Edelstein Cosmetic

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  • Medical informationLook Younger and More Vibrant

    The synopsis

    Aging is a process to which we are all subjected. The notable signs of aging develop earliest on your face, characterized by deep creases, displaced or excess fat deposits, loss of muscle tone and loose, saggy skin. In an effort to revitalize their appearance, 119,026 facelift procedures were performed on men and women in 2011 according to the American Society of Plastic Surgeons. A face lift, also known as rhytidectomy, has the ability to make you look about 11 years younger, according to a study led by Dr. E. Swanson[1]. In the same study, 93.5% of patients reported that they would recommend a facelift to someone else.

    How to look over a decade younger

    • A facelift is a cosmetic surgical procedure designed to address the visible signs of aging.

    One of the only studies conducted to determine the satisfaction levels for facelift patients was performed by American plastic surgeons. The study, The measure of face-lift patient satisfaction: the Owsley Facelift Satisfaction Survey with a long-term follow-up study[2], suggests that a full year after facelift surgery, 87% of patients describe their results as very good or beyond expectations. Even after an average of 12.6 years, close to 70% of patients still described their results in the same way: very good or beyond expectations.

    Your facelift will achieve a level of improvement with which you’ll be content, and although results will be altered by the natural course of aging, you can expect your desired improvement to be long lasting.

    What a facelift can do for you

    •  Tighten lax muscles to improve tone and eliminate jowls
    •  Remove excess skin.
    • Eliminate excess fat in the neck to create a sleeker contour
    •  Redrape the skin, banishing deep creases around the nose and mouth as well as under the eyes
    • Rejuvenate the entire face, making you look years younger

    The longevity of your results relies on the particular surgical techniques that our craniofacial plastic surgeon, Dr. Jeffrey A. Fialkov, applies during your surgery. Your facelift is not about “stretching your skin”; it is about restoring the structure that lies beneath your skin to its more youthful state. With this substructure optimized, your overlying skin will be adjusted for a more natural, less “pulled” result that lasts longer.

    A facelift is often performed in conjunction with a necklift. If you have poor bone structure, facial implants may also be used to create a more aesthetically pleasing result.

    For a restorative transformation of your appearance that you will feel better about, call (416) 256-5614 to book your medical consultation about a face lift with Dr. Fialkov.

    I am thrilled with the results and am happy every day when I look at myself in the mirror. Hector

    Are you a candidate?

    As we age, skin becomes looser. Underlying tissues (fascia and fat pads) also sag. Excess tissue adversely affects the jawline and neck as the development of wrinkles, creases and sagging becomes more visible. A facelift is designed to remove excess skin and reposition deeper tissues for a smoother, firmer contour. The procedure targets the mid and lower thirds of the face (a brow lift and eyelid lift target the upper third). A dramatic improvement can be achieved in smoothing away the creases and sagging tissues that exist in the areas of your cheeks, around the mouth, along the jawline (jowls) and neck. If you are concerned about how aging has affected any of these areas, then a facelift may be right for you.

    Surgery is mainly recommended to people ranging in age from 40 and over, but some younger patients with fat deposits under their chins or “weak” chin structures may benefit from surgery as well.

    Your consultation

    The path to getting the best results from any cosmetic treatment starts with suitability. Will a face lift help you look better and more youthful, or will another procedure better achieve your desired goals? A private consultation with our facial surgery specialist, Dr. Jeffrey Fialkov, will determine this. Bring all of your questions and concerns to your consultation so that they may be addressed thoroughly by Dr. Fialkov, an award-winning plastic surgeon who is recognized as a leader in craniofacial plastic surgery.

    Dr. Fialkov will make sure you have:

    • realistic expectations
    • the goal of looking like yourself, but younger
    • relatively good health, both physically and psychologically
    • a stable and healthy weight
    • no underlying health conditions that may make surgery risky
    • a good understanding of the facelift procedure, as well as its related risks
    • the ability to stop smoking for a few weeks before and after surgery, to minimize complications with healing

    Alternative treatments may be available to you. These include the following:

    Laser skin treatments: Highly advanced laser treatment systems can be used to improve the texture of the skin by eliminating common signs of aging such as sun damage and fine wrinkles that have developed. Read more about the Skin Remodeling System.

