Common Questions

Facelifts are for both men and women. Candidates are individuals who have a sufficient amount of facial laxity to make the procedure worthwhile. Typical physical characteristics are visible neck muscles that are causing banding in the neck, laxity of skin or an excess of fat in the neck, a loss of the clear border along the jaw between face and neck, jowling, deep lines from the corner of the mouth to the jaw, and lines from the nose to the corners of the mouth. Low eyebrows are not treated with a facelift; those are fixed with a browlift. Extra skin and/or fat of the eyelids are treated with an eyelift procedure.

Since a facelift is elective surgery, patients must be in good health. An important part of being a facelift candidate is to understand the outcome that is likely for you and deciding if the risks and complications and costs make that seem worthwhile to you.

What matters is appearance and not age. It is a question of how much a person is bothered by something that can be fixed with a facelift. In general, this process begins in the early forties, with the most common age for a facelift being in the mid-fifties. The oldest age is limited only by the health of a patient.

A nicely done study showed a portfolio of photographs of a group of patients before facelift and another portfolio of photographs to groups of observers. On average the facelift patients were judged to be nine years younger!

Unlike a breast augmentation in which there is an implant that could possibly break, there is nothing about a facelift that will ever force a patient to have a revision. A "redo" always remains a patient choice. Though a facelift patient will always look younger than if they did not have their facelift, they are subject to the changes of aging the same as anyone else. But they do not have to ever repeat the facelift if they do not wish to do so.

A mini facelift is not a distinct procedure; it can mean different things to different patients. It can even be a regular facelift, but the surgeon may use the term because it sounds less serious to some patients. A mini facelift usually involves some combination of eliminating the incisions above the ear and in the hairline behind the ear, and sometimes the incision behind the ear (though in fact there are ways to do a full facelift without making an incision up the back of the ear.) It may mean that it is only dealing with the face and not the neck, or it may imply that there is less dissection or elevation on the face. It produces less change and that change is less long-lasting than a full facelift. A mini facelift is the right procedure for a patient who has less severe aging changes. But it is not appropriate for a patient with more extensive aging changes.

Sometimes the neck is so good and the muscle bands under the chin so mild that nothing specifically has to be done to the neck itself. The muscles that create the muscle bands under the chin go all the way back to the ears, and so long as the muscle bands are not large and thick pulling on the muscles back there can make the neck perfect. If there is a large amount of fat in the neck, then liposuction can be done. It is important that the surgeon not overdo this as fat is important in keep the skin filled up and preventing it from developing fine lines and that crepe paper look. The fat can also help conceal any underlying muscle banding. If the muscle bands are thick, then an incision is made under the chin and the muscles are tied together in the center to make the neck as smooth as possible.

Much of what changes in the face is a loss of facial volume. The face frequently deflates and collapses inwards as much as it drops. In these cases restoration of volume through fat injection is an important aspect of a facelift. This concept was first recognized about fifteen years ago but in more recent years its importance has really been recognized.

The extent to which the scars go above the ear is dependent upon whether changes are needed in the upper cheeks and how much overall laxity there is in the face. Similarly the extent to which scars go from behind the ear into the hair behind the ear depends upon the amount of laxity there is in the neck. But in all cases a scar hugs the contours of the ear, going behind the tragus, the little flap of cartilage in front of the ear canal.

Dr. Teitelbaum places his incisions in such a way that patients are able to wear their hair back after their facelift. There are some patients though who have such thin hair behind their ear that it is difficult to make any incision totally inconspicuous.

Despite marketing claims to the contrary, there is no such thing as a "liquid facelift." Fillers replace volume, but they do not elevate sagging tissues, remove excess skin, nor reduce muscle bands on the neck. There is some reduction in wrinkles from filling up the skin, but the skin is not smoothed out nearly as much as it would be by a facelift. "Bought" fillers such as Juvederm and Restylane are not permanent, are painful, and need to be redone. For patients much to young for a facelift who want something inexpensive and not permanent, they are very good options. There is a role for fat injections during a facelift. And fat injections can be permanent and produce nice results. But they do not replace a facelift. For patients who do not yet need a facelift, fat injections alone can be the ideal treatment.

A facelift is more about lifting than it is about removing wrinkles. By elevating and tightening, the wrinkles on the cheeks will be a little more stretched flat and will look better. But it will not effect anything in the chin and upper lip area. A facelift does not actually make any change in the skin itself. So some patients will also do a peel either at the same time or later.

