Common Questions

When you will feel ready to do your job is highly individualized. So long as your work doesn’t involve straining and heavy lifting, you can expect to be back to work after three or four days. Some people go back even sooner, and many work from home the next day.

A facelift is the ultimate surgical procedure for making a man or woman look younger. It is the standard to which all other facial rejuvenating procedures are compared. That is why so many non-surgical treatments use terms such as, "laser facelift," "liquid facelift," "suture facelift," "luncthime facelift," etc. Only a facelift is actually facelift! A facelift involves an incision around the ear and sometimes under the chin. A facelift removes loose skin, thereby tightening the remaining skin. It elevates sagging tissues that cause nasolabial folds and marionette lines. It makes the outline of the jaw clearer and tightens the skin and muscles of the neck.

Facelifts are for both men and women. Candidates are individuals who have a sufficient amount of facial laxity to make the procedure worthwhile. Typical physical characteristics are visible neck muscles that are causing banding in the neck, laxity of skin or an excess of fat in the neck, a loss of the clear border along the jaw between face and neck, jowling, deep lines from the corner of the mouth to the jaw, and lines from the nose to the corners of the mouth. Low eyebrows are not treated with a facelift; those are fixed with a browlift. Extra skin and/or fat of the eyelids are treated with an eyelift procedure.

Since a facelift is elective surgery, patients must be in good health. An important part of being a facelift candidate is to understand the outcome that is likely for you and deciding if the risks and complications and costs make that seem worthwhile to you.

The most important factor to consider is whether a facelift does what you want it to do. A facelift tightens and lifts the face, but it does not fundamentally change elasticity. It does not remove fine lines or sunspots. Listen carefully to what the doctor tells you a facelift can do. It can produce wonderful results but ultimately you must consider is the outcome: does a facelift do what you want it to do for you?

What matters is appearance and not age. It is a question of how much a person is bothered by something that can be fixed with a facelift. In general, this process begins in the early forties, with the most common age for a facelift being in the mid-fifties. The oldest age is limited only by the health of a patient.

Studies have shown that the results of a facelift last longer when the facelift is done at a younger age. Nonetheless, a facelift is not done for prevention of aging changes; it is done as problematic changes get noticed.

A nicely done study showed a portfolio of photographs of a group of patients before facelift and another portfolio of photographs to groups of observers. On average the facelift patients were judged to be nine years younger!

A patient will always look better for the rest of their life than their imaginary identical twin that never had a facelift. It is not as if one day the result goes away and you look the same as if you never had one. Remember, gravity and normal aging occurs after the facelift has healed. In general, patients will develop enough laxity that repeating the facelift starts to become reasonable after seven to ten years later. The results last longer on a younger patient, but it is also true that by and large the woman getting a facelift younger will be more interested in repeating it at a shorter interval than an older woman. The biggest single predictor of duration beyond patient age is the amount of sun damage. Thicker, oiler, and less sun-damaged skin will "resag" less with time.

Unlike a breast augmentation in which there is an implant that could possibly break, there is nothing about a facelift that will ever force a patient to have a revision. A "redo" always remains a patient choice. Though a facelift patient will always look younger than if they did not have their facelift, they are subject to the changes of aging the same as anyone else. But they do not have to ever repeat the facelift if they do not wish to do so.

In a "skin lift" the surgeon elevates skin and a layer of fat beneath it. It is the most straightforward and has the fewest risks of any procedure. In order to tighten more and perhaps increase the duration of results (though neither has been shown to be true), tightening of the muscle layer of the face called the SMAS can be done. This can be done in a less invasive and risky manner, and this is called the "lateral smasectomy." More aggressive procedures include the "extended SMAS", "deep plane," and "composite" facelifts. Proponents argue that the results look better and last longer. Dr. Teitelbaum believes that the greater risk of nerve injury inherent in these procedures, the significantly prolonged recovery, and what can be greater pain than a smasectomy facelift do not justify these procedures. He also believes that they tend to look (though they do not have to be) more pulled.

A mini facelift is not a distinct procedure; it can mean different things to different patients. It can even be a regular facelift, but the surgeon may use the term because it sounds less serious to some patients. A mini facelift usually involves some combination of eliminating the incisions above the ear and in the hairline behind the ear, and sometimes the incision behind the ear (though in fact there are ways to do a full facelift without making an incision up the back of the ear.) It may mean that it is only dealing with the face and not the neck, or it may imply that there is less dissection or elevation on the face. It produces less change and that change is less long-lasting than a full facelift. A mini facelift is the right procedure for a patient who has less severe aging changes. But it is not appropriate for a patient with more extensive aging changes.

