Surgery for Aging Skin

A facelift, also called a rhytidectomy, is a surgical procedure that repositions and tightens skin on the face, resulting in a more youthful appearance. A facelift also removes lines around the eyes and mouth and accentuates the natural contours of the face, such as the cheekbones. Facelifts tighten skin on the neck and under the chin, making skin appear firmer and smoother.

To perform a facelift, surgeons make incisions at each temple and extend them to the front of the ear and the area behind the earlobe. Through these incisions, surgeons remove fat deposits and reposition facial and muscle tissues beneath the skin to contour the face. Surgeons then tighten the skin to make it look smoother.

After the skin has been repositioned, surgeons close the incisions with stitches. Surgery takes between two and three hours.

Mini Facelift

When appropriate, our surgeons may perform a mini facelift, also called a short scar or limited incision facelift. In this less invasive approach, surgeons make smaller incisions around the temples and ears. The smaller incision size minimizes postoperative scarring and may result in a shorter recovery time.

Surgeons determine if a person is eligible for a mini facelift based on his or her age, facial structure, and the extent of rejuvenation desired. Surgery takes the same amount of time as a standard facelift—between two and three hours.

SMAS Facelift

Surgeons perform SMAS facelifts by repositioning muscle as well as skin. SMAS stands for superficial muscular aponeurotic system, a technical term for the muscles that control facial movements. By adjusting this layer of muscle as well as a layer of skin, surgeons have more control over how the new contours of the face look.

Surgeons use the same incisions they use for a traditional facelift. Surgery takes between three and four hours.

What to Expect After a Facelift

After surgery, your face is covered in bandages, and small plastic tubes are placed near the incisions to drain fluid. Doctors may prescribe pain medication for one week to ensure that you recover comfortably.

A follow-up appointment is scheduled for 24 hours after surgery, so surgeons can remove the drainage tubes and bandages. Surgeons also examine your skin as it begins to heal. There may be some redness, bruising, and swelling, which fades over the following weeks.

For the next five to six days, you recover at home. After two days, you can shower. After one week, doctors remove the stitches holding the incisions closed. Additional follow-up appointments are scheduled for two and three weeks after surgery, so doctors can monitor how your skin heals and address any complications, such as infection.

During the first few weeks, your face may look bruised and red. The redness starts to fade after two weeks, and most people appear to be healed after three weeks. The skin and muscles heal completely after six weeks.

Fat transfer is a procedure that many people choose to have in combination with a facelift. In this procedure, surgeons remove excess fat from another part of your body, such as the belly or thighs, and use it to add volume in thin areas of the face. The fat is then processed in a centrifuge, a small machine that removes blood and oil. The remaining fat has an ideal texture for filler injections in the cheeks, around the jaw, and beneath the eyes. The lips may also be augmented with transferred fat.

Surgeons remove fat using a small, flexible tube called a cannula. The cannula is inserted into the thighs or belly, and a machine suctions fat out. After the fat has been processed, surgeons use a syringe to inject small amounts into the face. Surgeons are careful to inject just enough to create a healthy, natural look.

Recovery from fat transfer is minimal. A small bandage is placed over the tiny incision on the thigh or belly.

Newer nonsurgical methods of brow lifts—in particular, botulinum toxin, known by the brand name Botox^®—have largely replaced surgical approaches. Injections of botulinum toxin smooth brow lines and make skin look tighter.

However, surgeons do offer surgical brow lifts on occasion. People who are allergic to botulinum toxin, for example, may opt for surgery.

Our surgeons perform brow lifts using an endoscopic technique, which achieves the same cosmetic result as a traditional brow lift but uses smaller incisions, resulting in less scarring and a faster recovery time.

Your surgeon makes a series of small incisions, less than one inch each, just behind the hairline. Next, the doctor guides an endoscope, a thin, flexible tube with a camera and light at the tip, into one of the incisions. The endoscope transmits images to a nearby computer monitor and gives surgeons a clear view beneath the skin.

