12 Things to consider before getting a facelift
Over the last six months, Allure has been exploring the phenomenon of the facelift in our series, Want a Lift? And in the process we have spoken to over two dozen plastic surgeons. They’ve taught us a lot about the reality (and myths) of mini facelifts, the ideal age to get a facelift, even how a patients’ injectables might complicate a potential surgery down the road.
But the doctors can really only tell part of the story. So we have also spoken to many, many facelift patients from around the country, including a 66-year-old farmer, a 52 year old who’s married to her plastic surgeon, and a 96 year old who has had three facelifts. They opened up about what happened both before they entered the OR and after the anesthesia wears off and you’re back at home, convalescing and checking out your new jawline (and nasty bruises) in the mirror. And, from the decision-making process to the reality they faced months later, every one of them had surprises along the way. Here, straight from the people who have been through the swelling, bruising, and—ultimately—the transformation of a facelift: 12 truths everyone should know if they’re considering one of plastic surgery’s most popular procedures.
1. The term “facelift” doesn’t mean what you think it does.
This surgery will not in fact bring your entire face northward. It’s really more of “a lower face and neck lift,” explains Theda Kontis, MD, president of the American Board of Facial Plastic and Reconstructive Surgery. (Lowerfaceandnecklift doesn’t have quite the same ring to it, though.) And today, instead of just pulling skin up—like doctors used to do back in the ’70s, often giving patients that “wind-tunnel” look—“deeper tissue and fat pads may be repositioned, and ligaments are often released in order to restore a more youthful look,” says Jennifer Levine, MD, a board-certified facial plastic surgeon in New York City.
That means the benefits of a facelift might start further down than you’d expect: “I don’t worry about wearing a turtleneck anymore,” says Cindy B, 66, who had her own facelift done by Dr. Kontis. “I got the surgery at 64, mostly because of my neck.”
But it also means a facelift might not get you the results you’re looking for all on its own, which brings us to…
2. Facelifts are rarely solo acts. They’re almost always combined with at least one other procedure.
Not one of the people we’ve interviewed about their facelift had just a facelift—instead, they had a facelift plus a fat transfer (in which fat is injected into the cheeks to restore volume). Or a facelift plus an eyelid lift (aka a blepharoplasty). Or a facelift plus a brow lift plus a chemical peel. You get the idea. In fact, it wasn’t unusual for a patient to have as many as four procedures at once.
That’s partly because a facelift doesn’t address the upper third of the face—you need a blepharoplasty or brow lift for that. To smooth out wrinkles, a patient’s own fat can be suctioned from another part of the body and injected into the mid-face. This has the added bonus of lifting sagging skin so your surgeon doesn’t have to pull the face too taut. You’re basically replacing the fat that, as it’s lost from the area with age, causes lines and laxity. “Putting some fat back in is a very natural way to fix the root of the problem,” Steven Williams, MD, a board-certified plastic surgeon in Dublin, California, and president of the American Society of Plastic Surgeons (ASPS), has previously told Allure. The fat is harvested from your own body, which makes fat transfer an extra tempting proposition: “People like the idea of having liposuction and repurposing or recycling the fat where it might be better perceived,” Dr. Doft previously told Allure. Or you might address wrinkles with “a chemical TCA peel under the eyes or dermabrasion around the lips to help with vertical lip lines,” says Dr. Doft.
One patient was surprised at her facelift consultation, when her doctor examined a picture of her in her 30s: “He looked at my cheeks and was like, ‘If you want that volume back, you’ll need [a fat transfer].’ It was the best decision ever,” says Deborah E., 60. “The nice thing about it was that it eliminated the hollowness under my eyes altogether… I was like, ‘Hey, where did those dark circles go?’”
When Amir Karam, MD, a double board-certified facial plastic surgeon in San Diego, performed a facelift on his 52-year-old wife Neda Karam earlier this year, he also gave her a fat transfer and a lower eyelid “skin pinch,” which is when you remove a small amount of skin underneath the eyelids. “Crepiness under the eyes can be exaggerated by the vertical lifting of the cheeks so this helps,” he says.
3. You might not go under general anesthesia.
There are different schools of thought on the best way to sedate facelift patients, but we were surprised when some of the patients we interviewed told us they did not get general anesthesia for their surgeries. “I had nine hours of surgery, but I was under IV sedation, not general anesthesia, so I didn’t feel nauseated [after] or anything,” says Maria C., 53.
During IV sedation, you can still be asleep for a procedure—but you don’t have to be. Dr. Karam performs his facelifts under local anesthesia with IV sedation. When we asked what it was like operate on his wife, he told us, “Once I started the procedure, it really did feel like every other day that I'm operating.” Except for one thing: “She’s the only patient I’ve ever had who was asking toward the end of the surgery, ‘Are you done yet?’”
