Facelift basics

Prepare for your facelift

The goals of preparation are to minimize the risk of complications, bruising, and to expedite your healing process.

Two weeks prior to surgery, stop taking agents that can impede your body’s ability to clot. Do not take products containing aspirin, ibuprofen (ex. Advil, Motrin), or Vitamin E. Tylenol is okay to take. If you take Coumadin, plavix or other prescription medications to prevent clotting, be sure to discuss this with Dr. Ashbach.

You should also not smoke for two weeks prior to surgery and for at least three weeks after surgery. Other products that contain nicotine, such as ‘the patch’ or nicotine gum, should also be avoided. These all tend to impede the healing process and increase the risk of complications.

One week prior to surgery, it is advised that you do not drink alcohol, as it also contributes to additional bleeding. If you color or perm your hair, hold off for one week prior to surgery and for three weeks after surgery.

You will be given ice packs at the time of surgery to take home, but having a few extra or some bags of frozen peas to use at home is a good idea.

On the day of surgery, make plans for someone to drive you to and from the surgery location. If you are having general anesthesia or sedation for your procedure, do not eat or drink anything after midnight, as you need to have an empty stomach for surgery. If you need to take medications, do so on the morning of surgery with a sip of water.

Post operative instructions and guidelines

A face lift is an out-patient procedure. Most patients go home about two hours after surgery. A dressing is placed after the procedure around the head and neck. It is critical that the dressing is not removed until the next day by Dr Ashbach and his team. The dressing is designed to provide moderate compression so that the area can heal naturally. This also keeps the bruising and swelling to a minimum. Use ice packs over the dressing for at least 15 minutes every hour while you are awake.

For the first few days, focus on eating a gentle meal. Nausea can sneak up quickly and can lead to wretching, which puts a lot of stress on the tissues and stitches, which can lead to bleeding complications. For the first few days, it is more important to stay hydrated by drinking fluids than to worry about consuming a lot of calories.

Try to emphasize taking deep breaths often when you get home for the first 24 hours after surgery. This helps to expand your lungs and prevent pneumonias. You are encouraged to walk around the house on the day of surgery and thereafter. This helps to prevent blood clots from develop in the legs. Move/pump your legs frequently while lying down, as if you are pushing on a car’s gas pedal, if you don’t think you can do much walking. When you rest or sleep for the first three days, keep your head elevated with a couple pillows and avoid turning on your side. A recliner works great if you have one.

Avoid showering for the first 48 hours after surgery. Just let the water run over your face. It is okay if shampoo accidentally washes over the incision area. Don’t submerge your face in the bath for ten days, as that can impede healing and lead to infection. Sometimes the incisions accumulate dried blood or crusting around the edges. Keep the incision area clean with q-tips that have been moistened with clean water. After cleaning, apply a thin layer of Vaseline or lacrilube over the incision line to keep it moist.

If you have sutures, they will be removed around postoperative day seven. This is an uneventful and essentially painless process.

It is important to avoid sun exposure to the incision area for at least six months after surgery. Use an eye-safe sunblock that is SPF 30 or greater for this. We have options available for this in the office.

Avoid bending, lifting, pulling, pushing, straining and aerobic activities for three weeks. If you overexert yourself, bleeding or prolonged swelling may result.

You may begin to return to regular exercise three weeks after surgery. Ease into this, gradually increasing your exercise level back to normal by 5-6 weeks from surgery.

The First 24 Hours: Yawning places a stress on these fragile surfaces and should be avoided.

When to call

Call our office if you are concerned, or if you have any of the following:

Increased swelling, redness or bruising after a few days
Pain not relieved by medication
Adverse side effects to medications; such as, rash, nausea, headache, vomiting
Fever over 100.4 degrees.
Yellowish or greenish drainage from the incisions or a foul odor.
Bleeding from the incisions that is difficult to control with light pressure. If you have loss of feeling or motion.

How to Turn Head after Facelift

Avoid sudden movements of the head to either side during the first 2 weeks. When turning, turn your shoulders too, not just your neck. This reduces any tension on the sutures.

Ice after Facelift

Cold compresses to the eyes and cheeks(30 minutes on, 15 minutes off) through the day and until the hour of sleep will help to reduce swelling in this area. There are several techniques to ice the area including cool compresses, frozen peas, or ice packs. The eye area incorporates some of the loosest and thinnest skin in the body. Even though no surgery is done on the eyelids they do tend to swell.

Discomfort after Facelift

Discomfort and sensation of pressure, especially over and behind the ears, is quite usual. This is readily controlled with the Tylenol with codeine (taken with milk). Severe pain should be reported. All incisions are inspected and any minor blood collections removed. No washing, scrubbing or manipulation is done at this time. The bandage removal is not painful nor is the replication of a smaller bandage.

