>By Wesley Hyatt, Senior Editorial Assistant
>Goal of Procedure:
>To remove excess skin and tighten the skin for a more youthful appearance. However, a face-lift cannot fix wrinkles.
>Ideal candidates have skin that is elastic, able to stretch and heal. Other factors that make a good candidate are individuals with sagging cheeks, heavy lines from nose to mouth and jowls along the jaw line. A strong and well-defined bone structure and realistic expectations make someone a good candidate. A well-lifted face can last from 12 to 15 years.
>Smokers must quit both two weeks before and at least two weeks after the surgery, as smoke constricts the blood vessels in the face that are important for the healing process. This also means avoiding areas with smoke.
>What It Involves:
>There are at least eight different established procedures of doing face-lifts. Here are the basics for the most popular versions:
>The basic or traditional face-lift involves incisions made at the hairline. Incisions are the access sites at which the surgeon performs a facelift. Excess skin is removed. The skin is then gently pulled and tightened over the face, then incisions are closed with stitches.
>For the "mini" lift, a small incision is made in front of the ear. Then, a small area of skin is lifted. The "mini" lift works well for targeting areas in the face that are showing early signs of aging.
>The weekend face-lift removes excess chin fat with liposuction and tightens the loose skin with a laser. The laser is used inside the neck on loose tissue that often adds a heavy look under the chin with the jowls. This technique does not remedy deep lines above the jaw line. Rather, the heat from the laser constricts the fat cells and tightens the surrounding tissue. The area then becomes firmer. The operation time is usually no more than 90 minutes. Local anesthesia or sedation is used. Its name comes from the fact that many patients have the treatment Fridays and have the bandages removed Monday.
>The endoscopic face-lift lasts for three to four hours, and often general anesthesia is used along with an endoscope (a camera-like narrow tube with a bright fiber optic light on one end that lets a doctor view the area on a TV monitor). A superficial endoscopic face-lift has the skin elevated by incisions at the hairline, then pulled and pleated (folded at the incisions). Over several weeks, the pleats disappear above the hairline and behind the ear. As with a mini lift, no tissue is removed after the incisions. A deep endoscopic face-lift frees the original attachment of the skin into a more toned state to the facial bones. Tissue and muscle are secured higher and in a pulled back position. This is not a good procedure if one has saggy skin, especially in the neck.
>After an endoscopic face-lift, there is less pain and swelling and a faster recovery time. This is due to smaller incisions; consequently, the incisions heal faster with less chance of scarring.
>Length of Procedure, Recovery Time and Possible Complications:
>Most traditional face-lifts take 4 to 6 hours and use general anesthesia. Sterile dressings and bandages are applied to secure the head and neck area and prevent infection. Tubes used for draining are usually removed after the first 24 hours. Stitches are usually removed in seven to 10 days.
>For the first 24 hours, a cold compress should be used to avoid swelling and bruising. The bandages and stitched areas should not get wet, as this could cause infection. An infection usually appears as a pimple on the cheek, and one should see a doctor immediately if infection is suspected.
>The head should be elevated by pillows to reduce swelling, and, initially, motions such as swiveling the head should be limited. Too much pressure or stretching from activity can result in a less than desirable appearance. Walking will aid the healing, but a patient should not bend over for three weeks after the procedure.
>Often there is general discomfort and bruising. There should be no major pain or swelling. Bruising varies but usually fades after a few days. Many patients experience a sensation of tightness or numbness due to slight damage to the nerve fibers. After six to 12 weeks, the nerve fibers will grow back. In rare cases, numbness can last up to nine months.
>Patients should have an assistant who can help rotate the cold compress, prepare meals, etc. The patient should be on a high-protein, vitamin-rich liquid diet for the first 48 hours, as chewing promotes swelling and bruising. Preservatives, which promote swelling, should be avoided.
>For a speedy recovery and best results, a patient should not engage in sex or heavy exercising for a month. Sex and exercising increase the blood pressure and can result in bleeding or stretching of stitches. Even talking or moving the jaw can dislodge the stitches and should be avoided right after the surgery.
>After the first dressing is removed, the patient's face will be swollen and bruised and the hair matted from the antiseptic solution. Patients must wait until two days after surgery to shower and then should have an assistant to help them.
>Many patients are very tired after surgery and lose weight from a decrease in appetite and an increased metabolism from healing. The more sleep they get, the faster they will heal.
>Blood pooling beneath the skin happens in 5 percent of traditional and endoscopic face-lifts. Usually the collection of blood is small and heals spontaneously. In the first 24 hours after surgery, a hematoma (large amounts of blood elevated under the skin) may occur and result in increased swelling, pressure and discomfort. A doctor can easily treat it, but it should be treated immediately.
>If too much skin is removed, the incision sites will close tightly; this can result in too much pressure on the skin. This widens the skin and results in a wider scar. Patients may also lose permanent sensation in their faces. Some hair loss from tension on facial skin may damage the hair roots.
>Waiting Time From Procedure Until Diving: About two to three months.
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