Facelift in Philadelphia, PASee before and after
Beginning in the 40s, the ligaments that support the face stretch and the skin sags, causing the appearance of looseness in the neck and the jowls. A facelift addresses these changes. All surgery is done in an outpatient surgery center and under local anesthesia with sedation– which is usually both our patient’s– and our– preference.
WHAT IS A FACELIFT?
Known in cosmetic medicine as a rhytidectomy, facelift surgery is designed to restore a youthful look to the face. In many patients, the face ages more rapidly than other areas of the body. Aging is partially due to regular sun exposure and ultraviolet radiation, and our exposure to toxins in the environment, all of which break down the collagen and elastin in the skin.
Aging facial features cause the face to appear worn and tired as they begin to droop, wrinkle, and deflate. The cheeks begin to sag, and the jawline becomes less defined. Visible wrinkles form in different areas of the face, especially around high-movement areas like the eyes and lips.
These cosmetic changes, though perfectly normal, can create confidence issues and hold people back from feeling as youthful as they do inside. A facelift can restore youthful contour and reinstill confidence and vigor.
Facelifts in our practice are customized to the patient’s needs. They are not one size fits all. There are many different variations of the facelift procedure, which fundamentally involves a tightening of skin and muscle, but the goal is to look as natural as possible and not look pulled.
The deep plane lift, the extended SMAS procedure, and various small incision techniques (S lift, MACs lifts) are all considered. The least invasive technique to produce the most profound and natural aesthetic benefit will be recommended and discussed with you at the time of your consultation.
Facelift is often combined with others procedures, like a brow lift, upper or lower eyelid lift, and/or neck lift. A facelift only lifts the portion of the face that extends from the upper cheeks to the upper neck. It typically will not smooth forehead lines, treat sagging brows, bags or hollows under the eyes, or alter the look of a very saggy neck.
DO I NEED A FACELIFT?
Our patients vary in age from 40 to those in their 70s. The one thing they have in common is that they don’t like their jowls and their jawline. Many patients have tried many other options to avoid a facelift: they’ve tried hyaluronic acid fillers which are supposed to “lift” the face, procedures like thread lifts, Ultherapy, or Radiofrquency treatments with some improvement but not nearly to the extent that they desire. Some of our patients only began to notice the changes on a web cam or in family or selfie photos and have never done anything but want to find out what all the options are both up to and including a lift.
Bottom line: there is no specific age range, and whether you’ve done anything or not, a facelift can achieve certain objectives that no other procedure can. Your health and ability to undergo the surgery are the true and only major considerations.
WHY CHOOSE DR. WULC FOR FACELIFT?
A facelift specialist in Philadelphia, facial plastic surgeon Allan Wulc MD, FACS is praised by patients all over the country for his credentials, innovative surgical techniques, and record of successful procedures.
Dr. Wulc is board-certified in ophthalmology, facial cosmetic surgery, and plastic surgery, and is a diplomate of the American Society of Ophthalmic Plastic and Reconstructive Surgeons. Dr. Wulc stands out as the only tri-state area surgeon with these accomplishments.
In three decades of experience, the doctor has pioneered new techniques used during surgery, has given lectures and presentations and has published extensive material regarding his work. He specializes in creating long-lasting natural results. Because he only works in the field of facial plastic surgery, he has mastered techniques for issues specific to facial aging. and beautification.
YOUR CONSULTATION IN OUR PHILADELPHIA OFFICE
If you want to consider a facelift, schedule a facelift consultation with our office. During this first office visit, we will review your health history, perform an examination, and discuss various options. We will show you photographs of how patients with similar changes in appearance to yours look during their postoperative course and the results we can hope to achieve in your case.
Sometimes less aggressive procedures can produce astonishing benefit: a micromidface procedure, or the myEllevate + procedure with Renuvion might be recommended. A minilift that lives only a portion of the face may be all that someone needs. These surgeries can produce excellent results in patients that are not anxious to undergo the full open procedure. No surgery—a minimally invasive approach with injectables and technology such as external Radiofrequency—-may also benefit some patients.
