Face Lift (Lifting of the head and neck)
The Face Lift or rhytidectomy, is a procedure performed under general or local anesthesia and raises the cheeks, the jaw tightens and rejuvenates the lower face. Is often it combined with eyelid surgery and forehead lift, a so-called facelift for a more harmonious result.
The term facelift is a generic term and includes a series of procedures. Other terms used are: facelift, mini facelift, S-Lift, MACS lift, midface lift, SMAS facelift etc. It should be noted that Dr. Grassetti never performs two facelifts in exactly the same way, because no two individuals are exactly the same.
Our faces show different ages for many reasons: heredity, gravity, exposure to the sun. The Lifting (a procedure that has more than 60 years) are designed to reverse the aging process, smoothing and redefining the outline the neck and the line of the jaw to create a youthful appearance. No other type of surgery allows the surgeon more creativity, and no other type of surgery is more deeply personal to the patient.
The force of gravity pulls the soft tissues of the face down. Over time our cheeks begin to give way, the fold that goes from the nostrils to the sides of the mouth (nose furrow genieno or nasolabial fold) is accentuated, and the jaw line and the chin lose their smooth and refined appearance. As we age we lose some of our facial fat tissue (adipose bags malar) and our skin becomes less elastic, this leads to wrinkles and sagging of our skin.
Exposure to the sun can be a major contributor to accelerated aging. People who live in climates where the sun is strongest often suffer from prematurely aged skin, regardless of their ethnic characteristics. Other factors, such as smoking and drinking alcohol, especially if done in excess from a young age may grow old prematurely age the skin.
Years of research, and the cumulative experience of many surgeons, have led to an ever more sophisticated understanding of the aging process and the more subtle elements of the anatomy of the face. Hence, techniques have evolved to restore a more natural youthful appearance of the face.
A facelift can help refresh your appearance, but it will not erase permanent creases, particularly those around the mouth. There are additional procedures such as chemical peels, fillers and Adipofilling that can decrease those lines and can be performed simultaneously with the facelift.
Preparing to intervention
The surgery should not be performed in pregnant patients or nursing.
They should not be taken for two weeks prior to surgery or medications containing aspirin or acetylsalicylic acid, as well as taking oral anticoagulants should be adequately replaced with low molecular weight heparins agreeing everything with the patient’s GP. A month before the ‘intervention must be suspended progestogen therapy (birth control pills) in patients who use it: this to further decrease the risk of deep vein thrombosis in the legs.
If you smoke you should stop for at least one month before surgery to reduce the likelihood of post-operative complications of at least 10 times.
The night before or the same morning should be carried out thorough cleaning shower, carefully wash the hair, removed the nail polish for hands and feet and cosmetics from her face.
Observe the fast of at least 8 hours before the intervention. What to expect from your surgery
In most cases the facelift is done under general anesthesia and it is necessary to spend at least the following night in the hospital. It requires 3 to 5 hours depending on the parts to be treated and the technique used. Once you have been comfortably asleep, the surgeon will make an incision that starts high in the temple which is, at this point, hidden in her hair, following the curve of the top and bottom of the ear and behind (women) or forward ( men and smokers) the central part (tragus).
The incision continues then around the earlobe and behind the ear gently curving back into the hair. In some cases a second of 4 cm incision is made under the chin where it will also be well hidden by the presence of a natural fold. Its purpose is to increase the definition of the Neck Lift (chin and neck) by acting on Platysma muscle. Using these incisions on both sides of the face, skin, fat and muscles are reshaped. The masses fat ovoid to the chin margin (jowls) are if necessary lipoaspirate. The incisions are closed with stitches and metal clips in front of the ear hair. Two small drains are placed under the skin leaving behind the ears and are removed a few days after surgery. This helps to minimize bruising and swelling around the face and neck so that you can return to work and resume normal social activities without too much delay.
The day after surgery
The bandages are usually removed the morning after surgery. The pain is not strong and often coincides with the feeling of tension inherent to this type of intervention. In any case it is controllable with standard analgesics, avoiding those based on acetyl salicylic acid (Aspirin). It is different if you were to experience a sudden onset of pain accompanied by swelling, it might instead mean the development of a hematoma: in this case the surgeon should be contacted immediately. In the first three days after the ‘intervention is good to stay in a cool place and keep the head lifted by two cushions during bed rest to reduce the swelling. cold compresses on the face can help restore a sense of relief and reduce pain and swelling. Removing dlla dressing and suture points early is usually the fifth day after discharge. The points are all removed on the tenth day: until then it is recommended to limit the rotation and the ‘extension of the head. During the first week, the face has some swelling that alters the facial features: it will be normal and completely regress. In some areas like the cheekbones often the swelling is resorbed over a longer period of time. In some areas of the face you may also experience some hardening of tissues, which will be resolved within a few months. Few if any bruising (bruises) is typically located in the areas surrounding the eyes. It lasts a couple of weeks and can be masked with makeup. After 2-3 weeks you can go back to a normal life. Initially you can see an overcorrection or excessive lifting and tension of tissues. This is necessary to obtain a good result as in the following weeks there is a slight “loosening” of the fabrics. Some decreased skin sensitivity, extended to the pinna is often present and will resume gradually, although a slight numbness may persist for several months. For this reason it is recommended to avoid the ‘direct application of heat to the face operated to prevent thermal burns. During the first 5 months you will experience itching and tingling type of water drops that glide on the skin, small electric shock, etc.). Any undulations of the scalp near the scar regress spontaneously over the months.
