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What is a facelift?

A facelift (rhytidectomy surgery) is the most comprehensive approach to treating facial wrinkles and sagging caused by aging. Every year, thousands of people undergo successful facelift surgery and are pleased with the results.

Why get a facelift?

Your face can change with time, gravity, and sun exposure. If you feel like you don’t look like yourself anymore and want to look like a younger version of yourself, a facelift may be right for you.

A facelift is a great option if you have any of the below concerns:

  • Facial sagging
  • A loss of muscle tone low on your face (jowls)
  • Deep creases from your nose to your mouth (nasolabial folds)
  • Lines from your mouth’s corners to your chin (marionette lines)
  • A double chin or unwanted neck creases or folds

Below are some of the benefits of a facelift:

  • Improve many areas of the face in one surgery
  • Remove excess skin and tighten skin for a more youthful look (can make you appear ten to fifteen years younger)
  • Correct deep cheek folds, jowls, and loose skin on the face and neck
  • Get the gold-standard for recontouring the neck and jawline
  • Achieve smoother, firmer, and fresher looking skin on your face and neck
  • Improve your self-image and self-confidence

What should I consider before getting a facelift?

Please consult with your aesthetic plastic surgeon for more information on what is unique to you.

  • You need to be in good general health.
  • A facelift will create a younger version of yourself, not a ‘new’ you.
  • There will be some downtime associated with this procedure.
  • Depending on your age and skin type, you may desire secondary procedures later on.
  • The recovery time is typically at least two weeks, but the exact timing depends on how extensive the surgery is.
How is facelift surgery performed?

A facelift is typically an outpatient procedure, though I advise clients to remain at the outpatient surgical center overnight for observation and support from our 24 hour nursing staff. There are several different facelift techniques, with varying areas of focus. The type of facelift you receive will depend on your desired results.

Most facelift techniques focus on the lower facial areas, such as the jawline, jowls, and cheeks. In some techniques, deeper facial tissues may be repositioned or tightened to restore a more youthful contour. In other techniques, it may be necessary to remove or add fat or other soft-tissue fillers to achieve the best results.

Today, many different techniques exist with outcomes that can be consistently reliable, safe, and durable. 

The type of facelift determines the length of incision used. As the name suggests, a short-scar facelift uses a shorter posterior incision. For a full facelift, Dr. James Rosing will make an incision that starts in the temple area and extends downward along the natural ear curves, around the ear lobe and back up to the bone along your hairline behind your ear (see illustration for the most common incision types). The skin is then elevated, and the muscle and tissue underneath (SMAS) is tightened. The nuance in face lifting is in the SMAS dissection. Depending on each patient’s unique facial skin characteristics, soft tissue volume, shape, symmetry or asymmetry, neck obliquity, skeletal contour, and animation characteristics, Dr. James Rosing alters the SMAS dissection and tightening to fit these features. Once the SMAS has been addressed, the skin is then re-draped over the facial soft tissue, excess is trimmed, and the incision is carefully sutured. The incision is beveled at the hairline to allow for follicles to grow through the scar and is sewn along a natural crease to camouflage the incision area.

By default, when performing a facelift that involves elevating and tightening the SMAS layer, the neck is also tightened. This is the result of normal facial anatomy as the SMAS and neck muscle (platysma) are connected. The dissection will commonly also tighten sagging jowls (lower cheeks along the jawline) in front of the ear as the layers of the neck and lower face are in continuity.

Generally, because of the in-depth nature of the consultation, there is usually a cost associated with the initial visit.
During your initial consultation, you will have the opportunity to discuss your aesthetic goals. Your surgeon will evaluate whether you are a good candidate for a facelift and clarify what facelift surgery can do for you. Your surgeon may also ask you to look in a mirror and point out exactly what you would like to see improved. He or she will likely evaluate the elasticity of your skin and take photos of your face. Bring pictures of yourself at an earlier age as they may serve as a good point of reference when discussing your goals.
Once your surgeon understands your goals and medical condition, both alternative and additional treatments may be considered (see related procedures).
You should come to the consultation prepared to discuss your complete medical history, such as your:
• Previous surgeries
• Past and present medical conditions
• Allergies and current medications
• Your history with any noninvasive cosmetic procedures

It’s important that you take an active role in your surgery, so please use this list of questions as a starting point for your initial consultation.
• Am I a good candidate for a facelift?
• Are the results I am seeking reasonable and realistic?
• Do you have facelift before-and-after photos that I can see?
• How many facelift procedures have you performed?
• Where will you perform my facelift, and how long will it take?
• Where will I have scars, and will they be visible?
• What kind of anesthesia do you recommend for me?
• What will be the costs associated with my facelift?
• What will you expect of me to get the best results?
• What kind of recovery period can I expect, and when can I resume normal activities?
• What are the risks and complications associated with my procedure?
• What are my options if the outcome of my facelift does not meet the goals we agreed on?