The only true way to assess the options is in a consultation where you can weigh the improvements against time of recuperation, costs, and aesthetic benefit. We have the time to answer all your questions and don’t suggest you make a decision at the time of the visit—we make suggestions and give you the time to make decisions. A second consult is often scheduled that helps you understand the goals and intentions, as well as the risks.
HOW TO PREPARE FOR YOUR FACELIFT SURGERY
Before your facelift in our Philadelphia office, Dr. Wulc will provide you with instructions to follow in the weeks leading up to surgery. These include:
- Supplements and medications to avoid
- Supplements to take before the surgery.
- How far in advance to quit smoking
- How to prepare nutritionally for the pre and postoperative period
- Any required medical tests
You should also arrange for a ride to and from your surgery, as you will not be able to drive while the anesthesia wears off. It is best to have someone stay with you for the first few days after surgery.
THE FACELIFT PROCEDURE
Facelift procedures are performed on an outpatient basis. Under local anesthesia with sedation or general anesthesia, we hide incisions around and behind the ears and within the hairline to access the underlying structures of the face. We may perform the operation using modified traditional methods or endoscopically, as we specialize in minimally-invasive facelift techniques.
Extra fat can be removed or liposuctioned through a thin cannula, and tissue is repositioned to a more youthful location. The tissues are sutured during what is known as the SMAS (superficial muscular aponeurotic system) or the deep plane facelift.
We can simultaneously address the face and neck during the same surgery.
The surgery is outpatient: you are discharged home or to a hotel after you are fully awake. Initial recuperation is expected to last 10-14 days. We suggest cold compresses and a garment that you wear to prevent swelling for the first week after surgery. Over the counter pain medications and prescription medications keep you comfortable.
Facelift results are generally apparent after two weeks.
We suggest topical creams to help diminish scarring and hypoallergenic natural cosmetics can be applied to the incision sites to cover marks from the surgery, as well as associated bruising in the early postoperative period. We treat your skin with LED healing lights and lasers at this time to reduce the bruising and swelling. During the period of downtime, we ask you not to perform heavy-duty tasks, to avoid turning the head too abruptly to avoid sun exposure, and to follow our instructions.
Final facelift results will settle and can be seen a few months after the surgery. We give you exact information on what to expect with this procedure that anticipates and encapsulates almost all that a postoperative facelift patient may experience.
POSSIBLE RISKS AND SIDE EFFECTS
Healthy patients who choose a skilled facelift surgeon and follow all pre- and post-operative instructions carefully are unlikely to develop serious complications. Most patients might have minor side effects, such as swelling, bruising, and minor to moderate discomfort during the recovery period.
However, all surgeries carry risk. Occasionally, patients may develop issues such as:
- Postoperative hematoma
- Anesthesia complications
- Facial nerve injury
- Hair loss
- Infection or poor wound healing
Patients should call their plastic surgery or 911 immediately if any abnormal symptoms should arise during recovery.
DEEP PLANE AND COMPOSITE FACELIFT
Techniques also provide long-lasting anatomic improvement that involves different planes of facial dissection. There are no studies that confirm a benefit. We prefer this technique in some patients, especially in smokers.
DEEP NECK LIFT
Deep neck lifts are often performed in conjunction with facelift surgery. The neck procedure addresses the changes that occur in the neck with aging such as the laxity of the tissues of the floor of the mouth. With this technique, minimal skin is cut away, and most of the sculpting is done under the platysma muscle –fat, hanging muscle and other tissues–and provides dramatic resculpting of neck contours. The jowls can be trimmed directly. Once the muscles and laxity of the tissues of the mouth floor (in the lower neck) are addressed, the skin redrapes over the new contours rapidly. The incisions heal inconspicuously.
FACELIFT BEFORE & AFTER PHOTOS
A facelift is transformative, with dramatic results, both in the way you look in the mirror and in the way you look in profile, something much harder to see and appreciate. See our before and after gallery for typical results in the patients who were generous and open enough to allow us to use their photographs.
