Dr. Buckinghams Q&A

Question:
Is general anesthesia or local anesthesia usually used for a facelift?

Answer:
We never use general anesthesia for a facelift. We perform a limited incision lower facelift in the office with oral sedation and local anesthesia. For a full lower face which includes a neck lift, we prefer a slightly deeper level of anesthesia achieved with IV sedation. General anesthesia is rarely if ever used. The only indication in our opinion is the male patient with a very obstructive airway or the patient with severe uncontrolled acid reflux.

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Question:
I’m interested in getting a facelift. However, there are so many different techniques out there. In fact, it seems like there’s a new type of facelift every day. Can you explain to me what some of the more common or more effective facelift techniques are and what they’re best at treating?

Answer:
The number of facelift techniques that are described is mind-boggling. Most of these “techniques” are merely marketing tricks to re-name a common procedure that has been performed for years. There is even one large corporation that is nationwide which has trademarked the name of a facelift and used mass marketing to convince the public it is something better and unique. Don’t be fooled. Most facelift techniques or variations of incisions and elevations of the deeper fascial layer. Regardless of the name that is given, incising the skin, gaining access to the fascial layer and elevating it in some way is a requirement for an effective and long-lasting facial result.

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Question:
What is a local lift?

Answer:
This is not a standard term, but probably indicates a lift that is performed under local anesthesia rather than a deeper more systemic anesthesia.

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Question:
My mother lives in Marble Falls and she wants a complete facelift. I think she is too old for this operation. I worry that she won’t heal and I am also concerned that she will have a lot of pain. She is 79 years old. Can you tell me what she has in store for herself if she gets a facelift?

Answer:
Age is much less important than personal medical history and family history. The patient that is healthy and 79 is a fine candidate for surgery versus a 50-year-old who’s had 2 heart attacks. A lower facelift is easily tolerated at 79-years-old. As you add more procedures, the recovery time becomes more lengthy but in our experience is still well tolerated. With the sagging of facial tissue usually facial volume loss is evident at this age. A consultation is advised to determine which procedures would be appropriate and a lengthy discussion about risks and healing time.

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Question:
I am 62 and have been noticing for a few years the decent in my lower face. I am pretty apprehensive about getting a facelift and have been doing some research. What does SMAS mean? I keep seeing this term.

Answer:
SMAS is an acronym for submuscular aponeurotic system. It is the fascial layer which envelops facial fat pads and musculature and becomes the platysma muscle in the neck. This is the layer which is elevated deep to the skin and tightened during a facelift.

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Question:
I am a 52 year old woman from Round Rock. I recently moved here and would like to have a rejuvenated appearance. I have been doing a lot of research into my options and feel that a more permanent result is what I want opposed to injections. Could you please explain to me the similarities and differences of a facelift and a mini-facelift?

Answer:
A mini facelift is a type a facelift. Both of these terms are used to describe different procedures however. In our practice we utilize the term facelift to describe the procedure in which a small incision is performed under the chin gaining access to excess fat in the neck and muscle. An incision is then created around the ears which allows tightening of the deeper connective tissues that surround the muscle (fascia) and advancement of skin. We do not technically call any of our facelifts mini-lifts, but rather a limited incision lower facelift. This procedure does not involve opening the neck but only an incision that is placed around the ear which allows for  tightening of the fascia and again advancement of skin. The limited incision lower facelift is excellent for improving the jawline and somewhat useful in improving the neck. A regular lower facelift improves the neck and the jawline significantly. At your consultation, the best approach will be decided upon for your specific concerns.

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Question:
How much excess skin is removed with a facelift?

Answer:
Every patient is different and the patients with more skin laxity will have more removed. It varies from as little as 1 cm to as much as 5 or 6 cm in width. The amount of skin removed is not as important as what is done to the deeper facial tissues. Only enough skin should be removed to provide a tension-free closure.

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Question:
I am a 57 year old woman from Waco and I have been reading a lot about facelifts. I’m confused because I’ve heard that a traditional facelift and lower facelift are the same thing. Does this mean that the traditional facelift only treats the lower portion of the face and neck? What traditionally does the facelift address?

Answer:
Facelift terminology can be very confusing. A traditional facelift does not necessarily refer to the particular procedure. A lower facelift is usually a term used to treat the jawline and neck. We usually utilize the terms cheek lift or mid-facelift for the middle portion of the face and brow lift or forehead lift for the upper portion of the face.

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Question:
Do men ever get facelifts? How do you perform them differently than on women so that men don’t look too feminine?

Answer:
Men can definitely get facelifts and in fact the number of men having facelifts is increasing. The procedure is done very similarly to women however the incisions need to be altered slightly to account for the beard that men have. Creating a feminine appearance is not a problem.

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