Mini Facelift, Facelift, Neck Lift
Mini facelifts are targeted facial rejuvenation procedures. They are perfect for those with sagging or excess skin and fat in the neck, under the chin, or along the jawline. Ideal candidates for the minifacelift have good skin elasticity and mild to moderate sagging of the lower half of the face. Those patients with more advanced sagging or poor skin elasticity may wish to consider a full lower facelift or face/neck lift. To achieve balanced results, the minifacelift is commonly performed together with chin implants, eyelid surgery, or fat transfer.
While the jawline and neck typically begin to sag and show jowls, double chins, and bands in the front of the neck between 35 and 45 years of age, the appropriate time to intervene depends on the amount of aging change there is to reverse. Operating too early is unwise, as there will likely be no visible improvements after the surgery, and operating too late, after health problems develop or marked aging changes have occurred, sometimes limits the results that are obtainable. In general, nonsmoking patients ranging from 40-70, in good health, tend to be the best candidates.
Dr. Nayak performs the majority of his lower facelifting procedures in his in-office AAAHC-accredited operating suite under local anesthesia or intravenous sedation. For patients who would prefer general anesthesia, Dr. Nayak prefers Frontenac Surgery and Spine Care Center or Des Peres Hospital.
During your consultation for facelift or neck lift surgery, Dr. Nayak will ask you what about your middle and lower face bothers you, and may also ask you to talk about other, related areas of your face, such as your skin tone, facial hollowing, neck fullness, or cheek position. Dr. Nayak will likely ask you to point out, very specifically, what you’d like to see changed. Identifying exactly what needs to be addressed is the cornerstone of good results!
Dr. Nayak will then review your medical history form, and may ask for some additional information from you. Current and past smoking habits, or the use of nicotine gum or patch products, are especially important to mention to Dr. Nayak during this part of the consultation as nicotine dramatically reduces the chances of proper healing. Dr. Nayak will also pay special attention to parts of your medical history that need to be considered carefully when undertaking face lifting surgery, such as uncontrolled high blood pressure, or any medications or supplements you may take that thin the blood. In general, all over-the-counter pain/fever reducers (except Tylenol) are off-limits for 2 weeks before and after facelift surgery, as are ginkgo biloba, turmeric, St. John’s Wort, or high doses of fish oil, flax seed oil, or vitamin E.
The Physical Examination
Dr. Nayak will then examine your face to determine exactly what must be corrected to achieve optimum results. Almost all patients require lifting along the jawline to address jowls; alone, this is accomplished readily by a “mini facelift”. Many patients also have excess fullness or sagging under the jawline and in the front of the neck; this may require extra attention – a “submentoplasty”. Some patients have extensive aging changes or a tendency toward unpleasant skin wrinkling; these patients may require a “full lower facelift”. In addition, some may desire improvements of the eyelids, brows, chin, or earlobe areas to achieve balanced results. Dr. Nayak will take a few moments to discuss these options with you to make sure they meet your personal esthetic goals.
The Preoperative Visit
Once you have decided to undergo lower face or neck lifting surgery, Dr. Nayak’s staff will help you schedule your surgical date, and, about 2 weeks preceding that, a preoperative visit. Expect to spend about 90 minutes in the office on the day of your preoperative visit. During this visit, you will be educated on before instructions, after instructions, and prescriptions. Written copies of all of these will be given to you at this visit, as well, and you will be able to fill your prescriptions ahead of time. You will also be reminded at this time to avoid for 2 weeks before and after surgery any medications and supplements that thin the blood.
Also at the preoperative visit, your private preoperative photographs will be taken, the surgical consent form will be read to you, and you will have an opportunity to discuss with Dr. Nayak any questions you still have remaining. Finally, at the conclusion of this visit, the balance of your surgical, facility, and anesthesia fees will be due.
The Surgical Visit
In general, you will be asked to arrive at 7:15 AM the morning of your planned surgery. If you are having your surgery at an outside facility, you may be asked to arrive earlier. You should have nothing to eat or drink (not even water, candy, or gum) after midnight the night before your procedure. If Dr. Nayak prescribed antibiotics, oral sedatives, or if you take blood pressure medication in the mornings, you should take these with a small sip of clear water. Do not take any diabetes medication that morning.
You will need an adult driver on the day of your surgery to bring you and to take you home. Your companion may wait in our comfortable reception area, watching TV, reading, and enjoying coffee, soda, and snacks. Alternatively, if your companion wishes to leave a cellular telephone number, we can call him or her with updates and also at the conclusion of the procedure.