WHY CHOOSE DR. WULC FOR FACELIFT?
A full facelift involves a full facial incision that goes around the forehead, around the ears, and around the neck. Skin is excised from all those locations. A full facelift is not performed ever in our practice and, in general, is unnecessary. We feel that it does not produce natural results.
Our practice suggests multivector lifts whenever possible. These procedures, accomplished at once or in the area where a patient shows signs of aging, allow an elevation in the direct angle of the sagging that one experiences and in general, only a minimum amount of skin needs to be removed. The main goal of a facelift in our practice and a mini facelift in our practice is to elevate sagging volumes in the face, and when necessary (almost always), to supplement the volumes with liposculpture. The incisions are well-concealed below the sideburn and around the ears. An incision might also be placed in the temple if the cheek needs to be lifted. These incisions are small and are not interconnected.
WHAT IS THE COST OF A FACELIFT?
The cost of a facelift varies. It is based on where the surgery is performed, the extent of problems, any ensuing complications, whether the neck is actually sagging and addressed, and whether deep tissues of the neck require attention. A consultation in our office will allow us to develop a plan and arrive at a price tailored specifically to your personal goals.
WHAT IS A “LUNCHTIME FACELIFT”?
There is no such thing as a “lunchtime facelift.” The name is simply a marketing gimmick. But if something provides you with a personal sensation of improvement and it’s a facial treatment, like a haircut, color, highlights, new makeup, a peel, a filler injection or Botox, and the treatment can be cone, conceivably, “at lunch”—then it’s a “lunchtime lift.” Thread lifts are done in many offices and can provide you with short term—very short term—benefit and may be considered ways of addressing gravitational change. They do not produce long lasting improvement and we’ve seen many dissatisfied patients who have spent a lot of money and obtained no aesthetic benefit. Generally this type of lift lifts your spirits more than it lifts the sagging tissues of your face while simultaneously lifting money out of your savings.
WHEN IS A FACELIFT DONE? AT WHAT AGE IS A FACELIFT PERFORMED?
A facelift can be performed at any age if it is needed. If you are healthy and don’t like the changes around your jawline, a facelift Is at least worth discussing. We will carefully weigh the consequences and risks of surgery with you prior to making a definitive decision.
Some people elect to have a facelift at the first signs of sagging, which generally occurs in the early 40s. A facelift performed around the age of 40 generally lasts for a very long time because the scar that is created allows the volume of the face to stay in play over time and gravitational forces are controlled by the work done on the deep tissues. Smaller incisions can be used in the younger patient to address single areas of concern such as the cheek or the jawline.
Facelifts at age 50 generally involve treating the neck as well which begins to show laxity, platysma banding, and wrinkling.
Facelifts at 60 and 70 are also performed and involve comprehensive treatment of skin changes, gravitational changes, and the increasing volume loss that occurs with aging.
We have patients even in their 80s undergoing facelift surgery as well as other simultaneous antiaging aesthetic procedures who enjoy the benefit of looking better, more youthful, and who feel more confident as a consequence.
WHAT ARE THE NEWEST FACELIFT PROCEDURES?
The techniques of doctors performing facelifts vary from small incision to large incision. The much advertised smaller incision threadlift or Silhouette lift involves the insertion of threads or small barbed or coned sutures that provide a lift. However, these procedures provide only very temporary improvement (three to six months) and have thus been abandoned by many surgeons.
Our W Natural Lift micromidfaceTM lift is a researched and proven minimally invasive technique that provides longer-lasting and satisfying improvement that lifts the cheek and jowls.
DOES A FACELIFT CREATE NATURAL-LOOKING RESULTS?
Lie down and look at your face in the mirror. The skin and volumes of the face reposition themselves because you have changed the vectors of gravity. If your mouth was turned down and you had jowls sitting up and looking in the mirror, they just disappeared– magically—your frown turns to a smile and the jowls are gone. Your cheeks now rest closer to the eyes and the sags under your eyes also vanish. That look—a natural resuspension of tissues that have been influenced by gravity—is the look we strive for.
