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Robert S. Hamas, M.D.
8345 Walnut Hill Lane
Suite 120
Dallas, TX 75231
(214) 363-1073
(214) 890-7844 (fax)

As you age, your facial tissues relax and begin to sag. Not everyone’s face shows the changes of aging in the same way or at the same time. Some show more aging changes than others and some show changes sooner than others. This is due to differences in genetics, environmental damage to the skin, and damage to elasticity from the sun or weight fluctuations. For instance, in some people the neck first shows the most aging and sagging, while in others it may be the jowls that become very prominent.

A facelift turns back the clock and reverses many of the changes due to aging. This usually involves elevation of the jowls and cheeks along with contouring and tightening of the jawline and neck. The eyebrows and eyelids are not considered part of the face, though they are often lifted at the same time as a facelift.

When you start looking older and more tired than you feel and are bothered by sagging jowls or extra tissue in the neck, it is time to seriously consider a facelift.

Doing a facelift at too young an age (under 40) is rarely appropriate since the aging changes are usually so minimal. A facelift does not prevent or delay the onset of aging changes. Therefore, it is best to wait until you have aged at least enough that you will see a benefit from the procedure.

A well-done facelift should leave you looking rested and very natural, like you just came back from a great vacation. Your features should not look different.

The extreme "windblown" look can be avoided by not pulling the tissues or skin too tightly. Your face should not appear pulled or tight after a facelift.

Older facelifts just pulled on the skin, which left it abnormally stretched. Modern facelifts are done by lifting a deeper tissue layer called the SMAS. This relatively thin layer of fibrous tissue is just under the skin’s fatty layer. Lifting the SMAS transmits the lift to the skin via small fibrous connections. Unlike skin, the SMAS layer does not stretch, so it tends to stay where it is repositioned and sutured. The extra skin is trimmed away, but there is no pull on the skin, so it looks natural and heals well.

The direction of lift on the SMAS is mostly vertical, opposite gravity that caused the sagging. There is a smaller amount of lift toward the ears that also helps smooth the cheeks. This more vertical lift is a change from older facelift techniques which mostly pulled everything back toward the ears, giving a windblown rather than a lifted look.

before  /  after Click image to enlarge

68 year old with facelift, endoscopic eyebrow lift and lower eyelid lift

How is the neck lifted?

In both men and women, the goal for the neck is a well-defined jawline and a good contour in front. As with the face, just pulling on the skin is not desirable. Instead, the neck is lifted via a deeper tissue layer similar to the SMAS called the platysma. It is actually a thin sheet of muscle extending from low in the neck toward the jawline and is attached to the skin through fibrous connections. Lifting on the platysma lifts and tightens the sagging neck skin and defines the jawline.

In some patients, the platysma muscles may be so relaxed that noticeable vertical bands or "cords" extend down from the chin. These are actually the front edges of the platysma muscles. Lifting on the back edges of the platysma muscles may be sufficient to correct this problem. However, a small incision under the chin is usually made so the muscle fibers can be sutured together in front for additional tightening and contouring of the neck.

Many men and women also have a disproportionate collection of fat in their necks. This is typically under the chin, but may also extend to the sides along the jawline. This fat is removed during a neck lift to give the neck good contour and definition.

A weak or receding chin makes for an unattractive neck contour and facial profile. This can be corrected easily by inserting a chin implant at the time of the facelift.

Occasionally patients do not need or want a facelift, but have prominent platysma muscle bands in the neck. These can be tightened through a small incision under the chin, often with fat removal. This limited procedure can make a significant improvement in neck contour for such patients. In some cases, a chin implant will further enhance the neck lift result.

Your facelift procedure will be tailored to your specific needs and anatomy. For instance, there are variations in how the neck is contoured depending on the amount and location of the neck fat and the laxity of the platysma muscles.

Everyone’s face is different, everyone’s face ages differently, and everyone has different concerns. Therefore, the procedure is adapted to fit each individual.