Chris L., 54, also described being awake during her facelift. Her doctor used local anesthetic along with oral sedation (Diazepam and hydrocodone). “They also let me have laughing gas to get nice and relaxed.” (Nitrous oxide gas was administered only during initial injections of the local anesthetic.) “It did not hurt, but it was a lot of pulling and tugging and pressure and talking,” says Chris. “If I winced, he would stop immediately and go, ‘Did you feel that?’ And I’d say, ‘Well, yes, sir.’ And he’d get more of the local anesthetic, then there would be no more discomfort and the tugging would just continue.”
We asked David Shafer, MD, a board-certified plastic surgeon in New York City, how common this is. “For the right patients, it is possible to offer local anesthetic or laughing gas. However, this is the exception and not the rule,” he explained. “The face is delicate with complicated anatomy and having an awake patient risks the patient moving around during the surgery, which adds more risk. Additionally, in terms of safety, surgeons performing facelifts under local anesthesia generally don't have another doctor in the room such as an anesthesiologist. When a patient is having traditional anesthesia, the anesthesiologist [focuses] 100% of their attention on the patient’s vitals and comfort while the surgeon can [focus] 100% of their attention on the actual procedure. With local anesthetic, the doctor is constantly distracted by the patient moving or needing more local anesthetic, etc., and can potentially lose focus on the procedure at hand. Fortunately, modern anesthesia is much safer and gentler than the anesthesia available when their mom or grandmother had surgery.”
We asked Chris L.’s surgeon—J. Randall Jordan, MD, a double board-certified facial plastic surgeon in Jackson, Mississippi—about this, and he said, “Local anesthetic injections are very commonly used during facelift surgery—I can’t imagine doing one without them actually. They help both by blocking pain but also with bleeding, so I think the controversy is about using only local anesthetic, without general anesthetic or IV sedation. Over the last 10 years there has been a trend towards using local anesthesia along with oral sedation or lighter IV sedation as a safer way of performing surgery. There are many reports of this in the medical literature. Patients report less nausea and a quicker recovery with less anesthesia. Having said that, we are selective in who we use this technique [on]—they have to be in excellent health and of a calm nature. We do not hesitate to do the procedures in an outpatient operating room with more sedation or general anesthesia.”
4. The recovery period is not exactly a blip.
“Healing is a longer journey than you expect,” says Deborah E. “Overall, recovery took about four months total.” Kristy D., 52, says she was “actively recovering for at least a month.” And Mary S., 64, shares this advice: “If you have the luxury of being able to take time off, a solid month to six weeks is a good timeline.”
If you don’t have six weeks of PTO—and really, who does?— after three weeks, “most people can resume social activities without obvious evidence of surgery,” explains Patrick Byrne, MD, a board-certified facial plastic and reconstructive surgeon in Cleveland, Ohio. Those first three weeks, he adds, are when “patients may feel quite self-conscious about appearing in public. Still, it takes many months for the incisions and the tissues to fully heal.”
5. You might not want to look in the mirror for a while following a facelift.
“I looked like I had been in a street brawl.” “I was leaving the house at around two weeks with sunglasses on.” “I looked crazy afterwards with the swelling and bruising.”
That’s how some of the facelift patients we spoke to described their appearance for the first two weeks after surgery. “Honestly, you won’t look like your true self for about four months,” says Kristy D. “Listen, you have to have realistic expectations. You are not going to look great two weeks out of surgery.”
Marybeth M., age 48, had a different experience, though: “When you first come out of surgery, you don’t look that bad and then you proceed to look worse for three to four days. Everything gets bruised. About a week later, it looked like I got hit with a baseball bat. And then, 10 days later, I looked younger,” she says.
And some patients were even a little jazzed about the swelling: “Within two weeks, I was flabbergasted at how great I looked — a little bit of swelling can actually be very flattering,” says Joan Kron, 96, of her experience following her first facelift, at 63. (Kron is a former Allure editor, who went on to have two more surgeries.) Chris L. agrees wholeheartedly: “When I walked in for my first check-up appointment two days after surgery, I said, ‘If we could just keep this swelling, it’ll save me a fortune in future filler.’”
6. Parts of your face could be numb for months—maybe even half a year.
This is a lesser-known—but very common—side effect of facelifts. It’s not painful, per se, but it can feel odd—and it can linger. “The numbness is something I had to get used to for quite a few months,” Marybeth M. says. “Then, suddenly, I felt some tingling and I had my sensation back.” While it lasts, the numbness is pronounced enough that it might change the way you do some everyday tasks, like answer the phone. “Everything was exactly how the [doctor and nurses] told me it would be: It’s going to be numb when you put the phone to your ear, so be careful because you might hit your head without even knowing. If you put on earrings, you might pull too hard without knowing it, so no reason to wear earrings for a while,” says Elizabeth W., 59. “For a couple of months, I really had to press the skin to feel the area close to my ears.