While a mini facelift has a short scar, the term "short scar facelift" colloquially applies to any full facelift in which the scar goes around the earlobe, but not up the back of the ear and into the hairline behind the ear. The incision goes upwards into the hair in front of the ear, and it also has an incision starting underneath the sideburn and contouring around to proceed around the front of the sideburn. This technique has been in vogue in New York since the turn of the century, but it is not of much interest in California. Proponents argue that it eliminates the incision behind the ear, thereby making it easier to wear ponytails. Yet it is highly unusual for the scar behind the ear and into the hair behind the ear to prevent someone from wearing a ponytail. It requires more bunching of skin around the ear lobe which takes weeks or even months to flatten out, and the scar that ensues is often not as thin and faint as with a standard incision. The skin is pulled upwards in front of the ear in a much more vertical direction than a standard incision, which pulls neck skin up onto the face. Neck skin is different than face skin and this does not look natural. Finally, the scar around the hairline is frequently quite visible and patients are more bothered by that scar than they are one hidden behind the ear that no one will ever see.

Sometimes the neck is so good and the muscle bands under the chin so mild that nothing specifically has to be done to the neck itself. The muscles that create the muscle bands under the chin go all the way back to the ears, and so long as the muscle bands are not large and thick pulling on the muscles back there can make the neck perfect. If there is a large amount of fat in the neck, then liposuction can be done. It is important that the surgeon not overdo this as fat is important in keep the skin filled up and preventing it from developing fine lines and that crepe paper look. The fat can also help conceal any underlying muscle banding. If the muscle bands are thick, then an incision is made under the chin and the muscles are tied together in the center to make the neck as smooth as possible.

No surgeon could ever look at a facelift and know what was done on the inside. What is noticeable about a facelift is the location and quality of the scars, any distortion of the ear, change in the position of the hairline in front of the ear, and the amount and direction in which the sagging tissue was repositioned.

Much of what changes in the face is a loss of facial volume. The face frequently deflates and collapses inwards as much as it drops. In these cases restoration of volume through fat injection is an important aspect of a facelift. This concept was first recognized about fifteen years ago but in more recent years its importance has really been recognized.

The outcome of a facelift is largely determined by what a surgeon sees in their mind’s eyes and whether they have the ability to achieve it. That is far more important than whether the surgeon is choosing one particular type of a facelift than another. Beyond just envisioning the changes that create the aesthetic changes that will create the most beauty for each patient, the surgeon must have the attention to detail and technical precision to make the scars inconspicuous and leave behind little clues that surgery was ever done.

The extent to which the scars go above the ear is dependent upon whether changes are needed in the upper cheeks and how much overall laxity there is in the face. Similarly the extent to which scars go from behind the ear into the hair behind the ear depends upon the amount of laxity there is in the neck. But in all cases a scar hugs the contours of the ear, going behind the tragus, the little flap of cartilage in front of the ear canal.

Wherever an incision is made there will be a scar. Fortunately the areas of the facelift incision heal remarkably well. When incisions follow curves around natural landmarks they are extremely difficult to notice, even when viewed close up. Dr. Teitelbaum’s patients can be examined up close or seen enlarged on a large movie screen and the scars are barely if at all noticeable.

Dr. Teitelbaum places his incisions in such a way that patients are able to wear their hair back after their facelift. There are some patients though who have such thin hair behind their ear that it is difficult to make any incision totally inconspicuous.

Lasers can remove broken capillaries and brown spots. They can flatten wrinkles and tighten the skin. But they do not tighten skin as much as a facelift does, and lasers do not actually lift sagging tissue on the inside. They also cannot tighten necks. The best way to think about a laser versus a facelift is that the facelift is like taking in the hem of a garment and the laser is like pressing a fabric.