A small amount of staining on the bandage can be expected but any sudden painful swelling should be reported. Despite taking all precautions, medications, surgical meticulousness, proper bandaging and the patient's adherence to all directions, blood can accumulate under the elevated skin.

A small collection is usual, a large collection is quite rare.

The First Week:

How to Clean Incisions after Facelift

Swelling about the eyes is always worse 48 hours after surgery. The cold compresses are soothing and are still effective.

Further bandaging is not necessary after the fourth post-up day. Fine stitches, just in front of the ear (and beneath the chin if this area has been re-sculpted), are removed on the seventh day. The remaining tiny sutures in the hair behind the ear will come out on the 10th to 14th post-up day.

A few hours after the fourth day-bandage removal, you may shower in tepid water even though the staples are present. Slowly and carefully clean your hair by rolling it between your finger. Four days of bandage enclosure and the anesthetic solution have left your hair stiff and dry.

Baby shampoo acts as a good softener. The hair you'll see in the shower drain belongs to the redundant scalp skin removed at surgery.

You may gently groom the hair with a large-toothed comb. A hair dryer, if used at all, must be on a cool setting. The scalp cannot tolerate any heat at this time.

The face may be washed or cleansed with a gentle upward movement from the fourth day on.
Following all facelift operations, a small amount of "lumpiness'' is always noticed just in front of the ears. This is temporary and related to the repositioning of the tissues beneath the skin. It may take a week or two to smooth over.

In this same area, and also behind the ears and in the ear lobes, there is a mild numbness to the touch. This is always a part of the facelift procedure.

This numbness begins to disappear in a week or two, moving from front to back. It may take three months for sensation to return to the ear area.

In very rare instances some numbness may persist.

Other instructions:

It is best that you stay out of the summer sun for about 60 days. A sunburn could quickly cause the swelling to return. The mild insensitivity of the skin could lead to a severe burn and, possibly, some pigment changes. If you are to be walking between sun and shade, wear a large hat and be sure to apply a sun block or lotion.
Any discoloration (black-and-blue) is almost entirely gone by the 10th-14th day. You may notice that the discoloration has migrated from the sides of the neck to the space above the collar bone. This is normal. You may notice some crusting in the hair along the suture lines. This may recur for a period of two to three weeks, but is not a cause for concern. It may be removed gently after wetting the hair in the shower.
Temporary hair loss along the incision lines above and behind the ear can occur a week or so following the lift. This is usually a very narrow path when it does occur and can always be covered by the hair in front or above it. Regrowth will usually resume after a few weeks.
The "lifting" in the facelift is designed to allow as little tension in front of the ear as possible and as much tension as possible above and behind the ear.This produces a fine line scar in front of the ear and heavier scars in the hair and behind the ear. These scars in the hair may persist for several months, but can usually be camouflaged very satisfactorily with the hair itself. This scar behind the ear is hidden but may remain thick for several weeks.
At the end of the first week and the beginning of the second week, you may feel a little blue or depressed. 'This common reaction to facelift surgery is transient. In the next few days, as the bruising fades, the swelling subsides and you resume your normal life, a sense of elation replaces the down feeling. This "blue'' feeling may occur even though you have read about it and tried to avoid it. Your swelling, bruising and new scars are expected.

Only in the movies are the results immediate. The facelift operation can turn back the clock, but it can't stop time.

The face can retain its pleasant firmness for five to seven years, and you will not experience any sudden fall or drop in the tissues at that time.

Rather it is a gradual process of relaxation that occurs. However, the improvement from facelift surgery is always apparent. For example, if you had a twin who did not have the lift, you would always look better than your sibling.

Activities:

During the first week, walking about without staining, lifting, pulling or bending at the waist is the extent of permitted activity. It is most important that you not turn your head from side to side. It could weaken the undersign muscle and tissue reconstruction. Always move the head with the trunk.
During the second week, you may increase your activities but still no heavy lifting. You can turn you head slightly.
At the third week, you may begin exertional exercise, including mild weight- lifting.
By the end of the fourth week, you can resume a fairly normal range of activities including golf, tennis and swimming.

Our goal in facelift surgery is improvement. Perfection, as in all plastic surgery, is neither possible nor even desirable. Removal of wrinkles and upward stretching of skin is always done within the limits and tolerances of the tissues. What you can anticipate is looking as fresh, alert and rested as is possible for your age.
The facelift operation does not affect the fine wrinkling around the mouth. Nor does it eliminate the very deep lines that run from the outside attachment of the nose to the corner of the mouth. It also does not eliminate the very deep scowl or frown lines between the eyebrows and on the forehead. These require a separate, but different, procedure.

