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Types Of Facelifts

Today, there are many types of facelifts. There are Mini-Facelifts, Short-Scar Facelifts, and the Modern Facelift. Other options exist such as the Lunch Time Facelift, the Weekend Facelift and the Lifestyle Lift; although these latter ones are more marketing terms than anything else and actually fall into the categories of minor or short-scar facelifts. The Modern Facelift is the most extensive, but it tends to hold up the best and last longer.

San Francisco plastic surgeon Miguel Delgado, MD will often suggest a Short-Scar lift for a patient who has minimal to moderate laxity of his/her skin. For these patients, the Short-Scar lift is a good option because it can correct what is required without over-operation.

Procedure What It Does Surgery Recovery Results
Facelift
Lifts and tightens the face, addresses lax skin and loss of facial definition
Yes
About 2 weeks to heal, avoid strenuous exercise for about 6 weeks
Long-lasting (about 8-10 years)
Voluma
Restores lost volume in the cheeks and midface region
No
Little to no downtime
Instant results, visible for up to 18 months
bna-sample
bna-sample

The Short-Scar Lift

The Short-Scar Facelift is a relatively new procedure since about year 2000. The demand is for this procedure among Dr. Delgado’s patients is strong, because the lift can be significant and the incision is limited to the front of the ears. The keystone of this facelift method is that it lifts the deep structure. This deep structure is called the SMAS or Superficial Musculoaponeurotic System. The SMAS is a firm and fibrous network that runs under the skin but over the facial muscles and forms the framework of the face. When the SMAS is tightened, it can yield significant and long lasting results. Since the SMAS connects to the neck region, that area can be improved modestly with this approach. A Lifestyle Lift falls into this Short-Scar Lift category.

The Mini-Facelift

The Mini-Facelift involves only the skin. This is not a deep lift and does little, if anything, to improve the neck. If you pull the skin back and upwards in front of the ears, this will mimic the effect of a Mini-Facelift. Since the procedure only pulls the skin, the effects will not last for more than a few years. Unlike the underlying facial muscle, the skin is not structural and stretches easily. The degree to which the skin will stretch is determined by your genetic makeup and your amount of sun exposure. The Weekend Facelift and the Lunch Time Facelift are examples of the Mini-Facelift.

The facial rejuvenation incision for women is often within the tragus of the ear. This will avoid the incision in front of the ear. However, for the male facelift, the incision is often in front on the ear to avoid pulling the beard or hair bearing skin into the ear. This takes longer to fade but results in a more natural ear for a male.

The Modern Facelift

The Modern Facelift has evolved over many years, starting with the discovery of the SMAS. Surgeons have dissected and pulled the SMAS every which way as they learned how to best utilize this tissue plane.

The Modern Facelift technique often includes an incision behind the ear and into the hairline. This is needed if a significant amount of redundant skin is present, especially in the neck. This lift is a gold standard and will typically last eight to ten years. The SMAS is more extensively supported in the Modern Facelift than in any of the other facial rejuvenation surgeries.

The modern approach to facelift surgery has recognized the importance of facial fullness from fat.  As we age, fat is lost in many areas of the face, such as the cheeks, the eyes, lips and other facial regions. As this occurs, we look older. The skin loses its fullness and begins to appear deflated and saggy. In this situation, the facelift becomes a slightly flat pull with less contour or curvature, like in the cheek region. This shows as a more operated and un-natural look.  This is the reason for fat conservation and fat injections. Dr. Delgado often incorporates fat injection into his facelifts. An additional technique Dr. Delgado may use to restore fullness to the face is to overlap the SMAS, as opposed to removing a segment of this structure.

Even though fat is key component in facial aging, men do not require quite as much fat volume replacement as women. It should be much more subtle and not exaggerated, like a full cheek.

“Liquid Facelift” is a term used to describe injections of products to fill various facial areas and create more fullness. A patient’s own fat is commonly used, but products such as Sculptra®, Radiesse®, and JUVÉDERM VOLUMA® can be used as well.

