When can I go in the sun after a facelift?
The sun should be avoided for several reasons. First of all, excessive sunlight on fresh, healing scars may cause hyperpigmentation, or darkening of the healing areas. Secondly, excessive sunlight may create increased swelling. Finally, the sun will damage the skin on a long term basis, creating deeper lines and a more leathery appearance to the skin.
Although many patients describe enjoying a nice glow after the sun, it is not recommended by ANY plastic surgeons or dermatologists. The simpliest way to slow the aging process is to wear daily sunblock spF 15 or higher.
What is the youngest age you will perform a facelift?
The youngest age of a patient for a facelift I will perform is 40. The determining factors for a facelift are the inherent skin elasticity and the root cause of the aging factor in the patient. Some patients at 40 will benefit from a maintenance lift. In patients who are upset about their neck line, generally speaking 40 to 45 is the age where most patients will benefit from a lift and liposuction rather than liposuction alone. This is mainly due to skin elasticity. In some patients, particularly in African American and Asian patients, the skin may have excellent elasticity well into the 50's. For some of these patients, liposuction and neck sculpting alone may be an option rather than a facelift.
How do you address excessive fat in the neck or the heavy neck?
I take a different approach then most surgeons when addressing the neck. I am not a big proponent of liposuction, particularly in the central neck. There are several reasons for this. First of all, I have seen many patients with persistent lumpiness in their neck after central liposuction. I think that most patients will have some slight textural unevenenss to their necks after any procedure, but persistent lumpiness is not a desirable feature for my patients.
Second of all, I don't know if standard liposuction is actually that effective. There are two types of fat in the neck. There is a looser fat which is less fibrous. This fat is amenable to liposuction. Some patients also have a denser more fibrous fat which is much more resistant to liposuction techniques. In addition, there are certain locations which are not safe to liposuction in the central neck. All liposuction is superficial to the platysma muscle. But in some patients, all of the fat is located deep to the platysma muscle. This fat must be addressed with another technique or the neck will not have enough definition postoperatively.
Do hairlines shift after a facelift?
It depends on the surgeon and the technique. I do not change hairlines by placing my incision and vector of pull to account for the additional skin. The standard approach for a facelift is to make an incision straight up 5 cm above the ear. The main problem with this incision is that it can change the position of the temporal tuft. In addition, this incision does not serve a purpose. I am not sure the advantage of having an incision superiorly along the scalp. The incidence of hematoma is much higher in these patients. In addition, in a facelift procedure, the big question is how much skin did my surgeon remove WITHOUT tension. This will let the patient know how effective his or her lift is. If there is a large amount of skin removed, the hairline will shift in patients with excessive superior component to the lift. I perform a variety of incisions, but the key component is to maintain hairline position. Surgeons who have a straight line back into the scalp will shift the hairline, creating an obvious sign of a lift.
Are drains necessary after a facelift?
Drains are placed to remove excessive fluid after a lift. If a facelift takes more than three hours, a drain may be placed. I generally avoid drains for several reasons. First of all, I am able to perform a complete lift in a period of time where a drain is not necessary. Second of all, drains can be uncomfortable. I use a compressive dressing to help prevent fluid from accumulating.
I have had a previous facelift by an outside surgeon and want my scars to look better. Can you just cut them out?
A short answer is typically no. Most of the time, the patient needs the lift repeated. The reason for this is that one of the potential causes of wider scars can be too much tension on the incision line. If the lift is repeated, the skin incision will have less tension and the scar will have a better chance of healing appropriately.
I just want a very small facelift, is it possible?
The key concept in facial rejuvenation is to properly analyze the face and determine the most effective way of rejuvenation. Some patients in the early 40's may benefit from a facelift, depending on the position of the deeper tissue. A common misconception is that a little lift is safer and less invasive than a larger lift. Some of the minilifts offered rely solely on excision of skin without actually lifting the deeper tissue. A common occurrence after this type of lift is wide scars from large amounts of tension on the skin, ineffective lifting, and surprisingly an unnatural appearance. The unnatural appearance occurs because the skin is stretched with too much tension, creating a pulled look. It is important to realize that a youthful face looks plump and with a taut neck rather than looking stretched or pulled.
