Facelift (Rhytidectomy) & Necklift
Since Dr Kremer's arrival in London facelifts have been one of his most requested procedures. The facelift is a major surgical procedure whose purpose is to improve the appearance of the face, jaw area and neck. The improvement is achieved by tightening of the skin and facial muscles and, where needed, removal of fat. The degree of improvement varies from individual to individual, and is influenced by the physical traits of the skin, and the amount of sun damage, the underlying bone structure, and a variety of other factors. Prior to surgery, as part of your evaluation, photographs will be taken. Photographs are as important to the plastic surgeon as X-rays are to the physicians in other medical specialities. These photographs are part of your confidential medical record.
In a neck lift, excess fat is removed through a small incision under the chin, and the superficial neck muscle is tightened through a hidden incision behind the ear. In this lift, the incision is extended behind the ear to the ear lobe around in front of the ear and then behind the hairline of the temporal region. From this section of the facial skin is mobilized. The underlying tissue is tightened and then relaxed and the excess skin is removed. After closing the skin, your face will look much younger.
For strongly sunken cheeks and nasolabial folds, a strong lifting of the mid-face may be necessary. This lift will be cut above the gum or placed under the eyelid and is based on a new technique developed in Beverly Hills for mid-face lifting. In many cases, a superficial facelift for the patient is sufficient.
The positioning of the cuts is optimised so that the scars remain as invisible as possible, which is especially important for men in particular as they usually have a shorter hair cut and lighter hair growth. With my technique, we will be running the cut "in front of the ear" and partly hidden behind the ear cartilage (tragus).
If the wrinkles on your neck are not so pronounced, you can apply a gentle mini facelift. In this procedure, the incision is just in front of the ear and from here, cheeks are raised again to remove excess skin. The swelling after such a mini facelift is significantly less than after a full extensive facelift.
As men grow older, the facial skin and the underlying fat and connective tissue can become loose, resulting in an increasing loss of elasticity of the skin with accompanying folds. The degree of wrinkling is individual and is influenced by various factors, such as UV radiation, nicotine consumption, weight fluctuations and also by genetics. The anti-wrinkle creams offered by the cosmetics industry are usually of little help.
Men are often disturbed by a limp neck sagging with the split neck muscle (platysma), and the low-hanging eyebrows with a strongly folded forehead and deeply entrenched nasolabial folds.
In this case, a neck and facelift surgery, will help to smooth wrinkles on the neck, face and forehead, resulting in a fresh, youthful look. A facelift is often combined with a correction of the upper and lower eyelids.
In a detailed consultation Dr Dirk Kremer will discuss what type of lifting is appropriate for you.
What risks are associated with a face lift?
Are you considering a facelift? If so you should ensure that the procedure is carried out by a qualified specialist in plastic and aesthetic surgery - such as Dr Dirk Kremer. In such a case, it is rare that complications occur, and the long lasting results are subtle with a natural aesthetic.
Possible complications of a facelift:
Bruising and swelling
As with any surgery, bruising and swelling will occur. The bruising usually heals by itself but wearing a compression mask for 1-2 days can significantly reduce the swelling.
Discuss with Dr Kremer whether the wearing of such a compression bandage is suitable for you and the facelift you are having.
Bleeding from a facelift is rare, but significant swelling and pain associated with surgery can cause it and must be stopped immediately.
Infection of the wound area is very rare due to the very good blood supply to the face. If an infection should occur an appropriate antibiotic therapy can heal this infection very rapidly.
Wound healing disorders
Wound healing disorders are also rare. As a rule, various risk factors play a role, and you will talk with your surgeon before surgery to discuss these in detail. These so-called risk factors include: delayed healing in diabetic patients, smokers and patients with bleeding disorders.
Numbness of the skin
Numbness of the skin at the surgical site can occur temporarily during a facelift, caused by the severing of the finest skin nerves during the preparation. Sensitivity usually returns during the healing process.
Operating in the scalp area can lead to scarring and possibly alopecia, or hair loss. This is very rare and can be corrected later.
Injury of the facial nerve
Injury of the facial nerve is extremely rare for a facelift. In the preparation of the facial skin, the nerve can be slightly damaged by tearing or bruising. This causes a temporary weakening of parts of the facial muscles, but which later re-forms with the healing and regeneration of the nerve branch again. Since the facial muscles stimulate numerous nerve branches, a complete paralysis of a part of the facial muscles would require a complete separation of all these nerve branches and is almost non-existent.
Overall, the face lift or facelift has a high degree of efficiency and safety.
What to consider before surgery?
As with any surgery, you should be well and in good health beforehand.
- Alcohol consumption should be reduced to a minimum
- Smoking should be limited as much as possible, as nicotine reduces blood flow to the tissue.
- Heavy smokers should refrain completely preceding a facelift. Discuss with your surgeon, how long before and after surgery you should stop smoking.
- Aspirin and similar blood-thinning medications should for their inhibitory effect on blood clotting not be consumed for two weeks before and after surgery.
- It is advisable to plan for some recuperation time, up to seven days after surgery or after the facelift.
For questions and doubts before the surgery, please call your surgeon.
Where in London will the facelift take place?
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.
What kind of anaesthesia is used during facelift?
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.
Another alternative is the local anaesthesia with injection of local anaesthetic. With local anaesthesia, you will also receive a sedative (either as a tablet or by intravenous injection in the arm vein) which puts you in a kind of twilight sleep. You are awake, but relaxed and insensitive to pain. You get to witness the operation, and you may feel a pull or the like.
I hardly see any facelift before-after pictures on your website. Why is that?
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.
I am afraid of general anaesthesia. Can I do the facelift under local anaesthesia?
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.
How long does the facelift take?
For my facelift procedures, I usually take 2.5 hours. In combination with eyelift or submental liposuction, the whole procedure can take up to 3.5 hours. This is important to avoid dramatic swelling after the facelift.
Yes, I lift the SMAS as this is the most important part of a good facelift. With my TBT-facelift I can vertically lift the complete SMAS, and thus reposition the facial fat and muscles. Working on the SMAS means I can achieve a younger looking shape for your face.
What are the complications of a facelift?
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.
I am a smoker. Can I have a facelift?
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.
How long do I need to stay in the hospital after my facelift?
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 a lot of 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.
Does a facelift hurt?
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.
How long do I wear the compression bandage after my facelift?
You will wear the compression bandage for just one night, and I will remove it the following morning.
Will I have drains?
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.
What can I expect once I am home?
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 70% 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.
What should I do to not risk a complication after my facelift and to have a good healing?
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.
How long do I need to hide after my facelift? When can I go back to work?
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.
Where are the incisions in my facelift? Will the scars be visible?
The incision runs from the temporal area behind the hairline 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 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.
How long does the result of my facelift last?
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. 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 your skin with a strict skin care regime. I advise my patients to use products of my skin care range SkinDoc formula which has shown to be very effective for my patients.
When are the stitches removed?
Stitches are removed 12 days after your facelift. Around the ear I use sutures, and within the hair I use staples as they cause less harm to your hair follicles.
Do you shave my hair?
No, I don't shave your hair, no worries.
What to do after the facelift?
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.
During surgery drains are placed that can be drawn from on the first day after surgery and you may also use a compression mask is used which is removed after 1-3 days. 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.
After seven days, the first stitches are removed. The scalp needs a little longer to heal, so threads or brackets are left for a few days more.
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 your doctor, for at least 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 10-14 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.
Can a facelift be repeated?
After 10 years, a facelift can be repeated easily, or minor adjustments can be made, such as a mini-lift or a cheek lift. 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".