Every patient’s needs, means, and desires are unique. For example, patients in San Francisco Bay Area and Marin County often seek to work around their busy schedules, while patients who fly from around the United States often need a place to convalesce. We work with our patients to ensure that we meet their particular needs. Please don’t hesitate to tell us about your particular situation. We work with all of our patients to ensure that your experience goes as smoothly as possible.

Fat Injection Facelift

Fat injection, or augmentation is used to increase the fullness of certain areas of the body, the technique has been advanced since 2008. Dr. Sydney Coleman of New York City developed a new purification process. In the Coleman Technique, fat is selectively grafted from regions such as the abdomen or legs, with the assistance of liposuction. Once harvested, the fat is processed via centrifugation, an process that separates fat into several layers: an upper oil layer, a central purified and concentrated fat layer and a bottom level consisting of blood.

Extensive studies have discovered the lower 20% of the fat layer to contain an excess of fat cells and growth factors, beneficial in the healing process. When this fat layer is used in facial augmentation procedures, its survival rate is tripled. As the unnecessary elements are discarded, the fat is injected via 1cc syringes. The Coleman technique promotes a crosshatching effect that causes fat cells to thrive at and around the injection site. Unlike other techniques, the Coleman method guarantees that over 50% of the fat benefits your aesthetic goals.

Dr. Delgado takes great pride in providing each patient with a natural and elegant facelift. Whether you live in the San Francisco Bay Area, Sonoma or Marin County we have two office locations to serve your needs. Our San Francisco location is located at 450 Sutter at Union Square and our Marin County location in Novato at the Sutter Hospital Campus.  If you travel from around other parts of California or the United States we have a great travel package and accommodations.

If there were more than five stars to rate highly Dr. Delgado. I would. Everything about my facelift experience from the pre-surgical consultations, day of surgery and follow-up care could not have been fantastic. Dr. Delgado is not only a highly skilled surgeon but an artist, as well. Simply said, he is outstanding in every respect as is his professional staff. – First rate!

Nina S.

Before Facelift Surgery

A consultation with Dr. Delgado can be scheduled at either his San Francisco Bay Area office or his Marin County office.

During your consultation, Dr. Delgado will go over the facelift procedure and address any concerns regarding your face. He will want to know your short- and long-term goals. Based on these desires, he will explain the best technique for your needs. This conversation may include your eyes and eyebrows.

Dr. Delgado may use computer imaging to show a visual impression of the proposed outcome. This is a popular tool that is extremely helpful and enhances communication.

Prior to the facelift, you will receive an informative instruction booklet with precautions to follow before your procedure. The pamphlet will contain everything you need to know regarding medications to stop taking, and what steps to take at home before surgery. It explains that although you should stop taking aspirin two weeks before your procedure, Tylenol is recommended to alleviate pain. The instructions also detail vitamins and holistic options to reduce swelling and bruising after your cosmetic procedure.

Facelift Surgery

The surgery takes place at Marin Cosmetic Surgery Center, Dr. Delgado’s private surgery suite, located in his Marin County office on the Sutter Marin County Community Hospital campus. This allows Dr. Delgado to offer his patients private, concierge medical care, while providing the extra measure of safety and reassurance afforded by the surgery center’s contiguous location to the hospital.

The procedure begins with preoperative markings. Dr. Delgado will make drawings on your face for the location of the incisions and the direction of the pull vector. The SMAS location will be outlined. You will be lightly sedated and taken to the Operating Room. Once anesthesia is complete and all is sterilely prepped, the operation will begin.

