Rhytidectomy is the technical term for repositioning tissues of the face and neck— commonly called a facelift. Facial aging is the result of changes in the skin, fat, and muscle of the face. The decrease and shift of facial volume from the cheeks to the lower third of the face is responsible for the onset of cheek hollowing, deepening of the nasolabial folds, and the loss of jaw and neck definition over time. A facelift repositions the tissues of the face and neck to restore the contours and appearance of a more youthful or fresher face. Many areas of the face are improved: sagging, loose tissues of the midface, deep folds of loose skin at the sides of the nose and mouth, jowls or loss of definition of the jawline, and excess fat or loose skin causing loss of definition in the neck area. Visible banding of the platysma neck muscle below the chin can be corrected to provide additional improvement of the neck contour.
Dr. Forley brings over 20 years of expertise in the most advanced facelift techniques to his patients. Starting with a coveted fellowship in aesthetic surgery with Dr. Bruce Connell in California, Dr. Forley has developed a reputation for an unsurpassed attention to detail and precision in performing his facelifts. He has been recognized by his peers annually in the selection process for the Castle Connolly “Top Doctors” guide. His incisions are designed to optimally conceal your scars with tightening of the deep layer, known as the SMAS, producing the most natural, long-lasting results. He was an early proponent of the MACS-Lift “short scar” technique, which uses a series of sutures, woven through the deep fibrous layer of the face, to enable volume restoration of the cheeks and improvement of the nasolabial folds, jowls, jawline, and neck with natural, long lasting results. Dr. Forley also offers a comprehensive laser and skin care program to enhance the results of surgery by improving the quality of your skin.
Is This For Me?
You should consider a facelift if:
- Your face makes you look older than your actual age or older than you feel.
- You want to restore your confidence and both feel and look more youthful.
- Your face and neck have sagging and other significant signs of aging.
- You have benefited from non-surgical treatments but have reached a stage where a more natural, youthful appearance is best achieved surgically
Dr. Forley will discuss your individual concerns during your consultation and demonstrate the degree of correction you can expect in each area. He will explain the aging process and the reasons for performing the procedures he may recommend to you. In many cases, some or all of the facial procedures you desire can be performed in one stage. Dr. Forley always attempts to use the smallest and most well concealed incisions possible. He will explain how natural looking results can be achieved with advanced surgical techniques through limited incisions. You will have the opportunity to review before and after photographs of Dr. Forley’s patients to give you an idea of the type of aesthetic outcome that typifies his approach toward surgery.
Your pre-operative appointment will be scheduled 2 weeks prior to your surgery date. A complete review of the surgical plan as well as instructions for you to follow before and after surgery will be discussed. Medical clearance, including blood tests and cardiac testing as needed, will be obtained from your primary care doctor in preparation for your surgery. A program of vitamins and supplements to optimize your healing and recovery will be provided to you during your pre-op visit. Dr. Forley advocates a customized skin care regimen prior to and following surgery for all his patients and this will also be discussed. Photographs will be taken and kept strictly confidential.
UK-based Tatler discussed Dr. Forley in its 2008 Beauty and Cosmetic Surgery Guide as one of the "A-list of cosmetic surgeons"..."who are at the top of their game"...and whose "innovations are shaping the art of cosmetic surgery around the world." It was noted that Dr. Forley's "discreet Upper East Side clinic is perfect for women and men in search of minimally invasive natural-looking surgery. He was trained in France and the UK and has a straightforward, gentle, less-is-more approach. He uses the intimidating-sounding MACS-lift (Minimal Access Cranial Suspension), which is an ingenious short-scar method. A small incision is placed just above where the ear meets the hairline and the cheeks and jowls are gently pulled up. He makes sure the skin is in great shape by using the Fraxel laser for resurfacing and combines it with expertly placed fillers like Sculptra to maximise his results. He also does Juvederm, Botox and Restylane at the Elizabeth Arden Red Door Salon and Spa on Fifth Avenue. He has been on missions to Asia and Africa, where he has devoted his skills to treat children with facial deformities.
