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BEFORE AND AFTER PHOTOS

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WHAT TO EXPECT AFTER SURGERY

 

Dr. Eric Swanson-Facelift patient satisfaction survey

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 (Swanson E. Outcome analysis in 93 facial rejuvenation patients treated with a deep-plane face lift.  Plast Reconstr Surg. 2011;127:823-834). The numbers of patients who reported that the surgery met their expectations (96.7%) and they were pleased with the result (98.9%) were surprisingly high, attesting to the effectiveness of the surgical modalities and, just as important, appropriate patient expectations.

 

Appearance After Surgery

 

It is difficult to prepare for your appearance after surgery. I frankly tell patients that their appearance may startle their husbands or wives. Swelling and bruising are an expected part of the healing process. 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 after laser resurfacing 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 may wonder why they ever decided to have the surgery. All of this is normal.

 

Surprisingly, despite this appearance, patients do not usually experience much pain, although they are uncomfortable. This discomfort is to be expected, caused by the tightening of the tissue layer under the skin and superimposed swelling. Patients find they cannot open their mouth widely or turn their head easily from side to side. 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.  Frequently there is 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 responds to elevation and application of ice. Eyelid swelling goes down quickly, much of it 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 years ago. As it turns out, dressings were unnecessary and patients always 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 2 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 that gradually settle with gravity. Bruising is not caused by operative trauma to the neck or chest. Although bruising can be dramatic and colorful, with purple hues giving way to yellow, it is completely painless and goes away in a few weeks. Bruising may be concealed under a scarf.

 

Patients may notice 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 nodules under the skin. These are sutures that have been used to tighten the neck muscle (platysma) on either side of the neck. They gradually absorb over 3 months.

 

Patients may feel irregularities of 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, these 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 is the end of the incision, where there is puckering of the skin, (dog ear). This is also where the drain came out. No need to worry—this bump gradually smooths out.

 

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.

 

Temple Rolls After Facelift

 

The deep plane lift pushes up a roll of skin at the level of the temple, causing a bump, like a speed bump (See photo). This roll is caused by vertical advancement of the deep tissue plane (SMAS), and it is a sign of successful tissue elevation. Patients sometimes call these temporary bumps “handlebars.” 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.

 

We’ve all seen celebrities who always seem to conceal their temples and ears with their hair. If they wear their hair short, they may choose a pageboy hairstyle. They are doing so for a reason—to conceal any scars or tragal deformity after a (nonideal) facelift. A facelift technique that allows women to show off a youthful face including the ears is very much appreciated. A youthful jawline extending all the way back to the ear is always to be preferred to hair that overly encroaches the face. The ear is an underappreciated part of the facial anatomy and a youthful-looking, attractive ear is a plus. Women should be able to confidently wear their hair back and up after a facelift and show off all of the face, not just part of it. This full-face exposure not only looks youthful, but signals confidence too.

 

A temple scar can be even more of a problem for men with short hair, or a receding hairline. Fortunately, a scar following the temple hairline, or continuing forward at the top of the sideburn, is unnecessary. The temple roll gradually settles down over the 46 weeks after surgery. It is preferable to be patient and just allow this ridge to flatten on its own. This way there is no visible scarring or 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. Most patients can conceal it by draping their hair over their ears during this time.

 

A.B., Age 47, Personal Trainer

Procedure: Facelift, upper and lower blepharoplasties, submental lipectomy, fat injection (30 cc), periorbital erbium laser resurfacing, pulsed dye laser treatment of veins of face and neck, and tip rhinoplasty.

 

Comments: This sequence of photos shows the temporary bulge in the temples that is often created when the deep plane lift is performed. This temple roll gradually flattens and is no longer visible 2 months after surgery.

 

Dr. Eric Swanson patient before and after photo-facelift

Dr. Eric Swanson patient before and after photo-facelift

 

Numbness

 

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 numbness is caused by surgical division of the small sensory nerve branches that supply the skin. Gradually, these nerve branches regenerate and the area of numbness starts 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 to regain sensation is the skin in front of the incision line itself, where the skin has been most undermined and where the nerves have the farthest to grow.

 

Facial Nerve Branch Weakness

 

Patients may be aware of temporary tearing or blurring of vision after surgery. This may be caused by weakness of the lower eyelid. The facial nerve “motor” branches to the lower eyelid have been stretched during the cheek lift, so that the eyelid at first may not close completely. Sometimes swelling interferes with the tear duct’s ability to drain tears from the eye, so that tears spill over the lower eyelid, like water going over the edge of a dam. This tearing is temporary, and goes away as the swelling diminishes and the lid function returns. Any blurriness of vision gradually resolves. It is vital to keep the eye well-lubricated with artificial tears during the day and lubricating ointment at night, to keep the cornea from drying out until eyelid function has returned to normal.

 

 

 

 

 

 

 

Dr. Eric Swanson-Facelift patient satisfaction survey

Dr. Eric Swanson patient before and after photo-facelift

Dr. Eric Swanson patient before and after photo-facelift