Indications

Aging in the facial areas occur due to a complex combination of factors. The most important is the influence on your skin by your heredity. The aging features you see reflected in the mirror may be the changes experienced by your parents at a similar age. Other causative factors such as smoking, sun or weather damage, and environmental toxins add to the hereditary changes. Fortunately these latter factors can be guarded and protected against. Unfortunately, as children and teenagers, sun exposure without skin protection, frequently occurs. It would seem that the search for that first, most wonderful tan of summer or on vactation, is sometimes more important than thinking about aging many years away.

Facial aging occurs in three specific areas of the lower face all of which which will be helped with a facelift. In the neck there is progressive laxity (loosening) of the skin. This may be associated with the accumulation of fat and the separation of the midline muscles leading to frontal webbing or bands. Jowls may occur in the cheeks associated with a less distinct jawline caused by the laxity of the skin. Finally there may be deep nasolabial or cheek grooves occurring alongside the nose extending downward to the corner of the mouth.

The ideal patient for facelift is in her/his 40's or 50's, good medical health, and a non smoker. Facelifts have been performed on patients in their 30's or as late as the 80's. Age is not a determining factor, rather the motivation and health of the patient. Here the expression, "you are only as young as you feel," would certainly apply. One of our patients related the following incident. Although she was 85 years old, she kept herself in excellent shape, exercized regularly and imagined herself to appear in her early to mid 70's. While vacationing at a spa, another woman asked if she was 80 yet. She excused herself and immediately arranged for a facelift.

Any patient over forty may be asked to see their internist for medical clearance. Special tests will be requested of all patients to insure that they are healthy and that there will be satisfactory healing. Smoking and aspirin ingestion is prohibited for two weeks before and two weeks after surgery. Aspirin will cause more bruising and bleeding, thus prolonging the recovery period. It has been found that smoking may lead to delayed healing and more noticeable scars. Occasionally, a hyperbaric oxygen treatment is recommended for smokers to prevent postoperative complications.

You will be given prescription for homeopathic and pharmaceutical preparations to prepare your system for surgery.

Anesthesia

We are recommending General Anesthesia for our patients, so that there is complete rest, safety, and no discomfort during the procedure. This is especially true if the facelift is combined with other facial plastic surgical procedures or liposuction. Occasionally, a facelift, alone, is performed under intravenous sedation and local anesthesia, should the patient desire to be conscious during the procedure. You will have an opportunity to discuss these options with Dr. Sokol and our Anesthesia staff.

Procedure

The facelift is the second most frequently performed surgery (liposuction is the first), by Dr. Sokol. His technique has evolved over his nearly 30 years in practice to produce safe, reliable and reproducible results. Facelifting may be combined with other aesthetic surgery to enhance the results, such as browlifts, eyelid surgery and cosmetic laser skin resurfacing.

The facelift consists of the three level technique: liposuction and fat removal; muscle tightening and restoration; and skin redraping:

a. liposuction and fat removal. The initial stage of the facelift begins with a thorough suction of the unwanted fat in the neck. This is followed by a direct removal of the fat from the cheek, including any fat pads that would limit the later skin draping.

b. muscle repair- muscles of the face and neck, are subjected to the same forces of gravity, aging and heredity as is the skin. As you age, the muscle attachments separate and descend from their original location to the cheeks and upper neck. In addition the neck muscle, the platysma, normally attached across the front of the neck, loses this connection and appears as two unsightly lines or bands. These muscles and their overlying membranes or fascia are lifted and tightened as the second stage of the lift. This level or stage of facelift provides the long lasting results in Dr. Sokol's technique.

c. skin redraping- the skin, having been freed to allow the first two stages is gently redraped and any excess is surgically removed. The hallmark of Dr. Sokol's procedure, is that there is no tension on the skin. This is possible due to the previous muscle repair. Thus the patient appears natural without a pulled, unsightly look. The closure is meticulously accomplished with the smallest stitches. Scars are hidden in the hairline, natural creases, or within the ear to allow the patient to choose any hairstyle desired after surgery.

