Ask The Doctor

Rhytidectomy, commonly referred to as a facelift, is a plastic surgery procedure designed to tighten loose skin on the lower third of the face, the neck and the jaw line. The facelift procedure refreshes the natural facial symmetry unique to each individual while removing major folds and wrinkles on the face and neck that naturally occur with aging. The neck and jaw line regain a more youthful definition. The best results are seen in candidates with reasonable surgical expectations of looking rested, refined and naturally vibrant. Healthy men and women with sagging or laxity in the neck and jowl generally see great improvement.

Procedure Description

Dr. Hand performs the facelift procedure in our accredited Marin County outpatient surgical facility. Depending on the extent of the procedure, the procedure may be performed under local anesthesia with sedation or general anesthesia.

Several variations of facelift are available dependent on the amount of correction needed. Most procedures are completed in two to four hours. The procedure that best addresses the anatomical issues and patient's concerns will be decided at the consultation.

Mini-lift: This procedure is designed for the younger person that observes a general loosening of his or her face but has no major folds or wrinkles. The incision begins hidden in the hair above the ear and continues in the natural curve in front of the ear, finishing at the base of the ear or slightly behind it. Minimal swelling can be expected since no muscle correction is done. The scars fade quickly and will be difficult to visualize.

Facelift: This procedure is designed for the more mature face that not only has laxity of the skin but also muscle in the lower face that has relaxed. This patient may have "neck bands" and/or facial fat that has collected under the chin. Most often the neckline has lost its definition and youthful angles. The incisions begin much as in the minilift but extends behind the ear and up into the hairline. This facelift addresses all areas of the lower face and neck by tightening the underlying muscle, followed by trimming and redraping the facial skin. Frequently, another incision is made under the chin that allows Dr. Hand to tighten the muscles in the neck that have separated and usually cause banding and to remove fat deposits. A neck suspension is commonly done to improve neck definition.

Mid-facelift: This procedure is always performed by Dr. Hand on the patient that chooses lower lid blepharoplasty as a facial rejuvenation choice. Through the lower lid blepharoplasty incision, the malar fat pads are repositioned and the mid-face is lifted vertically to assist in softening the nasolabial lines (the lines between the nose and the lip).

Recuperation and Healing

A compressive dressing will be wrapped around the head immediately after surgery and will be changed the next day by Dr. Hand. On the third postoperative day, the dressing may be removed and the patient should shower and gently wash the hair. Most patients will see swelling and bruising subside within 1 to 3 weeks depending on the amount of muscle correction. Generally, the more extensive the procedure, the longer swelling continues. Sutures in front of the ear are removed at 4 days after facelift. The sutures behind the ear will be removed at 10 days to 2 weeks after the procedure.

Most patients can begin light exercise after 10 days and regular exercise at 2 weeks after surgery. Depending on the amount of swelling and bruising, most patients can return to work in 1 to 2 weeks. Postoperative discomfort is easily controlled by oral medications.

Other Options

Dr. Hand will carefully evaluate all aspects of the face during consultation. He will present recommendations based on attaining the most aesthetically pleasing outcome. Often, the midface and eyes need to be addressed with surgical correction (blepharoplasty) and sometimes the eyebrow position needs to be elevated (forehead lift) to achieve the best result. Other complimentary procedures that may be done independently or simultaneously during the facelift procedure will be presented if beneficial in achieving facial rejuvenation.

What Is A  Wrinkle and How Did It Find Me?

A wrinkle is "A furrow, fold, or crease in the skin, particularly of a type seen with increasing occurrence as a result of sun exposure or, in perioral skin, cigarette smoking; associated with degeneration of dermal elastic tissue."

What are the main factors that contribute to developing wrinkles?

• Smoking:  Smoking reduces the blood supply to the skin because of vasoconstriction.  Also, less oxygen reaches the cells because the hemoglobin oxygen saturation is decreased.
  
• Skin Color:  People with light skin tend to experience a higher level of sun damage, which usually accelerates the development of wrinkles.  That being said, high levels of unprotected sun exposure with any type  of skin, light or dark, will always become apparent later in life. Light skinned individuals may see surface laxity and age spots in their 40's.  Darker skinned individuals may see those changes later, perhaps even in their 60's, but will also see areas of hyper and hypopigmentation. It is not a question of if but rather when when sun exposure ibecomes a factor in the aging appearance of the skin.  Using sunscreen as early in life as possible and  often will help to postpone premature aging.
  
• Genetic factors:  If you noticed that your parents had facial qualities such as deep lip wrinkles or significant eye hooding  early in life, there may be a genetic component to your facial aging as well.  However, many of our parents did not have access to quality sunscreens or were ignorant of their benefits.  There  may be some significance to the assertion that early aging  may be significantly higher if a parent did so as well.  It is my opinion that lifestyle choices may have greatly influenced their aging process.  The greatest gift for yourself or your children is the early usage of sunscreen.
  
• Lack of protective clothing:  Basically a physical barrier such as long sleeves or a hat tends to decrease sun exposure and the development of wrinkles prematurely.  I always advise a hat for outdoor wear when participating in athletics or even activities such as gardening.
  