See Questions To Ask Your Aesthetic Plastic Surgeon

Based on your goals, physical characteristics, and your surgeon’s training and experience, your aesthetic plastic surgeon will share recommendations and information with you, including:
• An approach to your surgery, including the type of procedure or combination of procedures
• The outcomes you can anticipate
• The financial investment required for the procedure
• Associated risks and complications
• Options for anesthesia and surgery location
• What you need to prepare for your surgery
• What you can expect to experience during and after surgery
• Before and after photos of cases similar to yours
• Computer imaging to show you the improvements you can expect
• Answers to any of your questions
Once you’ve done your research and completed your consultation, you should be able to make an educated decision on whether a facelift is right for you and whether a surgeon is a good fit. If you still aren’t sure how to proceed, you should feel empowered to ask follow-up questions or set up a consultation with a different surgeon.

How do I prepare for a facelift?

Your surgeon will provide thorough preoperative instructions, answer any questions you may have before your surgery, take a detailed medical history, and perform a physical exam to determine your fitness for surgery.
In advance of your procedure, your surgeon will ask you to:
• Stop smoking before undergoing surgery to promote better healing.
• Avoid taking aspirin, certain anti-inflammatory drugs, and some herbal medications that can cause increased bleeding.
• Hydrate before and after surgery for safe recovery.
• Stabilize your weight before surgery or make other lifestyle suggestions to minimize your risk for complications.
A facelift is usually an outpatient procedure. Be sure to arrange for someone to drive you home after surgery and stay with you for the first twenty-four to forty-eight hours, unless you and your surgeon have decided on other postoperative recovery options.

For the most comfortable recovery period, prepare carefully:
• If you color your hair, you should do it just before surgery, or you will need to wait several weeks after surgery.
• Stock your refrigerator with lots of fruits and vegetables and lean protein. Lean protein assists in healing. Sodium increases swelling; avoid it! Prepare frozen meals in advance. High protein, low sodium foods are best for the first couple of days.
• Plan where you will recuperate. If you have a recliner chair, it is best to elevate the feet, knees, and head. If you do not have a recliner, be sure to have lots of pillows available to prop up your head and knees. If possible, keep your phone and remote control for the TV by your bed.
• Decide what you will wear for the first few days; pick items that open in front and do not have to be pulled over your head. You should wear the same kind of clothing on the day of your surgery. Wear slip-on shoes.
• Be sure to get plenty of rest and don’t do any housework, heavy lifting, or exercise. Avoid hot showers, hot tubs and saunas for two to three weeks.

What you can expect depends on the type of facelift you get. Be sure to consult with your surgeon before your surgery so you have the most accurate expectations.
• You may have your facelift in an accredited hospital, free-standing ambulatory facility, or office-based surgical suite.
• Facelift surgery typically requires at least two hours to complete, though more extensive procedures may take longer.
• The surgeon will administer medications for your comfort during the procedure.
• Local anesthesia combined with sedation is commonly used during facelift surgery, though general anesthesia can be used instead. If general anesthesia is used, an anesthesiologist or nurse anesthetist will be present to administer sedatives and assist in monitoring.
• For your safety during the surgery, various monitors will be used to check your heart, blood pressure, pulse, and the amount of oxygen circulating in your blood.
• Your surgeon will follow the surgical plan discussed with you before surgery. Once surgery has begun, the surgeon may decide to combine various techniques or change a technique to ensure the best result. It is important that you feel comfortable and trust your surgeon to make these decisions.
• After your surgery, you will go to a recovery area for continued monitoring.
• Your surgeon will likely cover your incisions with bulky bandages that provide gentle pressure to minimize swelling and bruising. They may also place a small tube under the skin behind one or both of your ears to drain any excess blood or fluid.
• Before heading home on the day of surgery, you or someone looking after you should feel comfortable emptying and resetting the drains.
• You should plan for pick-up by a friend, family or loved one the day after your scheduled procedure date at 7:00am from the surgery center. Under no circumstances will you be permitted to go home alone.

How long does it take to recover from facelift surgery?