The hair can be washed two days later, even before removal of stitches, taking care to use detegenti disinfectants. Similarly, the face can be washed gently with a sponge and avoid traumatizing the surgical suture lines.
Later however, it is useful to wash your hair with a mild shampoo (such as baby shampoo), however, being careful not to rub on the suture zone.
Avoid direct exposure to the sun, heat (sauna, turkish bath) or in tanning lamps for at least 3 months after the’ intervention. This could lead to hypertrophic scars or pigmented permanently.
For three weeks it is advisable to avoid wearing clothes with narrow necks.
The smoke can not be resumed for at least three weeks.
Do not lower his head to a more sloping heart level during the first week: to pick something up from the ground is therefore recommended to bend with your knees and keep your neck erect, as well as to tie his shoes. Avoid physical exertion and intense urge maneuvers during the ‘evacuation, which could cause blood pressure increases and then bleeding.
Two weeks after the ‘operation can be starting again with normal bland daily physical activity (walking, driving, sexual activity), with the work and with makeup.
In the week after surgery
With the progress of convalescence, you can expect that:
• the sutures are usually removed about seven days after surgery. It is advisable not to apply any color on the hair for four weeks after surgery because of harsh chemicals such as bleach or ammonia in the product;
• The scars usually are very thin and weak at first, then they thicken and redden for a few months after the surgery before returning to a more natural color;
• It is normal to feel a bit of torpor, observe bruising and swelling after a facelift. These symptoms are temporary and should mostly disappear after about two weeks. L ‘numbness (paresthesia and hypoesthesia) sometimes takes longer to go away. It may be present up to a month in the area of the cheeks and three to four months to the bottom of the chin.
To help reduce post-operative bruising, arnica can be taken for one week before surgery and two weeks after. Products like arnica cream can also be useful to reduce and delete faster bruises.
Dr. Grassetti like to stress that complications are rare today, but if you experience a any infection this usually can be treated with standard antibiotic.
If you encounter a hematoma (collection of blood under the skin) you may need to suck with a cannula at the bedside followed by a wash of saline and anesthetic or vasoconstrictor, if more significant size, you may also need to return to the operating room . If it is treated promptly it should not affect long-term results of surgery. Note that, although it is the most frequent complication after this surgery, it occurs from 2 to 7% of cases, and usually only in the first 12 hours. Small hematomas (from 2 to 20 ml) instead occur a little more frequently (10-15% of patients) and can be aspirated after 10-12 days from the operation when they start to liquefy. To prevent the formation of these hematomas we recommend in the two weeks prior to surgery to avoid aspirin, nonsteroidal anti-inflammatory drugs (ibuprofen, ketoprofen, ketorolac, diclofenac, etc.), excessive doses of vitamin E, smoke.
Occasionally, there may be reopened (dehiscence), delayed wound healing, or de-epithelialization of a few centimeters of skin. This is especially true in diabetic patients or in patients who smoke. All this will be managed with common medications.
Any surgery that requires more than one hour there is an increased risk of clots in the veins of the legs (deep vein thrombosis). Because of this, it is important that, apart from the measures taken during the hospital stay, we continue the gentle mobilization, exercising your legs slightly but regularly in the week after the surgery. This will help restore circulation and reduce the chance of blood clots.
Among the specific complications of this surgery were:
Damage to the facial motor nerves that control facial muscles or the parotid salivary gland are extremely rare with the facelift surgery in experienced hands. In the majority of cases where this occurs there is usually a full recovery. Sometimes even because of complications occurred, you may cause permanent paralysis of certain muscles of the face resulting asymmetry of facial expression (paralysis of half of the face, mouth half, closing the eyelids difficulty).
Darni nerve small-caliber psychics are inevitable, hence the feeling of anesthesia and numbness felt for several weeks. If damaged larger sensory fibers, the ‘anesthesia can last a year or in rare cases forever.
Necrosis and therefore loss of the low-cut leather during the ‘operation is a rare event, but possible especially in patients with diabetes or smoking. It presents with bluish color before then black part of the skin near the suture before and behind the ‘ear. It then will form a crust which will fall giving vision of a wound that will heal by itself, but leaving a bad quality scar. Of quest ‘last it may intervene in local anesthesia after a few months.
Undulations of the skin and small asymmetries on both sides are quite frequent, Ake minor.
Mal positioning of the ear lobe can be determined by excessive skin traction or alteration of healing. It can still be corrected under local anesthesia.
The duration of the result is individual and in relation to a number of constitutional factors such as the physical conditions of the face, the amount of fat present, the quality of wrinkles, the underlying bone structure and hormonal influences. The Facial Lifting slows the aging process, but does not stop them. It must be considered, however, that, at a distance of years from ‘intervention, although inevitably over time the skin will return in part to relax, the’ relaxed and youthful appearance of the face will still be better than you would if the ‘intervention was not performed.
The scars are located in a discreet area, normally imperceptible within a few weeks. Some patients with a tendency to irregular scarring, may develop reddened scars, raised or widened despite the utmost care taken in sutures. They can be corrected with medical treatment or surgery after 6-12 months by intervention. In the case of post-operative complications scars may be of worse quality.