Facelift and Neck Lift in Boston


Named Among the Best Plastic Surgeons in Boston

Helena O. Taylor, MD,PHD,FACS & Stephen R. Sullivan, MD,MPH,FACS

Many patients tell us they just want to “look how they feel”—namely fresh, healthy, alert and happy.

Dr. Taylor and Dr. Sullivan have a particular interest and expertise in facial plastic surgery as they are not only both board certified plastic surgeons, they also each have additional fellowship training in facial and craniomaxillofacial plastic surgery - a combination and level of training found in few other surgeons in New England.

If your lower face and neck appear disproportionately old relative to your true age, consider facial rejuvenation with a facelift or neck lift. If your upper face also shows signs of advanced aging, you may be a candidate for simultaneous eyelid lift (blepharoplasty), eyebrow lift, or lip lift.

WHAT IS A FACELIFT OR NECKLIFT?

A facelift addresses the descent of the mid and lower face, and is the most effective means of addressing redundant skin and soft tissues around the lower face, jowls and neck. A neck lift rarely occurs without a facelift, and vice versa, and the terms are sometimes used interchangeably. Aging leads to deflation of the cheeks, falling of the soft tissues, and loosening of the deeper layers of the face and neck known as the SMAS and platysma. The result is deep nasolabial creases and marionette lines, jowls, loose skin, and platysmal banding. A facelift, or necklift, puts things back where they belong by tightening the underlying layers, redraping the skin, and often adding volume to areas of deflation.

In the past, facial procedures may have focused on skin removal and tightening alone. With their clinical experience, research, and published studies on facial aging and facial symmetry, Dr. Taylor and Dr. Sullivan recognize that tightening skin alone, or “skin only facelift” is not adequate and may leave a patient with unnatural or tell tale signs of having had an operation. As such a facelift and neck lift are typically performed simultaneously in our practice. For a more natural appearance and longer lasting result, additional and simultaneous interventions are often necessary for facial rejuvenation. For example, most facial operations performed by Dr. Taylor and Dr. Sullivan include SMAS and platysma plication and volume enhancement with fat grafting - a minimally invasive method to restore facial fullness and correct deflation of deep facial fat compartments using your own tissue.

PROCEDURES FOR FACELIFT AND NECKLIFT

A facelift and necklift is performed under general anesthetic in the operating room.

The procedure lasts four to six hours, and patients spend the night in the hospital for close monitoring overnight. Dr Taylor and Dr Sullivan often operate together as a two physician team to provide complementary perspectives and the best possible outcome. The facial layers are accessed through carefully hidden incisions around the temporal hairline and ear, and often underneath the chin.

With this access, the SMAS is most tightened along the lateral superficial facial fat compartment in the preauricular region, along the junction of the middle and malar superficial fat compartments, and in the the midline of the neck to correct platysmal bands, and put things back where they belong. In other areas, such as the neck, patients may have excess fullness and fat deposits and require fat removal or neck liposuction before the muscle is tightened.

After the structures are tightened and repositioned, and the skin is redraped, the fat compartments are often enhanced with fat grafting. Common areas of fat grafting include the cheeks (to restore the malar fat pad), temples (to restore the lateral fat pad), nasolabial folds, Marionette lines,the prejowl sulcus, and around the lips.

After surgery patients are placed in a head dressing and admitted overnight for monitoring. While patients don’t typically experience much pain, we like to monitor blood pressure very closely to minimize the risk of bleeding complications. The morning after surgery, the dressings are changed, the drains are removed, and patients usually go home. (We warn everyone to bring a scarf or a hat, as your hair will be a fright!) Sutures around and behind the ear are removed at 6-7 days after surgery. Bruising is variable, but is predictably worse when eyelid surgery is combined with facelift. Patients are typically quite presentable by the end of the second week, although the scars and tissues will not yet have matured.

Some additional techniques for facial rejuvenation may include:

Lip Lift

With aging the length of the upper lip increases and becomes thin. Lip lift shortens the lip and helps evert and increase fullness and definition with a carefully hidden scar at the base of the nose.

Ear lobe reduction

Similar to the lip, the earlobes can become long and deflated. Earlobes can be shortened with a carefully hidden scar on the back side. Volume can also be restored with fat transfer or fillers such as Restylane or Versa.

Buccal Fat Pad Removal

The buccal fat pad can contribute to excessive fullness in the mid-cheek with a round appearing or heavy face. Although youthful, a round face, can lack the curves of an attractive or fit facial appearance with a gentle mid-cheek depression. Facial curves can be restored by reducing fullness of the buccal fat pad. This minimally invasive procedure is performed through small incisions hidden inside the mouth without visible scars. Some patients may also benefit from upper cheek and malar augmentation using fat transfer, fillers with hyaluronic acid, or cheek implants to restore natural facial curves and shape.