Tatler discussed Dr. Forley in its 2008 Beauty and Cosmetic Surgery Guide as one of the "A-list of cosmetic surgeons"..."who are at the top of their game"...and whose "innovations are shaping the art of cosmetic surgery around the world." It was noted that Dr. Forley's "discreet Upper East Side clinic is perfect for women and men in search of minimally invasive natural-looking surgery.”
Dr. Forley will carefully mark the incision sites and answer any last minute questions. The anesthesiologist will then review with you the twilight/sedation technique that is utilized exclusively in the Joint Commission accredited office surgical suite. Incisions for a facelift are designed to be minimally apparent following the healing process. They are carefully concealed within the hair in the area of the temples, in skin creases paralleling the curve of the ear, and behind the tragal cartilage edge of the ear. This is the extent of the incision in the MACS- Lift “short scar” technique performed by Dr. Forley. The incision is extended behind the ear and into the hair of the scalp when there is significant skin excess of the neck that needs to be improved.
To reposition your facial tissues, skin and deeper layers of the face are first very carefully mobilized. The deep SMAS layer is tightened to lift the sagging tissues and create a natural restoration of the youthful contours of the face. Fat grafts may be added to augment the loss of volume that often accompanies the aging changes in the face. In the neck, banding or visible thickening of the midline neck muscles is corrected to provide better support and optimal contour to the neck. Excess or malpositioned fatty tissue may be sculpted using small suction tubes to further improve the result.
After redraping the skin, excess is removed and the incisions are carefully closed to produce fine, minimally apparent scars.
What to Expect After Your Procedure
Recovery from plastic surgical procedures progresses steadily but varies slightly from person to person. Pain is usually minor and patients frequently do not require more than a few doses of pain medication following surgery.
A protective turban-style head wrap is used for 1-2 days. Compression is not used as it actually increases the amount of swelling you might experience. In most cases, a drain is used overnight to remove any post-operative oozing of blood so that there will be less bruising. Dr. Forley will remove the drain the following day when he changes your dressing.
You will be able to wash your hair within 2 days. Sutures are removed at about 5 days and 8-10 days.
You’ll feel some tightness in the neck area following surgery. This assures that you’ll have the best possible long term result. Most of the tight feeling resolves in the first few weeks.
Temporary numbness of the face and neck skin is normal after facelift surgery.
The Stages of Recovery
- Day of surgery: May be performed as an outpatient procedure in our accredited office surgery suite. A nurse can be booked to monitor you overnight.
- Bruising and swelling resolve: Most improvement occurs in the first 1-2 weeks with continued improvement occurring for several months. Minor changes may continue to occur for up to 1 year.
- Sensation returns: A gradual process that occurs over 6-12 months.
- Return to work, social activity: Average is 2 weeks.
- Aerobic or strenuous activity: 14-21 days.
We encourage a return to activity in the early post-operative period. Just don’t do any type of strenuous exercise that would push your pulse over 100 for about two to three weeks. Any aerobic activity that increases your pulse over 100 also increases your blood pressure, and could make you bleed.
Potential Risks and Complications
Risks common to all surgical procedures such as bleeding, infection and thickened scar tissue occur in a very small percentage of cases. There is a rarely occurring risk of affecting nerves that control facial movement. Dr. Forley will discuss the risks of facelift surgery in more detail with you during your consultation.
We encourage you to discuss any concerns you may have during your consultation. If you have hypertension or high blood pressure, it must be properly controlled prior to surgery to reduce the risk of bleeding. We will coordinate this with your primary care physician.
Facelift procedures involve more risk in smokers. Nicotine causes constriction of blood vessels that supply the skin, reducing blood flow, and increasing the risk of skin loss. If you are a smoker, Dr. Forley will make specific recommendations to you to reduce those risks.