Upon your arrival, Dr. Nayak’s staff will greet you and review your medical history, looking for any new changes since your initial consultation. Dr. Nayak and his staff will also confirm that they and you are in agreement about which procedures are to be performed, and those areas will be marked with you sitting upright in a chair. If you are a woman under 50 and have not been surgically sterilized, a urine pregnancy test may be performed. In any case, you will have one last opportunity to have last-minute questions answered and use the restroom, and will be escorted to our AAAHC-accredited surgical suite.
Once there, you will be positioned comfortably on your back, with pillows behind your knees and under your neck. Blankets are also available if needed. You may also bring your own iPod or CD’s, or listen to our choice of soothing music.
Painless blood pressure and oxygen monitors will be placed on your arm and finger, and massaging air-filled stockings will be placed on your legs and thighs to encourage excellent circulation while you are lying down. Most patients truly enjoy these stockings and find them very soothing.
Dr. Nayak and his staff will then perform one final “time-out” aloud to ensure they are about to embark on the appropriate procedure on the appropriate patient. As the sedation takes effect, you will drift off to sleep and your face will then be slowly, gently numbed with local anesthesia, and sterile towels will be placed around your face and neck.
Through hidden facelift incisions, Dr. Nayak will lift and tighten the underlying muscular layer and secure it in place. Dr. Nayak is skilled with many muscle tightening techniques: deep plane, extended high SMAS, SMAS plication, lateral SMASectomy, and MACS. Depending you your tissue types and anatomical shapes, he will use the technique he believes will produce the most natural, safest, and longest lasting result in your specific casee. Once the muscle lift has been accomplished, excess skin is tailored, and the incisions are meticulously closed.
Your Recovery – Day 1
At the conclusion of your procedure, Dr. Nayak will tell your companion how everything went, and he or she will have the opportunity to see you. You will be mildly bruised and swollen at this point. Your incision lines will be covered by waterproof tape, but there will be no other dressings, wraps, or straps. If you have had eyelid surgery, a thin layer of Vaseline may have been applied to the eyelid area.
You will be asked to spend 1 hour with us prior to being discharged. Dr. Nayak will call you the evening of the procedure to check on your progress, and you will also be given Dr. Nayak’s personal cellular phone number in case questions should arise after hours or on the weekends.
Your Recovery – Week 1
Due to a revolutionary, new, long lasting injectable local anesthetic (Exparel), most patients feel tightness, but no pain whatsoever after surgery. Dr. Nayak is one of the first facial surgeons in the country to offer this long-lasting form of depo Marcaine/bupivicaine that keeps tissues numb up to 72 hours. Many patients find they nap intermittently the first afternoon. Nausea is rare, and several measures are taken before, during, and after the surgery to prevent it.
Patients who choose to use Exparel generally have no pain, or need only Tylenol alone right from the start. Patients who elect not to use the long lasting numbing injection generally use prescription pain pills for 2-4 days after the procedure, and then switch to Tylenol – all other over-the-counter pain preparations are off-limits.
On the day after surgery, you will need a ride back to Dr. Nayak’s office. You will enter via a private entrance, bypassing the reception area. Dr. Nayak will perform an exam to make sure you are healing properly. You should bring a scarf with you that day to wear home.
You will be able to shower and get all sutures/tapes wet that day when you return home. You should refrain from wide mouth opening, heavy exercise, or prolonged periods of looking down for the first week or two. You will also be asked to use intermittent cold compresses and sleep with your head elevated for the first few days.
Your next checkups will be the 3rd and 7th days after surgery. Tapes and dissolvable sutures will be removed at the 7th day. If you have significant bruising remaining at this point, it may be treated with a laser to hasten its disappearance. If sutures were used behind your ears, they will be left in place to dissolve spontaneously over the next week or so.
By the 7th day, you may wear makeup, and almost everyone is “presentable” to run errands. Especially easy bruisers, or patients over 65, may require another 2-3 days for most of the bruising to resolve. By 2-3 weeks, most people are “undetectable”. If you are not self conscious about being seen with bruising or sutures in place, or work from home, expect to be back to work within 3-4 days!
Your Recovery – Long Term
Over the ensuing weeks and months, you will find your incision lines, hidden around your hairline and ears, become less and less noticeable. They are generally mildly pink for a few weeks, but easily covered with regular makeup. By 3-4 months, the pinkness is generally gone.
While duration of results depends on lifestyle, genetics, and ongoing skin care and sun protection, lower facelifts are quite durable. It is not uncommon for results to last 5-10 years or even longer before touchups are required.
For detailed information about facelift surgery please visit: Facelift St. Louis.