    Facial implants: Dr. Fialkov may recommend the placement of chin or cheek implants in order to improve weak or flat facial features. Since weak bone structures contribute to facial drooping, implants are capable of providing a dramatic complement to your neck/facelift results. Read more about chin augmentation or cheek augmentation.

    Brow lift: Dr. Fialkov recommends a complete or partial brow lift for patients whose eyebrows have fallen below the bony region of the eye. Read more about a brow lift.

    Cosmetic Eyelid surgery: The surgical alteration of the upper or lower eyelids is the procedure most frequently performed alongside a facelift. This improves wrinkles and sagging in this delicate area. Read more about eyelid surgery.

    Risks

    It is extremely important that every prospective face lift patient be informed of the type of risks associated with the procedure. Dr. Fialkov possesses the skill and surgical experience that significantly lowers the level of risk associated with facelift surgery, however complications are still possible when any surgery is performed, whether it is cosmetic or functional. You can only make an informed decision on whether or not to undergo a facelift when you’re fully aware of the problems that can result from the procedure. These are thoroughly discussed during the consultation process.

    While reading the following list of risks and complications, it is important to remember that everybody responds to surgery differently. It’s impossible to predict how high the level of risk is for a patient without the insight of both a physical evaluation and a review of their medical history.

    Certain complications can arise during or after any form of surgery. These include excessive bleeding, blood accumulation (hematoma), problematic reactions to anaesthetic and infection, all of which are temporary and treatable with immediate medical attention. To minimize the rate at which these occur, facelift procedures are performed within completely sterile environments and proper surgical techniques are applied.

    Aside from the type of risks inherent to surgery in general, there are also a number of specific complications that can result from the facelift procedure. These include:

    Nerve damage

    The nerves that are responsible for controlling facial movement can be injured during the facelift surgery, however this is extremely rare. A patient whose nerves are injured is likely to see full facial movement restored as the body heals. Permanent damage is very unlikely, but is possible.

    Irregular scarring

    Dr. Fialkov is mindful when making incisions since every mark made to the skin will result in some amount of scarring. He lessens the risk of leaving behind noticeable, unsightly scars by creating incisions where they will be hidden by the natural contours of the face.

    Changes to skin sensation

    The areas of the face where incisions have been made may feel tingly or become numb after treatment. Any changes to skin sensation typically resolve during the recovery process.

    Hair or skin loss

    In very rare cases, patients may lose skin or hair after undergoing a facelift. This complication is very rare and most often affects individuals with a history of smoking. Ceasing tobacco use for the instructed length of time before and after the procedure is essential.

    Skin discolouration

    The skin may become discoloured after a facelift. Very few people will experience this complication, but, if it does develop, the change in colour can persist for a period of several months. It is very likely to resolve over time, however.

    Incision scabbing or crusting

    The incision lines made during surgery may scab or crust over. This is only a temporary issue and will subside as the body heals itself.

    Hematoma

    Hematoma refers to the accumulation of blood underneath the skin. If this occurs, it requires surgical removal and the use of drains.

    Facelifts can lead to irregular facial contours, asymmetry, or other cosmetic issues, such as the following:

    Stretched or distorted skin

    Facelifts that are performed by excising and pulling the skin back incorrectly or excessively often leave the patient with stretched or distorted skin. Modern surgical techniques, like the SMAS procedure, avoid this result by primarily targeting tissues located below the skin. When internal structures are shifted, the skin itself is not stretched as much and a more natural appearance is achieved.

    Altered hairline

    If the excess facial skin is moved to an overly high position during the facelift surgery, the patient’s temple area hairline will shift upward and to the back. This gives the appearance of a receding hairline. By properly placing incisions and ensuring proper direction of lift, this problem can be avoided, leaving all hair-bearing tissue undamaged and in a natural appearing position.

    Overly high brows

    A poorly performed facelift can leave patients with overly elevated brows and a constantly surprised expression. Our craniofacial surgeon exercises caution when performing the operation to avoid this outcome.

    Rotated or distorted ears

    When too much tension is placed on the skin surrounding a patient’s ears it can cause the ears to shift sideways. Excess tension on the ear lobe may also lead to a stretched lobe (known as a Pixie Ear Deformity). By placing tension in the tissues deep to the skin (SMAS) to alleviate skin tension, the ears remain in their natural position.

