Facelift (Rhytidectomy)

There are many terms commonly used to describe surgical approaches to rejuvenation of the neck, lower face, and jawline. These have included facelift, neck-lift, rhytidectomy, mini-lift and countless others. Regardless of the exact name given to the procedure, the basic concepts are the same. Small, well-hidden incisions are made around the ears to give the surgeon access to the deeper tissues of the face, or “SMAS” layer. This layer is pulled in an upward vector, to treat the jowls, improve the appearance of the nasolabial folds, minimize the marionette lines, and tighten the loose skin in the neck and jawline.

Dr. Mehta uses the latest technology and surgical techniques to minimize downtime and provide long lasting results for his patients. By focusing on the deeper planes of the face, Dr. Mehta is able to provide a natural effect, without the undesirable “pulled look”.

A talented facelift surgeon, Dr. Mehta has many satisfied patients with outstanding results. He has been invited to lecture numerous times to residents and medical students on the topic of Facial Rejuvenation, at both USC Medical Center and Saint Louis University Hospital.

The Consultation

Your visit for a facelift consultation with Dr. Mehta will last approximately one hour. Dr. Mehta will begin by asking you what exactly bothers you about your appearance and what improvements you would like to achieve. There are numerous nonsurgical treatments that Dr. Mehta utilizes extensively, including Botox and Dysport, injectable fillers, and topical prescription skin care products. If you are a candidate for any of these treatments in lieu of or in addition to surgery, he will discuss these with you as well.

Dr. Mehta will then obtain a careful history, including medical conditions that may affect your ability to undergo and recover from surgery. Any history of adverse reactions to anesthesia or medications commonly given before, during, and after surgery is also determined.

This discussion is followed by a thorough examination of your face and neck, followed by a demonstration in front of a mirror of what Dr. Mehta hopes to achieve. Following the examination, Dr. Mehta will photograph your face from several different angles. The images are displayed on his computer, enabling both Dr. Mehta and you to inspect your face in detail.

After your consult, Jill, our Office Coordinator, will help you with scheduling your surgery and pre-/postoperative appointments with Dr. Mehta. If you would like to come in for a second consultation, we are delighted to make accommodations.

Preoperative Visit

After this initial consultation, you would return for a preoperative visit, two or three weeks before the scheduled surgery. During this visit, Dr. Mehta will again go over your list of medications and supplements, as it is usually necessary at this time to discontinue any products that can increase the risk of bleeding during or after the surgery. These include, but are not limited to, aspirin, ibuprofen, heparin, warfarin (Coumadin), Plavix, vitamin E, fish oil and numerous other supplements. The decision to stop any of these prescription or over-the-counter products is made in conjunction with your primary physician. Medical clearance and other tests may need to be obtained, depending on your age.

Dr. Mehta will give you prescriptions for your pain medication (or call your pharmacy) at this visit as well. This allows you to pick up these important medications prior to your surgery, so that postoperatively, you and your caretakers can rest and concentrate on your recovery. Dr. Mehta will advise you to pick up Arnica Montana and Bromelain, two homeopathic products that reduce bruising after surgery. These are taken as directed, beginning immediately after surgery. You will be given detailed preoperative and postoperative instruction pamphlets, to read prior to your surgery. It is important to minimize salt intake and avoid alcohol for three days leading up to your surgery.

Lastly, you will have the opportunity to spend time with Jill, our surgical coordinator, to answer any logistical questions related to your surgery. Your final surgical fees are settled at this visit as well.

Surgery

On the day of surgery, you will arrive at the surgical center with a friend or family member who will drive you home and care for you after your surgery. It is imperative to come in on an empty stomach, not eating or drinking anything for at least 8 hours prior to your surgery. This includes water and chewing gum. You should wear loose and comfortable clothing, including a shirt that buttons in the front to avoid having to pull anything over your head after surgery.