Despite marketing claims to the contrary, there is no such thing as a "liquid facelift." Fillers replace volume, but they do not elevate sagging tissues, remove excess skin, nor reduce muscle bands on the neck. There is some reduction in wrinkles from filling up the skin, but the skin is not smoothed out nearly as much as it would be by a facelift. "Bought" fillers such as Juvederm and Restylane are not permanent, are painful, and need to be redone. For patients much to young for a facelift who want something inexpensive and not permanent, they are very good options. There is a role for fat injections during a facelift. And fat injections can be permanent and produce nice results. But they do not replace a facelift. For patients who do not yet need a facelift, fat injections alone can be the ideal treatment.

Browlifts and eyelifts are frequently done with a facelift. Sometimes ear or nasal surgery is also done. Whether breast or liposuction surgery is done depends upon the age and health of the patient because it is important to consider the total time of anesthesia.

A facelift is more about lifting than it is about removing wrinkles. By elevating and tightening, the wrinkles on the cheeks will be a little more stretched flat and will look better. But it will not effect anything in the chin and upper lip area. A facelift does not actually make any change in the skin itself. So some patients will also do a peel either at the same time or later.

A facelift only makes improvements from the upper cheeks down. Nothing above the cheekbone will change; the eyes are only made more beautiful from an eyelift (blepharoplasty) and the forehead and brows are only improved with a browlift.

A facelift is the gold standard treatment for the neck. A necklift actually does not improve the neck as much as a facelift does. If you stop and think about it, the neck skin is connected to the face skin. If you try to move the neck skin without moving the face skin, then you are limited in how much you can improve the neck. But if you are also moving the face up, then you can do much more on the neck.

Despite even feeling "too tight" after a facelift, there are some patients whose skin loosens in the first year who will have a retightening. This happens in about 10% of Dr. Teitelbaum’s patients and is considered normal. It is safe to redo the facelift then; and it is safe to redo it later in life so long as the patient is healthy enough to undergo anesthesia.

Patients will look pulled for about the first two weeks after a facelift. After that the swelling will go down and the skin will relax a bit so that patients do not look pulled beyond that. Looking natural is a result of not just attention to detail with the incision and with the direction that the skin is pulled, but that that it is not over pulled.

Dr. Teitelbaum believes that changes in ear position is one of the most important features that tip off the fact that a patient has had a facelift - even though no one specifically notices the ears. That is why he is so fastidious about how he works around the ears to hide his scars and avoid manipulating the ears. When looking at facelift photos, focus on the ears and whether they look correct to you.

The best and most relaxing method for anesthesia for a facelift is general anesthesia. That way a patient is assured that there will be no pain. The surgeon can work totally free from concerns of causing the patient discomfort or of the patient moving during surgery. But what is most important is that the anesthesiologist, surgeon, and entire surgical team be accustomed and comfortable with doing facelifts together a certain way.

Some sutures are removed 5 days after surgery and the rest are removed at 10 days after surgery.

Bruising is minimal or non-existent for most of Dr. Teitelbaum’s patients after surgery. But it is still normal to have some on the neck. The amount and duration of it depends upon the patient. Some people bruise very easily and others do not. But Dr. Teitelbaum is particularly focused during surgery on reducing the factors that contribute to bruising.

Patients will all have facial numbness after a facelift. This will gradually come back over a period of months, but it is rarely permanent.

A facelift is considered a purely cosmetic procedure. Insurance only covers medically procedures so it is not covered by insurance.

Dr. Teitelbaum requires all of his facelift patients to go to an aftercare facility following their surgery. Only one night is required, but many stay longer. It depends upon who you have to take care of you at home, how much peace and quiet is at home, and of course the cost of Serenity.

Dr. Teitelbaum will stop by to see you the evening of your facelift at Serenity. The proximity of his office to Serenity is very important. And he lives nearby should there be any problem in the evening.

A facelift has surprisingly little pain. But we don’t like having a tightness in our face and neck, so the recovery is more about feeling a little tight and stiff than having pain per se. But this phase ends after a few days, but a tight neck can go on for several weeks longer.

You can drive when you are off of all narcotic pain medication and feel totally unrestricted by your discomfort such that you could make any movement you might need to safely drive your car. That is ultimately a decision that I cannot make for you. With a facelift it is also important to have enough looseness in your neck for you to move it freely. Certainly this will occur by ten days, but many patients can drive by about a week, but usually not before.

Many of Dr. Teitelbaum’s patients come from out of town and he allows them to return home ten days after their facelift or seven days if they are going to an area in which he has a colleague who can remove the last sutures or attend to any problems.