Does Dr. Shah use metal materials for facelifts?
None of materials Dr. Shah uses are metallic and will not effect xrays/ airport scanners. Dr. Shah does not use nonabsorbable (permanent) sutures for the suspension in facelifts.
Does Dr. Shah use nonabsorbable (permanent) sutures in the face to lift deeper tissues?
Dr. Shah does not use permanent sutures in the face. A permanent suture can lead to infection if it becomes impregnated with bacteria. In addition, a truly effective lift does not rely on a suture to suspend on the face. Repositioning of the deeper tissue will allow the newly positioned tissue to heal in a better place, obliterating the need for a permanent suture. Natural healing is far more effective than reliance on permanent sutures.
Does Dr. Shah use staples in rhytidectomy?
Dr. Shah does not use staples in aging face. He believes that staples can lead to "stepoff" deformity where the hairline is not matched up properly.
When can I exercise after the procedure?
Most patients can exercise 2 weeks after lift with the exception of skiing/horseback riding. Any exercise where the pull is felt on the neck should be avoided even at the 2 week mark.
Can I drink caffeine the day of the procedure?
Caffeine can raise blood pressure and thin blood which can delay healing. It should be avoided 4 days before a procedure and 4 days after.
Should alcohol be discontinued before surgery?
Alcohol thins blood and therefore can delay healing and lead to more swelling postoperative after a facelift. It should be discontinued one week prior and one week after.
How long does it take for a scar to mature?
Scars go through different phases of healing. Scars are considered mature at 6 months to a year after a procedure.
Do all scars after a rhytidectomy (facelift) heal to a fine thin line?
Healing of a scar is dependent on individual healing characteistics. A key to favorable scarring is location of scarring, size of scar, color of scar and texture of scar. By designing a facelift with the scar hidden throughout the hairline, in a small crease in front of the ear, behind the tragus, behind the ear, and hidden in the hair again, it is difficult to see the scar. In order to maximize the healing of the scar, closing the scar in a precise manner is critical.
Dr. Shah does not believe in the use of staples since it can lead to mismatched tissue postoperatively. In order to help minimize discoloration of the scar after a facelift, Dr. Shah recommends use of daily sunscreen (UVA and UVB), found in many moisturizers, and avoidance of direct sunlight on scars for 6 months. Even sunlight on a bruise can lead to discoloration. Some individuals have a propensity to develop thicker scars, called keloids or hypertrophic scars. It is critical that patients have close followup with Dr. Shah in order to maximize the healing potiential of each patient. Patients with keloids and hypertrophic scars can be treated with steroid injections and silicione sheeting.
How long does a lift last?
Lifts lasting are dependent on elasticity of tissue, adherence to lifestyle changes, including avoiding smoking and sun.
Will my scars become visible?
All scars are visible. However, ideally, the scar can be hidden to a fine line so it is difficult to see.
Will my hairline shift?
Dr. Shah hides scars in hairline but uses hair sparing technique to conceal scars.
Are facelifts painful?
Typically facelifts are not painful procedures. Most patients are able to take extra strength tyelnol the next day. However, every patient is different and sensation of pain is difficult.
What is a hematoma?
A hematoma is a large collection of blood which can accumulate after a facelift. Generally speaking, most hematomas are a result of patients being on blood thinners or elevated blood pressure. Dr. Shah advocates patients follow a strict preoperative regimen to minimize chance of hematoma formation. In addition, patients with a history of high blood pressure should monitor their blood pressure closely to ensure that it is under control.
How old are typical patients for a facelift?
