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. A combination of approaches can be taken to address this, from nonsurgical to minimally invasive to extensive. Historically, plastic surgeons had a relatively limited repertoire of treatment options, so many patients were treated with the same approach. 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.
A particular research interest of ours has been in facial symmetry. While symmetry is a fundamental goal of plastic surgery and is regarded as a key component of human attractiveness, some asymmetry is inherent to any face. Dr. Taylor and Dr. Sullivan, named among the “best plastic surgeons” in Boston, have used 3D photography to study facial symmetry and have found increasing asymmetry with increasing age and have also evaluated specific areas of the face that demonstrate asymmetry, such as the nose or the eyelids. They have published extensively on their research findings and customize interventions. Some patients are also born with anomalies or differences or may have injuries or cancer leading to facial asymmetry. Through their research and use of technology Dr. Taylor and Dr. Sullivan can tailor an operation to improve facial symmetry and create a natural appearance with facial rejuvenation treatments.
Facelift and Neck lift (Rhytidectomy) for Aging Face
Facelift or neck lift can be a good approach if there is significant descent of the mid and lower face, with redundant skin. 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 also be a candidate for simultaneous eyelid lift (blepharoplasty), eyebrow lift, or lip lift. Most facial operations also commonly include volume enhancement with fat grafting - a minimally invasive method to restore facial fullness using your own tissue. 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. With top Boston Mass cosmetic and plastic surgeons Dr. Taylor and Dr. Sullivan can provide a safe and naturally appearing rejuvenation when you have signs of facial aging. Operations are performed at Mount Auburn Hospital, a Harvard teaching hospital in Cambridge, Massachusetts. The operation usually takes Dr. Sullivan and Dr. Taylor about 4 to 5 hours. They often operate together as a two physician team to provide complementary perspectives and the best possible outcome. Patients may have sedation with local anesthesia though most have general anesthesia for safety and comfort. After facelift and neck lift, patients typically recover for one night in a private room at Mount Auburn Hospital. Sutures hidden around the ears are removed approximately one week later.
Fat Grafting and Facial Implants
Fat grafting and facial Implants can be used to restore facial volume, correct facial symmetry or improve facial harmony. Dr. Sullivan and Dr. Taylor will carefully consider your goals and evaluate your potential for facial fat grafting or facial implant surgery. If they feel you are an appropriate candidate, they may use 3D imaging and as well as 3D printing to customize your surgical plan. Facial fat grafting involves the transfer of small amounts of fat from unwanted areas such as the abdomen to the face and restores the volume of facial soft tissues. Minimally invasive surgery through a very small incision in the belly button, liposuction is used to gently remove fat from the abdomen. The fat is then carefully washed and filled into the desired areas of the face without making incisions on the face. The transferred fat can restore facial volume and is the ideal method of minimally invasive facial rejuvenation. Sometimes, patients have facial asymmetry due to bony changes or deficiency such as the chin or cheek bones. In these circumstances, facial implants are commonly used for both cosmetic surgery and reconstructive surgery. Many times, facial implants are used in combination with facial fat grafting. Reasons for fat grafting or facial implants include cosmetic appearance, history of trauma or facial operations, history or cancer or radiation, or a history of congenital or craniofacial anomalies. Fat grafting can also be used to fill depressed scars, revise unsightly scars, or treat acne scars. Facial implants are used to correct bone and are sometimes used in combination with fat grafting. Common areas for facial implants include cheeks, jaw bones, forehead and chin (genioplasty). Dr. Sullivan and Dr. Taylor both have fellowship training in craniomaxillofacial surgery and have published extensively on their experience with facial plastic surgery.
FACELIFT AND NECK LIFT (RHYTIDECTOMY) AFTERCARE INSTRUCTIONS
• In the week before your operation:
o Consider eating pineapple, it may help reduce bruising
o Consider supplementing with Arnica montana, it may help reduce bruising
o Complete household chores and prepare meals for the first few days of postoperative recovery
o 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.
o Acetaminophen (Tylenol) 1000 mg every 8 hours, space doses 4 hours after Ibuprofen so one or the other is taken every 4 hours
o Ibuprofen (Motrin) 800 mg every 8 hours, space doses 4 hours after Acetaminophen so one or the other is taken every 4 hours
o Gabapentin 300 mg every 8 hours for 7 days
o Vitamin C 500 mg daily for 50 days
o Oxycodone 5 mg – 1-2 tablets every 6 hours as needed for pain, though many patients may not need it
o Colace 100 mg twice daily to prevent constipation, it is important to have a bowel movement each day
o Zofran 8 mg every 8 hours if needed for nausea
o Scopolamine patch will be placed on the neck on the day of surgery and can stay for 3 days
o 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:
o Drink water or warm liquids
o 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.
• 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.
• 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:
o Continuous bleeding
o Significantly more swelling on one side when compared to the other
o Worsening pain
o Fever, spreading redness or irritation of the skin
o 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.