As we age, various changes in our skin and underlying soft tissues occur. The skin loses collagen and its elasticity, and the fat beneath the skin atrophies and disappears. As these processes occur, the face appears more hollowed and the skin begins to sag.
The once well-defined facial contours are hidden, making us look older. Additionally, the jowls and neck skin become more prominent and horizontal and vertical bands develop in the neck.
Your Personal Consultation
During the initial consultation, you may be asked to look in a mirror and point out exactly what you would like to see improved. This will help Dr. Boss to understand your expectations and determine whether they can realistically be achieved.
Maintaining a Relationship with Dr. Boss
You will return to Dr. Boss' office for follow-up care at prescribed intervals, at which time your progress will be evaluated.
Please remember that the relationship with Dr. Boss does not end when you leave the operating room.
If you have questions or concerns during your recovery, or need additional information at a later time, you should contact him.
How will Dr. Boss evaluate me for face-lift surgery?
In evaluating you for face-lift surgery, Dr. Boss will assess the thickness, texture and elasticity of your skin, and the severity of wrinkles and folds. Your hairline will be examined to determine where incisions can be discreetly placed. All of these factors, as well as your bone structure and underlying tissues, will be considered in developing an individual surgical plan.
Dr. Boss may discuss with you additional procedures that can be performed along with a facelift in order to address all the concerns you have identified. For example, a facelift is frequently combined with a forehead lift, eyelid surgery, nose reshaping or skin treatments such as a chemical peel, dermabrasion or laser resurfacing.
How a Face Lift is Performed?
Because of individual factors, not everyone will achieve the same results from a facelift. Dr. Boss will select the surgical technique that he feels will obtain the best outcome for you.
Strictly speaking, a facelift refers to a tightening of the skin and soft tissues from the cheek bones to the collar bones. Therefore, the cheeks, jowl line, and neck are all improved by this procedure.
This procedure can be broken up into either a cheek lift or a neck lift if only one of these areas is in need of surgery. The incision is tailored to the patient but is placed in natural creases in front of and behind the ear to make it unnoticeable.
For males and females the incision is slightly different so as to not distort the hair bearing skin of the face in males.
In order to address the neck muscles, fat, and skin, a small horizontal incision is placed beneath the chin in a natural crease where it cannot be seen. The skin is elevated off of the underlying soft tissue structures and in most cases, the underlying connective tissue is also elevated to provide for longer-lasting, more natural appearing results.These tissues are then re-draped and the redundant tissue is removed. This is done in a way to restore the natural youthful appearance and avoid a surgical appearance.
The best results in a facelift, occur when the patient has a well-defined bony structure and excellent skin quality. Therefore, Dr. Boss may recommend additional procedures such as facial resurfacing, liposuction, fat augmentation, or chin augmentation to guarantee the best results.
The length of the procedure can vary from 2-5 hours, depending on the exact facelift procedure and additional complementary procedures. It can be performed under conscious sedation or general anesthesia. Together with Dr. Boss, the appropriate anesthetic plan will be determined.
Where are the facelift incisions placed?
Although there are many variations to the facelift procedure, generally an incision is hidden in the natural contour of your ear, then extends around the earlobe and back into the hairline. Following surgery, incisions can be easily concealed by your hair or with makeup. There may also be a small incision hidden underneath your chin.
Most facelift incisions are placed within the hairline and within natural contours in front of and behind the ear. Sometimes the deeper tissues may also need to be repositioned in order to restore a more youthful contour to the face. After the skin has been pulled up and back, the excess is removed.
How is Dr. Boss able to restore a firmer, fresher look to my face?
Through the discreet facelift incisions, your plastic surgeon is able to free the skin from the underlying tissues to the extent necessary for the particular surgical technique selected. After the skin has been pulled up and back, the excess is removed. In some instances, the deeper tissues may also need to be repositioned in order to restore a more youthful contour to your face.
If necessary, a small incision beneath the chin permits the removal of fatty tissue in that area and smoothing of the cord-like structures of the underlying muscle in the neck.
I understand that every surgical procedure has risks, but how will I learn more so that I can make an informed decision?