Some patients seeking facelifts are seen as young as the early 40's. Patients as old as 85 years of age have had lifts performed. Vanity has no age.
Can a face lift erase lines?
The goal of a facelift is to reposition deeper tissue in an effort to give more definition to the jawline, neckline and change the appearance of the facial shape from a pyramid to an inverted V. Lines can be a result of aging to skin, which is addressed by a skin rejuvenation procedure not a facelift. Some lines are a result of excess skin, which can be repositioned during a lift.
Some doctors don't believe in facelift and advocate either fat grafting or other techniques?
I don't believe a traditional facelift is a great procedure either for rejuvenation. I think a modification of a deep plane technique, termed, CPMS, has worked well for me. A facelift does not fix every problem in facial aging, but can serve as a foundation which works in conjunction with other techniques.
Minilift vs full facelift?
Minilift has no place in plastic surgery. A classic minilift procedure is where skin is lifted and removed. Unfortunately this procedure is ineffective in facial rejuvenation. Some surgeons use the terms minilift interchangeably with short scar facelifts. Short scar facelifts can be effective in specific patients depending on the degree of skin laxity.
Is it possible to liposuction the face?
Typically liposuction is not a desirable procedure in the face. Sometimes in patients with extra fullness in the cheek, the buccal fat can be removed in an effort to give more definition to the face.
I have large parotid glands, can they be removed?
Parotid glands are necessary for salivation (spit) in the face. Their removal for aesthetic purposes is not recommended. Some patients with large partoid glands actually may have large masseter muscles. In that case, botox may help in certain cases. I would recommend a patient with a large parotid gland to have an otolaryngologist explore additional causes of bilateral enlargement.
I have large submandibular glands, can they be removed?
Dr. Shah does not believe in removal of submandibular glands for aesthetic purposes. Submandibular glands provide a necessary function in creating saliva. In addition, a motor nerve of the face courses through the glands, making their removal risky.
Does Dr. Shah perform midface lift?
I have not seen effective lift long term looking results or impressive results. In addition, the premise of all midface lifts is to lift the cheek pad and hold it in place with either a suture or a absorbable device and skin is removed from the lower lid. Unfortunately, when these lifts descend over time, the lower lid can be pulled down with it. Dr. Shah prefers the use of volumetric rejuvenation of the cheek area in an effort to lift the nasolabial fold. Most faces and malar areas flatten over time. When this flattens, The nasolabial fold can become more pronounced. By adding volume into the face, the malar area is improved, softening the nasolabial fold.
Can you cut out or remove wrinkles?
Removal of wrinkles is not a primary goal of facelifts. The name rhytidectomy is misleading. It means to excise wrinkles. A lift is designed to lift and reposition deeper tissues. In this process some lines may soften. Many lines seen in the face may be a result of aging in the skin. A common analogy is seen in that of cow hide and leather, with cowhide representing young skin and leather representing older skin. If you stretch leather, you will never recreate cowhide. Similarly, if you stretch aged skin, you can never transform it to young skin. Microscopically, there are changes seen in the skin which can show dramatic changes to the skin. A skin rejuvenation procedure may be needed to work in conjunction with a lift which helps to rejuvenate the skin.
What is a MACS lift and does Dr. Shah perform them?
MACS lift is essentially a form of a minilift where the lift is lifted by purse string suture and attached to the periosteum of the zygoma. I performed a study examining various anchor points and have found that this is indeed a good anchor point. I do not think this technique makes much sense to me from a theoretical standpoint and have seen patients postoperatively who have had MACS lifts performed. Changes created with this lift are subtle and unnatural in my opinion. I advocate elevation and repositioning of deeper tissue and have found results to look more aesthetically pleasing.
Is fat transfer better than a facelift?
Fat transfer has a role, as does the concept of addition of volume in facial rejuvenation in surgery. It can work well in conjunction with surgical procedures to help rejuvenate a face in most patients rather than as the solution.