Facial aging is a process that occurs in all layers of the face. The bony skeleton resorbs and provides less support. The muscle, fat and connective tissue layers descend due to less skeletal support and increased laxity in the retaining ligaments. On the surface, skin is thinner, less elastic, less hydrated, has uneven pigment and appears wrinkled. The result is loose, hanging skin and a heaviness in the lower face and neck, and hollowing and volume loss under the eyes and in the upper cheeks.
Whether you are experiencing some or all of these changes or are seeking to prevent or delay the aging process, there are a variety of treatment options available:
Camouflage and soften lines; Add back volume.
What is a facelift?
Sometimes referred to as a rhytidectomy, in simple terms, a facelift is a surgery that uses hidden incisions along the hairline and ear to lift and reposition the facial tissues in a more youthful position. Unfortunately, facelift surgery is associated with the stigma of ‘bad’ cosmetic surgery that appears unnatural or overdone. The reality is, in the hands of expert facelift surgeon Dr. Brace, a facelift is often the most natural and powerful procedure a person can undergo to rejuvenate their face and neck. It also has tremendous power in rejuvenating self-esteem and confidence. It is the surgery that restores what you see in the mirror to be more in line with your innate sense of youthfulness.
Types of facelifts offered
Due to the stigma with the word ‘facelift’ many surgeons have re-named and rebranded their version of a facelift to be more accessible to those who can benefit from this procedure. This creates some confusion for patients who are trying to research this surgery. The important distinguishing element for patients researching a facelift is to determine their tolerance for downtime and the longevity of the lift they seek.
Surgical facelifts have evolved from tightening the skin alone to tightening the layer of the face called the SMAS (superficial musculoaponeurotic system) and removing the excess skin. When the skin is treated alone (without SMAS), an unnatural appearance is created and is where the stigma of unnatural facelift surgery originates.
The procedures that tighten the SMAS are advantageous because tension is taken off the skin and put in a deeper layer of the face. This gives a natural result along the neck and jawline but the result is limited by not allowing for correction of the nasolabial folds. The advantage is minimal downtime (~1-2 weeks) but the results have a shorter lifespan with a high revision rate at 2 years.
Deep plane facelifts
A deep plane facelift is the most advanced and natural-looking technique that will correct the cheeks, jawline and neck. A deep plane lift is a delicate but extensive procedure where Dr. Brace releases the ligaments of the face so that the SMAS, fat pads, ligaments and muscles of the face and neck can be completely re-draped and repositioned. This gives the most balanced appearance between the face and neck, with correction of nasolabial folds and the longest lasting results of usually 10 years or more.
Because all the tension is placed deep on the SMAS there is no stigma of a facelift once the face is healed. This is Dr. Brace’s procedure of choice for facial rejuvenation. The incisions are meticulously and individually tailored depending on each person’s anatomy and degree of facial laxity. Sometimes the incisions are almost entirely in front of the ear, in others they extend behind the ear along the hairline.
The minor nuisance of a deep plane facelift is the degree of downtime. As a more extensive surgery with a larger area of tissue release and re-draping, the swelling and bruising tends to be greater. Social downtime from a deep plane facelift is usually a minimum of 2 weeks but may extend to 3 or 4 weeks depending on how much discretion is desired. The scar along the hairline at the sideburns can be higher than traditional facelift incisions and as such, is more conspicuous in those who wear their hair very short. This scar does fade away to a fine white line with hair growing through it making it virtually invisible after a few months.
Who is a candidate for this surgery?
Both men and women from across Canada seek facelift surgery from Dr. Brace. The most common reason to seek a facelift is loose hanging skin of the jowl, neck and cheeks with deep nasolabial folds. Most people seeking a facelift are in their 50s to 70s. However, deep plane facelifts are also effective in treating younger adults to improve acne-scarred skin or to remove excess skin after significant weight loss. The final reason to seek a deep plane facelift is to revise a previous facelift that placed excess and unnatural tension on the skin creating an unnatural, pulled appearance.