SWELLING

Any operation is accompanied by swelling of the surrounding tissues. The amount varies from person to person, but it always seems more prominent in the face. Swelling may be more noticeable after the first post-operative day. It may be more pronounced along the jaw line, and is generally most noticeable in the morning after you first wake up. This swelling is normal. It is not serious, and is to be expected after your surgery. The main thing to remember is that swelling eventually subsides. You can help decrease the swelling in the following ways:

Sit, stand, and walk as much as you can after you leave the hospital. Staying in an upright position can decrease the tendency for swelling. When you need to look from side to side, move your shoulders and head as one unit, as though you had a stiff neck. The healing process of the tiny sutures (or stitches) will be sufficient after two weeks for you to move your head normally again. Do not move your neck from side to side.

It is always a good idea not to use your back when lifting heavy objects. For at least a week after surgery, bend at your knees, not at your waist, to lift light objects that are below waist level. If an object is in the least bit heavy, ask a family member to lift and carry it for you.

For your own comfort and to aid the healing process, be especially careful not to bump your face and neck. Sleeping alone for one week after surgery will help insure that you rest comfortably. Sleep with the head of your bed elevated for one week after your surgery. To accomplish this, place two or three pillows under the head of the mattress. For the first three days after surgery, do not put a pillow under your head, but put your head flat on the mattress, with the mattress plumped up by the pillows underneath it. Sleeping on your face tendsto tear down the supporting stitches used under the skin. Therefore, it is necessary to sleep on your back for 3-4 weeks.

Some patients find a reclining chair placed at a 45 degree angle to be more comfortable.

Supporting the face and chin with a chin sling aids healing and protects the face and ears from undue stress. Wear the chin sling constantly for one week after your operations. After this, the sling should be worn at night until 30 days after your surgery. It is also beneficial to wear the sling during the day when you are alone during this 30 day period. You can continue to use ice compresses in the exposed areas of your face such as you were using at the hospital. They may help with the discoloration and swelling, as well as minor discomfort, for a few days after you leave the hospital. Avoid straining during bowel movements. If you need a laxative, your pharmacist can suggest an over-the-counter Protect your face from the sun with a sunscreen for at least one month; it is always a good idea to wear sunscreen to keep harmful rays from intensifying the aging process.

Remember – report any sudden increase in swelling to us.

DISCOLORATION

It is not unusual to have varying amounts of discoloration about the face. Like swelling, it may become more pronounced, especially in the neck, after the first day or so. Remember, this is temporary. It usually lasts no more than two weeks, and it decreases in intensity all the time.

The instructions given for decreasing swelling will also help the discoloration; however, there is no medication that will cause it to disappear rapidly. You can camouflage the discoloration to some extent by using makeup, and a concealer used around the eyes can help cover bruises. DO NOT APPLY MAKEUP OVER THE INCISIONS UNTIL SEVERAL DAYS AFTER THE SUTURES HAVE BEEN REMOVED. You can apply makeup within ¼” of the incision lines, however.

DISCOMFORT

You can take the pain medication which we will have prescribed for you. Under NO circumstances should you take any medications containing aspirin or salicylates. Be sure to check the labels of any pain medication you have, or that you purchase from the drug store. If you have a sudden onset of pain or a feeling of tightness around the incisions, especially if it is particularly strong on one side, call the office.

OOZING

If you notice bright red oozing coming through the bandages, go to bed, elevate your head, apply ice compresses to your face and neck, and call the office. We will give you further instructions when you call.

TEMPERATURE

Generally, your temperature will not rise very much above 100 degrees after your facelift; this rise is due to the healing you should measure your temperature by mouth. Report any persistent temperature above 100 degrees to the office.

WEAKNESS

It is not unusual after you have had an anesthetic or any type of operation to feel weak, have palpitations, break out in “cold sweats” or feel dizzy. This gradually clears up after a few days without medication.

INSOMNIA

We will have prescribed a sedative for you in case you have difficulty sleeping after your operation. It is important to remember that such drugs can make some people feel light headed and weak. You should only take this if you need it.

DEPRESSION

It is not unusual for you to go through a period of mild depression after cosmetic surgery. No matter how much you wanted the operation, the post-operative swelling and bruising can be disappointing. Be patient. The bruising and swelling will subside quickly, and your surgical result will be evident.

NUMBNESS

Parts of the face, neck, and ears will sometimes feel weak or numb after a facelift. This is temporary, and will gradually go away.

TIGHTNESS OF THE FACE

The skin of your face may feel tight for a while, and you may feel that it interferes with your smile. This will disappear within a few weeks.

INJURIES TO YOUR FACE

You may have some kind of accidental blow to your face during the early postoperative phase. This actually does happen to many people. You don’t need to be too concerned, unless the blow is hard, or if you have hemorrhaging or swelling afterwards. If you do have these symptoms, call the office. Otherwise, just mention it to us at your next visit.