The more extensive the procedure, the longer the recovery period will be. Your surgeon will let you know how long it will be before you can return to your normal level of activity and work. After your surgery, your surgeon will give you and your caregiver detailed instructions about your postoperative care, including information about:
• Drains, if they have been placed
• Typical symptoms you will experience
• Potential signs of complications
It is vital that you follow all the patient care instructions your surgeon provides, including instructions around bandages, drains, taking an antibiotic (if prescribed), and the level of activity that is safe. It is also important to know that the amount of time it takes for recovery varies greatly among individuals.

• Your surgeon may place you in a compression garment or wrap immediately after surgery. Wear this exactly as directed. Remove it only as directed for cleansing incisions or showering.
• To minimize swelling, recline rather than lie down. This will be more comfortable and can reduce swelling. Always keep your head elevated. Do not bend forward or over.
• You will have a mild to moderate amount of pain and discomfort that you can manage with medications.
• The discomfort and pain should begin to decrease within forty-eight hours after surgery. If you have a significant increase in pain after this period, call your surgeon. Severe pain is rare; if you experience this, call your surgeon immediately.
• You may feel tightness in your neck after surgery. This sensation is most pronounced in the first one to two days after surgery while the bulky dressing is in place.
• Expect bruising and swelling. These symptoms will peak within the first thirty-six to forty-eight hours after surgery and will gradually subside over the next ten to fourteen days. To minimize swelling, sleep with your head elevated for a couple of weeks after the surgery.
• It is not unusual to have some slight drainage for the first forty-eight hours. A bulky cotton compression dressing with drains will cover your scalp and face for one to two days to help prevent blood collections under the skin.

• You may not drive for at least a week after surgery.
• During your first post-op visit, your surgeon will likely remove the bulky dressing and drains. You may need to wear a supportive elastic face garment. Follow your surgeon instructions for how to wear the face garment and for how long.
• Do not take any aspirin or any anti-inflammatory medicine for two weeks before and two weeks after your surgery unless you first discuss it with your surgeon.
• You should sleep with your head elevated forty degrees for two weeks; an additional pillow or two under your mattress may help.
• Apply cool (not cold) compresses to your eyes. Do not apply ice or anything frozen directly on the skin. Soak soft, white washcloths or gauze squares in ice water and wring out well. Apply directly to the eyes, but not to the cheeks or neck. Do not apply any pressure. Apply cool compresses for no longer than twenty-minute intervals. Do not apply heat.
• Stay up (sitting, standing, walking around) as much as possible to help decrease facial swelling.
• Avoid bending or lifting heavy things for one week. Besides aggravating swelling, this may raise your blood pressure and encourage bleeding.
• You may wash your hair gently twenty-four hours after your surgery. Do not use a heated hair dryer; use the cap type, or use the cool setting on the blow dryer.
• You may shower or bathe the day after surgery, but do not let the spray directly strike your face.
• If you have any excessive bleeding that persists after applying pressure for fifteen to twenty minutes, call your surgeon.

How long will my facelift surgery results last?

Your genes, skin quality, and maintenance routine are important factors in the longevity of your facelift. However, the facelift technique is the number one factor in determining how long the result will last. The more extensive the procedure, the longer the recovery period will be, and the longer you will enjoy the results.

A minimal facelift technique where the recovery is quick, but the results last the least amount of time.

A facelift with a small amount of skin undermining with limited SMAS (superficial musculoaponeurotic system - the top layer connecting the facial muscles of the face) mobilization. A mini facelift is appropriate for younger facelift candidates. With this technique, the recovery is fast, and the results can last up to five years.

Many types of operations fall into this class, such as SMAS platysma, SMAS-ectomy, SMAS imbrication, deep plane facelift, composite lift, or subperiosteal. These all require extensive rearrangement of the underlying facial tissues in addition to significant skin undermining. These techniques address more advanced facial aging. Full facelifts are technically demanding procedures that should only be completed by trained, board-certified aesthetic plastic surgeons. The recovery is longer (two to four weeks), but the results generally last over ten years.

before and after photos can help you assess what a successful eyelid surgery result will look like.

To achieve the most beautiful and safe outcome, it’s important you return to your aesthetic plastic surgeon's office for follow-up evaluations at prescribed times and whenever you notice any changes. Do not hesitate to contact your surgeon when you have any questions or concerns.

What type of facelift surgery incisions are there?

Regardless of the type of facelift you undergo, you will have incisions that involve the skin around your ear. The incision line usually runs along the hairline within the natural contours in front and behind the ears as pictured here. Your surgeon will then pull the skin back and close the incision.