Facelift by Dr. Brace:
Dr. Brace is an expert facelift surgeon with double board certified training. His practice is focused exclusively on surgery of the face and neck. He has studied under facelift masters and innovators and has refined his own techniques. He continues to be a lifelong student and teacher of this surgery. His results are consistently beautiful and natural. His goal with each patient is to restore the face to youthful shape without changing an individual’s appearance or making him or her look like someone else. Dr. Brace creates elegant refinements; reversing the changes time has created and recapturing the natural beauty and contours of each face and neck.
Dr. Brace’s extensive surgical expertise in the face comes not only from hundreds of facelift procedures, but also from his advanced training and practice in head and neck surgery. Dr. Brace uses these same skills and techniques to treat patients with facial tumours. He enjoys an elite level of comfort and skill working in the face around the facial nerve. He extends the power of the deep plane facelift to provide cutting edge care for cancer patients by using hidden cosmetic incisions to access and remove facial cancers and to recruit skin with facelift ligament release techniques to reconstruct cancer defects. With hundreds of cases of experience, Dr. Brace is a talented surgeon with a keen artistic eye who is highly respected by his colleagues.
THE FACELIFT PROCESS
The first step in facelift surgery is the consultation. During the consultation Dr. Brace will assess your general health, your facial and neck aesthetic balance, your aesthetic concerns and the aging components of the face that lead to these concerns. He will then take standard photographs and 3D images. Dr. Brace will provide you with his recommendation at this time for the best facelift result. In most cases Dr. Brace will point out other areas of your face that will not be corrected by a facelift and will discuss options to address these areas if needed. This may include the eyelids, brow, upper lip and skin around the mouth. In some cases a facelift is not necessary to achieve your aesthetic goals and Dr. Brace will advocate for a different approach.
Facelift surgery is done in the hospital under general anesthetic in most cases. Rarely the surgery is done with IV sedation if preferred. Dr. Brace will meet you the day of surgery and mark all the incisions and landmarks prior to administration of anesthesia. The surgery is anywhere from 3-6 hours depending on additional procedures being performed. Incisions are closed with fine sutures along the hairline, in front of and behind the ear. In some cases there is a small incision in the skin under the chin.
Dr. Brace uses drains to minimize bruising. These can be felt in the neck as small rubber tubes. They exit behind the ear in the hair-bearing scalp. When you wake up your head will be wrapped with a light compression dressing to apply gentle pressure to your neck and cheeks. You are able to go home the day of surgery with a friend, family member or caregiver providing a drive. Prescriptions for antibiotics, nausea, swelling, and pain are provided preoperatively.
Bruises: After leaving the hospital it is not uncommon to start to notice bruising around the eyes and in the neck and upper chest. Gentle application of ice packs help decrease the bruising. Anti bruising treatment with arnica supplements will be discussed preoperatively and provided if desired.
Bleeding: a small amount of oozing from incisions onto the dressing or around the drain is normal. The drains are under suction and will also collect blood. This is normal. It is abnormal to have rapid firm swelling of the face or neck and brisk filling of the drain. This is rare but usually indicates a hematoma and requires removing the sutures in the OR to cauterize bleeding. This will be discussed in consultation.
Swelling: The eyelids and cheeks and neck will become swollen to some degree. This should be soft swelling.
Nausea: some people develop nausea as a reaction to the anesthetic medication. IV medicines are given to minimize this. Gravol can be taken at home if it persists. The nausea does not usually persist beyond the first 24 hours after surgery.
Discomfort: Most people report the majority of discomfort to come from the dressing/head wrap as an itch or sweaty discomfort. You may experience tenderness in the cheeks or neck from a bruise.
Numbness: Elevation of the skin around the ear will often lead to cheek or ear lobe numbness. This will recover within a few months. There is also lidocaine injected into the face during the surgery that may produce hours of facial numbness and weakness with an asymmetric smile.
