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Watch Dr. Daniel Krochmal, MD, FACS review Facelift Surgery at The Krochmal Center for Plastic Surgery.
Dr. Daniel Krochmal, MD, FACS answers your most common questions about Facelift Surgery
A Facelift is a procedure intended to restore youthfulness to the face by repositioning the tissues and removing excess skin. As we age, the skin, and the tissues underneath the skin, sag (thanks, gravity!). By getting the tissues back to where they were before, people appear to resemble their younger selves.
In the past, many Facelifts relied on making the skin really tight, which pulled up the tissue under the skin (called “subcutaneous tissue”) secondarily. This technique gave the dreaded “wind-tunnel” look, and made the scars worse because of excessive tension on the suture lines. Now, the emphasis is on lifting and repositioning the subcutaneous tissue, and then gently laying the skin overtop after trimming off the excess. In this way, the patient doesn’t look “pulled”, but looks “refreshed”, “natural”, and “ideal”. And because the incisions aren’t under tension, they heal very favorably.
There are many types of Facelift procedures. The “standard” Facelift involves repositioning the jowls and addressing the skin laxity of the neck (no more “Turkey Neck”!). A “Mid Face Lift” addresses the cheeks, and is typically done through incisions around the lower eyelid. A Necklift addresses only the neck, and is good for people who already have defined jawlines and no jowling. Many times additional procedures are also performed to enhance the appearance of the face, such as a Browlift, Blepharoplasty (eyelid surgery), or Lip Lift. As we age, in addition to sagging of the skin and subcutaneous tissue, we also have volume loss. To restore that volume, many patients also elect to have fillers (e.g. Juvederm, Restylane, Sculptra), or fat grafting to the face (Dr. Krochmal prefers fat grafting during his Facelift procedures, as this minimizes foreign substances, and is a “permanent filler” that doesn’t require replacement every year or so).
A standard Facelift can be performed under general anesthesia or sedation. An incision is made that starts in the hairline, hugs the ear, wraps aroud the earlobe, goes on the backside of the ear, and then down the neck hairline.
The key layer of tissue for a Facelift is called the Superficial Musculoaponeurotic System, or more simply the “SMAS”. Some people mistakenly refer to it as the “Submuscular Aponeurotic System”, but this is incorrect, as this layer of tissue is actually above (or “superficial” to) the muscles and not deep to them (“submuscular”). The SMAS is a thin layer of tissue, but it is very sturdy. Manipulating this layer lifts and repositions the rest of the subcutaneous tissue and lifts the skin with it. Surgeons choose to do different things to this layer (e.g. simply put stitches in it, cut out the excess and sew it back up, design flaps that can be resuspended elsewhere, etc.) based on their preferred technique and the individualized goals of the surgery.
If a patient has skin laxity and bands running up and down the front of the neck (“platysmal bands”), the neck appearance can be addressed as well during a standard Facelift procedure. Some surgeons tighten and remove the laxity by repositioning the platysma muscle back towards the hairline. Other times a small incision is made under the chin and the muscle bands are sewn together in the midline to create a smooth, cylindrical appearance to the neck (called a “corset platysmaplasty).
After the face and neck are addressed, the extra skin is marked and removed. Care is taken to realign the skin edges precisely to create a thin, flat scar that is virtually invisible.
A good candidate for a Facelift is anybody with skin laxity and jowling who looks in the mirror and wishes they looked younger. For safety, patients should generally be in good health.
The recovery time isn’t bad at all. You may have a “tight” feeling around the ears (which is what we want!), but a Facelift is typically close to painless (believe it or not). Still, you’ll get some pain medications to help with any discomfort you may have. Bruising and swelling are typically minimal, but you’ll want to plan for 7-10 days of “laying low” if you don’t want other people to know. You can shower the next day, but no soaking in water, heavy lifting, or strenuous activity for 1 month to allow for the tissues to heal properly.
There are great options for people who have mild volume loss and sagging/jowling. Fillers such as Juvederm, Voluma, Restylane, Sculptra, and fat grafting can restore volume and smooth contours. For repositioning the tissues, many patients opt for Silhouette InstaLift Threadlifting, which uses special threads underneath the skin that slowly dissolve with time and are replaced with collagen for continued support. And the actual skin needs to be addressed regardless of whether or not you have surgery (walls look better with a “fresh coat of paint”, and likewise, healthy skin makes people more attractive). To address the skin, frequent HydraFacials, dermaplane and peels, microneedling, laser skin rejuvenation, and skincare products with retinols and growth factors are essential (and don’t forget the sunscreen!).
However, there are limitations to the treatments above, and we have to be realistic about what can be achieved. We are medical professionals, not magicians. A syringe of something or a laser treatment isn’t going to magically reverse years of aging and sun damage.
When most people think of people who need a Facelift, they think of an elderly person with lots of winkles and sagging skin. So many patients say they “don’t want a facelift” because they aren’t even close to the person they think needs one. Admitting to needing a Facelift is also difficult mentally for some people, as this means accepting that we are aging (and we aren’t fine wine, so aging generally sucks). However, most patients also don’t want to drastically change their appearance because their friends, family, and coworkers would know immediately. To stay looking youthful without people knowing, the key is to have a Facelift earlier in life and then do smaller “maintenance” procedures for upkeep. What’s incredible is that people won’t realize you had something done. They’ll comment that you look great and well-rested, or ask if you’ve changed your hairstyle or have lost weight. It’s kind of funny when it happens!
There is no “best” surgeon for any procedure. But, there are some qualifications and credentials that improve the chance that you will achieve your desired result safely. Make sure your surgeon is a Board Certified Plastic Surgeon. Make sure they operate in a fully accredited facility. If the procedure is not being done in a hospital, make sure they have privileges at a local hospital to do the procedure you are getting done. Make sure they have completed an accredited residency or fellowship program. Read their reviews to get a sense of what other patients have experienced. Check out their before/after pictures to get a sense of their technical and artistic style, and see if they operate on patients that appear similar to you.
And most importantly, schedule a consultation with that doctor to see if they are a good “fit” for you. Every doctor has his or her own personality and approach to patient care, so you will want to see if you like that particular approach. Do they inspire confidence and trust? Are they calming and reassuring? Do they take the time to answer your questions? Do they discuss alternative approaches and say why those approaches may or may not work? Do they seem like they will continue to care for you after the procedure?
There is no “best Facelift surgeon”, but there is a “best” surgeon for you. You just may need to consult with several to find the right one. Hopefully Dr. Krochmal is on your “short list” of Chicago and Hinsdale plastic surgeons to interview. We’re happy to help Shape Your Future!
Facelifts costs start at $12,000+.
The Facelift result is permament in the sense that the lower face and neck skin excess will always be improved compared to if you had never done the procedure, even if the skin does become a bit more lax with time. A Facelift “turns back the clock” but the clock keeps going once surgery ends.
You should get a Facelift if you have excess skin on the lower face and neck and desire to have a refreshed, more youthful appearance. A well-done Facelift doesn’t change what you look like, but rather improves your appearance and confidence.