A facelift is the gold standard treatment for the neck. A necklift actually does not improve the neck as much as a facelift does. If you stop and think about it, the neck skin is connected to the face skin. If you try to move the neck skin without moving the face skin, then you are limited in how much you can improve the neck. But if you are also moving the face up, then you can do much more on the neck.

Patients will look pulled for about the first two weeks after a facelift. After that the swelling will go down and the skin will relax a bit so that patients do not look pulled beyond that. Looking natural is a result of not just attention to detail with the incision and with the direction that the skin is pulled, but that that it is not over pulled.

The best and most relaxing method for anesthesia for a facelift is general anesthesia. That way a patient is assured that there will be no pain. The surgeon can work totally free from concerns of causing the patient discomfort or of the patient moving during surgery. But what is most important is that the anesthesiologist, surgeon, and entire surgical team be accustomed and comfortable with doing facelifts together a certain way.

Bruising is minimal or non-existent for most of Dr. Teitelbaum’s patients after surgery. But it is still normal to have some on the neck. The amount and duration of it depends upon the patient. Some people bruise very easily and others do not. But Dr. Teitelbaum is particularly focused during surgery on reducing the factors that contribute to bruising.

A facelift is considered a purely cosmetic procedure. Insurance only covers medically procedures so it is not covered by insurance.

Dr. Teitelbaum will stop by to see you the evening of your facelift at Serenity. The proximity of his office to Serenity is very important. And he lives nearby should there be any problem in the evening.

You can drive when you are off of all narcotic pain medication and feel totally unrestricted by your discomfort such that you could make any movement you might need to safely drive your car. That is ultimately a decision that I cannot make for you. With a facelift it is also important to have enough looseness in your neck for you to move it freely. Certainly this will occur by ten days, but many patients can drive by about a week, but usually not before.

Wait four weeks after a facelift before exercising. Bleeding is an uncommon but serious problem after a facelift and doing anything that increases the blood pressure in your face should be avoided for about three weeks after surgery. When you start exercising after a facelift or any surgical procedure, listen to your body. You will be a little out of condition and a bit sore. But you will get back to where you were before surgery very quickly.

Sex can be resumed as you feel comfortable. Most often patients hit their level of comfort to have sex about ten to fourteen days after a facelift.

Dr. Teitelbaum watches over all of his patients very closely and offers patients more appointments than they will typically need. But he does need to see all facelift patients the day after surgery. He will see them the second day if their drain was not removed the first day, but drains rarely stay in longer than the second day. The next appointment is five days after surgery to have the first of the sutures removed, and the remainder are removed at ten days. Dr. Teitelbaum will see you again at one month, three months, six months, and then yearly.

Facelift incisions require little care. When the sutures are in, place a thin layer of Bacitracin antibiotic ointment over the incision. Clean off the Bacitracin with peroxide and reapply the Bacitracin twice a day. After the sutures come out the incision can be gently cleaned with a soapy washcloth. Protect your incisions from the sun for a few months either by diligently wearing a hat, applying sunblock, or keeping your hair over your ears.

There are two things that can occur early after a facelift that a patient needs to be aware of. The first is a hematoma, which is swelling due to bleeding. Usually one side of the face or neck will suddenly swell and become painful. It is important to call Dr. Teitelbaum immediately if this happens so that he can meet you at the office. Most oftentimes this requires a return to the operating room to stop the bleeding. This can occur in the first several days after surgery, but there is a second peak of this occurring at ten days to two weeks after surgery. The other problem to look out for is an infection. If this uncommon situation arises, it is usually about five to ten days after surgery. Patients may notice a little redness or swelling around the incision, occasionally with some drainage. Alert Dr. Teitelbaum’s office if you notice these changes. He will examine you and place you on antibiotics if necessary.

A facelift lifts and tightens, but it does not fundamentally change the quality of the skin. So if skin is crepey and has fine wrinkles before surgery, once the swelling is gone those will reappear. Patients with sundamaged, thin and inelastic skin will find that their results will not last as long as patients with thicker and more elastic skin. When patients have little fat in their necks, it is unlikely that the muscle bands will be completely concealed. When neck skin is very thin and crepey, even the neck that is very smooth and tight right after surgery can often loosen in that area more than a patient –and the surgeon – would desire.