"Doctor, could you just lift my neck and cheeks, I’m looking old!"

I hear this more often than any other complaint about the face except for, of course, patients asking me to help reduce their wrinkles.

What is a facelift? Also known as rhytidectomy, a facelift is a surgical procedure to improve visible signs of aging in the face and neck. Depending on the degree of change you’d like to see, your facelift choices include a traditional facelift, limited incision facelift or a neck lift.

A traditional facelift incision often begins in the hairline at the temples, continues around the ear and ends in the lower scalp. Fat may be sculpted or redistributed from the face, jowls and neck, and underlying tissue is repositioned. Commonly the deeper layers of the face and the muscles are also lifted.

Skin is re-draped over the uplifted contours and excess skin trimmed away. A second incision under the chin may be necessary to further improve an aging neck. Sutures or skin adhesives close the incisions.

Traditional face lifts can involve different procedures, here is a brief explanation of the most common ones:

Type I Skin Lift: This pulls the skin vertically upwards to lift the sagging neck and jowls — technically the easiest, but the results are not long lasting (highest recidivism).

Type II Skin Lift and Muscle Lift: These types of lifts combine excision and suturing of the muscle upward to bony areas of the face and the skin. They tend to last longer than the skin lift only. This procedure goes by many names ("Swift lift," "Quick Lift," "Macs Lift," "S Lift," "Mini Lift") and all are variations of lifting. Most now have small or limited incisions compared to several years ago.

Type III: Midface Lift: This type utilizes sutures, barbed sutures, absorbable tacks and "ribbon" type tacking to lift the cheek vertically upward toward the eyes. Most people can benefit from this type.

Type IV: Ribbon Lift: Uses and absorbable tacking device inserted around the temple region and tunneled toward the face.

The type of facelift depends on the problem, and the amount of sagging. It is a very personal choice between you and your surgeon. Suffice it to say that regardless of your choice, facelifts or mini-facelifts can be performed under local or local + sedation or general anesthesia. I prefer facelifts under local + oral sedation, which can be performed in 2.5 hours to decrease problems with anesthesia, including nausea and vomiting.

The risks include:

• Unfavorable scarring

• Bleeding (hematoma)

• Infection

• Poor wound healing

• Anesthesia risks

• Correctable hair loss at the incisions

• Facial nerve injury with weakness

• Facial asymmetry

• Skin loss

• Numbness or other changes in skin sensation

• Fatty tissue found deep in the skin might die (fat necrosis)

• Fluid accumulation

• Pain, which may persist

This is not a complete list but one you can begin to discuss with your surgeon.

It takes about six weeks for the swelling to reduce 80-90% after a facelift. You can expect redness around the incisions for up to 6 months. The effects of a facelift (which includes a neck lift) typically last five years or more. However, the results are dependent on the skin quality and strict postoperative adherence to surgeon instructions. You will be out of commission for one to two weeks. The best time to have a facelift performed is the winter, as sunscreen needs to be worn. There is less change of sun exposure during the winter months.

Men are increasingly becoming more comfortable with plastic surgical procedures and comprise 11% of the cosmetic market. Whether it is for personal or business reasons, men seem to be taking care of themselves more and more.

I am often asked, "Why can’t you just lift my neck?" In rare cases a neck liposuction combined with Smart Lipo may be enough, and occasionally an isolated neck lift is sufficient.

But only about 30-40% of the population can benefit from those isolated procedures.

Discuss all these options with your surgeon and as always, make sure you are talking to An American Board of Plastic Surgery Board Certified Plastic Surgeon.

[BY: DR. THOMAS T. JENEBY]