach
Dr. Creasman will gather a thorough medical history, with particular emphasis on your weight, underlying medical problems such as diabetes or high blood pressure, history of cigarette smoking, and bleeding tendencies. Skin care regimen is reviewed as well.
Following this, a thorough directed physical examination of all of your facial features is carried out, including upper face or brow, eyelids, midface or cheeks, and neck. Examination of the chin as it relates to your other facial bone structure is also reviewed. The doctor vocalizes what he sees to give you a comprehensive overview of how he perceives your appearance has been affected by aging, with an eye to how each component relates to the other, and what might be done to improve each surgically. You may not wish to take advantage of every avenue of treatment that is available for rejuvenation, but at least you should know about every available approach and what each can offer. Plastic Surgery is an art, and the application of any particular line of treatment must be tailored to the patient’s goals and desires.
Beyond what Dr. Creasman provides in terms of surgically treatable quantitative aging, there are several other areas that can improve your appearance that may be of equal, or even greater, value. These would include injectable filler materials (lines, lips, scars, and overall volume loss), skin care (addresses qualitative aging such as sun damage, prominent blood vessels, and wrinkles) and skin maintenance. We have two superb aesthetic nurse specialists that assist with skin and injection treatments and we rely on these professionals to make their important contribution to your well-beingusing a comprehensive approach to rejuvenation. When you see someone who looks years younger than her age, it is likely there is more to it than just a talented plastic surgeon.
Frequently, to communicate visually what is possible with surgery, Dr. Creasman will offer to demonstrate the anticipated effect of the facelift using a very sophisticated computer-imaging program. After taking a digital image of your face, he can "morph" your image, thus showing you how the facelift would make you appear. Though not a warranty of the effect of surgery, this offers the best educated guess technology and good judgment has to offer.
Risks of Facelift
Complications following facelifts are infrequent and usually minor. Nevertheless, individuals vary greatly in their physical reactions to surgery, their healing tendencies, their scarring potential, and certainly in their psychological reaction to the effect of surgery.
Complications that can occur include infection, hematoma (a collection of blood under the skin that must be removed by the surgeon), injury to nerves that control facial muscles (usually temporary), and reactions to medications. Poor wound healing is usually seen in cigarette smokers, and so Dr. Creasman will not perform a facelift unless you are committed to DISCONTINUE CIGARETTE SMOKING FOR AT LEAST A MONTH PRIOR TO OPERATION AND FOR TWO WEEKS AFTERWARDS.
Scars from facelifts are usually very inconspicuous, but in some patients they may be more obvious as a consequence of that person’s particular tendency to form thick scars. This cannot be predicted prior to operation, but treatment is available to minimize the appearance of thickened scars. Certainly, any history of poor quality scars should be mentioned to Dr. Creasman at the time of the consultation.
Before Your Procedure
It is imperative that patients refrain from ingesting any medications or other substances that could potentially be the cause of surgical complications. A list of medications should be reviewed and discontinued at least two weeks prior to operation. Patients are seen two weeks prior to their surgery date for a general physical examination to ensure that no underlying medical problems exist that may interfere with the safety of their surgery. Specifically, any infections that arise prior to operation, however seemingly trivial, should be reported to our office. You should avoid any dental procedures for one month prior to and one month after surgery. If you have hypertension, this must be under very good control with your medications prior to surgery; you should plan to take your blood pressure medication right up to the time of your operation.Avoid hair bleaching, coloring or permtreatments for two weeks before and two weeks after your facelift.
CIGARETTE SMOKING MUST BE DISCONTINUED FOR AT LEAST SIX WEEKS PRIOR TO OPERATION. Serious wound healing complications can occur in patients who are exposed to smoke, even passively.
Prophylactic antibiotics are administered intravenously just prior to surgery to reduce the risk of surgical wound infection. A prescription for pain medication is given at the preoperative visit, so that you have your pain pills when you return home from the operation. Homeopathic pills such as Arnica Montana may be used to minimize swelling and bruising.
Pre-operative photographs are taken so that you can see the improvement from your surgery afterwards. We generally take post-operative photographs at 3 - 6 months after your procedure. You will be asked to sign a surgical consent, which enumerates the risks of the procedure in detail. These risks have been explained here, but are also discussed at the consultation.
Facelifts are very individualized procedures. Dr. Creasman typically performs all of his facelifts in our private operating suite, and under a local anesthetic with intravenous sedation or under a general anesthetic. You will not feel the injections of local anesthetic, and you will be asleep throughout the procedure. You may elect to have a general anesthetic; this will be discussed at the consultation.