Six months later, the feeling is still coming back and I have been told it’s a process. It’s a slightly different kind of numbness, with tightness to it. It’s not a pain, though.” Adds Melody M., 42, “I’m four months out from surgery and I’m still numb, but my doctor says the feeling will return in a couple of months.” Neda Karam says that for six weeks after surgery her face “felt like a rock. It didn’t look swollen, but it felt swollen. I didn’t really like touching it, to put sunscreen on for example. It just didn’t feel like normal skin.”
Prolonged numbness after a facelift is “almost universal,” says Melissa Doft, MD, a board-certified plastic surgeon in New York City. “It’s caused in part by inflammation—as swelling goes down, some of the feeling comes back—and part of it is that we just elevated the skin, so nerves have to grow back to re-innervate the area.” While the nerves are recovering, your skin can feel tingly and numb—but that won’t happen to your entire face. “Most patients have numbness right in front of the ear—that’s the most common spot—and occasionally around the ear, on the earlobes, or right under [the ears] on the neck, while everything is still swollen,” says Dr. Doft. “For some people, feeling comes back quickly. For some, it takes a while. It’s usually like a pins and needles feeling, it’s not totally numb.” Dr. Karam says that numbness “usually settles down by month three or four.”
7. You may feel depressed or anxious at some point after your facelift.
“Around day three after surgery, I got a bit overwhelmed. You start to question, ‘Why did I do this?’” says Maria C. “But that feeling passed and I started to see the positive changes in my face.” She’s not alone—about half of facelift patients experience some kind of “post-operative psychological reactions, [most commonly] depression and anxiety of varying degrees” within the first five days after surgery, according to a review of studies on the psychology of facelifts, published in the journal Facial Plastic Surgery. The review also found that, for most patients, these feelings go away by the end of the first week.
In her own practice, Dr. Doft most commonly sees patients experience a post-facelift low three weeks after surgery—they’re off pain medication, their stitches are out, but they’re not back to their old selves just yet. “By the third week, you’re tired, it’s been awhile, and you want to be fully healed but you don’t feel 100 percent normal,” says Dr. Doft. “These surgeries take around five to ten hours—and that’s a long operation, with anesthesia. You have to think of surgery as a car accident—it is a real trauma, your body is recuperating and needs extra calories, extra protection. It’s a drain. Recovery takes a long time. It takes months to recuperate and for swelling to go away, and people get frustrated.”
But it’s also true that facelifts are associated with long-term psychological gains—the same review of studies found 95% of patients experienced positive changes following facelifts, including “increased self-confidence and self-esteem, decreased self-consciousness about their appearance, and overall improvement in quality of life,” says the review. Patients who were less satisfied with their results tended to be male or have unrealistic expectations for what a facelift could achieve. It’s important to talk with your doctor about what a facelift realistically can—and can’t—do. As Kron says, “A facelift won’t transform you into any of the icons you admire. It won’t change your personality. It won’t restore your youth. But it can make you a fresher version of yourself and provide you with a sense of control—and that may give you more confidence.”
8. You can expect to wear a compression garment at the beginning of your recovery.
“I was wrapped up like a mummy after,” says Christine K., age 54. The garment—which prevents swelling—might feel as unpleasant as it sounds. “The compression bandage I had to wear around my face for three days after the surgery was the most uncomfortable part,” says Maria C.
But it doesn’t last long: “It’s not like Liz Taylor in Ash Wednesday, where she had mummy-like wrapping around her head for a month,” says Kron.
Dr. Doft says that most patients wear the compression garment for two to three weeks; some return to the office to have it removed the next day.
9. If you’re not already an accomplished binge-watcher, you’ll have to learn. (May we recommend Love Is Blind.)
Pause your workout plans and snuggle up—it’s best to avoid heavy lifting, strenuous activities, and even bending over for the first three weeks after a facelift. “Resting was the hardest part. I had to stop exercising for almost three months, which is a big part of my daily routine. I like to be active. But it is important to your healing, and you’ve just invested so much [in this procedure]. It’s your health, it’s your face,” says Mary S.
