It is axiomatic that all facelifts are different and certainly one cannot recover from all facelifts in a single week. What I wish to describe is the optimal situation from both the patient’s point-of-view and the surgical perspective. Choosing the right patient with application of the correct facelift procedure under optimal anesthetic conditions will usually yield the quickest recovery: one week from my perspective.
Who is the best candidate for the facelift procedure? Ideally, the best candidates for facelift are women between 40 and 60, healthy, non-smokers, with the proper motivation and support. More specifically our ideal patient is active and actually benefits from a return to normal activity in a week. As with any surgical procedure, the difficulty and extent of deformity provided by the patient is important. In the perfect world described here, our female patient has moderate aging of the cheeks with early marionette lines, somewhat deepened nasolabial folds and the presence of the “bubble” of cheek fat tissue obscuring the jawline. Once these conditions exist, there is no amount of injecting or fillers that can camouflage or “lift” tissues to redefine the jawline. Some skin elasticity remains as opposed to our older patients with “leather” skin, and a multitude of deep wrinkles indicated a total loss of elasticity. Weathered skin is usually due to extensive sun exposure without sun-block, as well as environment toxins and smoking. These older patients with skin elasticity problems are still candidates for facial rejuvenation, but the operations are more extensive and cannot be recovered in one week. Minor aging of the neck can also be treated simultaneously and does not prolong our one week recovery.
We try to address as many skin quality problems as possible pre-operatively. We prescribe the nightly use of a Retin-A, hydroquinone, steroid solution as well as a cleansing facial treatment pre-operatively if possible. We frequently recommend lower blepharoplasty with our midface lift and thus recommend an eye exam prior to blepharoplasty in most cases. Previous surgery for cataracts or glaucoma is noted as the post-operative incidence of swelling in the form of a chemosis is more likely in these patients and may take more than a week to resolve with prescription eye drops.
Optimal anesthetic conditions include the use of local anesthesia with sedation rather than general anesthesia. The control of blood pressure within a narrow range of the pre-operative value is necessary to minimize swelling and bruising that is expected when emergence from general anesthesia is necessary. Aspirin and NSAIDS are stopped 2 weeks pre-operatively, and Bromelein and Arnica are recommended peri-operatively. The liberal use of ice on and around the eyes with constant head elevation, regional blocks for peri-orbital anesthesia, and minimal injections directly in the ultra-thin eyelid skin reduce the chances for injection bruising in the lids.
The most important discussion to lessen edema, bruising, and to expedite recovery within one week is the choice of the mid-facelift and the details of its performance. Lapsing into technical jargon, our lift is a short-incision mini-lift with a multi-vector, progressive tension SMAS plication. The combination of techniques results in an aggressive lift with a minimal of undermined skin resulting in minimal “dead space” to accumulate blood or fluid. For this small area of undermined skin, we have further developed a system of “micro-drains” utilizing vacutainer tubes as the collection/suction mechanism. These 21 gauge drains are effective for removing any possible fluid collections and are removed at 24 hours post-operatively. These small drains are incorporated into 24 hour post-op compression dressing, and in most cases the patients don’t know they exist. The light compression dressing is augmented with “rest-on foam” on the neck and adjacent to the peri-auricular incisions. This foam is also removed at 24 hours and is replaced by an ace bandage to compress the dependent portion of the neck and to protect the ears, especially at night. The neck compression is important to achieve our goal of one week to “street-ability.”
Incision care is of the utmost importance to achieve our goals. Gentle cleansing using peroxide once a day with careful application of Aquafor, especially around and behind the ear where it is difficult to see and for the dissolvable lower eye-lid stitches. If the lower led sutures are allowed to dry, they will become brittle and will not dissolve on schedule at about 5 days. The nylon sutures about the ear and in the submental neck are removed at 5 days except for a few “key” sutures in areas of tension. These key sutures are removed on day 7.
Lastly, a word or two on the general aspects of healing. It should go without saying that a calm, smoke-free, supportive environment is important to have the mindset to heal uneventfully. We request careful attention to the instructions provided and the comfort to call at any time if any uncertainty arises. All of the medications are provided for a reason and should be taken exactly as prescribed. We will go over all of your medications in detail with you so there are no mis-understandings regarding when to resume them. Controlled activity beginning post-operatively day one is important. There will be three office visits during the first week and of course these are very important. It is probably equally important for your mental recovery to parallel your physical recovery. Although we aim for your physical recovery to be well along at one week so that you can be in public, your recovery will continue for many weeks and months to total normality. We use serial photography to allow you to follow your recovery visually, which in most cases, helps your physical recovery and state-of-mind as well. You will receive copies of all photos as well as the constant reminder of your pre-op condition with a set of your before photos as well.
We believe that we are all “goal oriented” people and that goals for life as well as for recovery from surgery are important. Our goal for you is a one week recovery and we will provide you all of the tools necessary to achieve this goal.