- Reasons for Facial Aging
- Am I a Candidate for a Face Lift?
- Getting Ready for Surgery
- Location of Your Surgery
Reasons for Facial Aging
As people age, the effects of gravity, exposure to the sun, smoking, and the daily stress of life can be seen in their faces. The typical signs of aging begin with the deep creases that form between the nose and mouth (nasolabial folds or the “parentheses”), “crow’s feet” around the eyes and creases across the forehead. “Laugh lines” and “marionette” lines also become visible on the lower face. The jaw line becomes poorly defined, and jowls form. Folds and fatty deposits appear around the neck. Overall, one can think of aging as the effects of gravity and a decrease in volume. Over time, the fat in the face droops with age, while both the bone and fat resorbs. The end result: drooping skin with fat in the wrong areas and an overall loss of volume.
Nothing can completely stop the process of aging. There are a number of treatments to reverse facial aging. They include non-invasive topical medicines, lasers, and injections to temporize the effects of ageing. Many patients present to Dr. Zemmel desiring a more aggressive, permanent solution to the effects of ageing. Richmond Aesthetic Surgery offers a number of surgical procedures to address the face, forehead, eyelids, and neck.
A facelift (technically known as rhytidectomy) cannot stop the aging process but can “set back the clock,” and improve the most visible signs of aging. Individuals who undergo a facelift find that they appear more rested, as if they just went on a long and relaxed vacation. This is accomplished by removing excess skin and redraping the remainder, tightening underlying muscles, and repositioning the fat in the face. A facelift can be done alone or in conjunction with other procedures such as a forehead lift (brow lift), eyelid surgery (blepharoplasty), chin augmentation, and nose reshaping (rhinoplasty). Oftentimes, Dr. Zemmel adds volume through fat injections, a novel and cutting-edge technique that replaces the fat that is lost with time, giving a “reinflated,” youthful look.
In decades past, facelift operations attempted to pull the face tight, often times giving a windblown, artificial appearance.
If you’re considering a facelift, this page will give you a basic understanding of the procedure: when it can help, how it’s performed, and what results you can expect. Dr. Zemmel at Richmond Aesthetic Surgery will be pleased to answer all of your detailed questions during your consultation.
Am I a Candidate for a Face Lift?
The ideal candidate for a facelift is a man or woman whose face and neck have begun to sag, obscuring the jaw angle through the creation of jowls and marionette lines. Most patients are in their forties to sixties, but facelifts can be done successfully on people in their seventies or eighties. A facelift will make you look younger, fresher, and rejuvenated. While a facelift may enhance your self-confidence, it can’t give you a totally different face, nor can it restore the health and vitality of your youth. Also, it will not remove the fine lines or wrinkles; for this Dr. Zemmel at Richmond Aesthetic Surgery may recommend a chemical peel or laser resurfacing treatments as an adjunct.
- Sagging of the central face
- Thicken nasolabial folds (laugh lines) and jowling
- Poorly defined jaw line
- Laxity of the neck with an obscured neck line
- Hollow check areas
- Sagging of the brow
- Excess skin and sagging of the upper and lower eyelids
Before you decide to have surgery, think carefully about your expectations and discuss with Dr. Zemmel of Richmond Aesthetic Surgery. Dr. Zemmel listens carefully to your expectations and concerns and implements his medical knowledge and experience into addressing them. Most importantly, he will discuss his main objectives of facelift surgery: to create a natural, more youthful appearance, while avoiding the lateral sweep or “wind blown” look. Dr. Zemmel strives to always provide this in a safe and reliable fashion.
The face must be seen as a full unit, and in order to create optimal surgical results and a youthful appearance, all areas of the face must be considered. Often, correcting the problems associated with facial aging in one area will cause the other areas to be much more noticeable. Think of it as an outfit. If someone updates the dress or suit they are wearing, their overall appearance improves. However, if they fail to change their outdated jewelry, shoes, belt, etc., then these areas will standout. The overall improvement will be severely hindered by lack of accessory updating. One can imagine that similar to clothing, the facial areas are connected and age together. Although, one area of the face may age faster, it is important to approach a youthful rejuvenation of the facial components together. The lower eyelids flow into the cheek, which connects to the lower face, and finally into the neck.
Getting Ready for Surgery
No two faces are alike, and therefore, no two facelifts procedures are the same. Facelifts are very individualized procedures. During your initial consultation, Dr. Neil Zemmel at Richmond Aesthetic Surgery will evaluate your face, including the skin and underlying bone, and discuss your goals for the surgery and which technique is safest and most applicable to achieve this.
Dr. Zemmel will check for medical conditions that could cause problems during or after surgery, such as uncontrolled high blood pressure, blood clotting problems, diabetes, or the tendency to form excessive scars. A full history and physical will be performed and the team at Richmond Aesthetic Surgery will send you to obtain “surgical clearance” from your primary care doctor and sometimes a cardiologist.