Wait four weeks after a facelift before exercising. Bleeding is an uncommon but serious problem after a facelift and doing anything that increases the blood pressure in your face should be avoided for about three weeks after surgery. When you start exercising after a facelift or any surgical procedure, listen to your body. You will be a little out of condition and a bit sore. But you will get back to where you were before surgery very quickly.

Elevating your heart rate or blood pressure, breathing hard, straining or sweating. But light walking is beneficial starting the day of surgery. With a facelift it is important not to bend over and increase pressure in your face for several weeks after surgery.

Sex can be resumed as you feel comfortable. Most often patients hit their level of comfort to have sex about ten to fourteen days after a facelift.

You can take a shower the day after a facelift. You should wait a week or so before taking a bath.

Dr. Teitelbaum watches over all of his patients very closely and offers patients more appointments than they will typically need. But he does need to see all facelift patients the day after surgery. He will see them the second day if their drain was not removed the first day, but drains rarely stay in longer than the second day. The next appointment is five days after surgery to have the first of the sutures removed, and the remainder are removed at ten days. Dr. Teitelbaum will see you again at one month, three months, six months, and then yearly.

Swelling increases after surgery, usually peaking about 5-6 days after surgery. After that, the swelling will subside, rapidly at first, and then gradually. After one month, you’ll think the swelling is gone, but it will still go down more at three months, and even more at six months and even a year, though at that point changes are subtle.

Facelift incisions require little care. When the sutures are in, place a thin layer of Bacitracin antibiotic ointment over the incision. Clean off the Bacitracin with peroxide and reapply the Bacitracin twice a day. After the sutures come out the incision can be gently cleaned with a soapy washcloth. Protect your incisions from the sun for a few months either by diligently wearing a hat, applying sunblock, or keeping your hair over your ears.

Usually the facelift scars are small and heal very well. You may put any scar prepartion you prefer on the incision, but there is no evidence they will do anything to change the outcome of a facelift scar. In some cases during the healing phase, the scar will thicken and Dr. Teitelbaum will inject a small amount of steroid to soften and flatten the scar. If the scar becomes particularly red it can be treated with a laser, but this is uncommon following a facelift.

There are two things that can occur early after a facelift that a patient needs to be aware of. The first is a hematoma, which is swelling due to bleeding. Usually one side of the face or neck will suddenly swell and become painful. It is important to call Dr. Teitelbaum immediately if this happens so that he can meet you at the office. Most oftentimes this requires a return to the operating room to stop the bleeding. This can occur in the first several days after surgery, but there is a second peak of this occurring at ten days to two weeks after surgery. The other problem to look out for is an infection. If this uncommon situation arises, it is usually about five to ten days after surgery. Patients may notice a little redness or swelling around the incision, occasionally with some drainage. Alert Dr. Teitelbaum’s office if you notice these changes. He will examine you and place you on antibiotics if necessary.

The first thing patients talk about is how beautiful they feel when they look at themselves in a mirror or in pictures. They will more frequently hear comments such as, "You look so pretty today." But it should be uncommon to be asked whether you had a facelift. When looking in the mirror, patients feel that extra charge of energy from that feeling of looking great. Though that is a general feeling, what they are noticing is a restoration of high cheeks, the removal of jowling, a better jawline, softening of the liens between the nose and the mouth and the mouth to the jaw, and improvement in their neck. The look is also happier, more energetic, and even sexier.

A facelift lifts and tightens, but it does not fundamentally change the quality of the skin. So if skin is crepey and has fine wrinkles before surgery, once the swelling is gone those will reappear. Patients with sundamaged, thin and inelastic skin will find that their results will not last as long as patients with thicker and more elastic skin. When patients have little fat in their necks, it is unlikely that the muscle bands will be completely concealed. When neck skin is very thin and crepey, even the neck that is very smooth and tight right after surgery can often loosen in that area more than a patient –and the surgeon – would desire.

Following any surgical procedure, there is a chance of bleeding and infection. The chances of bleeding can be reduced by avoiding activities that can raise the blood pressure during the first several weeks after surgery. Infection is uncommon after a facelift and can typically be treated quite easily with antibiotics. There can be problems with healing, and this is exaggerated in patients who smoke. This can result in widened scarring. Nerves that control the movement of facial muscles can be affected by surgery, resulting in temporary reduced muscle movement. In very rare cases this can be permanent.