BENEFITS OF FACELIFT/NECK LIFT

Many patients tell us they just want to “look how they feel”—namely fresh, healthy, alert and happy. An aging face can often look tired, fatigued and haggard, in contrast with how someone may feel. Many of our patients just haven’t liked their grandchildren playing with their “turkey necks.” While a facelift may not make you look dramatically younger, it does make people look better, without looking like an entirely different person. For patients who notice that their faces and necks are getting “bottom heavy” a facelift can put things back up where they belong.

  • Youthful appearance and facial shape
  • Correction of midface descent
  • Improvement in jowls and neckline
  • Tightening of fascial layers of face and neck
  • Volume enhancement in cheeks and around the mouth
  • Redraping of skin over tightened facial architecture
  • Improvement in nasolabial and marionette lines

Frequently Asked Questions

What are the risks of facelift/necklift?

The dreaded risks of facelift and necklift are bleeding, problems with wound healing, scarring, and nerve damage. In order to minimize bleeding risks we pay careful attention to blood pressure pre, intra and post operatively. Patients with hypertension should have their blood pressure management optimized prior to surgery. We put most patients on clonidine pre and post operatively to keep blood pressure steady. We minimize wound healing risks by using meticulous technique, and would not perform this surgery on smokers, or people on steroids, who are much more likely to have complications of this type.

The nerves that are at risk of injury are the branches of the facial nerve that raise the eyebrow, and lower the lip. Our gentle techniques are designed to minimize the risks to these nerves as much as possible while still performing a thorough tightening of the fascial layers. Scarring is typically minimal and relatively hidden, but everyone does scar slightly differently. Everyone has some numbness in the cheeks after surgery, which does resolve with time. Often this lack of sensation is what bothers people the most in the months after surgery. Very rarely patients may loose sensation in the earlobes.

When will I be presentable?

The first week after surgery you are often quite bruised and may not pass the “supermarket test”. Your sutures will be removed the week after surgery, and much of the bruising and swelling will resolve within 7 to 10 days, though can last longer particularly if you also had lower eyelid surgery. You may have some subtle color changes in the skin for a few weeks after surgery, but these can be hidden with clothing or makeup. Most return to work and other social activities within 2 weeks. The scars take a full year to mature, but are usually quite hard to see within a few weeks. Often the skin hidden behind the ear is the bumpiest for the longest.

How long does a facelift last?

While gravity and time continue to take their toll after a facelift, you never go back to your pre-facelift condition. The goal of our facelift and necklift is to tighten and elevate structures as anatomically as possible, without distortion, minimizing the chance that you would ever want another facelift. That being said, some patients may desire a secondary procedure 10-15 years after their primary facelift. Secondary facelifts can be performed but can be more challenging and carry higher risks.

CONSULTATION FOR FACELIFT/NECKLIFT

Each patient is carefully evaluated and if Dr. Taylor and Dr. Sullivan consider you to be a good candidate for an operation, they will customize a surgical plan for your face and neck, with care taken to hide surgical approaches around the ears and under the chin so others can be left guessing. As top Boston Mass cosmetic and plastic surgeons Dr. Taylor and Dr. Sullivan can provide a safe and naturally appearing facial rejuvenation when you have signs of aging.

With an expansion in tools and techniques, as well as fellowship training and experience, we try hard to assess each face and patient individually, and scale the treatment options to the problem. It is not uncommon for someone to come in thinking they “need a facelift” and leave with a different, less invasive treatment plan such as Botox, fillers, or fat grafting. Fat grafting in particular has allowed us to do more with less, and achieve fresh, natural results, with a shorter operation and recovery. Dr. Taylor’s and Dr. Sullivan’s experience with facial surgery and specialty training in craniofacial plastic surgery sets them apart when operating on delicate facial structures and rejuvenating the face and neck.