Bruises: bruises will develop under the eyes, around the mouth and in the neck. Use arnica as directed
Bleeding: Dr. Brace will remove the dressing and the drains in most cases. There will be some bleeding from the drain removal site initially. This will stop within the hour with a dressing. Dr. Brace will replace the gauze dressing with an elastic compression facial sling to minimize bleeding and bruising under the skin.
Brisk firm swelling in the neck or cheeks is usually the start of a hematoma from a bleeding blood vessel. Dr. Brace will discuss this with you and what to watch for. The risk of this happening is greatest in the first 72 hours after surgery but is a rare occurrence around 1-2%.
Discomfort: expect tenderness of the neck and cheeks. Acetaminophen and ice with the compression dressing is usually all that is required.
Swelling: usually peaks in the first 1-3 days. Dr. Brace provides a prescription for solumedrol to minimize the swelling. Sometimes the area under the cheek skin where the facelift sutures are placed will look dimpled. This will soften and is only visible due to the swelling.
Nerve function: Dr. Brace will assess the function of the facial nerve branches at your appointment. Rarely the nerve that travels to the lower lip will be bruised and weak from the surgery producing a crooked smile. This usually recovers within 1-4 weeks.
Bruises: present and may worsen and darken as blood settles
Bleeding: there should be little to no bleeding
Incisions: clean any incisions according to instructions
Discomfort: tender to touch. Acetaminophen and ice as required.
Swelling: peaking but mitigated by prescription
Dr. Brace will see you back for removal of the sutures and to examine your healing.
Bruises: most bruises will have appeared around the eyes, mouth and in the neck. If there is a red or purple discolouration present Dr. Brace will offer pulse dye laser treatments to accelerate the resolution of these bruises.
Bleeding: there may be a small amount of bleeding around the skin edges if sutures are removed. This will scab over within the first hour. The scabs can be gently removed with a Q-tip moistened with peroxide. Incisions will be red and swollen.
Discomfort: removing sutures does not hurt but can feel like the pinch of plucking a hair. Many people are anxious about this part of the follow-up and are pleasantly surprised at how easy and quick it is.
Swelling: continue with the facial sling 24 hours a day (except bathing/showering) for 2 weeks after surgery. Once you reach the 2 week post-operative recovery point, wear the sling nightly and when around the house as much as possible.
Follow up with Dr. Brace to assess the early resolution of swelling, the healing of the incisions and resolution of bruises.
Bruises: these should all be resolved. If not Pulse dye laser may be offered.
Discomfort: minimal if any at all.
Swelling: Some minimal cheek and lower eyelid swelling is normal. If the cheek still has the dimpled appearance from sutures massage will start to soften and resolve this.
Scars: red or dark pink in colour. Pulse dye laser treatments to help fade the scars will be offered. Possible injection of anti-inflammatory medication to speed up resolution of scars.
Follow up with Dr. Brace
Swelling: should be resolved at this point with nice definition of jawline, neck and cheeks. Rarely minor swelling under the chin is still present. Dimpling should be resolved or minimal if it was present.
Scars are light pink and fading nicely. Pulse dye laser and injections as necessary
Follow up with Dr. Brace. Photos taken. Swelling resolved. Scars faded to white lines or slight pink. Pulse dye laser or injections as necessary.
Follow up with Dr. Brace
Scars matured and faded. Final photo taken. Any discussion of revision procedures.
As in any aesthetic procedure there will be a small subset of patients who do not achieve the complete aesthetic goals of facelift surgery. This can be for a host of factors. Common reasons to seek a revision after a deep plane facelift are recurrence of the neck bands at the front of the neck or an unsightly scar that did not heal as intended. These are usually dealt with as a minor procedure under local anesthetic.
One of Dr. Brace’s passions is deep plane facelift surgery. The degree of correction and restoration of youthfulness from this surgery is a key component of what drew him to facial plastic and reconstructive surgery as a specialty. The impact that this type of facelift surgery has on his patients who are given the gift of renewed confidence and self-esteem is Dr. Brace’s motivation to continue to refine and enhance his techniques.