A necklift is
performed to tighten neck skin only. A necklift without a
facelift is uncommon since, in most cases, it is impossible
to remove neck skin without leaving redundant cheek and face
skin. A neck lift as part of a full facelift involves
tightening the muscle and skin. Prior to undergoing a
necklift without a facelift, we strongly recommend a second
opinion to see if two surgeons agree that you will not be
left with an unsatisfactory result from redundant face and
cheek skin. Best to do it right the first time.
We have included preoperative and postoperative routines and
instructions for facelift below. If by chance you did have a
neck lift without a facelift, the procedure information is
As life spans lengthen, most people feel energetic long
after their appearance begins to show premature signs of
aging. One of the most common requests we hear is "for the
outward appearance to reflect the more youthful energy a
person feels inside." Many patients want a smoother contour
and tightening of the jowl area. Some want to elevate
sagging cheeks; others want to elevate facial expression
"laugh lines" from their drooping position. Many want to
reduce jowling in the areas of the chin and neck. Patients
who request one or any combination of these improvements are
seeking information about a facelift.
Rhytidectomy (rye-tidd-ec-toe-me - the technical term for
facelift) can affect one's appearance as dramatically as any
facial cosmetic surgery. Rhytidectomy is a safe, effective
procedure performed to restore a more youthful appearance
and less fatigued look while maintaining or improving
function. Once thought a beauty procedure sought by only
wealthy women, men in today's competitive corporate
workplace are increasingly seeking facelift procedures to
restore a younger look that more typifies their energy
When patients come to our office seeking facial plastic
surgery, it's not uncommon for them to focus on a single
aspect of their appearance rather than the overall picture.
One of the most common concerns we hear from patients
seeking facelifts is the "turkey wattle," the loose skin
dangling under the chin. Many times patients will request
just a "neck lift." It is important to know that patients
are rarely satisfied with "just a neck lift." Why? When
excess neck skin is removed, the lax skin of the face
bunches up in front of the ears and the look is unnatural.
If a plastic surgeon tells you he can do a neck lift alone,
we strongly encourage obtaining a second opinion before
proceeding. Furthermore, the benefit of doing the neck and
face together is the opportunity to combine neck liposuction
to obtain fat for placement elsewhere in the face. Fat
injections make use of fat that would otherwise be
discarded. Fat injections can be used in many areas of the
face including the smile lines and for lip augmentation.
An experienced, knows that his responsibility is to evaluate
not only the areas of concern but also the motivation behind
the requests. It goes without saying, a facelift won't save
a failing marriage. Similarly some patients not ready for
cosmetic surgery are better served with conservative
measures, such as Botox for fine lines and wrinkles or
Collagen for crows feet. Patients who educate themselves
about facial rejuvenation know when and if the time is right
When discussing rejuvenation procedures the best place to
start is by looking at before and after photos to see just
what can be accomplished. As you will see in the photos,
patients often ask to combine a face lift with a brow lift
for correction of frown lines between the eyes or
blepharoplasty for improvements in bags under the eyes. Chin
implants, cheek implants, rhinoplasty(nasal surgery),
otoplasty (ear surgery) and lip surgery can also be
performed in conjunction with a facelift.
Many patients seek information about improving superficial
skin wrinkles with a chemical peel, laser surgery or similar
skin resurfacing procedure. Although some improvement in
facial wrinkles can be obtained from a facelift, it will not
address all the superficial lines that come from premature
aging, overexposure to weather and genetics. Facelifts
address "saggy" skin; skin resurfacing addresses textural
wrinkles and imperfections.
At your initial consultation, we will evaluate the soft
tissue and bony architecture as well as the form and
function of the head and neck. An overall assessment of the
face provides the basis for what one may expect from a
facelift. Skin type, ethnic background and age, along with
the degree of deformity and function are important factors
influencing the outcome of surgery.
As with all facial plastic surgery, a thorough health
assessment and realistic expectations are prerequisites.
Your understanding of procedures and routines is essential
to a successful final result.
At your preoperative appointment our nurse will provide all
the instructions for you to follow before and after surgery.
On the business day prior to the operation we ask you to
call to confirm your arrival time for surgery. Upon arrival
for your surgery, you will talk with a nurse (who will start
an IV), discuss anesthesia (local anesthesia with IV
sedation keeps you asleep and comfortable) and meet with
your doctor before going to the operating room. A facelift
takes about three hours depending on the structure and
amount of excess tissue prior to surgery. If you are having
a combination of procedures your surgery will take longer.