• Employment:  Constant outdoor jobs increase UV exposure.  Protective clothing and sunscreen usage should be considered to be mandatory to avoid skin cancers and wrinkles.
  
• Facial expressions: The fact is that if you smile, squint or frown repeatedly, repetitive motion wrinkles will develop earlier.  Some of the newer solutions such as Dysport or Botox will help in reducing the ability  to habitually make a facial expression that results in a deep wrinkle.  When a facial muscle contracts, the dermis is creased and a wrinkle is created from the constant pleating.   In our youth, the skin springs back quickly but as the facial skin becomes thinner and less pliant, a groove may be formed. The goal with agents such as Botox is to weaken the facial motion, while still allowing for expression without deep wrinkling.
  

What are the treatment options for wrinkles?

• Medications such as topical retinoids and glycolic acids:   The goal of utilizing these medications is to help reduce fine wrinkles and pigmentation.  They assist is refining the texture of the skin, making it smoother.  With these types of skin care options, transient redness and dryness may occur and sun protection is necessary because the facial skin may be more susceptible to burning.  Many of my patients have experienced wonderful refinement of their skin appearance by using the Obagi protocol.
  

• Surgery and other medical procedures
  
  
  • Dermabrasion: A surgical procedure involving the controlled wearing away (abrasion) of the upper layers of skin with a dermabrasion device.  I utilize this procedure most often for the wrinkles surrounding the mouth, particularly on the upper lip.  There will be some scabbing, swelling and redness, which generally go away after a couple of weeks. In all of my years of practice, I still find that this is the preferred method of treatment for significant upper lip wrinkles.
    
  • Dermaplaning  with glycolic acid peel:  This procedure removes the outermost layers of skin cells, the stratum corneum, and stimulates cell growth in the underlying dermis.  A fresher and smoother appearance to the skin is apparent, as well as diminishing the appearance of lines and wrinkles, enlarged pores, coarse skin, and sun damage. The patient may have slight redness in the areas of treated skin. for a day or so.  Repeated treatments are required approximately every 4 to 6 weeks.
    
  • Intense pulse light source and radiofrequency -  Non-ablative lasers, radiofrequency devices and pulsed light sources do not damage the epidermis - the dermis is heated, triggering the formation of new collagen and elastin. The skin feels firmer and appears refreshed after several treatments, resulting in faster recovery times; while at the same time more treatments are required and results are subtler.
    
  • Botox - (Botulinium Toxin Type A) - Botox blocks the chemical signals that cause muscles to contract. It is injected in small doses into targeted muscles. If the muscles can no longer tighten the skin flattens, giving a less wrinkled and smoother appearance. Botox is effective for lines on the forehead and between the eyes (frown lines), as well as crow's feet (around the corners of the eyes). As treatments generally last about three to four months, repeated injections are required.
    
  • Chemical peel - These peels vary from light to totally ablative.  It is important to have an experienced physician perform any peels utilizing TCA or phenol.  I often peel my patients that have had a blepharoplasty (eyelift) in order to further tighten finely wrinkled skin around the eyes.  After this procedure, sunscreen is mandatory and redness with scabbing may occur for up to 1 week.  Residual pinkness gradually fades and can be covered with a cosmetic cover stick such as Dermablend Quick Fix.
    
  • Facelift, eyelift or browlift:  Any of these procedures or a combination may be the best choice for significant facial laxity with deep wrinkles.  Most patients see significant improvement for 5 to 10 years.
    
  • Soft tissue fillers:  These may include  hyaluronic acid or fat. They are injected into deeper face wrinkles, plumping and smoothing them out, giving the skin more volume. Patients may sometimes experience swelling, redness and bruising in the treated areas for a short period.  Most patients experience significant correction for 6 to 12 months.
    

How Do I prevent wrinkles?

• Use barriers to protect your skin - The more the skin is exposed to the sun the faster it will age. Protecting your skin by wearing hats, protective clothing and sunscreens will reduce UV damage, and the consequent development of wrinkles.  Try to sit in the shade or under an umbrella.  I see many patients that cannot give up a "healthy glow".  That glow will develop into spots some day, for sure!  Some early morning or late afternoon sun exposure may be helpful as a Vitamin D source but dietary supplements  work equally as well.
• Wear sunscreen and moisturizers -  A recent Japanese study looked at women that wore makeup and/or sunscreen and moisturized compared to those who did not.  The surface fine wrinkles were dramatically increased in those that did not.  The deeper wrinkles were similar in all subjects. Moisturizers applied after cleaning the skin traps moisture and decreases the appearance of fine lines. I suggest at least a SPF 30 for most days and a higher concentration, water resistant sunscreen for athletic and outdoor activities.  Apply plenty of it and often if you are in a situation that may include high altitudes, sun or snow, or profuse sweating.
• Quit Smoking:  Smoking absolutely accelerates aging of the skin and the repetitive motion pucker wrinkles of the lip. Don't just reduce your consumption of cigarettes, quit!
• Get enough sleep: Try to get at least  7 hours of high quality sleep.  When we sleep, the body regenerates itself mentally and physically.
• Don't worry, be happy: Studies show that stress is a huge factor is physical aging or not just the skin but also  internal organs.  Find a source of happiness daily and reflect on your good fortune!