Facelift

A face lift can be carried out either in the clinic or outpatient basis but with a short stay in the hospital too. The individual time scale usually depends on the extent of the planned operation and will be carefully discussed with your surgeon (Dr. Dirk Kremer). Generally, you should plan for 1-2 days of hospitalisation, during which time post-operative care will be ensured by trained staff.

Facelifts are usually performed under general anaesthesia, which means that you sleep during the entire procedure. Details of the anaesthesia will be discussed pre-operatively by an anaesthesiologist, which clarifies your specific anaesthesia requirements. The anaesthetist will be present during the entire procedure and control the anaesthesia.

Alternatively, the so-called “standby-anaesthesia” is available. It is also controlled entirely by the anaesthetist, they will be calculated not intubated and ventilated. You fall into a deep, pain-free sleep.

Undergoing a facelift is a very private decision. Most patients won’t admit to having undergone a facelift. Therefore, it is understandable that patients don’t want their before-after pictures on a website revealing their ‘little secret’ to the public. With other procedures, you can cut out body parts to hide a person’s identity. To show the full effect of a facelift, you can’t cover parts of the face. During your consultation, I will show you many before-after pictures so you can get an idea of what can be achieved when a facelift is performed on you.

Generally speaking, yes, it is technically possible to perform a facelift under local anaesthesia. BUT, the patient should carefully consider the following: When undergoing a facelift under local anaesthesia, large areas of the face and the neck have to be infiltrated with local anaesthetic. The infiltration can be painful at the beginning. Also, you must know that under local anaesthesia you are fully awake during the procedure. You will feel pulling and tagging, and even though this is not painful, many patients find that they do not like being aware of the procedure taking place. On top of this, you will have to lay for up to 3.5 hours on the theatre table, while remaining completely still. Many people complain about back pain after a while, and need to change their position. This must be avoided under all circumstances. I generally prefer to perform a facelift procedure under general anaesthesia. If you have any doubts or worries about general anaesthesia, it may help discussing this with our anaesthetist, who can answer all your questions and put your mind at ease. If you decide that you do not want general anaesthesia for personal reasons, I would advise that you have the facelift done with local anaesthesia, but under sedation. Our anaesthetist will administer painkiller and sedatives through an IV line. You will sleep during the procedure, but you have full control of your own breathing and will become fully awake as soon the sedative is no longer administered.

For my facelift procedures, I usually take 3 hours. In combination with eyelift or brow- or lip lift, the whole procedure can take up to 4 hours. If more several smaller procedures are added the surgery time is prolonged respectively. It is important to avoid too long surgery times to keep the amount of swelling after the facelift low.

Complications are rare. An acute complication (within the first 24 hours) would be a post-operative bleeding. If the bleeding doesn’t stop or the built-up haematoma is too big, you will to need to be re-operated on to stop the bleeding, or for the hematoma to be emptied. The risk of an infection and seroma is small but existent. Other potential complications of a facelift procedure include dying of part of the skin (this is a major risk if you are smoking), loss of sensitivity, facial nerve damage with temporary or constant loss of facial movement, asymmetry, stretched earlobes and visible scars (stretched or hypertrophic). Remaining damage to the facial nerve is very, very rare. Usually, a nerve recovers within days to weeks.

You most certainly should not have a facelift if you are a smoker. Smoking results in the blood supply to your face being compromised, due to the constriction of blood vessels. Undermining and lifting your skin, as required in a facelift procedure, would further compromise the blood supply of your skin, and there is a real risk that part of it may die. A further risk is that the wound may not heal correctly, and you could develop a seroma which would need to be drained a few times until the wound does successfully heal. I often hear my patients tell me, ‘you are a fantastic doctor, this won’t happen with you’. This has nothing to do with how good of a cosmetic surgeon you are, therefore this can happen to any surgeon operating on a smoker. Therefore, you must stop smoking at least 4 weeks before your planned facelift. This gives your body time to regenerate its blood vessels within the skin of your face. Following 4 weeks of no smoking, a facelift can finally be performed without such risks.

I like my patients to stay one night in the hospital after their facelift procedure. You will wear a tight head bandage which puts quite some pressure on your ears, and this can cause discomfort. In the hospital we can provide you with IV pain relief and monitor you closely, looking out for any post-operative bleeding. In the hospital you can relax and put your mind at ease. In the morning, I will remove your bandage and assess your face before discharging you from the hospital so that you can return home.

A facelift doesn’t really hurt. The head bandage following the facelift procedure can be quite uncomfortable, but this is only worn for one night. The pressure on the ears is what many facelift patients complain about most often. Once the bandage is removed the following morning, you will feel much better. You will feel a tightness, but rarely any pain. I then discharge you with painkillers, although many of my patients do not need to use them.

You will wear the compression bandage for just one night, and I will remove it the following morning.

I usually decide during the surgery if you will need little drains (mini-vacs) or not. If you are not bleeding, or if you are only bleeding a little during your facelift, I won’t use drains. If you are quite oozy during your facelift I will use two mini-vacs. These drains are removed before you leave the hospital the next morning.

