First Facelift

The term “first facelift” is showing up more and more frequently on Google searches these days. Although what the term means is intuitive, it is not a medical term that plastic surgeons frequently use. Medically speaking, the proper term is primary facelift but you can’t argue with a Google search.

Not particularly in tune with the “mind” of the internet, my assumption is that a first facelift is considered intrinsically different than secondary (second) or tertiary (third) facelifts. While there is some truth to the fact that first facelifts are performed differently than the others, there is no truth to the thought that a plastic surgeon can be an expert at firsts and not seconds or thirds. Although I am unaware of any statistics to the effect that at least half of the patients who have a first facelift before the age of 55, will also have at least a second as well as any number of touch-up procedures.

The importance of first facelifts is that any plastic surgical procedure including facelifts, eyelids, noses as well as cleft lip and palate achieve the best results the first time they are done;

Thus, the term first facelift. A good first facelift can lead to an even better second and even third. I truly was not aware that “first facelifts” were something people look for, or Google for, but I learn something about Google every day. With that said, I’m probably the best first face lifter around these parts.

Read more about top facelift surgeon Dr. Paul Howard in Birmingham, Alabama.

Facelift Swelling

The subject of facelift swelling is one that has driven a large part of my facelift procedures and practice over the last decade. It’s an easy subject to get your mind around because no one likes it, your reputation can depend on how much of it your patients have, once created it is hard to get rid of and regardless of how well patients are prepared for their surgery and the incumbent, yet evil swelling, they still feel like something is wrong when they have it.

For years all plastic surgeons thought that the swelling after a facelift under general anesthesia was a necessary evil and therefore spent little time trying to figure out what causes it and how to prevent it.

After years of failing to prevent swelling by doing small things that never worked like corticosteroids, drains, dressings, Vitamin K and dozens of other special medications and emollients. Being unwilling to accept failure, we started to question the basic tenets of doing a facelift. The most obvious and successful change was to stop doing general anesthesia for all facelifts. This was met with skepticism by many plastic surgeons that could not imagine operating on a patient for the hours necessary and have to deal with the anesthetic also. It was thought that the patients, usually a bit older than our average patient, wouldn’t or couldn’t tolerate the procedure “awake.” Concerns about the volume of anesthetic needed as it relates to toxicity and whether or not the entire face, neck and eyes could be rendered numb enough for surgery. All of these concerns quickly fell to the wayside; patients hated general anesthesia and the ability to anesthetize the face only required relearning all of the pharmacology of local anesthetics we learned in medical school. The only remaining question was whether or not the plastic surgeon (me) would exhibit patience in dealing with the conscious patient and subjugate the ease, comfort and lack of responsibility inherit in general anesthesia to the need and desire of the patient to have little or no swelling and a simpler, faster return to normal. The answer to the question for me was –absolutely.

From that point forward, we worked out the details of the sedation, the local anesthetic agents, monitoring and significantly changed the operation to accommodate the wishes of the patient which were primarily based on having minimal to no postoperative swelling. The accumulation of the techniques of anesthesia and its agents, sedation, operating room ambiance and the ability to perform a first-class and lasting facelift under these circumstances has led to what we call the Howard Lift procedures which include rejuvenating procedures for not only the face but the eyes, forehead, nose and neck. The Howard Lift is not necessarily a procedure but a new way to do facial procedures concentrating on minimal swelling leading to minimal downtime and a first-class, longstanding natural result.

Read more about facelift recovery.