    Preparing

    You’ll receive instructions on how to prepare for surgery with guidelines for eating, drinking and smoking. Smokers should stop well in advance of surgery. You’ll most likely need to stop taking certain medications, particularly those that may increase bleeding. You’ll also find out what to do the night before and day of your surgery. You should make plans to have someone pick you up after surgery and help you the first few days of recovery, since simple tasks may be difficult to perform.

    Your surgery

    A facelift requires general anesthesia.

    The procedure typically involves a single incision that extends along the hairline, at the temples. If your neck is to be addressed as well, an incision may be made just under the earlobes. Through this incision, fat is sculpted and excess tissue may be removed. All incisions will then be closed and dressed. A bandage may be placed around your face.

    Following your surgery

    When you awake from your surgery, you will be in the recovery room. Dr. Fialkov does not use any dressings for the most part, only Polysporin ointment. Dr. Fialkov may elect to insert a soft drain under the skin. The drain will help remove any fluids that may accumulate under the skin, and is usually removed on the first or second post-operative day. Dr. Fialkov encourages all facelift patients, whether having undergone a necklift, mini facelift or full facelift, to stay overnight to recover. You must have a driver who will be responsible for taking you home (taxis are not acceptable).

    You may feel some pain and discomfort, but this is generally well controlled by pain medications. Most patients experience a moderate degree of discomfort for up to one week. Your cheeks, scalp, and neck can be very numb (numbness can last several weeks).

    Swelling, bruising and numbness

    A few patients may even have eyes that are almost swollen completely closed in the days after surgery. Most of the swelling will be gone in seven days. Your lips, mouth, cheeks, and back of your neck may feel tight for the first few days. Most bruising resolves in 10-14 days. Some light skin discolouration can last several weeks.

    During this period, we recommend that you keep your head elevated above your shoulders as much as possible, and to sleep on several pillows (this will increase drainage of the swelling by gravity). Sleep on your back as much as possible. Do not bend your neck forwards (bringing your chin close to your chest) when you are lying back on a pillow. This can interfere with blood flow to the skin.

    Soft, conforming ice packs (or frozen peas) can be used for 20 minutes at a time to help soothe and reduce swelling. You can do this up to four times per day. There is no added benefit to cold compresses after the fifth or sixth day after surgery.

    Make sure to rest quietly at home for the first week. This is very important, as any straining, such as fast walking, running, bending over, coughing, or lifting heavy objects, will increase blood flow to the face, which may result in increased bleeding, bruising, or a blood collection under the skin (hematoma). Remember: no Aspirin or anti-inflammatories (e.g. Advil) for at least one week, and no smoking for at least two weeks.

    Sensation will begin to return to your skin and ears by eight weeks.

    Going out in public

    It will generally be 10 to 14 days before the swelling and bruising has resolved enough that you will want to go out in public. This is when you will really start to see the rejuvenative effects of the surgery. Be patient during the first two weeks. After this time, camouflage make-up can be worn.

    Activities

    Dr. Fialkov encourages walking starting immediately post-op, but walk slowly and avoid strenuous exercises. Walking will help reduce swelling and minimizes the risk of deep clots in your leg veins. During the first 24 hours, someone should be there to assist you when you get up.

    For the first two to three days, eat a soft diet and drink fluids to rest your jaw as much as possible. The skin must stick to its new position and excessive talking disrupts it from its new location.

    Eat and read from a high table surface to prevent bending your chin down. Keep your chin elevated as much as possible.

    Driving should be avoided for the first three to five days until the swelling begins to settle (the swelling can make your vision blurry).

    You may return to normal activities after two weeks. Strenuous activity should be avoided for 4 weeks (eg. cardio, weight training, tennis etc).

    Avoid pull-over tops for two weeks. Be careful when you’re outside in cold weather—you can develop frostbite if you don’t wrap up in a scarf and hat (your cheeks and earlobes will be numb so you can’t feel how cold it is).

    Caring for your incisions

    You may begin to shampoo your hair and cleanse your incisions after the drains are removed, usually the second or third day after the surgery. Hair should be shampooed every day until all sutures are removed. Don’t forget to shampoo where the incisions are in the scalp as well, but don’t rub too hard.

