Facelift Recovery Guide
We all age in 3 ways. Our skin begins to have surface changes (sunspots), loss of volume (mostly fat), and elasticity in our skin. The rate at which these occur depends on your heritage and your degree of exposure to the environment (sun, smoke, etc).
The word, “Facelift” may make some people nervous given that historically, facelifts led to a “tight” or “windblown” appearance that was anything but natural. Older procedures that focused on simply pulling the skin tight were short-sighted and failed to provide durable, natural rejuvenation. Newer procedures focus on rejuvenation and not augmentation. The goal is always to make you look like a younger version of yourself – not someone else.
I hope this guide provides useful information so that we set appropriate expectations and guide you through the recovery process. Think of us as a guide or partner. Most patients we have seen have concerns about facial aging. This begins to occur when there is discord between the image you see in the mirror and your own self-perception. We believe that we can maximize your quality of life by rectifying this discord.
I like to think of the face as a whole. Though we will discuss different areas of concern, it is usually critical to address neighboring areas of the face in order to ensure that we do not create a “surgical” appearance. Imagine a smooth neck. As you begin to shift the skin on your neck and jaw up, it may appear to bunch on your cheeks, so we have to then lift the cheeks, and then the lower eyelids, etc. So while a more extensive procedure may sound intimidating or less natural, it is usually this holistic approach that gives us the most natural outcomes.
Learn more About
the Procedure
The Procedure
Let’s start with the basic procedure. There are many techniques for rejuvenating the face and every procedure is distinguished by 3 basic components: the incision, how the deeper layers of the face are lifted (SMAS: Superficial Muscular Aponeurotic System), and how the neck is refined.
My preferred incision is hidden along the sideburn, along the edge of the ear (the Tragus), and then wraps around behind the ear. The amount of extension behind the ear depends on the degree of excess skin (many times there is very little excess and it need only be repositioned) if any. In most of my patients, I like to use a “High SMAS” facelift that is able to reposition the deeper layers of the face into a more youthful position without causing any distortion of the mouth or muscles of facial expression.
The neck is refined by creating a smooth, elegant foundation. Just like the face, the neck is composed of layers and loses fat in the layer just under the skin (subcutaneous fat) as we age. Therefore, there are very few patients that benefit from liposuction of the neck even if you feel that your neck is “fat”. A youthful neck is smooth and free of lines or veins. An older appearing neck tends to have lines, veins, and “bands”. The difference between the two is the amount of subcutaneous fat. So while neck liposuction can provide a temporary improvement for some patients, it can accelerate the aging process. My approach focuses on contouring the deeper structures of the neck (platysma muscle, submandibular glands, subplatysmal fat, and digastric muscles) while leaving the more superficial, “youthful” fat unharmed. I believe this creates a more natural, durable result.
Additional Procedures
Since a natural rejuvenation requires that all areas of the face appear to be the same age, many patients benefit from combining fat grafting, an eyelid lift (blepharoplasty), brow lift, or laser resurfacing with their facelift in order to create a “non-surgical” appearance. For example, a refined jawline and youthful cheeks may be noticeable if your forehead still appears wrinkled. The human eye is incredibly sensitive to small changes in facial configuration or expression. We have to ensure that there are no incongruencies. While you may decide to share the details of your procedure, no one should be able to tell that any surgical procedure has occurred.
The Day of Surgery
We will meet at the surgery center where you will have the chance to be introduced to your team including the Anesthesiologist. The Anesthesiologist will review all necessary documentation provided to ensure accuracy and that we deliver a smooth, safe anesthetic and recovery.
Minimizing the risk of post-operative nausea and wooziness starts in the pre-operative area; you will be given an IV to remain well hydrated and the Anesthesiologist can provide medications during the procedure.
To keep you safe during surgery, you will have a breathing tube or an LMA during the operation. This may cause scratchiness and discomfort for the first couple of days post-surgery. Chloraseptic or a nice throat-coat tea can help with the discomfort.
So that you have very little discomfort after, I like to use long-acting local anesthetics during your surgery. It is common to only require a single pain pill the night of surgery. Tylenol and ibuprofen are all that is typically required, though, you will have more pain medications available.
