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Facelift and Necklift

Facelift and neck lift are surgery procedures aimed to refine and recover the firmness of facial and neck skin, along with its inner soft tissue support. Generally, individuals aged 50-60 years old can be candidates to undergo these procedures. For those in their 40’s or younger, these procedures can be done after careful consideration by a plastic surgeon, but it is usually uncommon. For some tips before you decide to undergo aesthetic plastic surgery, please visit the “Smart Tips for Smart You” article on this website.

Other than the age requirement, candidates of these procedures must be healthy from vital organ disturbances such as heart, lungs, liver, and kidney problems. Candidates will undergo complete physical and laboratory examination before the surgery, including electrocardiogram, blood test, and chest X ray. Those with diseases such as diabetes and high blood pressure must receive medication until the problems are controlled adequately. In the writer’s opinion, people with serious medical condition should delay having plastic surgery procedure. To evaluate candidates’ physical condition, a plastic surgeon can cooperate with other doctors in the field of internal medicine, cardiology, or pulmonology. An anesthesiologist may also be consulted to help evaluate the feasibility of the surgery and the choice of anesthesia that will be taken.

There is a simple way to get a preview of the effect of facelift and neck lift procedure on your face. While holding a mirror in front of you, sit on a bed or sofa. Observe your face and neck while you slowly change position to a recumbent position. If you do not see a significant change on your face and neck, you might want to delay having the surgery. On the contrary, if you observe a significant change, you may continue your wish to undergo the surgery and start consulting your plastic surgeon. One thing you should remember is not to set your expectation too high. For example, you shouldn’t expect that after the procedure your face will look like how you used to be 10 years ago.

Similar to other surgeries, there are some preparations that you must comply to. You are required to stop smoking and alcohol consumption habit 2 weeks before the procedure. Consumption of supplements containing ginkgo biloba, ginseng, vitamin E, “pien tze huang”, and blood thinners must be stopped.

On the day of the procedure, you will be asked to wash your hair. No shaving will be needed. You will also need to fast for 4-6 hours before the surgery to prevent complications associated with anesthesia. At the hospital, you will be asked to sign a consent form. Several photographs of your face will be taken before the surgery. After a brief explanation and ensuring your history of medication allergy, the procedure will begin with anesthesia.

On a standard facelift and neck lift procedure, incision will be made on the border between ear and cheek, and then continued to above and behind the ear, following the ear edge then transversal to the edge of the hairline. Through the incision, the inner supporting structure can be folded or removed to produce a pulling effect. Excess loose skin will also be removed. The length of surgery varies from 3-6 hours.

Several specific variants of facelift are:

  • Minimal access facelift, in which incision is made on the border of ear and cheek, without continuing to the back of the ear. This technique is indicated for face and neck which are not too loose. The recovery period is shorter and the scar will be smaller. However, neck tightening is not as optimal.

  • Lower facelift, usually done along with neck lift

  • Mid-facelift

  • Forehead lift. Incision is made above the hairline. Another technique for this particular procedure is by endoscopy, where surgery is done through a minimal incision by special equipments.

  • Suture/thread lift. Candidates are those in their 40’s with loose skin that is not too obvious. This procedure includes a very small incision on the temple, from which a thread is inserted to lift the facial skin. The procedure lasts for approximately 1 hour. However, this technique doesn’t give a significant effect if the candidate is not a suitable one. The effect also doesn’t last as long (only 2-3 years). Side effects include facial swelling (usually 3 weeks) and infection.

After the surgery, you can return to your home on the same day or the day after. Your face will be bandaged on the sides and below the chin. You will be asked to return for a follow-up in 2-3 days post surgery. After that period, you are allowed to take a bath and wash your hair. Surgery wound will be managed by ointments, and this can be done by you at home. Stitches will be removed in 7-10 days post surgery. No special diet is required. Recovery time needed before you can start your activity range between 1-3 weeks depends on the technique and extent of the surgery. Final outcome of the surgery can be seen after 2-3 months. Post surgical scar will fade away after 3-6 months.

Like all medical procedures, facelift and neck lift can be accompanied by several complications. Bleeding, swelling, scar, and bruises are examples of early complications. Bruises usually resolve in 2 weeks. Bleeding under the skin needs to be managed by removing the blood clot. You may experience numbness at areas around the ears and neck. This is temporary, and will recover in 3-6 months. Another possible complication is facial paralysis caused by damage to the nerves. If the facial nerve is severed, a reconstruction needs to be done by microsurgery.

(Source: Prasetyono TOH. Facelift & necklift. Bazaar 2009 Feb;Chapter 4:39-41.)

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