Facelift Surgery With A True Specialist
A Facelift or Rhitidectomy is a surgical procedure that is used to address signs of aging in the face and neck. These signs include cheek descent or ptosis, deep nasolabial folds, jowls and marionette lines, and neck rhytids or wrinkles and bands. These issues can be corrected with the right surgical technique.
Dr. John Michael Thomassen has specialized in face and neck lifts and has over 10 years of experience. He offers a SMAS facelift technique for his mini and full face and neck lifts to ensure a natural result that lasts.
What Causes the Face to Age?
A myriad of environmental and genetic factors affect how our faces age with time. Loss of volume occurs as we age including both due to changes in our bony structure and the size and position of fat pads in our face. Loss of skin elasticity and its ability to repair itself also occurs with time. Rapid weight loss, as well as exposure to toxins and even excess sunlight, can accelerate these changes. Some of these change occur even in younger patients due to exposure to these damaging environmental factors.
The Benefits of a Facelift (Rhytidectomy) with Dr. Thomassen
Dr. Thomassen offers the most current procedures tailored to your goals. In addition, we tailor the anesthetic approach to ensure you feel most comfortable with the procedure. From local anesthesia only to general anesthesia, you have options we can discuss that will ensure your safety and satisfaction. In addition, we perform this surgery in the privacy of our Office Surgical Center with a board certified Anesthesiologist.
A gradual approach to maintaining a natural yet more youthful look is important. It can start with some fillers and Botox, and then progress to fat grafting, and eventually to a mini or full facelift. A Rhytidectomy should not change an individual’s natural facial expressions or make the patient unrecognizable. Instead, a successful facelift result involves subtly improving the contours of the face to essentially turn back the hands of time and provide the patient with a healthier looking, more attractive version of himself or herself.
Steps Involved in Completing your Surgery
Step 1 – Initial Consultation
During an initial consultation, Dr. Thomassen will ask questions related to the patient’s medical history.
- Current medication, vitamin and herbal supplement use
- Familial medical history (diabetes, high blood pressure, etc.)
- Previous surgical procedures and/or other treatments
- Smokes or chews tobacco
- Uses recreational drugs
It is essential that patients are candid with Dr. Thomassen and his staff regarding these matters. This ensure’s that Dr. Thomassen takes the right measures to ensure patient’s safety. Once Dr. Thomassen has gathered the information he needs from the patient; he will want to examine his or her facial features. At this time, he may also take photos to use as reference when creating the patient’s surgical plan.
Step 2 – Preparing for your Surgery
Prior to their surgery, patients need to refrain from taking certain medications for at least two weeks before his or her surgical procedure. Some medications increase the incidence of bleeding and include products that contain aspirin and ibuprofen.
Dr. Thomassen advises individuals who smoke or chew tobacco to stop using these products at least four weeks prior to their surgery. Patients should stop any nicotine products designed to help an individual stop smoking or chewing tobacco.
Dr. Thomassen may request that patients visit their general practitioner to have a physical prior to their surgery. In addition, patients may need to have blood work and other routine testing performed before their surgery.
A facelift is an outpatient procedure: It takes approximately two hours. Prior to the procedure, Dr. Thomassen and the patient will discuss which technique will meet his or her needs the best. Patient’s need to arrange transportation home since they will not be able to drive after the procedure.
Step 3 – Day of Surgery
The day of your surgery, a board certified Anesthesiologist will administer medications for your comfort during the procedure. The choices include intravenous sedation and general anesthesia. In the case Dr. Thomassen can perform the procedure under local anesthesia, then you will not need an anesthesiologist. Dr. Thomassen will recommend the best choice for you.
Step 2 – The Procedure
Depending on the degree of change you’d like to see, your rhytidectomy surgery choices include a a mini-facelift, a full face and neck lift, and any combination of these with other ancillary procedures like fat grafting and eyelid lifts.
Traditional Facelift (Face and Neck Lift)
A traditional facelift incision often begins in the hairline at the temples, continues around the ear and ends along the posterior hairline. Dr. Thomassen then elevates the SMAS in your cheek and neck area and sutures it higher to give the lift the longevity a skin only procedure does not.
Dr. Thomassen then redrapes the skin over the uplifted contours of the SMAS and trims away excess skin. Dr. Thomassen places a second incision under the chin used to further improve an aging neck. Small sutures close the incisions.
A mini facelift is designed to correct midface ptosis or droop, jowls and the neck. This is done without dissecting into the neck itself. It is a faster procedure that can be comfortably done under local anesthesia. Dr. Thomassen recommends this procedure for the younger patient that needs facial rejuvenation and does not have excessive neck rhytids or fullness. It is also a good option for the older patient that wants a quicker procedure and recovery.
Short Scar Facelift
An alternative to a traditional facelift uses shorter incisions at the temples and only in front of the ear. This technique treats mostly the midface and lower face without concentrating on the neck.
Dr. Thomassen offers the standalone neck lift to patients who are only interested in neck rejuvenation and not interested in addressing cheeks or midface issues. The scar around the ear is a little shorter and this is combined with a small incision under the chin. It is an excellent procedure for men interested in improving necks without affect their face generally.
Step 4 – Following Surgery
After surgery, you will recover in the postoperative area and then be discharged home. You will have dressings and drains in place. You will see Dr. Thomassen inside of 24 hours after the procedure to ensure you are healing well. After this visit, you will be able to shower and wash your hair and treat your incisions with an antibiotic cream. Dr. Thomassen will provide you with a compression garment to keep gentle pressure on your face and reduce swelling.