When your surgery is complete, the nurse will contact your family member to let them know your procedure is done and the time for pickup. If the surgery runs longer than anticipated this is not a bad thing, though, it can cause some anxiety in your family. Your face is unique, and we must take our time to ensure that every little detail is accounted for as the work done during your surgery must last for the next 10-20 years.
Evening After Surgery
In preparation for surgery, I recommend preparing a few dishes that are comforting and soft. Dishes like soup and yogurt can be soothing for your throat and easy to eat. You may feel the area around your mouth is tight given the swelling. I recommend getting up and moving around at home. Surgery can increase your risk for blood clots in the legs and we want to ensure the blood is kept flowing. In contrast to most recovery strategies, I do not recommend icing your face. The fat that has been used to rejuvenate your face is sensitive to cold and pressure.
During your first evening, please ask for assistance from your loved one since you may not feel as stable as you would normally. If you are a stomach or side sleeper, I recommend getting some wedge pillows and/or place a pillow behind your knees to help simplify sleeping on your back. I recommend sleeping flat on your back. If you need a small neck pillow, that is fine. But otherwise, we want to avoid sleeping on the side of your face or worse sleeping in a chair where your head falls forward. Swelling will follow gravity; if your face is below your head, the swelling will be worse. A deeply reclined chair is a great option in order to avoid the tendency to roll over while sleeping.
Recovery
Typical downtime from a facelift is about 2 weeks. Luckily this is not due to discomfort as we use long-acting anesthetic to improve recovery and frankly facial surgery is not typically painful. Our post-operative dressings are minimal. There will be some bruising and swelling, but you will be presentable to a stranger after roughly 2 weeks after surgery.
Early recovery is not the challenging aspect of facial rejuvenation. You are an energetic, successful individual that is not used to “taking it easy”. I find that people mentally tolerate the first week of recovery much better than the first month. You expect that the first week will be slow and relaxing, but your body needs time for all of the little details and nuances to become apparent after surgery. It is VERY common to feel frustrated around 1 month after surgery because you feel good, but you still have little bits of swelling around your eyes that no stranger will notice, but you will notice. I promise, these frustrations will subside and you will be happy with the transformation. No matter what, we are here to help care for you and offer reassurance.
Incision Care
During your first week post-operative, you will have very small sutures along your incisions. All of these will be removed during your 1-week follow-up. In this first week, apply bacitracin or Neosporin (antibiotic ointment) to the incision area twice, daily.
You may gently wash your face with lukewarm water on the 2nd day after your surgery. You may have some numb spots, so please be cautious as I do not want you to burn yourself and not know it. We will wash your hair at the time of surgery, but it can be very refreshing to have your hair washed by a loved one on the 3rd day after surgery. If using a blow dryer, make sure the blow dryer is not too hot. If there is some crusting that occurs around the incisions that is ok.
Be very gentle when donning or doffing your shirt. Believe it or not, your earlobes have been placed very strategically and it’s important that your shirt not get caught on your earlobes when removing your shirt. A button-up shirt can help decrease this risk. Your incisions will be at maximum strength about 6 weeks after surgery.
Multi-Modal Therapy Medications
Tylenol Extra Strength (500mg) take 2 every 6 hours for 5 days
- Do not wait for pain. Tylenol makes up the foundation of your pain management and will decrease the number of narcotics needed.
Ibuprofen (600mg) take 1 every 6 hours scheduled for 3 days
- Do not wait for pain. Ibuprofen makes up the foundation of your pain management and will decrease the number of narcotics needed.
Gabapentin (100mg) take 1 every 8 hours for 14 days
- Do not wait for pain. Gabapentin makes up the foundation of your pain management and will decrease the number of narcotics needed.
Tramadol (50mg) take 1 every 6 hours as needed for pain. If you use antidepressants, this will be exchanged for Oxycodone (5mg).
- It is okay to wait until you have pain. Tramadol is a long-acting narcotic that will begin to work in about 30 minutes and can last up to 6 hours. Oxycodone is a fast acting, strong medication that can exacerbate nausea and or make patients feel “loopy”.
Zofran (Ondansetron, 4mg) take 1 every 8 hrs
- The dissolvable tabs can be placed under your tongue if you are feeling nauseous from the anesthesia.