FACELIFT AND NECK LIFT (RHYTIDECTOMY) AFTERCARE INSTRUCTIONS

  • In the week before your operation:
    • Consider eating pineapple, it may help reduce bruising
    • Consider supplementing with Arnica montana, it may help reduce bruising
    • Complete household chores and prepare meals for the first few days of postoperative recovery
    • Follow preoperative instructions with eating, drinking, and medications
  • Postoperatively, get out of bed and walk (with assistance) every few hours after your operation to decrease the chance of postoperative problems such as blood clots.
  • Practice 15-20 deep breaths every hour to keep your lungs open.
  • After surgery, it is important for you to have someone available to stay with you for the first 24-48 hours, as you may feel drowsy. You may require help the first few times you get out of bed.
  • Please take your medications as directed by Dr. Taylor or Dr. Sullivan to manage discomfort or symptoms.
    • Acetaminophen (Tylenol) 1000 mg every 8 hours, space doses 4 hours after Ibuprofen so one or the other is taken every 4 hours
    • Ibuprofen (Motrin) 800 mg every 8 hours, space doses 4 hours after Acetaminophen so one or the other is taken every 4 hours
    • Gabapentin 300 mg every 8 hours for 7 days
    • Vitamin C 500 mg daily for 50 days
    • Oxycodone 5 mg – 1-2 tablets every 6 hours as needed for pain, though many patients may not need it
    • Colace 100 mg twice daily to prevent constipation, it is important to have a bowel movement each day
    • Zofran 8 mg every 8 hours if needed for nausea
    • Scopolamine patch will be placed on the neck on the day of surgery and can stay for 3 days
    • Bacitracin ointment twice daily to the incisions
  • Eat a light diet for 2-3 days and avoid spicy food. Some suggestions to ease abdominal discomfort or indigestion after surgery:
    • Drink water or warm liquids
    • Prune juice to prevent constipation
  • You may have drains under the skin in the neck. These will be secured and you can sleep with them, but avoid pulling on them. Keep the drainage bulbs compressed at all times. Instructions regarding the drains will be given to your caretaker or nurse. The drains and head dressing are usually removed by Dr. Taylor and Dr. Sullivan the morning after surgery.
  • You may shower or sponge bath the day after the operation after your dressings and drains have been removed. You may wash your hair with a gentle shampoo and conditioner and your face with a gentle soap. Pat dry and then apply a thin layer of Vaseline or antibiotic ointment (e.g. Bacitracin or Polysporin) to incisions and suture lines for 5 to 7 days.
  • Elevate your head and shoulders and when in bed keep your head elevated about 30 degrees (two pillows under your head and back) to help with the swelling.
  • Do not smoke or expose yourself to smokers or nicotine as skin and wounds can be compromised.
  • You may apply ice packs to the face and areas around the eyes for the first 48 hours to reduce swelling and bruising. Bags of frozen peas and corn make for excellent ice packs. You might also consider Icewraps Gel Packs or Swiss Safe gel packs, which can be ordered from Amazon or online. Apply the ice packs for 20 min of each hour while awake.
  • Cosmetics can be worn on the face as early as 10 days after surgery as long as all sutures have been removed.
  • Your hair may be dried with a blow dryer on a cool, not a hot, setting. Hair coloring or use of hair products should be delayed until 3 weeks after surgery or when all wounds are healed and there are no crusts or scabs.

ACTIVITY

  • For the first week following surgery, raising your blood pressure and heart rate can cause bleeding. Avoid straining, stress on your facial muscles or vigorous activity. Facial movements (smiling, talking, chewing, yawning, etc.) should be kept to a minimum. We recommend walking 15 minutes 2 to 3 times per day.
  • Please do not drive for 7 to 10 days or while taking pain medications such as oxycodone.
  • Do not lift anything heavier than 10 lbs, run, lift weights, or perform strenuous exercise for 3 weeks. Normal activity can be gradually resumed after 3 weeks.
  • Massage to the areas of scar and skin of the face and neck can help increase circulation and soften firm areas. Please wait at least 3 to 4 weeks after surgery to start massage to avoid increased swelling.

GENERAL OUTCOMES

  • Moderate swelling and bumpiness of your face and neck is to be expected. This is most notable in the neck and will increase for 48 hours. Much of the swelling usually resolves within the first few weeks after the operation. Though you may find that your neck is slower to resolve. A feeling of tightness of the face and neck is to be expected. Please be patient. The swelling and feeling of tightness will gradually subside over the following months.
  • Bumpiness of the skin is also normal and will smooth out as the swelling resolves and the tissues soften.
  • Tingling, itching, and numbness of the face and neck skin are all normal. Tingling and itching are signs of healing and will resolve. Sensation usually returns gradually and slowly over weeks to months. Please be patient and avoid resting against hot surfaces, which can injure or burn the skin.
  • Scars and tissues take one full year to mature. You may notice that they become red, raised and firm for several weeks to months before becoming soft, flat and pale. Avoid Vitamin E as it can irritate the scar. Mederma has no proven benefit and is not worth the expense. All incisions will be sensitive to sunlight during the healing phase. Direct sun contact or tanning booths are to be avoided. Silicone cream or skin moisturizer with sunscreen and gentle massage may be helpful.
  • A small amount bleeding from the incision is expected. Please call our office (617-492-0620) if you have:
    • Continuous bleeding
    • Significantly more swelling on one side when compared to the other
    • Worsening pain
    • Fever, spreading redness or irritation of the skin
    • Shortness of breath

It is important to be seen by Dr. Taylor or Dr. Sullivan after your operation. They will see you in follow-up appointments at 1 week, 3 weeks, 3 months, and 1 year or as often as needed post-op. Call to schedule your appointments at Taylor & Sullivan Plastic Surgery office at (617) 492-0620 between the hours of 8:30 – 5:00 or visit our webpage at www.massplasticsurgeons.com. We are always available for postoperative concerns or emergencies and can be reached through our paging service 24 hours per day at (617) 492-0620.

Download our Facelift and Neck Lift Aftercare Instructions here.

Call Today 617.492.0620

To schedule a private consultation with Dr. Taylor or Dr. Sullivan, please call the office or request an appointment using our form. We welcome your visit and your questions.

300 Mount Auburn St. Ste 304, Cambridge, MA 02138

617.492.0620

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300 Mount Auburn St. Ste 304, Cambridge