As people age, the effects of gravity and exposure to the sun, can be seen in their faces. Deep creases form between the nose and mouth, jowls develop, folds and fat deposits appear around the neck.

A facelift, or rhytidectomy is designed to improve the signs of aging by removing excess skin and fat, tightening underlying muscles, and redraping the skin of your face and neck. A facelift can be done alone, or in conjunction with other procedures such as a eyelid surgery, or nose reshaping.

The best candidate for a facelift or necklift is a man or woman whose face and neck have begun to sag, but whose skin still has some elasticity. Most patients are in their forties to sixties, although older patients commonly have this procedure performed.

Deep folds, facial creases, and loose skin develops

All surgery carries some uncertainty and risk, although complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable. Complications that can occur include hematoma (a collection of blood under the skin that must be removed by the surgeon), injury to the nerves that control facial muscles (usually temporary), infection, and reactions to the anesthesia. Poor healing of the skin is most likely to affect smokers. You can reduce your risks by closely following Dr. Bromley's advice both before and after surgery.

Facelifts are very individualized procedures. In your initial consultation Dr. Bromley will perform a thorough evaluation of your face, including the skin and underlying bone. Medical conditions that could cause problems during or after surgery, such as high blood pressure, blood clotting problems, or the tendency to form excessive scars will be evaluated. Be sure to tell the doctor if you smoke or are taking aspirin.

Dr. Bromley will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly. If you smoke, it's especially important to stop at least a week or two before and after surgery; smoking inhibits blood flow to the skin, and can interfere with the healing of your incision areas.

A facelift can be performed on an outpatient basis though some patients may require an overnight stay. Most facelifts are performed under local anesthesia, combined with sedation to make you drowsy. You'll be awake but relaxed, and your face will be insensitive to pain. In some cases a general anesthetic may be used. The procedures usually lasts about two hours although the exact time will vary with each individual patient. Whether your facelift is being done on an outpatient or inpatient basis, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two if needed.

Incisions usually begin above the hairline at the temples, extend in a natural line in front of the ear and continue behind the earlobe to the lower scalp. For a neck lift, the incisions will be modified. The exact shape of your surgical incision will be discussed in more detail during your consultation.

At surgery, the skin is separated from the fat and muscle below.  Fat may be trimmed or suctioned from around the neck and chin to improve the contour. The underlying muscle may be tightened, the skin pulled back and the excess skin removed. The incisions are then closed. Following surgery, a small, thin tube may be temporarily placed under the skin behind your ear to drain any blood that might collect there. Your head will be bandaged for comfort and to minimize bruising and swelling.

There is usually mild discomfort after surgery. Appropriate pain medication will be prescribed. You will be instructed to keep your head elevated and limit physical activity in the days following surgery. If you have significant pain and sudden swelling of the face this should be reported to Dr. Bromley immediately. Some numbness of the skin and the ear is quite normal following the procedure; this usually resolves.

Drainage tunes are usually removed on the first post-operative day. Bandages are usually removed after one to five days. Mild or moderate bruising is normal after the surgery. Facial swelling is also expected This bruising and swelling will gradually resolve in the days and weeks following surgery. The sutures will be removed between five days to two weeks following surgery. Most of the scars will be hidden within you hair and in the normal creases of your skin.

Most patients resume normal light activities one to two days after surgery. It will most likely take approximately two weeks until you can resume your normal daily schedule. This time frame will obviously vary with each patient. Specific questions regarding work, athletics, etc. can be discussed with Dr. Bromley during your consultation. Most patients are back at work about ten days to two weeks after surgery.

The facial bruising should resolve in about two to three weeks. If required, special makeup can be applied to hide the bruised areas. Even after the swelling and bruises are gone, the hair around your temples may be thin and your skin may feel dry and rough for several months. Men may find they have to shave in new places, behind the neck and ears, where areas of beard- growing skin have been repositioned.

You'll have some scars from your facelift, but they're usually hidden by your hair or in the natural creases of your face and ears. In any case, they'll fade within time and should be barely visible.

Having a facelift doesn't stop the clock. Your face will continue to age with time, and you may want to repeat the procedure one or more times-perhaps five or ten years down the line. But in another sense, the effects of even one facelift are lasting; years later, you'll continue to look better than if you'd never had a facelift at all.

If you have any questions regarding facelift, necklift or any other procedure, please contact our office.  Photo  galleries, in addition to 3D animation of this procedure can be found at the American Society of Plastic Surgeons website

5 East 84th St., New York, NY 10028  (212) 570-5443