MiraLAX (Constipation, OTC)
- Drink 1 full cap twice daily while using Tramadol/Oxycodone until first bowel movement. MiraLAX brand is preferred though, any stool softener is fine. We want to avoid constipation as bearing down can increase your blood pressure in the first week and can put you at risk for bleeding, in addition to being uncomfortable.
Medication Schedule
A proposed schedule has been supplied in order to simplify the scheduling of medication. We understand there are a lot of medications to follow, but rest assured, we believe Multi-Modal therapy provides the greatest comfort and decreases post-operative nausea, drowsiness, and constipation. If your pain has become severe or additional recommendations are needed, do not hesitate to contact our office.
| Medication | Multi-Modal Therapy Schedule |
|---|---|
| Tylenol (1000mg) | 4AM, 10AM, 4PM, 10 PM |
| Ibuprofen (600mg) | 4AM, 10AM, 4PM, 10 PM |
| Gabapentin (100mg) | 6AM, 2PM, 10PM |
| Tramadol (50mg) / Oxycodone (5mg) | 4AM, 8AM, 12PM, 4PM, 8PM, 12PM |
| Zofran (4mg) | 6AM, 2PM, 10PM |
Follow Up Schedule
1 Week
Your swelling will be reduced and will have very minimal pain. Some patients feel a sensation of tightness along their neck, this is normal and will relax in the coming weeks/months. In order to minimize scarring, any/all little sutures will be removed. Much of the bruising will be fading to a yellow color tone. During this visit, we will also remove the drain (small plastic tube) that has been helping get rid of all the swelling fluid, and checking the liposuction areas (they will appear bruised and swollen). If you use contact lenses or corrective lenses, they may still feel like they are not quite the right prescription – this will go away.
1 Month
Bruising will be gone and there are still small areas of swelling, particularly the under-eyes may still look puffy as they tend to be very sensitive to surgery. Your incisions are healing well but will still appear redder around the surrounding skin. They may even feel like a small ridge. Overall, you will be feeling great!
3 Months
You will be enjoying the results of your surgery! The incisions are fading and will continue to improve all the way until one year after surgery.
6 Months
Feeling good, looking good! There are small nuances that we want to make sure are still progressing well.
1 Year
“Why do I have to see the doctor?” Facial Rejuvenation is a lifelong process of constant assessment and reassessment. I want to ensure that you have healed well and that we have improved your quality of life. I also want to ensure that we continue to use the most cutting-edge techniques that provide high-quality, durable outcomes. I will need your help to continue this process to ensure that our patients receive the best possible outcomes.
1 Week
Your swelling will be reduced and will have very minimal pain. Some patients feel a sensation of tightness along their neck, this is normal and will relax in the coming weeks/months. In order to minimize scarring, any/all little sutures will be removed. Much of the bruising will be fading to a yellow color tone. During this visit, we will also remove the drain (small plastic tube) that has been helping get rid of all the swelling fluid, and checking the liposuction areas (they will appear bruised and swollen). If you use contact lenses or corrective lenses, they may still feel like they are not quite the right prescription – this will go away.
1 Month
Bruising will be gone and there are still small areas of swelling, particularly the under-eyes may still look puffy as they tend to be very sensitive to surgery. Your incisions are healing well but will still appear redder around the surrounding skin. They may even feel like a small ridge. Overall, you will be feeling great!
3 Months
You will be enjoying the results of your surgery! The incisions are fading and will continue to improve all the way until one year after surgery.
6 Months
Feeling good, looking good! There are small nuances that we want to make sure are still progressing well.
1 Year
“Why do I have to see the doctor?” Facial Rejuvenation is a lifelong process of constant assessment and reassessment. I want to ensure that you have healed well and that we have improved your quality of life. I also want to ensure that we continue to use the most cutting-edge techniques that provide high-quality, durable outcomes. I will need your help to continue this process to ensure that our patients receive the best possible outcomes.
Questions & Concerns
I am overjoyed and grateful to be part of your journey. I do not take this responsibility lightly. As questions and concerns arise, I expect you to contact me and my staff under any circumstances (925) 966-3920. This is a journey that is best done together. I look forward to caring for you and your family.