In most patients, the incisions along the front of the ears curve behind the tragus, the small piece of cartilage at the front of the ear canals. This helps hide the incisions by placing part of them inside the ears. The incisions continue just in front of the earlobes and then wrap around behind to lay in the depth of the folds.

Facelift incisions are quite inconspicuous once healed. I take great care with the closure of these incisions and do all suturing myself rather than use an assistant for this.

It is important to avoid elevation of a woman’s sideburns, since this is a telltale sign of facelift surgery. When incisions in front of the ears extend up into the hair, the sideburns can be elevated with the face, sometimes as high as the top of the ear. I avoid this undesirable look by not extending these incisions up into the hair. Instead, I go along the lower edge of the sideburns. Then, when the face is lifted, any extra skin is trimmed below the sideburns, and they are not raised.

before  /  after Click image to enlarge

53 year old with facelift, endoscopic eyebrow lift and perioral dermabrasion

Behind the ear, I do not place incisions along the edge of the hairline that extends down the neck because they may be visible during active athletics, when the hair is wet from swimming or when it is windblown. Instead, high behind the ears, I extend the incisions back into the scalp where they are hidden.

In men, the incisions in front of the ears can be extended up into the hair because elevation of the sideburns is not a problem. All a man has to do is shave lower to effectively lower the sideburns to their preoperative level.

The small strip of skin in front of the ear is normally bald. During a facelift, the bearded area of the face is lifted and may be moved toward the ear, narrowing this bald strip. It can be preserved by removing hair follicles at the time of surgery or afterward by electrolysis.

Though a facelift turns back the clock, the clock keeps running. The aging process continues after a facelift, but you will always look better than if you did not have a facelift.

Modern facelifts with elevation of the SMAS and platysma layers typically last between eight and 10 years. This does not mean that you will revert back to your original condition at that time. What this means is that after eight to 10 years, you will see enough changes from aging that you may want to consider having another facelift to keep you looking your best.

This area can be resurfaced to eliminate lip lines. While often done during a facelift, it can be done as a separate procedure under local anesthesia.

At the end of the procedure, you will be placed in a headwrap dressing. This is removed the next day so you can shower and wash your hair. The stitches in front of the ears and under the chin are removed on the third or fourth day after surgery. Stitches on the inside of the ears and behind the ears are dissolvable.

There is very little pain following a facelift. Tylenol with codeine is all that you will need for a day or two.

You may begin wearing make-up by five days after surgery. Bruising resolves between 10 and 14 days. Most swelling is gone by two weeks. At this point, many patients are getting out of the house, usually with some camouflage make-up and fluffed hairstyles. By three weeks, you should be comfortable and confident going out in public. However, for major social events such as a wedding or class reunion, allow six weeks to look your best.

You may resume athletics without restriction at two weeks.

Facelift procedures are usually performed under a light general anesthetic. You will be totally unaware of the procedure. Because the anesthetic agents are short acting, you will wake up quickly at the end of the procedure when you are taken to the recovery room.

You will be completely comfortable and safe either at home, or at a nearby hotel if you are from out of town. You need a responsible, caring adult with you for the first 24 hours.

You do not need a registered nurse since there are no nursing duties like dressings to change. All you need is someone there to help you to the bathroom and get you something to eat and drink.

Some of the risks include infection, bleeding, altered sensation, muscle weakness, asymmetry, delayed healing and scarring. Detailed information will be provided during your consultation.

Cosmetic surgery is done in my own accredited office operating room facility. Click here for more information.

Is there financing?

You may wish to use your VISA or MasterCard to pay for your surgery. Should you desire a personal loan, your own bank or credit union is your best source since they are already familiar with your credit history. If you prefer, the office will recommend a source for financing your cosmetic surgery.

For more information, or to schedule a personal consultation, call 214-363-1073

Robert S. Hamas, M.D.
8345 Walnut Hill Lane, Suite 120
Dallas, Texas 75231

Certified
American Board of Plastic Surgery

A Complete Guide to Cosmetic Surgery