Q. Facelift Recovery? Thinking about a facelift, but concerned about taking time off work. When can I go in public without looking like a freak (or like I just had facelift surgery!)?
A. Healing of a surgical incision is probably the most mis-understood aspect of any pre-operative surgical education process. In today’s fast paced society, we wish for quicker healing due to less recovery time. Unfortunately, we can optimize the healing process but not make it as fast as you expect or wish for.
The following is a simplified overview for you to consider in your quest for fast healing following facelift or for that matter any surgery. The healing process depends on many factors. The body, whether it is the face, trunk, arms and legs or organs follows a fairly defined process to seal skin and tissue breaks or injury. Short and long incisions, invasive or non-invasive; healing is the same. It is the magnitude of the trauma that prolongs healing according to the bigger or smaller injury.
Scar, collagen or fibrosis are all the same name for the mortar that keeps the tissues together. It is also the process for repair and rejuvenation we desire of from dermal lasers and medications or injectibles to firm and tighten the skin.
Each patient is unique and creates the environment for optimal healing. Your heritage, high blood pressure, heart disease, clotting syndromes, diabetes, nicotine use, vascular disease, auto-immune syndromes, nutrition, hydration and prior skin injury are many factors which can prolong healing.
When the skin is lifted off the underlying tissues as they are with a facelift, the incision AND the underlying skin is now devoid of its normal supply of circulation. This compounds the factors towards optimal healing and prolongs the process. The “larger” the flap, the more potential lack of circulation. Incisions in hair-bearing areas and certain thicker healing areas will factor into facelift incisions. In the most optimal case, it takes:
· 3 to 7 days for circulation to stabilize;
· 7 to14 days for healing cells called fibroblasts to begin to make scar / collagen;
· 3 weeks to develop enough scar strength for return to non-exertional activities of daily living;
· 3 to 6 weeks for swelling to diminish (although it roller coasters with increased activities until 6 months or longer);
· 3 months to maximal scar thickening and lumpiness; and
· 3 to 12 months or longer for the healing to “remodel”, ie thin and stabilize to its best.
Your surgeon will guide you in the ways to optimize your healing.
· Most patients are “social” following a face lift after 3-6 weeks. That’s when most of the swelling and bruising are gone and the incisions are strong enough to begin increasing activities and using make-up for cover.
· Most patients look their best between 3-6 months when the underlying lumpiness and scars have begun to settle down.
o Some patients, particularly those with reddish skin or of darker pigmentation may take 12 or more months until their scars are smooth and flat.
o If no incisions are made, these timelines maybe shorter to increasing activities but not shorter regarding the natural healing process.
· ”Mini” indicates smaller. A smaller face lifts mean less surgery, less incisions, less lift, less tightening, etc.
o You should expect less but focused results.
o For example, if you wish your cheeks and eyelids lifted using a “mini” – midface lift, the incision will be along the eyelid or in the mouth but only the eyelid and cheek will lift with no expectation of skin tightening. The “mini” short scar face lift will make “shorter” incisions around the ear but not necessarily elevate and redrape the skin to the nasolabial fold, jowl or neck like a fuller traditional face and neck lift.
· A lift generally requires an incision (although not all the time; for example, the Silhouette InstaLift) and it is usually the incision that most people consider the site of healing but any tissue that is lifted or moved will require healing time as well. So, it is not so much the length of the incision but the amount of surgery that is performed that will determine how much swelling, bruising, lumpiness and therefore the amount of time before a patient feels social once again.
· Tightening is a different issue. A (face and neck) lift will elevate and redrape the skin upwardly, trimming off the excess sagging skin and re-attach it to the other side of the incision. During the healing process, the skin will firm up but at the middle to end of the healing process, the fabric of the skin is no different (only shorter) than it was originally.
· Other options such as: exfolliation, retinoids (vitamin A creams), peels, laser, light and other options will rejuvenate the skin fabric for a firmer, tighter more lustrous and youthful skin.
As noted above, the dynamic course of healing is different for everyone. Physiologically, any incision or puncture of the skin will cause bleeding and bruising. The length of the incision and amount of lift or undermining determine the magnitude of the healing to occur. More surgery means more bruising, swelling and potential side-effects or complications but the healing time is similar and that is because the “army” of healing cells and scar formation is the same for any injury.
You must anticipate:
Swelling and bruising for 10 days to 3 weeks
Potential bleeding complications and incision concerns during the first 3 weeks
Under the skin firming, lumpiness and irregularity during the first 3 months
Every patient shows goes through a “roller coaster” of emotional concerns and presentations whether they proceed with injectables or brow, face and neck lift.
You can expect:
1-5 days: initial surprise: “I didn’t expect this”
1-3 weeks: concern and a feeling of “did I do the right thing”
2-4 weeks: worry: “when is this swelling, bruising going to go away”
4-12 weeks: more worry: “why am I forming lumps and irregularities”
2-4 months: depression: “I have to look socially acceptable and I look deformed”
3-4 months: sunlight: “it’s getting better”
6 months: elation: “wow, I look good”
9-12 months: super-elation: “wow, I look hot!”
3-10 years: eventual disappointment: “where did it all go?”
Each patient and each physician interpret their changes and findings differently. Return to your treating physician to compare you and your pre-operative photos.
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This information is not meant as medical advice. It is provided solely for education. Our practice would be pleased to discuss your unique circumstances and needs as they relate to these topics.
Give us a call at 410.602.3322 or email Lauri@DrDeanKane.com and make an appointment soon. We’re located on Reservoir Circle just a block off the Baltimore beltway, convenient to greater Baltimore, Annapolis, the Eastern Shore, Southern Pennsylvania, Delaware and Frederick.