Please expect your face to swell over the next three days. This can be very subtle but it can also be quite impressive. The jawline and neck usually don’t swell, but the major swelling occurs over your mid-face. Also, your earlobes can swell. Also, you can be bruised over the face and neck. Quark applications can help, and cold packs can also give some relief. Don’t look in the mirror every hour – there won’t be much of an improvement in the first three days. Usually, by day 4/5 the swelling starts to settle to the relief of my patients. Day by day, the swelling will subside and you will recognise the excellent result of your facelift. By the end of the second week you will already look much improved, and some people decide to go back to work at this point. However, you must know that after 2 weeks your face will still be swollen. After 6 weeks 80% of the swelling will subside, 90% will subside after 6 months and 100% after a year. This swelling is not visible to anyone, but you can feel it.

Please avoid drinking coffee and black tea in the first 2 days since it can raise your blood pressure and cause a bleeding. Also, avoid smoking cigarettes. This can compromise the blood supply to your skin and cause facial skin to die. You shouldn’t smoke for at least 2-3 weeks after your surgery. Don’t work out in the first 4 weeks. Sleep with your upper body elevated under a few pillows to reduce swelling. Avoid bending over in the first weeks.

Usually a facelift patient will hide in the first few days. This is when your face will keep swelling. During this time you won’t want to be seen by others. By the end of the first week you can do your errands. I always say that people who don’t know you won’t think anything of it, but if you run into friends they might wonder why your face looks swollen. After 2 weeks the swelling may have reduced enough for some people to go back to work. If this is a big issue for you, and you want to keep your facelift a secret, you might consider going back to work after 3 weeks. This is difficult to predict as some of my patients hardly swell, whereas the faces of others blow up, and they may not be ready to return to work or to socialise after 2 weeks.

The incision runs from under your sideburns down to right in front of the ear, running behind the ear cartilage/tragus, around the earlobe and back up behind the ear in the post-auricular sulcus, and then crosses from the top of the sulcus behind the ear concha into the haired area of the occiput. Behind the ear the scar is not visible, just the very short distance in front of the earlobe, and above the tragus, before the temporal hair starts to become exposed. These areas can be easily hidden when you have longer hair, but can be more difficult with shorter hair. Men in particular can have a problem hiding it. Once the sutures are removed, a scar will turn red and slightly elevated, which is a normal part of the process in scar healing. During this period of time it helps to cover the scar with a concealer. Once the scars are fully healed they appear to be faint lines which are difficult to spot, and in most cases almost invisible.

This is the question all my facelift patients ask me! Well, a facelift can last 10-15 years, but this doesn’t mean that your face will look the same over this period of time. With a facelift we solely turn back the time (10-12 years), but we can’t influence nature and the ageing process. I will recreate the younger shape of your face but your skin cells still have your biological age. But surely you will look much better after 12 years than if you hadn’t undergone your facelift. It is vital for a long lasting result to condition the metabolism of your skin to produce higher quality collagen with a strict skin care regime and non-surgical treatments as RF microneedling, polynucleotides, mesotherapy and other treatments.

Stitches are removed 9-14 days after your facelift. Around the ear I use sutures, and within the hair at the back of your head I use staples as they cause less harm to your hair follicles.

In the first 3-5 days after surgery, you will feel mild pain in the entire area of operation, and a feeling of tension. Thus your facial expression is restricted and your head movement is limited. In general, you are given pain medication to alleviate the pain.
If during surgery drains are placed that can be drawn from on the first day after surgery. Your compression bandage will be replaced with a compression garment which you should wear day and night during the first 4-5 days and then during the night in the following weeks. You will need to keep quiet in the first days after the face lift and keep your head elevated in order to reduce the swelling.
You can resume your normal daily activities relatively quickly, usually after a couple of days. You should continue to plan time to rest in the first week after surgery and sport should be avoided, in consultation with Dr. Kremer, for six weeks. As explained above, smoking and alcohol consumption should be reduced to a minimum after surgery. Visits to the sauna and steam room should be avoided for several months.
At first your face will look unfamiliar to you: your features may be altered by some swelling, or you expression will often seem a little stiff. The initial pale red scars will fade more and more until you can only see narrow white lines and after 2 weeks you will usually be relaxed and recovered.
After 14 days, depending on the extent of the facelift, most patients can again resume their work. Any remaining scars still visible can be covered with camouflage make-up.

A facelift can be repeated easily, or minor adjustments can be made, when signs of aging have reoccurred. Some people deliberately choose the option of repeated repairs at shorter intervals, to avoid a dramatic change and rejuvenation of the face. In the U.S. this is known as “maintenance”.

No, I do not shave your hair, so there is no need to worry about that.

The prices of a facelift vary and are specific to the individual and the type of surgery required. If you are considering having facelift surgery in London then please get in touch with us to book in for a one-to-one consultation with Dr Dirk.