The operating room nurse will meet with you first to go over your instructions in detail. You will then meet your anesthesiologist, who will have carefully reviewed your medical and surgical history. You will have the opportunity to ask the anesthesiologist any questions you may have at this time. Finally, Dr. Mehta will meet you and your friends/family to answer any last minute questions as well.

For the vast majority of his facelift surgeries, Dr. Mehta and the team of anesthesiologists use “twilight” sedation, in which the patient is completely unconscious but breathing on his or her own throughout the surgery. This prevents the need for placement of a breathing tube, paralysis or use of a ventilator. Additionally, patients awaken more quickly after the surgery and have less nausea and “hangover” effect. For some patients, the procedure can even be done under lighter IV sedation.

The surgery begins with small, well-hidden incisions in front of and behind the ears. Dr. Mehta designs these incisions such that the ear hides the majority of the incision. His design allows you to wear your hair in a ponytail after surgery, while the fine healed incision lines remain undetectable. There is no shaving or cutting of hair.

The lift is performed on the deeper layer of the face, the SMAS, creating a natural rejuvenating effect. Because the skin does not bear much tension, the incisions heal quite well. The risk of fluid collection under the skin is also likely reduced using this technique. Dr. Mehta, in fact, does not use any drains after his facelift surgery.

In addition to his SMAS facelift technique, Dr. Mehta often performs platysmal plication during this surgery. This procedure begins with a small (~2 cm) incision underneath the chin. The “neck bands” or front edges of the platysma muscle, are sutured to one another to make them much less visible and create a sling-like effect.

After surgery, you will awaken in the recovery room, where your vital signs are carefully monitored by the anesthesiologist and recovery room nurse. Your head will be wrapped with a soft compressive dressing to hold pressure on your face during the recovery process.

After Surgery

After approximately two hours in the recovery room, you will be discharged home, in the care of a responsible adult for the first night. Your friend or family member will check your incisions, ice your face and neck, assist with your pain medications, and help you with your normal daily activities. You will sleep with your head elevated at 30-45 degrees. At this time, you will begin taking your prescribed medications as well as the Arnica Montana and bromelain. Eating fruits such as pineapple and papaya are encouraged as well, as they are thought to help minimize bruising.

You will return to the office the following morning to be seen by Dr. Mehta. He will remove and replace your compressive dressing and go over your instructions in detail. The compressive dressing is worn for an additional 72 hours. During this time, most patients develop bruising around the eyes, cheeks and neck, while pain and discomfort are usually mild to moderate. Patients are encouraged to walk and do light activities as early as the day after surgery. Often patients will work from home 2-3 days after surgery though most avoid work or social situations until around day 8-12.

Your diet should be soft, mild in flavor and with minimal salt for the first 10-14 days after surgery. To minimize swelling and the risk of complications, you should avoid any vigorous activity or heavy lifting for this same period of time.

Your next visit will be 6-7 days after surgery, at which time your sutures are removed. Your face and neck may be somewhat swollen and bruised at this time, though the majority of the swelling and bruising disappears over the subsequent few days. On average, patients return to work or social activities 8-12 days after surgery though this certainly varies depending on one’s degree of bruising/swelling and comfort level. Any faint incision lines at this point are quite inconspicuous and can easily be masked with a small amount concealer, if this is even needed.

The next visit will be at three weeks after surgery, at which time, Dr. Mehta will check your progress and answer any questions you may have. Your next visit will be at six weeks, followed by 3-6 months, at which time the “after” photographs are often taken. Typically, your future visits will be every three months until the 12-18 month mark, at which time, photographs may again be taken.

Conclusion

The facelift procedure can yield dramatic yet natural appearing results when performed for patients who are good candidates for the surgery. It is well tolerated by most patients with a brief recovery period afterwards.

For more information or to schedule your consultation, please contact us.


Mehta Plastic Surgery

3351 El Camino Real
Suite 205
Atherton, CA 94027
650.363.1500