Northern Virginia – Fairfax and Manassas
By: George Bitar, M.D. and Larry Lickstein, M.D.
Board Certified Plastic Surgeons
Your face is your most prized feature. It reflects to the world how you feel inside. Unfortunately, a lot of our patients feel like they’re 20 on the inside but their face does not reflect that. Facial aging affects the skin, muscle, and fat of the face. In order to truly rejuvenate the face all the layers need to be addressed. A facelift that is well performed by an experienced plastic surgeon will accomplish that. The reasons why men and women choose to have facelifts in their forties, fifties, and up to their eighties vary from wanting to look good to competing in the workplace to being able to shave better.
When someone looks in the mirror and is unhappy with their face, it can sometimes be difficult to verbalize why they are unhappy. Assuming that genetics and the aging process play a role in a person’s unhappiness with their appearance, it is important to identify the problem and offer a surgical solution:
- If a patient is unhappy with excess fat in their neck but has good skin tone and good muscle tone of their neck, then he/she is a good candidate for neck liposuction.
- If a patient is unhappy with excess fat in their neck and has loose skin and/or muscle in their neck, then he/she is a good candidate for a neck lift.
- If a patient is unhappy with laxity in their neck as well as their jowls and jaw line then he/she is a good candidate for a mini facelift
- If a patient is unhappy with their neck, jowls, and cheeks then he/she is a good candidate for a facelift.
- If a patient is unhappy with droopy eyebrows and wrinkles in the forehead then he/she is a good candidate for a forehead lift.
Preparing for Surgery
An initial consultation is set-up where we discuss the facelift procedure and whether you are a good candidate for the surgery. Your medical history is reviewed, and you will be asked to see your medical doctor for a physical check-up and a few labs to make sure you can undergo the surgery safely. You are asked to stop smoking, if you are a smoker, two weeks before and two weeks after surgery, for the surgery to be performed safely, and for you to have optimal results. You are given the opportunity to talk to patients who have had the same surgery that you are considering. We will see you shortly after the surgery (in a day or two usually). You are seen regularly after your surgery. You are always welcome to come back for follow-up, even years after your surgery, free of charge.
The Facelift Procedure
A facelift rejuvenates the cheeks, the jowls and the neck. It is the gold standard for facial rejuvenation, and the best time to do it right is the first time by a plastic surgeon who is experienced in performing facelifts.
The way that we perform a facelift is essentially a check lift plus a neck lift. First, the face is injected with tumescent solution to decrease bleeding and pain during and after the procedure. Next, if liposuction to remove excess fat in the face is needed, then it will be performed. After that, the skin is elevated from the underlying fat in the cheeks, jowls, and the neck. The fat in the jowls is repositioned upwards into the cheek to give a more youthful face. The muscle in the neck is tightened. A special suture is used to lift the muscles and give the neck a long-term youthful look, as well as a well-defined jaw-line, despite the pull of gravity and the aging process. After the underlying fat and muscle is addressed then the excess skin is excised, and the incisions are carefully hidden around the hairline and inside the ear. Two drains placed behind the ears to remove the fluid that accumulates after a mini facelift. Antologous fat transfer to the mid-face (cheeks and nasal labal folds) is very effective in restoring facial volume loss associated with aging. It is complimentary to a facelift which addresses laxity of tissue and both procedures are often combined.
Benefits of this Facelift Technique
- Very natural results without a “done” look.
- This facelift technique is moderate in terms of aggressiveness. It provides an excellent long-term result (about 7-12 years) with a low risk of major complications.
- The scars are very nicely hidden. In most cases, it is difficult to appreciate them. Hair is not shaved, and the hairline is not raised.
- This technique is flexible and can be adjusted to different shapes of with varying amounts of fat, laxity of skin, and laxity of muscle, with excellent long-term results.
- Facelifts, when done properly require a prolonged healing time. It takes a month for a patient to become socially presentable, 6 months to be really happy with the results, and a year to see the final results.
- This technique does not address the forehead. The forehead is addressed with another operation (that can be done simultaneously, a forehead lift).
How We Minimize Complications of Facelifts:
At the Bitar Cosmetic Surgery Institute, we take pride in making sure we provide for our patients the best surgical experience possible , anticipating problems or set-backs, and addressing them before they happen. This is a process that includes the pre-operative preparation, the actual surgery, and the after care.
General complications can occur with any surgery. Cosmetic surgery is usually a safe surgery performed on healthy patients and, as all surgeries go, is with low risk. What we do to even lower the risk of complications is to operate at a first class hospital with board certified anesthesiologists and nurses. To avoid post-operative complications, we advocate early mobilization –patients seen in our office one or two days after surgery- and active participation in their own post-operative care. When we create a partnership, the results invariably improve.
Bleeding after a facelift happens in about 1-2% of patients in general. Before surgery, our patients are tested to make sure they don’t have any common bleeding disorders by their own physicians, and by lab tests. The use of tumescent solution before liposuction of the face is performed during a facelift minimizes bleeding. Furthermore, the use of drains helps manage any post-operative bleeding as well. In our practice the rate of significant bleeding is about 1-2%. The treatment of a hematoma or a blood clot under the facial skin is to open the incision and evacuate the blood clot. Typically this is a straightforward procedure.
The most important step in avoiding infections, in our opinion, is to perform the surgery at a first-rate surgical facility with board certified anesthesiologists and nurses. Patients are given the appropriate intravenous antibiotics coverage throughout the surgery. During the surgery, the skin surface of the patient is cleaned properly. After the procedure, our patients are prescribed a one-week course of antibiotics to minimize infection. As a result of these extra precautions, our rate of infection after a facelift is extremely rare. It may occur at the superficial incision level around the hairline and inside the ears where the tension is highest, and a small open wound may occur which will usually heal nicely with dressing changes and antibiotic ointment.
In a facelift, there is manipulation of a relatively large amount of skin and the closure of skin under some mild tension. Because the incisions are under tension, there can be either loss of some skin or a small opening of the wound around the hairline or near the ears. To minimize this potential complication we urge our patients to stop smoking two weeks before and two weeks after surgery, to improve the result of their facelift. Open wounds, if they happen, are treated with dressing changes and cleaning of the wound in the office as needed. This can occur in about 1% of patients. Usually the wounds heal very well, and nothing further needs to be done with nicely hidden scars. Very rarely, we will do a scar revision to improve the appearance of that scar.
The rate of significant facial injury is about 1-2%. In my facelift technique, I do the dissection away from the major nerves to avoid injury. The result is a minimal rate of nerve injury. Sometimes, temporary loss of sensation from a “stunned” nerve or a bruised nerve may occur in the time period after surgery. This may result temporarily in an uneven smile, but full nerve function usually returns within days to weeks.
Smoking is an absolute contraindication in facelift. The carbon monoxide and nicotine in cigarette smoke causes severe reduction in blood supply to the skin and breast tissue during healing. This results in delayed wound healing, wound separation, death of the skin, and a higher risk of infection. Cotinine testing is performed in patients with a smoking history to ensure that they are safe when having this procedure.
Our office will provide you with a detailed post-operative instruction sheet that will be individualized to your needs. We usually see patients the day after surgery in one of our offices to make sure that everything is O.K., and that you are healing as planned. Multiple visits in the year after the procedure will ensure the best outcome possible.
For more information about this procedure call our office and speak to our friendly staff member at 703-206-0506.
Information on this web site is for information only. Do not use the information to diagnose or treat your plastic surgery or cosmetic surgery problems. Please contact your plastic surgeon with all questions and concerns.