The doctor then inserts small surgical instruments into another one of the incisions, and uses these to reposition skin and muscle to lift the brow and smooth wrinkles. The incisions are closed with stitches.

Brow lifts are performed using local or general anesthesia. This decision is typically based on your preference and is made in consultation with your surgeon. Surgery takes about two hours, and you can expect to return home the same day. Doctors schedule a follow-up visit after five to seven days to remove the stitches and examine the skin as it heals.

There may be some pain, tenderness, and itching for the first two weeks. The skin heals completely within six months. If necessary, doctors may prescribe pain medication for one week.

Eyelid surgery, also called blepharoplasty, is a procedure used to tighten drooping skin on the upper or lower eyelids and reduce puffiness and sagging skin around the eyes. Surgeons can improve the look of just the upper or just the lower eyelids, or it may be performed on all four areas at the same time. The result can smooth crow’s feet and eliminate bags beneath the eyes.

To perform surgery on the upper eyelids, your doctor makes an incision in the fold of skin where the upper eyelid meets the brow. He or she removes a small amount of skin to tighten the area and removes fat from beneath the skin if the upper eyelids look puffy. The incision is closed with stitches.

Surgery on the lower eyelids is slightly more involved. Your surgeon makes an incision inside the lower eyelid to avoid any visible scarring. Through this incision, he or she may remove skin or fat, depending on your anatomy and whether aging has made the lower lids appear droopy or puffy.

The surgeon may suggest adding a small amount of fat to smooth skin and reduce the appearance of “bags” under the eyes. In this instance, surgeons perform a fat transfer by removing fat from another part of your body—typically the belly or outer thighs—to be injected as a filler into a sunken space beneath the eyes.

Surgeons may also use laser therapy to rejuvenate skin beneath the eyes. Laser therapy uses high-energy beams of light to stimulate the growth of collagen and smooth surface cells. The result is skin that looks brighter and firmer.

Eyelid surgery is performed using local anesthesia and usually takes less than two hours. Most people return home within hours of the procedure. Doctors schedule a follow-up appointment five to seven days after surgery to remove the stitches and examine the skin to ensure it heals normally. You have another appointment one week after that to confirm that there are no complications.

What to Expect After Eyelid Surgery

Recovery from eyelid surgery varies depending on what procedure or procedures are performed. If only the upper eyelids are altered, skin heals very quickly, usually within five to seven days. You may experience slight bruising around the eyes for a couple of days, and your eyes may water and be sensitive to sunlight.

Recovery from lower eyelid surgery may take longer. Slight bruising may persist for three or four days, and skin usually heals in 7 to 10 days. If surgeons perform laser therapy beneath the eyes, the skin may be red or tender for a few days. It heals in about one week.

A tip rhinoplasty is surgery to tighten and shrink the skin and cartilage at the tip of the nose. As people age, the tip—which is made of a tough, spongy material called cartilage—begins to droop and may make the nose look larger. Our surgeons can contour this part of the nose without altering bone. The result is a smaller nose.

Your surgeon performs tip rhinoplasty by making a small incision in the skin at the tip of the nose. He or she then removes excess fat and tissue and uses two small stitches to tighten the skin. This procedure is performed using local anesthesia. You can expect to return home within hours of surgery.

Doctors schedule a follow-up appointment after five days to remove the stitches. There may be some bruising around the nose for a week or so. The nose is completely healed within six weeks.

The skin of the earlobes is not immune to aging. Earlobes sag over time, which may be more noticeable to women who wear earrings. Our surgeons can perform a quick and simple procedure to remove a small wedge of skin. They close the incision with a couple of small stitches. The result is a smaller, firmer earlobe.

Earlobe surgery is performed in a doctor’s office with local anesthesia and takes 30 minutes. You can return home immediately after the procedure. Typically, there is little or no postoperative bruising or discomfort.

You return for a follow-up appointment five to seven days after the procedure, so your doctor can remove the stitches. The skin is completely healed within two weeks.