Facelift

What is facelift surgery?
Technically known as rhytidectomy, a facelift is generally the procedure that will provide the most significant rejuvenation in the face and neck. Dr. Forsberg emphasizes a natural approach to facelift surgery. He wants you to look naturally younger but certainly not artificial or overdone.

A facelift will improve skin laxity, jowling, the hollow appearance to the cheeks and below the eyes, a jawline that lacks definition, and a droopy neck. If you find yourself standing in front of a mirror and giving a gentle oblique push on the skin near the corner of the jaw, you may want to come in and learn more about face lift surgery with Dr. Forsberg. Click here to request your consultation with Dr. Forsberg.

The patient pictured below had a facelift done by Dr. Forsberg. In her after photos, she looks rejuvenated and refreshed, but still very much like herself and not like an obvious plastic surgery patient. Yes, she still has some wrinkles and imperfections but the patient is thrilled because she just looks like a younger version of herself – exactly the goal of her and Dr. Forsberg!
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How does Dr. Forsberg’s approach to facelift surgery address all of the major changes in the aging face but still look natural?
During the aging process, 3 major predictable changes to the face occur.

1. The majority of the volume containing fatty tissue in the face is intimately associated with a muscular layer called the SMAS. With time and the effects of gravity, this muscular layer stretches out and the soft tissues of the face fall downward. This change takes a youthful, upside down pear shaped face with most of the volume high around the cheek bones to a more square shape with volume shifting from the cheeks to lower in the face, along the jaw (jowls) and neck. This decent of soft tissue enhances the appearance of the fold going from the nose to the corner of the mouth and the “marionette line” which extends from the corner of the mouth down on the outside of the chin, revealing the edge of the jowl.
2. Over time, the skin loses its elasticity and appears looser, with more lines and wrinkles. Loose skin on the neck also contributes to the loss of definition in the angle between the chin and neck and can even lead to the appearance of a double chin in people who are not overweight.
3. More recently, we have recognized that there is also significant volume loss in the face with time. A younger face is fuller and has more soft tissue.
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Dr. Forsberg takes a natural approach to correcting all 3 of these major changes in aging.

1. Muscle laxity and descent of facial soft tissues. Dr. Forsberg believes that correcting muscle laxity and drooping soft tissues in the face is critical for providing both a natural and long lasting result to the facelift. After the facial skin is lifted up, sutures are placed to tighten the deeper muscular layer (SMAS) and restore a natural contour to tissues in the cheek, pull the tissues drooping over the jaw bone (the jowl) back up, and tighten the muscles in the neck to help redefine the angle between the chin and neck.
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2. Skin laxity. It is true that over time, the skin will lose some of its elasticity and start to sag. Dr. Forsberg usually removes a relatively small amount of skin during the facelift to tighten it up a bit. Some surgeons, however, rely solely or predominantly on skin tightening to provide their facial rejuvenation. When this approach is taken, the face can look pulled, over tightened, and unnatural. Additionally, skin stretches back out very quickly and so the results don’t usually stand the test of time. Dr. Forsberg is also extremely meticulous about placing the incisions in locations that will minimize their visibility. Below is a patient 6 months out from facelift surgery from Dr. Forsberg who’s incisions around the ear are nearly impossible to identify.
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3. Volume loss. A facelift alone manipulates the existing tissues and helps to restore a youthful proportion to facial dimensions but it does nothing to address the volume that has been lost in the face over the years. Dr. Forsberg has found that a conservative amount of fat transfer to the face during his facelift procedures helps to complete his natural rejuvenation. Fat cells are harvested from elsewhere in the body and injected into areas where volume is deficient in the face.

Below is a 74 year old patient of Dr. Forsberg who had facelift with laser resurfacing around her mouth, along with microfat grafting to various areas in her face. The fat grafting helped to further improve her cheek bones, the hollowness under the eyes, and add some volume back to her lips without looking overdone. While this patient’s improvement is dramatic, you don’t look at her after photo alone and think “this is a patient who’s had plastic surgery!”
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What other procedures are commonly performed in conjunction with facelift surgery? Is it safe to have all of these procedures at once?

Multiple facial rejuvenation procedures are frequently performed by Dr. Forsberg in a single operation. While there are some combinations that would be unsafe or require too much time in the operating room (that Dr. Forsberg would advise you of), facelifts are frequently performed with many of the following procedures:
Brow Lift
Blepharoplasty (eyelid surgery)
Fat Grafting
Laser Resurfacing
Neck Liposuction
Chin augmentation

While a facelift can go a long way to rejuvenating the face, it does not address all the issues of facial aging. The advantages of undergoing multiple procedures at once when they are indicated include a single recovery period for multiple procedures, reduced costs, and a more complete and balanced rejuvenation. It’s sort of like remodeling your kitchen by replacing the cabinets and countertops but leaving the old paint and appliances. Suddenly the need for a paint job and updated appliances stand out as much as the nice new countertops and cabinets!

The patient of Dr. Forsberg’s below underwent a combination of facial rejuvenation procedures, including facelift, brow lift, and upper and lower blepharoplasty.
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How long can I expect my results to last?
Patients should be aware that no plastic surgery procedure can stop the progression of aging. While in many ways, it can set the clock back, skin will stretch and soft tissues will fall with enough time. The most important surgical step in providing the most natural, long lasting result with a facelift is to perform a complete repair of the drooping muscular layer below the skin. Skin stretches out again much quicker than the underlying muscle. Dr. Forsberg has seen too many patients a year or two out from a facelift at other facilities where only the skin is addressed who tell him they feel like they don’t look any better than they did before they had the surgery. Because the muscular suspension will hold up much longer than tightened skin, many patients who have had this type of complete approach to their facial rejuvenation are happy for a decade or much more!
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What is the expected recovery following facelift surgery?
Typically patients who have a facelift procedure will go home the night of surgery with bandages wrapped around their face and head. Drainage tubes may be used and are usually removed on a visit back to the office the morning after surgery. Keeping the head elevated and icing are important to minimize bruising and swelling after surgery. Sutures from in front of the ear are removed about 5 days after surgery. At this point, make-up can be applied and some patients are comfortable enough to venture back out into the public eye but noticeable bruising and swelling can persist for several weeks after surgery. The face will feel quite tight and there can be numbness around the ear lobes for weeks to months after the procedure. While everybody’s healing and employment situations are different, most patients take about 2 weeks off from work after surgery.

If I don’t want to have a traditional facelift, am I a candidate for a “mini” facelift?
In appropriate patients, Dr. Forsberg performs a type of mini facelift called the MACS (minimal access cranial suspension). In this procedure, a shorter skin incision is made around the ear, and less extensive facial undermining is performed. This can result in reduced down time, and significantly less bruising and swelling. The most important, thing, however, is that even in this type of “mini” facelift, Dr. Forsberg still places sutures in the deeper muscular layer to re-suspend and tighten these drooping tissues and provide a more natural, long lasting result. While the results of even this type of MACS facelift cannot be expected to last as long as the more extensive traditional facelift, many surgeons who perform some version of a mini facelift only put a slight pull on the skin and do not address the deeper muscular layer. This leads to results that can last less than a year and look unnatural. If you are considering facial rejuvenation surgery, be sure that you are working with a board certified plastic surgeon who can perform the appropriate operation for you, whether that may be a mini-lift with muscular repair or the more traditional full facelift.
 
Click here to view an animation explaining the Facelift (Lower).

Click here to view an animation explaining the Facelift (Mid).

Click here to view an animation explaining the Facelift (Mini).

Click here to view more photos of the Facelift Procedure.
 

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