In many patients with aged, sun damaged skin that has lost it's elasticity, the addition of skin resurfacing whether by skin peel or laser, will enhance the results by creating a fresher, more elastic skin layer. As mentioned, other Facial Plastic Surgery, browlift, blepharoplasty, rhinoplasty or liposuction, may be combined with the facelift to improve your results.

Recovery Room

Following surgery you will be moved into our recovery area. A trained nurse is present at all times to insure that your vital signs are stable. In addition you are placed on a specially designed bed with continuously circulating warm air to prevent a chill and increase your sense of well being. Constant attention is given to your operative area to make certain there are no complications. If there is any question, Dr. Sokol is just steps away and will check your wounds. After a period, not less than two hours, you will be transferred out of the recovery room to your waiting transportation.

After Care

Many patients elect to use an aftercare facility in a nearby hotel. These are fully staffed with 24 hour expert nursing care. All patients using these facilities have had cosmetic surgical procedures. Thus the nurses are experienced with the needs of this surgery and highly attuned to your privacy and comfort. Meals and transportation to your postoperative visits are provided. You will be seen by the nursing staff the next day for a dressing change and a reduction of your bandages to a more comfortable less confining dressing.

If you live less than one hour away from the office, you may wish to go home with a nurse. We have a number of home care nurses who will provide one on one nursing care. Our scheduling staff will make this arrangement for you. If you have a family member or friend that can devote the time to you, this may be a preferable aftercare situation for you. If you live more than one hour away from the office, a nearby hotel can be utilized for at least one night. Your family, friend or the home care nurse can stay there with you. The next day, before your trip home, you'll be seen by our staff for the dressing change.

Pain

Many patients experience little or no pain following facelift. Everyone is different and you may feel some discomfiture. You will be provided with a prescription for pain pills that will assist you during the first 48 hours. This is the period that some patients experience pain.

Activity

It is recommended that for the first 3-4 days, you sleep on your back with the head elevated on one or two pillows. This will reduce the swelling and lead to a more comfortable and shorter postoperative period. No bending over, keep your head above your heart at all times. No exercise, intimacy, emotionally charged situations, or alcohol is permitted for the first 7-10 days. No smoking is permitted for 14 days. This will insure a safer, shorter postoperative period, without increased bruising or delayed healing.

Results

Your results will be partially seen after your dressing is removed on the third day. You will still be bruised and swollen as it takes 10 to 14 days for all the swelling and discoloration to disappear. Makeup may be applied after the first set of stitches are removed on day 4-6. It is important that you set up a date with a friend or relative on day 7-10 for a dinner or movie. By that time, all your stitches will have been removed and you will look forward to getting out of the house. Your final result will take approximately one month to occur, although you may see changes during the first year. Numbness in the operative area, especially around the incision sites is normal for the first 6 weeks to three months. The return of sensation may be associated with lightning sparks or vague crawling sensations. These are nerves coming back and a normal experience.

Other complications may occur although they are quite rare in Dr. Sokol's practice. These are nerve damage with resulting facial weakness or paralysis leading to asymmetry of facial expressions. In addition, skin loss (usually due to smoking), hair loss near the scalp incisions, scar hypertrophy and keloids, and hematoma or collections of blood or fluid requiring drainage are additional, infrequent complications. If these complications occur, they may require further operative and/or non operative treatment and may lead to permanent unfavorable results.

You will be given an appointment for postoperative photos at approximately one month. At this visit you will be asked to come in with makeup and any change of your hairstyle you desire. Many patients arrange for a professional consultation with a makeup artist or image consultant after surgery. This professional recommends different combinations of hairstyle or makeup to enhance your results. In addition, a change from the old way of applying makeup or doing your hair, will camouflage the fact that you have had facial plastic surgery.

45 yo female who underwent lower facelift, chin implant, endoscopic brow lift, and
lower blepharoplasty (eyelid surgery).

Patient in her fifties who underwent Dr. Sokol's specially designed Facelift,
eyelid surgery, brow lift and full face laser rejuvenation.

The lower postop pictures, show the results from chin Liposuction
and a Neck Tuck, a one hour procedure without conspicuous scars.