The standard facelifts vary somewhat in the incisions used, but typically involve an incision around the ear, and possibly beneath the chin. Two variations the doctor uses are the SMAS lift and the MACS lift.This will be discussed in greater detail during your consultation. Incisions are marked prior to taking you to the operating room. If necessary, your hair is gathered in rubber bands to keep it out of the incision lines. Minimal amounts of hair are clipped to provide exposure to do your surgery.
In most patients, the procedure usually takes about four to five hours, depending on the extent of your particular procedure. In most patients, fat is taken from one area of the body using liposuction, and after preparing the fat tissue, it is injected into certain areas of the face to help inflate depressed or atrophied facial fat. This is called fat graftingand is an important part of the rejuvenation process. Once this is completed, incisions are made around the ears and usually just beneath the chin to tighten muscles in the central neck area. Dr. Creasman does a very thorough operation, and almost always tightens not only the skin, but also a layer of muscle and fascia just beneath the skin (also known as the SMAS) to give the best result with the greatest longevity. The neck (platysma) muscle is tightened to define the angle where the jaw and neck meet. Excessive fat is sculpted from the neck.
Excess skin is removed and the skin is then stitched with very fine suture material. A small drainage tube is sometimes placed just beneath the skin and is connected to a suction bulb to drain any small amounts of blood in the first 24 – 48 hours. A non-constricting bulky dressing is applied for comfort and to minimize swelling and bruising.
The Post-Operative Period
You will need to have an escort to drive you home from the operation and to stay with you for the first 24 hours. We will provide you with detailed aftercare instructions at your preoperative appointment two weeks prior to surgery. The dressings will be removed on the first or second day after your surgery, and if applicable, the drainage tube will be taken out. On the fourth or fifth day, most of the stitches will be removed. A couple of key stitches are left in until the ninth to tenth day.
Though you will be up and around in a day or two, you should plan to rest as much as possible for the first week. Most people take 10 –14 days off of work to recover.
By the second to third week, you will look and feel much better. If bruising persists, we can offer assistance with a referral for special laser treatment or camouflage makeup. If you are planning to undergo a laser or chemical resurfacing procedure, you need to wait at least three months after your facelift before you have these procedures.
What follows is a testimonial written by a patient who underwent a facelift and is transcribed verbatim:
Cosmetic Surgery: A Personal Experience
Rule Number One: This is clearly one of the best decisions I’ve ever made.
Having said that, may I say it was one of the most difficult decisions I’ve ever made, and one that took me nearly 2 years to make.
Introduction: I am now 3 months post-op, and have a face, neck, and eyes (upper and lower lids) that rival a woman in her 30’s….and I am almost 50. Every time I see myself in the mirror, I am struck by the changes in my visage from the very talented surgeon, Dr. Craig Creasman, yet am struck by how beautifully my “wounds” have healed, leaving absolutely minimal evidence of ever having had this done. The surgeon you choose should be as driven, detail-oriented, and as “healthy” as Dr. Creasman. While he interviewed me as a prospective surgical candidate, I did a little interviewing myself. His quest for perfection appealed to me instantly, but more importantly, his desire to have “time for himself and family” spoke volumes to me…his need for balance and control in what could easily become a controlling profession told me this is the surgeon I wanted for the procedure I’ve been dreaming about for years. I asked how many cases he did each year, and what he did for relaxation. His surgical schedule seemed reasonable rather than overanxious, which suggested to me he is aware of the demands and draining nature of his chosen vocation. When he answered that he oil painted for relaxation, both landscapes and portraits, and that he found it to be invigorating, confirmed in me how committed he was to doing his personal best, each and every time he picked up a surgical instrument. On my surgery date, I was nervous and a little weepy, but the staff comforted and assured me that I would be happy with the results. Oh, how right they were!
I’ve always been a proponent of “plastic surgery”. I remember vividly when Betty Ford and Elizabeth Taylor re-presented themselves after having had “some work done” years ago, and how obvious Betty’s work was compared to Elizabeth’s…Betty clearly looked better but looked SO DIFFERENT, whereas, Elizabeth looked incredibly refreshed and even more beautiful, as if that were possible. While I am interested to always look my best, I would prefer a more subtle outcome (like Liz) rather than Betty’s. To date, friends that have seen me have said I look rested, that my new hair color (brownish-red with streaks) brings out my eyes more than the blonde I used to have…but no one has said, “wow, you look so different…did you have a f---lift?”. Isn’t that the IDEAL scenario?
If I had to do it all over again, I would do it exactly as I did…so here are my “tips for success” for having a full face and neck lift, and upper and lower blepharoplasty.
I think you’ve sensed I’m a Type A personality, liking control over anything I can control, and that appearance and image are important to me. Chances are you are not too dissimilar from me, and if given the opportunity to read “how it really was” from another patient’s perspective, you would be. I hope my documenting how I planned ahead for my surgery and recovery will be of help to you. May you experience the happiness I have!
