In many ways, the rise of minimally invasive cosmetic procedures has shifted the way patients think about surgical alternatives. Perhaps this is no more evident than in recent figures related to the rhytidectomy (a.k.a. facelift). According to the American Society of Plastic Surgeons (ASPS), there were about 122,000 facelift procedures performed in 2018, down from around 126,000 in 2017 and 134,000 in 2000. That amounts to an approximate 10 percent drop in that two-decade span. Similar trends exist for cosmetic surgery procedures like blepharoplasty (i.e. eyelid surgery) and brow lifts, which isn't surprising given that those surgeries are often combined.
When you consider that there were some 16 million minimally invasive cosmetic procedures performed in 2018 compared to just under 2 million surgical ones, it is clear that there has been a trend toward going under the needle (think: dermal fillers and neurotoxins like Botox®) instead of under the knife. But, in a society in which time is of the essence, plastic surgeons have recently noticed more and more patients inquiring about treatment options that would allow them to trade their routine injectable and laser appointments for longer lasting results.
For patients seeking a more youthful appearance and hoping to address loose skin or excess skin, facial plastic surgery procedures like facelifts work wonders. And, fortunately, technology has come a long way from traditional facelift techniques. Today, SMAS facelifts, midface lifts, and neck lifts can provide facial rejuvenation with inconspicuous incision sites, better wound healing, and faster recovery times. Here, a facial plastic and reconstructive surgeon and facelift patient discuss the allure of the procedure.
The Benefits of a Facelift
Don't call it a comeback — the facelift has been around for years. When it comes to addressing skin sagging and laxity on the face, jawline, and neck, the surgical procedure remains the gold standard. “Facelifts never actually went out of style because it is difficult to rejuvenate the lower face and neck without surgery,” says Jason D. Bloom, MD, a double board certified facial plastic and reconstructive surgeon and founder of Bloom Plastic Surgery in Bryn Mawr, PA. “There are other options than surgery for the upper face. But when it comes to banding in the neck, that is the 'back in style' and 'never left' option.”
But that's not to say it is for everyone. The ASPS estimates that the average cost of a facelift in the United States in 2018 was $7,655 — no small expense. And, for patients who are used to the little or no downtime associated with 'tweakments', the recovery time associated with a facelift may seem daunting (more on that below). At the end of the day, consulting with a board certified plastic surgeon will ensure you get the best treatment for your needs. “You need to be prepared by doing your homework,“ Dr. Bloom says. “Examine multiple before and after photos, but, most importantly, ask the surgeon to see the whole journey of other patients.“
That 'journey' includes finding the right provider, understanding the financial and time commitment involved, and deciding what type of facelift is best for you based on aesthetic goals, bone structure, medical history, and more. “When you only look at the before and after, it is like only looking at the cover of a book and the last page,“ he explains. “When you see the journey, patients are able to understand what is normal and become more educated.“
Ideal Facelift Candidate
“In general, my patients that are looking for facelifts — specifically, facelifts for the lower face and neck — are anywhere from mid- to late-fifties or sixties,” Dr. Bloom shares. For patients who are on the fence about going under the knife, he admits there are less invasive options that can bide people time. “With the lower neck area, early shadowing bothers a lot of women,“ he explains, adding that he has a group of patients in their mid-forties, who he calls “the tweakers.” That group tends to be interested in non-surgical options like ThermiTight®, which uses a radiofrequency probe to manipulate the soft tissue, muscle, and layer beneath the surface of the outer skin without stitches, scalpels, or surgery.
But minimally invasive solutions can only go so far. “Many people try to put off having surgery, whether it is because they are not ready financially, feel that they are too young, or are not prepared to mentally follow through with the procedure,” Dr. Bloom says. “That typically trends for five to 10 years, but there comes a point in the aging process when they seek improvement in the area via surgical options.”
It goes without saying that a facelift is a surgical procedure. As such, it may require general anesthesia, and it involves several weeks of downtime. While most patients resume 'normal' activities (think: going to work) in 10 to 14 days, 'strenuous' activities may be limited for upwards of a month. Bruising and swelling, meanwhile, usually peak at 48 hours and subside over the following two weeks or so.
“The first 12 to 24 hours are the most critical for a safe and effective recovery,” Dr. Bloom says. “I always check on the patients — most ask to stay overnight — the day after. My private nurse checks on them for the next three days to monitor for fluid buildup and infection.”
Additionally, he requires patients to wear a bandage at the surgical site and a velcro neck strap and advises applying a scar gel and ointment to help the healing process. Generally speaking, results take three to six months to finalize and incision site scars can take a year or more to fade.
Nothing lasts forever — not even a facelift. “On average, there is a visible improvement of the face for seven to 10 years,” Dr. Bloom says. “Let’s put it this way: you will always look better than if you did not have the procedure.” As he explains it, aging is a “moving walkway,” and while you can't stop it, you can slow it down and set it back.
Environmental factors like smoking and sun exposure will impact the long term quality of the results, but Dr. Bloom says the technique used plays the biggest role. “The idea behind modern facelift techniques is release and suspension, while the old technique is to pull the skin to a mini-facelift,” he explains. ”When using the older methods, one does not release the deep attachments — the ligaments that connect the bone to the soft tissue in the face — and gravity almost always wins. The skin will sag at tether points. If the facial tissue is released and suspended, the results are natural and long lasting.”
Jennifer, 48, had a facelift to address the loss of skin elasticity in the lower half of her face. After looking into a range of options to solve her laxity concerns, she decided that undergoing a more invasive procedure from the outset would suit her lifestyle best. Here, she explains how she came to that decision and what it was really like to get a facelift.
The AEDITION: Why did you decide to get a facelift? Did you consider any non-surgical treatment options?
Jennifer: The area I was most concerned with was my neck and chin. My skin was starting to sag noticeably, and it was affecting my confidence. I considered a range of solutions from liposuction to thread lifts, but ultimately opted for a facelift. From my point of view, it seemed like the most sensible way for me to invest in my appearance. The longevity of the results was very attractive. I also figured I would be better off having longer downtime for one procedure, as opposed to repeated short periods of downtime. It just fits best with my lifestyle on the whole.
The AEDITION: What was your recovery process like?
Jennifer: When it came to what to expect from recovery, I asked my surgeon to be very honest with me during my consultation, so I was suitably prepared. I’ll be honest: the first few days were unpleasant. I had to remind myself of the results when I was uncomfortable. After the initial soreness, the recovery process for me was more about giving my body time to get over the swelling, and there was a fair amount of bruising, too. My surgeon gave me clear instructions on when I could re-start each category of activity, and I followed that to the letter, which was a great help for me.
The AEDITION: Do you have any advice for people considering a facelift?
Jennifer: I found it helpful to have a list of questions to ask my surgeon during the consultation. I also took a friend with me in case I found anything overwhelming. It was an extra person who could remember anything I forgot. I made sure to write all the important dates down — including when I could take up activities again — in my diary, so I could keep track of things easily. Aside from the practicalities, I think people should consider why they are thinking of having the procedure and should look at all of the options available to them. I also think consulting more than one surgeon is advisable. I ended up going with the first surgeon I met, but I consulted a couple of others to be sure I had found the right person for me. In essence, I think it’s important to make educated choices when it comes to something as important as having surgery.
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