THINNING OF THE HAIR

You may experience some thinning of the hair in some areas by the suture lines in the temple and behind the ear. This is temporary.

MEDICATIONS

As we mentioned before, a prescription for pain and one for sleep have been ordered for you. Take these only if you feel you need them. Take ALL of your antibiotics until you run out. After we remove your dressing, you should clean the incisions with hydrogen peroxide two or three times a day. You should then apply the antibiotic ointment we prescribed for you with a Q-tip to the incisions. Keep the incisions thoroughly covered with the ointment until we tell you to stop using it.

INCISIONS

After all your stitches have been removed, the incisions will be a deep pink. There will be varying amounts of swelling in and around the incisions themselves. With time, the pink will become white, and the firmness of the scars will soften, making them less noticeable. Everyone heals at a different rate, but it takes approximately one year for all the changes to occur.

THE POST-OPERATIVE PERIOD

When you come out of the anesthesia after your surgery, you will have a large bulky dressing. This will remain in place for about 24 hours after your surgery. If your dressing begins to feel very tight or uncomfortable, report it to your surgery, or at your first post-operative visit to the office the day after your surgery. Call us if one of the drain reservoirs fully fills with blood. You should be as quiet as possible during this time. A great deal of talking and having too many visitors is discouraged.

At your first post-operative visit, we will remove your dressing, remove drains if you have them, change your bandages, clean your incisions, and apply ointment. You will probably feel much better after this visit. At no time should you try to remove any sutures or disturb any crusting yourself. If you are bothered by something after yoursurgery, call us or tell us about it at one of your post-op visits.

On the fourth or fifth post-operative day, we will check your healing. We may remove some sutures at this time as well.On the seventh or eighth post-operative day, we will remove the sutures around your ears and some of the staples in the scalp. You may want to wear makeup at this time, but remember not to apply it directly on the incisions.

Between your tenth and twelfth post-operative days, we will remove the rest of the staples. After this visit, you can wash your hair, but avoid straining your neck. Please do not visit your hairdresser or color your hair for three weeks after your surgery.

We will see you again for a three week visit. By this time, you will already be somewhat familiar with the “new you”. After this visit, you can see your hairdresser for a professional styling.

Two months after your surgery, we will take photographs and monitor your healing. We will also be doing this at intervals during the following months.

RESUMING ACTIVITIES

Eye glasses may be worn as soon as bandages are removed.
Contact lenses may be inserted the day after surgery.
You can use cotton balls to wash your face gently after the first week. Use a mild soap and wash with a gentle, upward motion.
You can take a shower by the fourth post-operative day, but NEVER take one on a day after your have sutures removed.

Do NOT tweeze eyebrows for one week after your surgery.

You can be up and around with your usual activities, except for lifting heavy objects.
For one week after surgery, wear clothing that doesn’t have to be pulled over your head.
For six weeks after your surgery, do not swim, perform any kind of strenuous athletic activity, or perform any exercises that involve turning the head
Move your face and neck as little as possible after your surgery to help your skin heal faster to the underlying tissues. To help achieve this, you should do the
Avoid excessive smiling.

Do NOT bend your head forward or backward for two weeks.

Avoid gum and foods that are hard to chew. Easily chewed foods such as soup, mashed potatoes, and hamburger are allowed. Stay away from steaks, French bread and other hard to chew foods for at least one week.
Avoid yawing with your mouth opened widely for at least one week.
Turn your head with your neck and shoulders as one unit. For two weeks, move your head as though you had a crick in your neck.
Do not drive a car for at least 2 weeks after surgery, because you should not be in a situation where you have to turn your head.
When you return to work depends upon the amount of physical activity and public contact your job involves, and also the amount of swelling and discoloration you develop. Many patients return to work and go out socially two or three weeks after their surgery. As soon as you are comfortable with your new appearance, let others enjoy it too.

FINALLY

Remember the things you were told before your operation:

When your bandages are first removed, your face will be swollen, and you will have some amount of discoloration. The swelling will be mostly gone within two weeks; however, it will take six to eight weeks for all of the swelling to disappear.

The discoloration will gradually disappear over a period of ten to fourteen days in most cases.

Report any of the following to the office:

• Temperature elevation • Yellowish discharge from the wound

• Sudden swelling or discoloration • Development of any drug reaction

• Excessive Bleeding • Increased pain or feeling of tightness

I/We have been given an opportunity to ask questions about my condition, alternative forms of treatment, risks of no treatment, the procedures to be used, and the risks and hazards involved, and I/we have sufficient information to give this informed consent. I/We certify this form has been fully explained to me/us, and I/we understand its contents. I/We understand every effort will be made to provide a positive outcome, but there are no guarantees.

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Patient / Legal Guardian