I awoke one day, about 3 weeks before surgery, feeling like the decision to have these procedures was the right thing to do. All of a sudden, the weight was off my shoulders and I was “ready”. I was still nervous because it is surgery, but I was READY… and I personally believe things go better when you’re ready… so be ready.
Pay attention to the pre-op visit you have in the office, and get your house/home/support systems ready to help you recover in the least stressful way.
Purchase an infant toothbrush
Purchase and package the frozen peas in small ziplock bags to serve as your “cooling agents” for your eyes if you are undergoing eyelid surgery…this was singularly the best, most soothing treatment for my eyes.
Take the pre-surgical vitamins/homeopathics and obey “dental soft diet” and “do not talk” rules to minimize bruising and swelling. I had one (repeat, 1) bruise on my face, no swelling or bruising around my eyes, and minimal yellowish discoloration on either side of my neck post-op. These treatments work, so be especially adherent to all of these. You are the winner if you follow the rules, no one else!
Follow post-op instructions TO THE LETTER... make sure you have enough time off after surgery to give you an optimal recovery… do not overuse your eyes, and do not stoop or put undue pressure on your eyes. As a hard contact lens wearer for umpteen years, I was anxious about my being able to wear my lenses again, but also how to remove them without stretching my lids… my ophthalmologist gave me a tool to use (mini-suction tool) to remove my lenses so I would not have to “stretch” the skin around my eyes... and I practiced for two weeks BEFORE my surgery so I was facile with this tool. To date, I use it to remove my lenses, and am happy to have learned the technique BEFORE I needed to use it. Have a hair appointment 2 weeks before surgery, and then schedule one for 2 weeks post-op, so you’ll be on track with your monthly visits.
Schedule a massage the night before your surgery, so you are as “relaxed as possible”.
Schedule a manicure/pedicure right before surgery (make sure your 2 index fingers are free of any nail coverage for surgical monitoring purposes).
I told 3 friends about the surgery, all of whom participated in some way in my recovery. I wasn’t sure how my husband would fare, so I had 2 friends scheduled to see me for two 3-4 hour shifts (9-12, 1-4) on my first post-operative day. My husband did extremely well, and did not really need “relief”, but having my friends there did ease the strain. My husband bought a new telephone system, one with “an intercom”, and we practiced using it (me with my eyes closed) just in case… and it was time and effort well spent. We used it several times, allowing me to stay in bed and make a request for assistance without having to get out of bed.
I bought some “books on CD” to help keep me occupied…and what a relief it was to have them available. I donated those I bought to Dr. Creasman’s office, so a “library” could be established for future patients.
I cleared my calendar for a month….and stuck to it.
I took catnaps any time I felt one coming on, until I didn’t feel the need to do that anymore.
I used gel antibacterial agents constantly… and kept them at my bedside table to assure my hands were germ-free. My 3 cats were eager to be around me (and while their being around me was not recommended), I petted them to say hello… and then cleaned my hands immediately.
I ordered my housekeeping service to visit me every week so I did not have to bend over for any reason. This was in keeping with the rule to not bend over and increase intracranial pressure (hurt my eyes). I kept my weekly service for 6 weeks, and then eased my way back into cleaning, being cognizant of proper body mechanics to reduce eye pressure. Expect your face and neck to feel tight…and learn to live with that new feeling.
Take your pain medication before you see the surgeon for suture removals…it will reduce your stress and pain insurmountably… and have a friend or spouse drive you both ways. These are not visits to go to on your own. Don’t be surprised about: not being able to yawn widely (yet); I still have some reduced sensation around my jawline, near my ears, … and as such have difficulty sleeping on my side… but things have improved dramatically since my surgery, and I suspect will continue to do so.
Invest in Trish McEvoyeyeshadow brushes. In my experience, they are the best available and will do the job beautifully with the least stress on you new lids. Initially, my lashes did not feel like my own, but now they do… anything you can do to reduce undue stress and pressure on your new eyes will help you immensely.
I also committed to giving up jogging as well as any high impact exercises, as they would all contribute to “pulling down” on what Dr. Creasman worked so hard on “pulling up”. I now participate in low impact step aerobics, do free weights, ball class, and step’n’sculpt, all of which are stretching, toning, strengthening, but all low impact. I also walk with friends around our property complex, about 4 ½ miles, at a good clip. Mentally, I can commit to this, and am doing this of my own volition. I feel wonderful and believe I’m still getting good exercise but less stressfully than before.
In summary, I am happy with my decision, my surgeon, my surgery experience, and my outcome. I wish you all the best for yours!