Answer:
It is normal for your skin to feel somewhat tight after a facelift.  It is not usual, at least in our hands, for your skin to look tight.  The tight feeling will gradually lessen and is usually resolved by about 3 months.  If your skin looks drawn and stretched that may mean that you had tension placed on the skin rather than on the underlying tissues.  This may still be alright as long as your incisions do not widen, but it may take longer for the sensation to resolve.  In our technique the lift is done on the deeper layers of the face and no tension is placed on the skin.  This results in longer lasting more natural results with improved scarring.

Posted by Dr. Buckingham

Answer:
The reason that some people get that wind-blown look after a facelift is because the surgeon has relied on skin tension to get the result instead of performing the lift on the deeper layer of the face known as the SMAS (submuscular aponeurotic system). When the lift is done properly the SMAS is lifted from the underlying tissue and elevated.  This is the layer that is responsible for facial aging to begin with and so it makes sense that this layer is elevated to get the result. When this is done the overlying skin will move with it and some skin is excised. The skin should be under no tension however. When a surgeon puts tension on the skin, not only does the patient get a wind-swept appearance, but also widened scars. The scars from a facelift should be barely visible to invisible every time.  It pains me to see patients come in with facelifts by other surgeons and see widened scars or hair that has been shifted into unnatural positions that are very difficult to correct. A facelift should provide a significant, but natural result and one that no one can tell you have had surgery. The patient should be able to wear their hair in any style, including a pony-tail without visible scarring. Please look at our before and after photos of our facelifts to convince yourself.

Posted by Dr. Buckingham

The timing of a facelift with regard to weight loss is not really important.  A facelift is designed to improve the jawline and neck.  The excess fat that exists in the neck will be removed during the procedure and so it is not necessary to lose the weight first.  Having said that, significant weight loss in the face can lead to aging of the cheeks and lower eyelids.  This can be corrected with a facial fat transfer.  Usually the timing of this is not that important as long as you are not losing large quantities of weight.  I usually use 30-40 pounds as a rough guideline of enough weight to make a difference.  As long as you don’t have that amount of weight or more to lose then I feel it is OK to proceed with a facelift or fat transfer.

Ed Buckingham

Deciding whether liposuction alone would suffice to treat a neck or whether a neck lift is needed depends on what components are involved and what the condition of the skin is.  Three components contribute to the sagging neck, skin, fat and muscle.  We tuck the muscle up on every neck, known as a platysmaplasty.  Some necks have a fatty component that needs to be removed with liposuction and if there isn’t much redundant skin and the skin is elastic then you can expect the skin to conform to the new underlying neck anatomy and do nicely.  If the patient is older or has considerable redundant skin however, then something may need to be done to reposition the skin as well, a neck lift.  At times the decision is straight forward, but in other patients the decision is a little gray.  As long as the patient understands that liposuction and platysmaplasty alone may not give perfect results, we may stick with the lesser procedure and reserve the neck lift for if the result is less than expected.  I hope this has been helpful.  Our before and after gallery can also help you compare your neck with other patients.  As always we would be happy to see you in consultation.

Ed Buckingham

Thanks for your question regarding why you would consider a facial plastic surgeon over a plastic surgeon for a facelift.  I would advise you to look at the questions differently, a facial plastic surgeon or a general plastic surgeon could be equally qualified or not-qualified to perform a facelift.  It depends upon what they have chosen to specialize in.  First, lets compare the difference betwen the training of a general plastic surgeon and a facial plastic surgeon.

A general plastic surgeon receives their board certification by completing medical school, followed by 2-3 years in general surgery performing abdominal surgery, trauma surgery etc, followed by 2-3 years in plastic surgery residency performing plastic surgery of the face, body, breast, hand etc.  Following their residency they may pursue a fellowship in an area to further hone their skills.  This may be in cosmetic breast, body or facial plastics as well a  host of other specialties related to plastic surgery.

A facial plastic surgeon obtains their board certification by completing medical school followed by a 1 year internship in general surgery and a 4 year residency in head and neck surgery, aka otolaryngology.  During that 4 year training the facial plastic surgeon spends their entire focus on the face, head and neck including cancer surgery of the oral cavity and neck as well as skull base surgery, sinus surgery, reconstructive facial surgery etc.  Basically, a facial plastic surgeon is immersed in the anatomy and conditions of the head and neck for 4 years.  Most facial plastic surgeons then complete a 1 year fellowship in facial plastic and reconstructive surgery where they further improve our skills related to the area of facial plastic surgery they are interested in.  This may be free flap head and neck reconstruction, cleft lip and craniofacial surgery or cosmetics.

Having compared the training, your question should really ask on what the surgeon has chosen to focus their practice on.  If the surgeon is performing mostly breast and body surgery and only performs an occasional facelift then they might not be as adept as facelift surgery.  In our case we only perform cosmetic facial surgery ie. facelift, rhinoplasty and skin cancer reconstruction on the face.  Therefore we have plentiful opportunity to practice our preferred procedures and master them.  In choosing a surgeon I would take a look at their website.  If they look like they are focusing on breast and body and only have a few facial patients you may take a look somewhere else.  If they look like they have a volume of facial patients and the results are natural and significant then they may be someone worth seeing in consultation.

I hope this helps in answering your question.  I encourage you to look at our before and after photos and video gallery.  Please feel free to call for a consultation if you feel comfortable.

Ed Buckingham