Be sure to tell the team at Richmond Aesthetic Surgery if you smoke or are taking any drugs or medications, especially aspirin or other drugs that affect clotting.
Dr. Zemmel at Richmond Aesthetic Surgery will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Following these instructions will help your surgery go more smoothly. You will be given all of your prescriptions before surgery during your preoperative visit. This will allow you to fill them ahead of time and have them ready for your arrival at home.
If you smoke, it’s especially important to stop at least 6 weeks before and after surgery. Smoking reduces blood flow to the skin, and can interfere with the healing of your incision areas. People who use tobacco in any form are at a higher risk of wound healing problems, infection, tissue loss, and widened scars. Dr. Zemmel insists that you stop using tobacco and nicotine in any form a minimum of 6 weeks prior to surgery.
Don’t hesitate to ask any questions you may have, especially those regarding your expectations and concerns about the results.
You should arrange for someone to drive you home after your surgery, and to help you out for a day or two if needed.
The Location of Your Surgery
Dr. Neil Zemmel performs facelifts at St. Francis Hospital’s Ambulatory Surgical Center. Smaller facial cosmetic procedures are usually done on an outpatient basis, but Dr. Zemmel of Richmond Aesthetic Surgery frequently admits patients overnight for full facelifts. By staying overnight your surgeon can treat your pain and any nausea or vomiting with intravenous medications, you will be hydrated all night with IV fluids, and the nurses will check on you often throughout the night.
If you are discharged home after your procedure, you will be seen the next day in the office for your first check up. If you are admitted overnight to the hospital, Dr. Zemmel and his team will see you the next morning. Your bandages will be changed and you will get a first glance at your new look!
A facelift is a complex operation that should be performed by a qualified plastic surgeon. While the magnitude of a facelift operation is less than a cardiac or abdominal operation for example, face lifting has risks that must be addressed. Dr. Zemmel will do everything in his power to provide you with the safest, most reliable procedure, with the best outcome. Dr. Zemmel accomplishes this through a number of ways:
- Dr. Zemmel performs all of his surgery in the hospital setting and uses only operating rooms with the highest level of safety certification and accreditation.
- Dr. Zemmel performs surgery only with Board Certified Anesthesiologists and Board Certified Nurse Anesthetists to ensure the safest anesthesia.
- Dr. Zemmel performs surgery with the same operating room team on every procedure in order to maintain consistency with each operation.
- Dr. Zemmel uses only the highest quality materials and instruments when performing your procedure.
- Dr. Zemmel follows his patients very closely after surgery to ensure the smoothest and easiest recovery for his patients.
Your team at Richmond Aesthetic Surgery believes it is safest to perform all facelifts under general anesthesia. You will be unaware, pain-free, and asleep for the entire procedure. All of your vital signs will be monitored continuously throughout the procedure. A facelift is a meticulous procedure and Dr. Zemmel requires you to remain completely still throughout the procedure. Anesthesia is provided by Board Certified Anesthesiologists and Board Certified Nurse Anesthetists. You will also be given medicines before, during and after the procedure to prevent any post-operative nausea and vomiting. Dr. Zemmel will prescribe Zofran (Ondansetron) to prevent this from occurring.
A facelift takes Dr. Zemmel at Richmond Aesthetic Surgery approximately two and a half to three hours to perform. However, facelifts are often combined with other facial procedures and the overall time depends on the number of areas addressed.
Incisions begin hidden in the sideburn area and extend in a natural line in front of the ear. It then courses in back of the small cartilage at the front of the ear (tragus) and continues behind the earlobe to the lower scalp. All of these incisions have been proven to be well hidden and concealed. If the neck needs tightening, a small incision may also be made under the chin.
Dr. Neil J. Zemmel at Richmond Aesthetic Surgery separates the skin from the fatty tissue and muscle layer below. A critical part of the facelift procedure is to tighten the underlying deep layer of facial tissues. This layer is called the SMAS (the superficial muscular aponeurotic system). The SMAS layer is essentially the layer of muscle that gives expression to the face. Dr. Zemmel tightens this layer by performing maneuvers called a lateral SMASectomy or SMAS plication. By doing so, he recruits the sagging fat and musculature and raises it back to its youthful position and reestablishes volume in the cheek area. This is critical in obtaining proper lift and returning volume to the face. By tightening and lifting the deeper layers, Dr. Zemmel gives an excellent, natural, long lasting result. Lastly, the skin is redraped over the face and any excess is removed. Stitches secure the layers of tissue and close the incisions. A light dressing to protect and secure the skin and incisions is then placed carefully over the face.