The subject of risks and potential complications of surgery is best discussed on a personal basis between you and Dr. Boss. Some of the potential complications that may be discussed with you include hematoma (an accumulation of blood under the skin that may require removal), infection and reactions to anesthesia.
While plastic surgeons are trained in techniques for safely manipulating facial skin and tissue, injury to underlying structures is possible, though it is usually only temporary. Facelift incisions are most often inconspicuous, but this is not entirely predicable due to individual variations in healing. You can help minimize certain risks by following the advice and instructions of your plastic surgeon, both before and after surgery.
Your Surgical Experience
The goal of Dr. Boss and his entire staff is to make your surgical experience as easy and comfortable for you as possible.
How should I prepare for surgery?
If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. your surgeon will advise you and provide additional preoperative instructions.
If your hair if very short, you may want to let it grow enough to cover your incisions while they heal. If you are overweight you have a realistic desire to lose more that 15 pounds, you should discuss this with your surgeon. If your facelift will be performed on an outpatient basis, be sure to arrange for someone to drive you home and to stay with you at least the first night following surgery.
What will the day of surgery be like?
Your face-lift may be performed in a hospital, free-standing ambulatory facility or office-based surgical suite. Medications are administered for your comfort during the surgical procedure. You and Dr. Boss will have decided in advance what type of anesthesia is to be used, either intravenous sedation or general anesthesia. For your safety during the operation, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulation in your blood.
When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. A bandage may have been wrapped around your face to be closely monitored. A bandage may have minimize swelling.
Sometimes small tubes will have been inserted beneath the skin to drain away fluids that might otherwise accumulate, but you will not feel these at all. In fact, there is surprisingly little discomfort from the surgery. You probably will be permitted to go home after a few hours, although some patients may stay overnight in the hospital or surgical facility.
How will I look and feel initially?
It is important to realize that the amount of time it takes for recovery varies greatly among individuals. After surgery, you will be asked to restrict your activities and simply relax for a few days. Elevating your head when you sleep will help to minimize swelling and bruising.
Remember, you must not take aspirin or certain anti-inflammatory medications, and you should not smoke or be exposed to heavy secondary smoke for a while. Any bandages and drain tubes will usually be removed in one or two days. At that time, you will notice puffiness and discoloration which may be more pronounced in some portions of your face than others.
Do not be alarmed by any unevenness or temporary asymmetry caused by this variance in swelling and bruising, which is perfectly normal. Generally, the greatest amount of swelling occurs 24 to 48 hours after surgery, but it may take several weeks before all puffiness is resolved. Most bruising will disappear within two weeks. After a few days, you will be permitted to wear makeup which will help conceal and discoloration.
You will also experience some numbness in the facial area, which may be present for several weeks or longer. Your stitches will be removed from four to seven days after surgery.
When can I resume my normal activities?
Straining, bending and lifting should be avoided during the early postoperative period. In many instances, you will be able to resume most of your normal activities within two weeks and begin to exercise three to four weeks after surgery. You will be instructed to temporarily avoid exposure to direct sunlight and, for the long-term, to be conscientious about the use of a sunblock to protect your skin.
The patient should be able to return to work within 10-14 days. At the end of the procedure, the incisions are wrapped in an occlusive dressing to minimize swelling and promote wound healing.
This dressing is removed 1-3 days after the procedure. Some swelling and bruising is expected and normal. After the dressing is removed, you will be instructed on how to clean and care for the wound. Sleeping with your head elevated will minimize the swelling and expedite the recovery. No sutures will need to be removed as they are all resorbable.
Results of Your Face-lift
The results of your face-lift may be dramatic or subtle, depending on how you look before surgery as well as the specific goals that you and Dr. Boss have established. Since the healing process is gradual, you should expect to wait at least several weeks for an accurate picture of your "new look." Additional minor changes, or settling, may occur over several months.
Fortunately, significant complications from facelifts are infrequent. Every year, many thousands of people undergo successful facelift surgery, experience no major problems and are pleased with the results. Anyone considering surgery, however, should be aware of both the benefits and risks.