|Need assistance (days)||5.0|
|Time Off Work (days)||24|
|"Back to Normal" (days)||72|
|Exercise again (days)||33|
|Sleep comfortably (days)||18|
|Positive reaction from others||87%|
|Do it again (includes "unsure")||87%|
|Surgery met expectations||96.7%|
|Pleased with result||98.9%|
|Look younger||11.9 years|
Of the 93 patients, 87% reported a positive reaction from others and 83% reported an improvement in self-esteem. Remarkably, only 2.2% were unhappy with their scars. Only 6.5% of patients reported a negative reaction from others, almost the same percentage that said their significant other was not happy about it (5.5%). Almost all patients (96.7%) thought they looked younger after surgery, by an average of 11.9 years.
Notably, 13% of patients responded that they would not have the surgery again. Clearly the surgery and recovery was not an experience they relished and one still fresh in their memory at the time of their postoperative interview. However, this is not to say that they are not glad they had it done, rather they would not care to repeat it. I suspect that many patients in the days after surgery question their sanity for choosing to submit to this surgery (many have commented to me, "What was I thinking?"), but with time, and particularly when looking at their before and after pictures later on, they are glad they did it. The numbers of patients who reported that the surgery met their expectations (96.7%) and they were pleased with the result (98.9%) was surprisingly high, attesting to the effectiveness of the surgical modalities and, just as important, appropriate expectations.
It is difficult to prepare for your appearance after surgery. I explain to patients that their appearance will startle their husbands or wives. Swelling and bruising are part of the healing process and medical personnel get used to it, but they create a disturbing impression on other family members. There is even more swelling when eyelid surgery or laser skin resurfacing is performed simultaneously. The eyelids may be swollen almost completely shut. The skin is red and the lips are swollen, sometimes quite dramatically. Patients look a lot worse before they start to look better. For the first few days, patients often wonder why they ever decided to do this.
All of this is also completely normal. Surprisingly, despite this appearance, patients are usually not having pain, although they are uncomfortable. This is to be expected, due to the tightening of the tissue layer under the skin and superimposed swelling. Patients find they cannot open their mouth widely or turn their head very far. They notice numbness around the ears. They may find they are not moving their lips symmetrically, or closing their eyes completely. It may be difficult to articulate because of lip swelling. They cannot drink from a cup at first. A syringe is used instead. There may be more swelling on one side of the face than the other. Vision may be partially obscured by swelling and by the use of lubricating eye ointment. Fortunately, swelling does respond to elevation and application of ice. Eyelid swelling goes down quickly, usually within a few days.
I see patients on the morning after their facelift. Although I used a wraparound head dressing in the past, I stopped using dressings a few years ago. As it turns out, they were unnecessary and patients felt better when they were removed. Usually the drains are taken out at this visit the day after surgery. Patients are able to start bathing right away when they get home. They can shampoo their hair and wash their face, which is soothing.
During the first two weeks there is bruising of the neck, sometimes spreading down to the chest. This bruising is caused by small amounts of blood under the skin, which gradually settles with gravity. The bruising is not caused by any operative trauma to the neck or chest. Although the appearance can be dramatic, it is completely painless and goes away in a few weeks. It is well hidden under a scarf.
Sometimes patients feel bumps on the sides of the neck and wonder whether their glands are swollen. These bumps are caused by swelling. The tissue temporarily fills with fluid and becomes firm. Sometimes patients feel little bumps under the skin. These are sutures, which have been used to tighten the neck muscle ("platysma") on either side. They gradually absorb over about two months.
Patients may feel irregularities in the skin behind the ear. This is normal. This wrinkling is caused by gathering of skin along the skin edge at the time of the lift. After the sutures are removed, the irregularities gradually soften, although a crease or fold may persist. Patients may feel a bump in their scalp a few inches behind the ear. This represents the end of the incision, where there is puckering of the skin, called a "dog ear" and is also where the drain came out. No need to worry, this bump gradually smoothes out.
Numbness is normal after a facelift. The skin in front of the ear, under the chin, and up behind the ear is numb after surgery. This is due to division of the small sensory nerve branches that supply the skin. Gradually, the nerves regenerate and the areas of numbness start to recede like a puddle evaporating. The first area to regain feeling is the part of the skin farthest from the ear and the last area is to come back is the skin in front of the incision line itself, the skin which has been most undermined and the area where the nerves have to grow the farthest.
Patients having a facelift without any other surgery usually recover quickly, and have minimal discomfort even a few days after surgery. For those patients having laser resurfacing with the facelift, the worst of it is over by the sixth day after surgery. The facial skin is usually healed in a week. Patients seem to "turn a corner" at this time and start to see the benefits. The recovery proceeds rapidly. Some areas heal faster than others. The cheeks and forehead may be healed in a few days. The skin around the mouth and eyes can take longer. Usually these areas were more wrinkled and an additional pass or two with the laser were used, accounting for the longer healing time for these areas.
The deep plane lift pushes up a roll of skin at the level of the temple, causing a bump, like a speed bump. Although it is possible to remove this extra skin surgically (and many facelift techniques include such an incision), this would leave a horizontal scar in the temple, which can be a telltale sign of surgery and prevent women from wearing their hair back and up. It can be even more of a problem for men with short hair. This scar can be a few inches in length and, as it turns out, is unnecessary. This bump gradually goes down on its own over the four to six weeks after surgery. It's better to be patient and just allow the ridge to flatten out spontaneously. This way there is no scar and no unnatural elevation of the hairline or sideburn. Patients need to know about this temporary bump before surgery so that they don't worry about it afterward. I reassure them I have never had to surgically remove skin in this area – it always goes down on its own. Until it does, they can partially conceal it by draping their hair over their ears. The bump is caused by vertical advancement of the deep tissue plane ("SMAS"), so it's a sign of successful deep tissue tightening.