There isn’t usually significant discomfort after facial cosmetic surgery; if there is, it can be lessened with the pain medication prescribed. You face may feel slightly tight, puffy, and bruised. This usually resolves quickly in 5 to 7 days. Dr. Zemmel will prescribe analgesics (Percocet or Dilaudid), antibiotics, and medicine for nausea (Zofran or Phenergan). Dr. Zemmel’s team will go over each medicine prescribed before surgery so you are comfortable with your medications after surgery.
If you are admitted to the hospital over night, you will receive your medications intravenously. Pain medication, antibiotics, and nausea medicines will be given by the route. You will be monitored closely overnight, and a qualified nurse will take good care of you. Dr. Zemmel will then see you early the next morning to check on your progress. Bandages will be changed and any medication adjustments will be made. Once you are feeling well, you will be discharged later in the day.
If you have a more minor procedure, you will be discharged home after surgery. You will then be seen in the office the next day, and your dressing will be removed.
After surgery it is important to keep your head elevated and as still as possible for a couple of days to help with the swelling. Don’t be surprised at the pale, bruised, and puffy face you see. Just keep in mind that in a few weeks you’ll be back to normal and look like a new younger you.
Most of your stitches will be removed after about five days. Your scalp may take longer to heal, and the stitches or metal clips in your hairline could be left in a few days longer.
Feeling Normal Again
You should be up and about in a day or two, but plan on taking it easy for the first week after surgery. Be especially gentle with your face and hair, since your skin will be both tender and numb, and may not respond normally at first.
The surgical team at Richmond Aesthetic Surgery will give more specific guidelines for gradually resuming your normal activities. They’re likely to include these suggestions: Avoid strenuous activity, including sex and heavy housework, for at least two weeks (walking and mild stretching are fine); avoid alcohol, steam baths, and saunas for several months. Above all, get plenty of rest and allow your body to spend its energy on healing.
At the beginning, your face may look and feel odd. Your features may be distorted from the swelling, your facial movements may be slightly stiff and your incisions will be slightly red. Some bruising may persist for two or three weeks, and you may tire easily.
By the third week, you’ll look and feel much better. Most patients are back at work about ten days to two weeks after surgery. If you need it, special camouflage makeup can mask most bruising that remains.
Your New Appearance
You will be excited with the youthful transition and new, younger, more rested you. Remember that the results may not be immediately apparent because of swelling and natural healing. Most of the swelling will resolve in 3 to 4 weeks, but a small percentage may take 3 months or more to completely resolve.
You will have some scars from your facelift, but they will be well hidden by your hair or in the natural creases of your face and ears. In any case, they’ll fade with time and will be scarcely visible.
Having a facelift does not stop the clock; it just turns it back. Your face will continue to age with time, and you may want to repeat the procedure one or more times-perhaps around ten years down the line. But in another sense, the effects of even one facelift are lasting; years later, you will continue to look much better than if you had never had a facelift at all.
When a facelift is performed by a qualified plastic surgeon, complications are infrequent and usually minor.
Dr. Zemmel will do everything in his power to minimize the risks of complications. While the magnitude of facial plastic surgery is less than abdominal or orthopedic operations, for example, face lifting has defined risks that must be addressed. Dr. Zemmel will provide you with the safest, most reliable procedure, with the best outcome.
With any surgery, however, there is always a small possibility of complications or a reaction to the anesthesia. Bleeding and infection following a facial operation are extremely uncommon and occur less than 2% of the time. You incisions can widen to form thickened scars or you may have some asymmetry between the right and left sides. Complications that can occur include hematoma (a collection of blood under the skin that must be removed by the surgeon), injury to the nerves that control facial muscles (usually temporary), problems with skin loss and wound healing issues, and reactions to the anesthesia. You can reduce your risks by closely following Dr. Zemmel’s advice before surgery and post-operatively. Dr. Zemmel will discuss all of the risks and potential complications during you initial and preoperative appointments.
Dr. Zemmel will order the appropriate preoperative test including blood work and an EKG to ensure that you are healthy for surgery. In some patients, Dr. Zemmel may have you see an Internist or Cardiologist to obtain “surgical clearance.”
Smoking and other tobacco use increases the complication rate and increases the time needed to heal. Dr. Zemmel requires all of his patients to completely quit smoking a minimum of 6 weeks prior to surgery and 6 weeks after.
Dr. Zemmel at Richmond Aesthetic Surgery will instruct you how to reduce your risks of complications before surgery. He will assist you in quitting smoking to optimize your ability to heal. Dr. Zemmel and his team at Richmond Aesthetic Surgery will provide you with a full set of instructions after surgery as well.
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Directions to Our Office
Dr. Zemmel is proud to provide his plastic surgery services to patients traveling from nearby cities. For your convenience, we have provided driving directions to our practice from the following locations:
- Directions from Charlottesville
- Directions from Chesterfield
- Directions from Colonial Heights
- Directions from Glen Allen
- Directions from Henrico County