An incision is made in front of the ear. If a Minor Lift is done, the cheek skin is undermined, pulled and the redundant skin is excised and finally sutured. If a Short-Scar lift is done, the skin is further undermined into the cheek area and down toward the neck. The SMAS is then elevated and anchored, pulling the neck tissue and facial tissue upward. The skin is trimmed and closed. A chin incision is sometimes used to further tighten the neck region. If the Modern approach is used, the incision continues behind the ear and into the hairline. This incision exposes much of the neck and cheek area. The SMAS can be completely modified to achieve a stronger face and neck improvement in a natural fashion. Much more skin can be excised and then meticulously closed. A drain is often placed and a light compression dressing is used. At the same time, additional facial procedures can be done, such as a chemical peel, fat injection for facial fullness, or a lip augmentation.

Anesthesia

Most of our face lift procedures are performed while the patient is under non twilight anesthesia. However, in some cases, one may use local anesthesia with intravenous sedation. At Marin Cosmetic Surgery Center, only a board-certified physician, trained in anesthesia works with you throughout the procedure. Dr. Delgado and the anesthesiologist work closely together to promote comfort throughout your rhytidectomy surgery. The night before your Facelift, the anesthesiologist will call to confirm your medical history and answer any last minute questions before your procedure.

After Facelift Surgery

The first few hours after surgery will be spent in the Recovery Room. When you are completely alert and oriented, you will be able to go home with someone to assist you. You are to apply cold packs around your face and neck area for 48 hours to reduce swelling and sleep with your back and head elevated at 45-60 degrees for approximately four to five days.

Some patients will spend the night in the Recovery Room at Marin Cosmetic Surgery Center in Novato, California, especially if a complete facelift is performed. If you are staying overnight, your care will be provided by a Registered Nurse with post-operative training, including ACLS (Advanced Cardiac Life Support) certification. An additional person will be assisting her overnight with your care.  These recovery personnel have been hand picked and trained by Dr. Delgado to provide the highest level of surgery after care.

Dr. Delgado will see you the next morning and inspect your incisions. If drains were placed, they may be removed. You will be discharged with a responsible adult to transport you to your home and settle you into your recovery environment. You may shower and wash your hair the following day if the drains have been removed.

Maintaining elevation of your back and head is very important to minimize swelling. You may experience minimal pain, but most patients report primarily a sensation of tightening from the swelling. Pain medication is prescribed, but usually it is needed for just a day or two.

Much of the swelling and mild bruising will resolve in seven to ten days, as long as proper care is taken. Makeup may be applied after one week. Most patients return to work or social activity after seven to ten days. Strenuous physical exercise is to be avoided for four to six weeks following surgery.

Male and female facelift surgery has many similarities and differences. We have discussed the aging, the incisions and volume replacement.  The male facelift should produce a strong jawline; this may even require a chin implant. The female jawline should be very distinctive but in a softer way.  More attention is spent on the female neckline to achieve a tight and smooth appearance. It is imperative for both the male and female facial rejuvenation that the hairline not be altered.  This is especially true for the male who doesn’t, in general, wear long hair.

Risks and Complications

As with any surgery, there are risks and complications. However, with a board certified plastic surgeon, a board certified anesthesiologist and a well-trained surgical team, complications are rare. The facial surgery carries the possibility of nerve injury, but this risk is minimal with a skilled, mature surgeon, such as Dr. Delgado. Occasionally, incisions need to be modified with scar improvement techniques. In general, the incisions blend and fade beautifully over time.

Male facial surgery patients have a higher rate of postoperative bleeding due to the added hair to the face. This brings in more blood supply to the area.  The blood pressure needs to be controlled after surgery and the patient often stays overnight at the Marin Cosmetic Surgery Center.

Outcome

The results of the procedure are to rejuvenate the face, neckline, jawline and their relationships. The angle of the neckline and facial area will be improved with more contours as a result of removal of fat and tightening of the musculature. The skin around the mouth and the prominent folds below the sides of the nose will be improved. You will look rejuvenated with a natural and elegant appearance. The improvements can be expected to last for many years. Although you will continue to age and gravity will continue to affect your face, the area will remain rejuvenated. Facial surgery can be done again in the future and combined with other procedures, as desired.

Frequently Asked Questions

What is a facelift?