Most of the incisions are hidden above the hairline or concealed around your ears.
Many patients are afraid they will look windswept or overtightened and that their mouths will look funny after the procedure because they’ve seen celebrities—or friends—or someone in a restaurant– with awful results. However, they don’t count the number of good results they see out there because a good facelift remains virtually indistinguishable from natural aging—certain problems just appear “photoshopped” or filtered away by the procedure.
IS A FACELIFT PAINFUL?
Patients are comfortable during the facelift procedure. Most commonly, we perform the surgery under local anesthesia with sedation. Some patients, however, prefer deeper sedation or general anesthesia.
We administer pain blocks at the conclusion of the procedure and often consult preoperatively with a pain specialist when necessary if your fear of pain is a consideration who can aid in your postoperative pain treatment. Most patients do well with minimal pain issues after surgery that can be relieved with Tylenol alone.
DEEP PLANE, SMAS OR SKIN ONLY? WHAT TECHNIQUE SHOULD I CHOOSE?
This entirely depends on the surgeon’s comfort level. Generally, deep plane lifts do not address skin excess and wrinkles as well as surgeries that address both the deep tissues and the skin excesses separately (older patients). The SMAS descends vertically, but skin excess may require a more upwards and backward pull. Separating these two layers may be better for some patients so that the muscles and sagging deep tissues can be lifted directly upwards and the skin lifted slightly more backwards. A deep plane lift may be ideal if the issues are not related to loose skin but to a drooping of the muscles and ligaments. We feel comfortable with all these techniques.
Suspension surgeries (Slift, MACS lift, JZPlazty) may be very adequate, particularly in younger patients, and require much less surgery and consequently have a faster recuperation.
DRAINS OR NO DRAINS?
We base our decision on whether to use drains on how you respond to the surgery, on how much bleeding is present during the surgery. We make this decision in the operating room. Drains, if placed, are generally removed on postoperative day 1 or 2. If the neck is addressed, drains may be left in longer. Drains are not painful, but they certainly are a nuisance, and we avoid them if we feel it is safe.
CAN A FACELIFT BE COMBINED WITH OTHER PROCEDURES?
We virtually never perform a facelift without also addressing volume loss with liposcupture and volume excesses with either liposuction or direct removal of fat excesses.
Facial implants, dermal fillers like Juvederm®, Restylane®, or Radiesse® can be employed to improve the mobile areas around the lips, and conservative chemical peeling, lasers, and dermal rolling can all be used simultaneously.
Dr. Wulc may also recommend in office skincare or suggest patients undergo in office treatments like laser, radiofrequency skin tightening or intense pulsed light (IPL) sessions both before the facelift to condition the skin and after to expedite the healing.
I AM TROUBLED BY MY FACE AND WHEN I PULL UP ON IT, IT LOOKS BETTER? AM I TOO YOUNG FOR A FACELIFT OR IS NOW THE TIME?
While there is no set age for patients, many find that they can postpone the procedure until their 50s or later. Newer technologies have emerged that do an amazing job of postponing a lift. Radiofrequency microneedling using Intracel or Morpheus 8, subcutaneous RF with Renuvion, peels, lasers and injectables can maintain a youthful appearance and delay the need for a lift. And when the time comes, we will let you know –and gently suggest that possibility…
I AM TROUBLED BY MY FACE AND WHEN I PULL UP ON IT, IT LOOKS BETTER? AM I TOO YOUNG FOR A FACELIFT OR IS NOW THE TIME?
While there is no set age for patients, many find that they can postpone the procedure until their 50s or later. Newer technologies have emerged that do an amazing job of postponing a lift. Radiofrequency microneedling using Intracel or Morpheus 8, subcutaneous RF with Renuvion, peels, lasers and injectables can maintain a youthful appearance and delay the need for a lift. And when the time comes, we will let you know –and gently suggest the procedure….
For more information on facial procedures that complement Facelift, visit WFaces
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