    Take great care using a hairdryer or curling iron not to burn your scalp, ear or cheeks, as these will be very numb. You can gently brush out your hair.

    All the incisions should be cleansed with soap and water once or twice a day (any mild soap will do, for example, Dove or Ivory). Make sure you cleanse the incisions within the hair as well. Remove all crusts. If the crust doesn’t come off with soap, use a Q-tip soaked in 3% hydrogen peroxide to gently remove the crust. A thin layer of Polysporin ointment should be applied along the incisions in front of the ear (you don’t have to put Polysporin on the hair incisions because it becomes fairly mucky after a while).

    Sutures in front of the ear will be removed after five to seven days. Remaining sutures will be removed by two weeks.

    Once the incisions have healed, Polysporin should not be applied anymore. You can gently massage some scar cream such as Dermatix into your incisions.

    Avoid direct sunlight to the incision line as this may result in pigmentation changes. This is particularly true during the first year after the surgery. Never expose the incision to sunlight without sunblock—use SPF 30 or greater.

    Scars will initially be red and a little raised, but over three to six months they usually get lighter in colour and flatten out.

    Drains

    Drains are used to remove any excess fluid or blood, preventing accumulations under the skin. Drains are usually removed within two to three days. Occasionally, they need to be left in longer.

    If the drains are going to remain in longer than overnight, before you are discharged home the nurse will show you how to empty your drains, but here are a few reminders:

    1. Remove the cap. Hold the bulb upright and measure the amount of blood and fluid in the bulb by reading the measurement levels. Record the amount (see below).
    2. Turn the bulb upside down and squeeze out the blood and fluid into a garbage, toilet, or sink.
    3. Turn the bulb upright again, squeeze the bulb so it crumples and expels all the air, then while holding it tightly squeezed replace the cap. Release the bulb, it should stay collapsed. (The bulb should not quickly re-expand or there is an air-leak.)
    4. Measure and empty your drains every 12 hours.You may have to do this more often if the bulb becomes full before the 12 hours are up.

    Record the drainage in the following format:

    • DATE
    • TIME
    • DRAIN SITE (if more than 1 drain)
    • AMOUNT (in cc’s)

    Make-up and hair dyes

    No make-up should be used for the first 10 days. When you resume applying make-up, avoid heavy, dark brands as the incisions and scars may collect the pigment.

    You may have your hair styled and/or permed after two weeks, and you can wear your hair as you see fit.

    Avoid hair colouring for six weeks to avoid pigmenting the scar.

    Your results

    You’ll most likely be pleased with your rejuvenated appearance. Results will be long lasting. Over time, aging changes will reappear, but you will always look younger, more rejuvenated than if you had not had the surgery in the first place. You can maintain your new, beautiful look with these tips:

    Follow your plastic surgeon’s orders. Your plastic surgeon will provide you with specific instructions to help you while you heal. These instructions are designed to reduce the risk of complications and anything that may negatively impact your results. You should follow these, and if you have any questions or concerns about them, please let your surgeon know. It is important you understand every instruction so that you can have a successful outcome.

    Take care of your body. You should eat nutritious meals and exercise regularly. Not only is this good for your overall health, but it also gives your body what it needs to maintain a youthful appearance from your skin right down to your bones.

    Take care of your skin. Keeping your skin clean and well maintained is essential. Keep your skin supple and healthy by following a customized skincare regimen designed by our Head Medical Aesthetician. You should take advantage of her expertise, plus it’s totally free!

    Avoid sun exposure. You should use a sunscreen with a skin-protection factor (SPF) of at least 30 at all times when you are outside. Double or triple up on your protection by wearing a hat and appropriate clothing to protect your skin. Applying sunscreen daily will reduce sun spots, wrinkles and other signs of aging.

    Get regular massages. Massages help your circulation and muscle tone, not to mention they’re so relaxing!

    Your facelift can effectively address sagging and serious wrinkles, but your results aren’t impervious to the effects of time. While you can maintain your results with the tips listed above, you can also consider nonsurgical treatments to address any concerns that develop in the years after your facelift. Fillers and BOTOX® are designed to fight the signs of aging.



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