A facelift is a cosmetic surgery procedure, the purpose of which is to erase, or at least ease, the telltale signs of aging seen in the face. A facelift reduces heavy wrinkles and eliminates sagginess of the neck and facial skin. Fat deposits can be removed in some areas like around the neck or replaced in the cheek region. The underlying muscles of the neck and face are tightened. The skin is then re-draped over the firmer underlayment and the excess skin is removed.

Who is a good candidate?

The best candidate is a man or woman whose skin has begun to sag and/or develop laxity. Most patients are between 40 and 60 years of age.

What are the risks?

Like any surgical procedure, it does involve certain risks. The most common risks include: infection, bleeding, and adverse reaction to anesthesia, poor healing, asymmetrical results and the very remote risk of temporary or permanent nerve damage.

Can I have other cosmetic procedures at the same time?

It is common for patients to have other cosmetic procedures at the same time. These procedures can include a brow lift, neck lift, eyelid lift, chemical peel, and volume replacement in the face, such as fat injections. Dr. Delgado may advise you to consider one or more of these additional procedures in order to achieve the most harmonious and natural results possible.

Who is an ideal candidate?

The ideal candidate will understand that a facelift is intended to enhance the appearance, not to give an entirely new look. It is vital that you are realistic with your goals. You can have dramatic results, but it is not designed to make you look like someone else. What it does is turn the clock back eight to ten years.

What happens during my initial consultation?

Dr. Delgado offers consultations at both his offices; the San Francisco Bay Area office at 450 Sutter and his Marin County office in Novato, California. All of Dr. Delgado’s surgeries are performed at Marin Cosmetic Surgery Center.  During your consultation, he will discuss your concerns and your goals. He will examine your face to evaluate the extent of skin laxity and assess other aspects of your face that may need correction in order to achieve a balanced and natural appearance. Dr. Delgado will explain incision placement, often with the aid of computer imaging. He will show you before and after photographs of patients on whom he has performed facelifts so you can see actual results of his work. You will receive a DVD that has recorded the experience of one of Dr. Delgado’s patients. An exact price quote will be explained.

Are the results permanent?

Although a facelift will improve your appearance; it will not stop the aging process. While patients have a more youthful appearance than they would naturally, wrinkles will eventually reappear with the progression of skin laxity over time. In general, depending on when you have your procedure, you will look eight to ten years younger. This will always be the case. For example, when you are 70, you will look as though you are 60 years old.

Will I have scars?

Dr. Delgado will make minimal incisions in well-concealed areas. The incisions resolve extremely well over time. It is always the goal to minimize the incisions, as well as preserve the natural hairline. The incisions are slightly different for men and women and Dr. Delgado will review this issue.

Where are the incisions made?

Your incisions will be made within your hairline and along the natural contour of your ears. The incision will go behind the ear as well. In men it is often placed in front of the ear to keep the beard hair from going into the ear region. Depending on the extent of the procedure, an additional incision may be hidden underneath your chin to complete a neck lift. Dr. Delgado will show you exactly where your scars will be located during your initial consultation.

When can I return to work, exercise and driving?

A typical patient undergoing a facelift procedure will be very comfortable returning to work in approximately two weeks. Minor concealing makeup may be desired in areas where bruising has not yet completely resolved. You can plan to drive seven to ten days after surgery, or as soon as you are comfortable and off pain medications. Exercise routines can be resumed approximately four to six weeks after surgery, advancing slowly. The post-operative goal is to reduce swelling as quickly as possible, allowing you to return to your usual activities looking as natural as possible. Men may require a little extra-time because make-up is not usually worn.

What is the cost of a facelift?

The cost of a facelift can vary greatly depending on the combination of procedures to be done. At the time of your consultation you will be given a personalized quote showing a breakdown of all fees.

Do men have facelifts?

Yes, men are having facelifts at a higher rate each year. The reasons are similar to women. Some of the most common are work related issues, divorce, midlife crisis or just want to look how they feel.

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