You will then see Dr. Thomassen at 1 week after the procedure. Dr. Thomassen removes all visible sutures on this visit. A few are left in place until the 2nd week. You will look nice at this point with only some residual swelling. You will be fine to return to clerical duties if you do not mind a few questions from the people around you. At 2 weeks, you will have all sutures removed and be able to be around people without any evident signs of having had surgery. You can expect to workout between 3-4 weeks after surgery.
What are the Different Types of Facelifts?
There are so many different names used to describe facelifts that it can get confusing very quickly. In reality, all these different names refer to more often than not a very similar technique and sometimes a particular name is used not to differentiate a technique but rather to market a certain practice. A typical example is the so called “Lifestyle Lift” which did not refer to any particular technique but rather to a company that would attract business to its contracted surgeons by promoting the name. As for the bona fide techniques, the list below will attempt to clarify them.
Mini Face lift (Mini Lift, S-Lift)
- The Mini Face lift provides a complete natural facelift with minimal incisions. This technique avoids a submental incision. Dr. Thomassen limits these incisions to in front of the ear and extending it to behind the ear. If you extend the scar further into the hairline behind the ear, the incision is no longer considered minimal and the technique starts resembling a full facelift.
- The most basic Mini Lift technique is to make the incision and then remove skin in the area in front of the ear and close the incision. Dr. Thomassen recommends this in the younger cohort of patients desiring facial rejuvenation. The improvement can be subtle and does not last as long as other techniques. Dr. Thomassen can perform this procedure quickly under local anesthesia in the office setting. However, for the incision used, it is probably better to perform a more sophisticated lift to the improve longevity of the result.
- The SMAS (superficial musculoaponeurotic system) is the tissue present just underneath the skin in the face. It lies just above the parotid gland and its covering and also just above facial nerves that power the facial musculature.
The five layers of the face, analogous to layers of the scalp and neck. The facial nerve travels deep to layer 3, becoming more superficial within layer 4. (Reprinted with permission from Mendelson B. Facelift anatomy, SMAS retaining ligaments and facial spaces. In: Aston SJ, Steinbrech DS, Walden JL, eds. Aesthetic Plastic Surgery. London: Elsevier; 2009:57.)
When this SMAS tissue is manipulated, the longevity of a facelift is improved. During a Mini Lift, the SMAS can be plicated, where sutures are placed to hold it up. This has been popularized with the MACS lift (Minimal Access Cranial Suspension).
Illustration showing the minimal access cranial suspension lift with loop sutures tethering soft tissue to the deep temporal fascia. (Reprinted with permission from Tonnard PL, Verpaele AM, Morrison CM. MACS face lift. In: Aston SJ, Steinbrech DS, Walden JL, eds. Aesthetic Plastic Surgery. London: Elsevier; 2009:138.)
The surgeon dissects the SMAS from the underlying tissues and forms a flap of tissue. The surgeon sutures the SMAS upwards to hold facial tissues. There are proponents for both types of techniques. Although SMAS manipulation may increase the risk of nerve injury, in experienced hands, this is a rare complication.
Combining a mini-lift with SMAS manipulation is an excellent way to improve the longevity of the result. The more extensive the SMAS dissection, the more the technique starts becoming a full facelift and not a mini-lift.
Traditional Facelift (Full Face Lift, Face and Neck Lift)
A full facelift procedure usually involves access to the neck via a submental incision as well as the periauricular incisions. Also the dissection into the neck is more extensive than in the mini-lift variety. There are a few varieties as listed below:
- As mentioned, addressing the neck directly elevates a mini lift to a more involved face lift. A common procedure is to make a small incision under the skin dissecting over the platysmal muscles and removing excess fat. This dissection communicates with the dissections on each side of the face.
Medial suturing of paired platysma muscles with partial transection of the anterior border. [Reprinted with permission from Stuzin JM. MOC-PSSM CME article: Face lifting. Plast Reconstr Surg. 2008;121(1 Suppl):1–19.]
- A subcutaneous facelift involves a wide undermining of skin. SMAS manipulation can be added but not necessarily. A wide dissection into the neck is necessary to rejuvenate a very wrinkly neck.
- The SMAS tissues are manipulated by either suturing tissue superiorly or dissecting the tissue off the underlying tissues and then suturing it up. The SMAS manipulation is important factor for improving the longevity of results
Illustration showing Barton’s “high SMAS,” with cheek soft tissue raised along with overlying skin. (Reprinted with permission from Barton FE Jr, Meade RA. The ‘HIGH SMAS’ facelift technique. In: Aston SJ, Steinbrech DS, Walden JL, eds. Aesthetic Plastic Surgery. London: Elsevier; 2009:133.)
- The composite facelift involves elevation of the skin flap and the SMAS flap together in one flap. We recommend this technique in smokers who are at high risk for wound complications. It is technically more challenging and not used often.
Illustration showing Hamra’s original composite face lift flap, with orbicularis, malar fat, and platysma raised in continuity with overlying skin. (Reprinted from Hamra ST. Composite rhytidectomy. Plast Reconstr Surg. 1992;90:1–13.)
- This involves elevation of the cheek soft tissues in the subperiosteal plane. It is more of an adjunct to other techniques and helps correct cheek ptosis. We do not recommend this technique due to the risk of significantly altering your appearance and looking “done”.