Face

Facelift

Facelift surgery is helpful for patients who are experiencing typical aging changes in the face, including laxity of the skin of the cheeks, deepening of the nasolabial folds (alongside the upper lip), and marionette folds (alongside the lower lip), prominence of the jowls, as well as muscle bands and skin laxity in the neck. The procedure is tailored to the specific needs of the patient, and may include a midface lift alone (treating cheek and jowl laxity), a neck lift alone (treating skin laxity, muscle bands and fatty deposits in the neck), or a facelift, which treats both the midface and neck. It is commonly performed in conjunction with an endoscopic browlift, which treats wrinkles in the forehead and between the eyebrows and sagging of the eyebrows, upper and lower eyelid surgery (blepharoplasty), dermabrasion, or smoothing of fine wrinkles around the mouth or between the eyebrows, and fat injections in deep facial creases. It may also be performed in conjunction with breast or body contouring surgery.

Non-smokers in good general health who believe they have a tired or aged appearance are generally good candidates for this procedure. Both men and women may be good candidates for facelift surgery. With male patients, Dr. Casso is careful to avoid maneuvers which could cause facial feminization. Incision lines are carefully planned with patients to avoid visibility of scars or objectionable hairline distortions.

Many patients who have previously undergone facelift surgery may benefit from secondary facelift surgery. If previous surgery left poor quality or poorly positioned scars, oftentimes these may be improved with further surgery. Other complications of poorly planned or poorly executed surgery, such as a “pixie ear deformity”, “lateral sweep”, or misdirected neck wrinkles, may be addressed. Even optimal previous facelift surgery will be followed by further inevitable aging, which may be addressed with revisionary surgery.

While this procedure is sometimes performed under local anesthesia in outpatient facilities, Dr. Casso recommends general anesthesia and an overnight hospital stay at Houston Methodist St. John Hospital, which provides the patient with a comfortable surgical experience, and close, expert nursing attention, treatment of postoperative nausea, if present, and immediate medical attention in the event of any unforeseen emergency. The option for surgery in a full-service, state-of-the-art facility such as Houston Methodist St. John provides patients with a measure of safety and security which is unmatched.

In this procedure, Dr. Casso makes incisions beginning along or behind the hairline above the ear which are then extended carefully along the ear contours and then extend around the earlobe and end along or behind the hairline behind the ear. The skin and subcutaneous tissues of the face and the neck are undermined by releasing their attachments to underlying tissues. A deeper layer of tissue (SMAS) is similarly detached and repositioned in a vertical orientation. This deep plane face lift allows for more complete and long lasting facial rejuvenation than older, skin-only face lifts, which tended to result in early failure and unnatural tension lines, due to the tendency of skin to stretch and give. Dr. Casso has further refined existing deep-plane procedures to more comprehensively address facial aging, and to provide a more natural aging process over the years following surgery.

Excess fat, when present, is removed in the neck. Tightening of neck muscles may require a small incision under the chin. Finally, the facial skin is redraped, and excess skin is removed. The wounds are then carefully sutured, and scarring is often imperceptible.

While the improvement in appearance is often dramatic, Dr. Casso strives, above all, to insure a natural, un-operated appearance, with nearly undetectable scarring.

Many procedures are promoted for facial rejuvenation, often promising quick recovery, limited invasiveness, local anesthesia, and early return to normal activities. Unfortunately, significant, lasting improvement requires certain surgical maneuvers, which, of necessity, result in some degree of bruising and swelling. Given the substantial and lasting improvement, patients are very accepting of this recovery period.

Postoperative pain is generally moderate, and well controlled with oral pain medication.

The patient is typically seen in the hospital the day after surgery and discharged after small drains in the neck are removed.

Daily showers and shampooing are resumed at home the day after surgery. Patients are seen frequently in the early post-operative period. In some cases, a facial compressive garment is used.

Sutures are removed within 10 days, and bruising and swelling will decrease to socially acceptable levels in 14 to 21 days. Most swelling resolves in four to six weeks, but continued improvement is apparent for several months.

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