Many patients ask me at what age they should consider having facial cosmetic surgery. I wish it were that simple! Everyone ages at a different rate and in different areas of the face. Some patients are bothered only by the lax skin in their neck, even though they have hooded upper eyelids and large bags underneath their eyes. Rejuvenating a person’s face is really an art, but a surgical plan has to be constructed individually for any given patient. When I see a patient in consultation, my first question to them is, “What do you see in the mirror that you would like to improve about your appearance?” It is much more important that I hear what they think the issues are than to interject my own opinions.
Once I hear what is important to them, I let them know that providing natural-appearing results is what is most important to me. No one should ever have to look stretched, tight, or odd following well-executed facial rejuvenation surgery. In our 20s and 30s when we all looked pretty good, none of us looked stretched or tight, so there is no reason to believe we would look good at 50 or 60 with really stretched skin. I study photos of my patients at younger ages so that I can create a younger version of that individual, not someone who looks different to their family and friends. I put sagging tissues back where they started, not into a position they have never been.
As I wrote in a previous article, it is very rare for me to perform facial rejuvenation surgery without having my patients take advantage of non-invasive treatments that benefit their results. Quality skin care prepares the skin for surgery, giving me better quality material to work with. It improves the longevity of the result, too. BOTOX® softens fine lines and furrows in the forehead and around the eyes. Dermal filler plumps up furrows around the mouth and in the lower jawline. No matter how skilled a facelift surgeon I am, I always like the results of facial surgery better when these non-invasive treatments are also used. It is not non-invasive treatments or surgery, it is both for the best results to be achieved.
Most people age from the top of their faces down, with changes to the upper and lower eyelids starting to show by the late 30s. Sometimes, the brows descend as well. In people under 45, it is most common to remove upper eyelid skin and fat, and re-position sagging muscle and fat in the lower lids. These procedures are performed under general anesthesia as an outpatient. Recovery time for upper lids is 7 to 10 days, but the lower lids take four to six weeks before the swelling resolves completely. If the brows need to be lifted, a scope is inserted through small incisions behind the frontal hairline, avoiding a large incision over the top of the head. This procedure results in a 7- to 10-day recovery.
Many patients in their mid-40s and beyond start to notice jowling on their jawline, as well as extra skin and fatty tissue in their necks. There is no non-invasive treatment that is significantly effective at repositioning tissue that has sagged in response to gravity. I see patients spending thousands of dollars on ineffective treatments such as Thermage and Fraxel when they really need surgery. While these non-surgical treatments may improve the appearance of the skin some, they don’t lift skin to any noticeable degree.
Facelifts reposition sagging tissue in the cheek, jawline, and neck. The incisions are hidden around the ears and in the crease underneath the chin. This procedure is performed with the patient asleep under general anesthesia. I have my patients spend one night in the recovery care center. They are discharged after I see them early the following morning after I remove the bandages. Most patients are surprised that the recovery is almost painless. While there is bruising, swelling, and some numbness in the skin, patients do not complain of pain. Most feel they look quite presentable 7 to 10 days following surgery.
Some patients ask me if they are too old to have a face lift. Almost anyone over 50 can benefit. It is important that all other health issues are stable and well managed, so a checkup with a primary care physician is important prior to any elective surgery. My number one goal is to perform the procedures safely. Once the checkup is completed, it is safe to proceed. Always seek out board certified plastic surgeons for your consultations. You can then ensure your surgeon has completed appropriate training and exams in the field of plastic surgery. Surprisingly, not all practitioners performing facelifts are plastic surgeons, so do your research and ask your surgeon which board certified them. If it is not the American Board of Plastic Surgery, look further.
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