Recovery time from the anesthetic takes about an hour and
you will be discharged about five to six hours from the time
Please avoid any aspirin, aspirin-containing products, or
ibuprofen for one week prior to and two weeks following your
surgery. See our "Medication List" for products to avoid
prior to surgery. If you are on any medications that affects
bleeding (such as coumadin or warfarin) please notify the
Please refrain from tobacco products and alcohol for one
week prior and three weeks following surgery. Along with
delayed wound healing, persistent skin redness and other
complications may persist when tobacco and alcohol are not
Please notify us of all routine medications and significant
health history. We ask that you remain on your daily
medications unless instructed otherwise. At the preoperative
appointment, our nurse will tell you which daily medications
to take with just a sip of water on the morning of surgery.
At your preoperative appointment you will be given
prescriptions for use following surgery including an oral
antibiotic and pain medications. Please obtain these
prescription medications before your surgery so you will
have them ready for use when you return home after surgery.
We will ask you to start Vitamin C (ascorbic acid), which
helps promote healing, for one week before and two weeks
You may not eat or drink after midnight the evening before
the procedure unless instructed otherwise. You may brush
your teeth. Your procedure will be cancelled if you do not
follow these instructions.
Someone must be available at all times while you are here at
the clinic for surgery. Someone will need to drive you home
after your surgery and stay with you that evening.
Transportation to the office for packing removal the day
following surgery is also required.
After Necklift Surgery
When you wake up from surgery you will notice a soft, bulky
head wrap dressing. Attached to your head dressing are
"balls" or drains. These drains collect excess drainage and
help prevent infection. Following your facelift, the nurses
will ask assist you to meet the discharge criteria: to drink
liquids, walk with a steady gait, void, manage your
discomfort, and monitor and empty the drains. For patients
who have a combination of procedures such as an eye tuck,
your vision may be cloudy from the ointment we place in your
eyes at the time of surgery. The nurses will review all
instructions you will need for care following your facelift.
You will be asked to come to our office the following day
after surgery for a dressing change and drain removal.
Although most patients describe drain removal as discomfort
rather than pain, you are encouraged to take your pain
medication about an hour prior to drain removal. You will be
asked to return in four to five days for suture removal.
Keep dressing dry and intact the evening after surgery.
Notify your doctor if the dressings become loose or fall
off. It is easy to monitor the drainage. Our nurse will show
you how at the time of discharge.
Following dressing removal the morning after surgery, an
elastic wrap will be applied. We will again instruct you on
suture care. Cleaning the suture with a Q-tip dipped in
hydrogen peroxide and then applying the antibiotic ointment
twice a day is an essential part of the healing process.
Sutures that have been kept lubricated with ointment are
less painful to remove. Keep elastic wrap in place at all
times other than suture care.
Most patients complain of discomfort more than pain. Do not
drive or drink alcohol while taking pain medication. Taking
pain medication with food helps minimize nausea sometimes
associated with pain medications.Start your antibiotic
(Keflex/cephalexin) when you get home. It is not uncommon to
have a low-grade fever for 24 hours following surgery.
Start swelling medication when you arrive home. Take with
Take Vitamin C (ascorbic acid) that helps promote healing,
for two weeks following surgery.
Advance diet from liquids to soft food to your regular diet
Rest for entire day after surgery. Sleep with head of the
bed elevated or use two to three pillows for one week after
surgery. Absolutely no bending, lifting or straining. If you
have little children, bend at the knees or sit on the floor
and let them climb on to your lap. No driving for one week
following surgery. Two weeks off work is recommended.
After 24 hours, keep incisions dry except for cleaning and
ointment. Bathing is ok as long as you don't get your
incisions/hair wet. You are encouraged to shower and wash
your hair twice: the evening before and morning of suture
removal (usually postop day four or five).
After suture removal steristrips, which must remain dry and
in place for four days are applied. Bruising can be
camouflaged at one week postoperatively with make-up. Always
protect your face from the sun. At this point, a hat and
sunglasses are a good idea. Following surgery, our staff
will tell you when it is ok to apply sunscreen, cosmetics or
facial creams. Avoid unprotected prolonged sun exposure for
three months following rhytidectomy to prevent pigmentation
of incision lines.
Your head dressing and drains will be removed the morning
after surgery. Sutures will be removed four to five days
following your surgery. You will need transportation to and
from these appointments. Your next appointment will be for
removal of remaining clips and sutures on or around
postoperative day seven.
Swelling, bruising and disrupted sleep are very normal
postoperative symptoms and will decrease as the healing
process occurs. Assistance with daily activities the first
two to three days after surgery is strongly recommended.
Following rhytidectomy, it takes time for the swelling to
subside and for the skin to heal. Most patients return to
work two weeks following surgery, however three weeks is
ideal, depending on the degree of privacy one is trying to
maintain. At three weeks postoperatively, swelling and
bruising may be apparent to you but not to many of your
coworkers and closest friends.
Final results following facelift are not apparent for one
full year following surgery. After three months, the changes
are ever so subtle, although still important. Being
perfectionists about our work, you may tell us you are
pleased long before the one year anniversary. However, we
request that you follow-up with us at that time for
postoperative photographs and so that we can enjoy your