Of course, that doesn’t mean you can only lie in bed immersed in reality TV: “I was up and walking every single day. After eight weeks, I was told I could do gentle exercise, but I still gave myself another month before I went to the gym,” says Elizabeth W. It’s not a bad idea: “It takes many months for the incisions and the tissues to fully heal,” says Dr. Byrne. As with any surgery, “it's crucial to follow post-operative care instructions to minimize complications,” says Kimberly Lee, MD, a board-certified facial plastic and reconstructive surgeon.
Neda Karam, though, was pleasantly surprised at how soon she was able to return to her workouts following her facelift. After two weeks, she was walking and lifting light weights at home. On week three, she was back to group classes, though modifying her weights. “Before Neda’s surgery, I was very hardcore with patients about no working out before four weeks,” says Dr. Karam, her husband. “But then seeing what Neda was going through physically and understanding that you're past the point of bleeding or hematoma [bleeding under the skin] by two weeks, I’ve changed my mind. If the patient wants to exercise a bit at two weeks, maybe they'll get a little bit more swollen, but that's their choice. If they feel better mentally when they work out, then I'm going to be much more lenient.”
10. You will experience pain—but it might not be as bad as you think.
“It was really painful for the first couple of days. If you ever wore those old-timey, clip-on earrings, it felt like you had 1,000 of them on your ears,” says Cindy B. But that level of discomfort passes relatively quickly. The patients we spoke with generally didn’t need pain medication for long—most of them took something prescription-strength for two or three days following surgery, then switched over to Extra Strength Tylenol. Neda Karam says she only took Tylenol, from day one.
There were exceptions, though: Christine K was in for a few long nights right after her surgery. “I was vomiting for three days. I spent the first few nights sitting upright in a recliner chair because of the drainage. I used Tylenol around the clock for the pain. During the second week, things got progressively better.”
11. The scars really shouldn’t be a deal breaker.
Although scars were a big pre-facelift concern for many of the patients we interviewed, not a one was bothered by their scars after the fact—turns out plastic surgeons are very good at hiding incisions. “You can’t see any scars because [my doctor] hid them inside my ears,” says Melody M, age 42.
Adds Marybeth M., “the only telltale sign is scarring behind the ears and back hairline for me. Nobody really notices it. My masseuse can see it, I’m sure my hairdresser can see it, but for the most part you’d have to be six inches from my ear to notice—and if you’re that close, you better be somebody I like.”
Generally, facelift incisions—and their scars—are at the earlobe, behind the ear, and into the hairline. And advancements in facelifts have allowed plastic surgeons to make them shorter than ever before. “I can get [the scar] to be invisible,” Marc Mani, MD, a board-certified plastic surgeon in Beverly Hills previously told Allure. The endoscopic lift, in which surgeons use a lighted camera to see more of what’s going on under the skin through minimal incisions, has been dubbed the “scarless” facelift and is “a really good option for select patients who don’t need a big lift,” Ben Talei, MD, a double board-certified facial plastic surgeon in Beverly Hills has previously told Allure.
To help reduce the redness and thickness of scars, some plastic surgeons recommend post-surgery laser treatments—specifically, the Vbeam pulsed-dye laser: “After a couple of weeks, I went back to [my doctor’s] office and they lasered the incisions and made sure I was healing properly,” says Mary S.
Others might include dietary guidelines and LED in your after-care plan: “I took really good care of myself. I rested, did the hyperbaric chamber, the LED bed, ate a lot of protein,” says Kristy D. One small study of 20 female facelift patients found getting multiple sessions (7.22 on average) of hyperbaric oxygen therapy after surgery translated to statistically significant, shorter recovery times. Another study suggests LED treatment after a facelift may help mitigate scarring.
12. You just might get some time back in your beauty routine.
“My skin looks so good at 62 years old that I’m not wearing foundation anymore. I put on a little eye shadow and lip gloss and that’s it. Before, I had to carry a makeup bag like a tool chest,” says Connie C. 52-year-old Kristy D. used to get filler regularly. After her facelift, “I get Botox every six months or so. I don’t feel the need to get filler like before.”
And that can be incredibly liberating: “I feel like I wake up with a filter on,” says Marybeth M. “I don’t look tired or withered. It’s pretty amazing.”
Neda Karam has had a similar experience: “Sometimes I’d look in the mirror at the end of the day, feeling haggard, and that’s how I’d look, too. Now, even when I’m exhausted, I look in the mirror, and I look refreshed.”
A facelift is a major surgery. It will cost you time, and a lot of money. You will be swollen and bruised, and at points you may well regret the whole thing. There will be some surprises. But with the recovery behind them, every one of the facelift patients Allure has spoken to over the course of this series were pleased with their decision. Actually, in most cases, “pleased” would be a pretty serious understatement. As Chris L. put it, “I would do it again tomorrow. I’d do it again today!”
Original article appeared on Allure