A board-certified aesthetic plastic surgeon will place the incisions in hidden areas and areas where the scars look like natural wrinkles, making facelift scars virtually invisible.
Your incision healing will depend on the surgical technique, the steps you take to prevent infection (nutrition, not smoking, hydrating) and any underlying medical conditions or genetic tendencies.
There is a risk of 'hypertrophic scars' and 'keloids' anytime the skin is cut. This risk is greater in darker-skinned patients. Your surgeon may inject corticosteroid medication or conduct other treatments to improve scar appearance.

What are the risks of facelift surgery?

Fortunately, significant complications from facelift surgery are infrequent. You should discuss the risks and potential complications with your aesthetic plastic surgeon during your consultation and after your procedure to ensure you are on the right track to recovery.
All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:
• Adverse reaction to anesthesia
• Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
• Infection and bleeding
• Changes in sensation
• Scarring
• Allergic reactions
• Damage to underlying structures
• Unsatisfactory results that may necessitate additional procedures
You can help minimize facelift risks by following your board-certified aesthetic plastic surgeon’s advice and instructions, both before and after your surgery.

How much does facelift surgery cost?

The cost of facelift surgery  varies significantly based on your individual needs and aims for the procedure, all of which are reflected in the duration and complexity of the procedure.

No. Facelift surgery is not covered by insurance. 

Choose your surgeon based on quality, training, and experience—not cost.
Your surgeon should be board certified by the American Board of Plastic Surgeons or one of the few other American Board of Medical Specialties approved boards where aesthetic surgery is part of the required training and certification.

Look Like Yourself, Only Better.

It’s hard to feel like yourself when you don’t look like yourself anymore. Don’t recognize that face in the mirror? When your appearance no longer reflects the way you feel on the inside, it’s easy to become uncomfortable in your own skin. It’s never too late to love the way you look again

Dr. Rosing answer's all your questions and explains his approach in great detail. His education and background of credentials is amazing which he provides in the patient packet. He really listens and is kind and caring. He ensures you are both on the same page so that he can fulfill your expectations. I had the same cosmetic procedures 15 years ago (breast implants and tummy tuck) and he amazed me when he explained his techniques of surgery and the recovery process for his patients. It made me feel that recovery will be much smoother, put me at easy, took away any concerns and calmed my anxiety. His office staff are professional and courteous. His office manager Rachell, goes further in depth with you on procedure and what to expect both pre-op and post-op. She is extremely knowledgeable and answers all of your questions.
I honestly cannot say enough wonderful things about Dr. Rosing!!!! Not only is his bedside manner caring and thoughtful, but he is meticulous and has a great amount of integrity that you cannot find in many doctors these days. In August 2018, my fiance had a suspicious mole removed from his head but instead of the dermatologist closing it up or referring him to someone who could close the hole, she sent him home. She said he would most likely have a scar, even a divot but that he should consider it a badge of honor. (Basically, be thankful that you don't have cancer and a suspicious mole is now gone!) I have to say that had Dr Rosing not squeezed us in the very next day, he would have had a very high chance of getting an infection. So we went to Dr. Rosing who was confident he could close the hole in a way that there would be minimal scarring and more importantly, the hair could grow over the scar so you wouldn't see it. He called it the "O" to "Z" procedure. Not only did he get us in the day after surgery, he stayed after business hours to get the procedure done. All I can say is these pictures speak a thousand words!! We are so happy with the results provided by Dr. Rosing and his staff!! You would never know that my fiance had anything done to his head! Thank you all so very much. We are forever grateful and would recommend every one of our family members to Dr. Rosing for any procedure. He is absolutely a God Send!!
From the moment Dr. Rosing introduced himself, I knew I had found my plastic surgeon. During my consultation, he was able to spend as much time as I needed answering my questions, while teaching me along the way. My expectations were beyond exceeded and my procedure has dramatically changed my life for the better! All the staff at Allure MD are so lovely and welcoming. From helping with coordinating my surgery date, to my weekly check-in appointments, and everything else in between, I was always comfortable and well taken care of. I can assure you, when in the care of Dr. Rosing and staff, all of your needs will be met and exceeded. Dr. Rosing is more than just my surgeon; he is a mentor and an inspiration. I cannot thank Dr. Rosing and his team enough for making my dream become a reality. I am without a doubt recommending Dr. Rosing and his staff at Allure MD to anyone and everyone I know!
Dr. Rosing is a masterful surgeon who’s technique is refined and subtle. The results are stunning, yet very natural. His eye for detail and his thoughtfulness make for results that exceed expectations. I don’t know how he does it, but post-surgery downtime and healing is very minimal. Dr. Rosing truly cares about his patients and works closely with you to ensure an optimal outcome. The staff is caring and available before and after surgery for any questions or concerns. I highly recommend him as I am a repeat patient…he’s just that good.

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