What are hair-sparing incisions, and why is this important?
One of the main goals of facelift surgery is to remove excess skin caused by lax skin, especially in the neck. Permanently removing your scalp hair by hiding the incision in the temples and in the scalp behind the ears is not a desirable feature in facelift surgery, but is frequently offered. The reasoning behind the permanent removal of your scalp hair is to hide the incisions in the scalp, in the event that you wish to wear your hair back – even if now there is permanently less of it.
At Facial Plastic Surgery in Edina, Minnesota, Dr. Szachowicz believes in planning your incisions to maximize the removal of excess skin, especially in the neck, without altering your hairlines or permanently removing any of your hair-bearing scalp. “Hair-sparing” incisions are preferred for the following reasons:
- Nobody has too much scalp hair as they mature. Maintaining the density and nature of your hairline is critical as you age.
- You will have more choice and variety in hair styles and hair-cuts when you have all your own hair, without incisions traveling in the scalp. Ask your hair stylist – most prefer to cut & style the hair of clients whose facelifts are planned around incisions which maintain the client’s own hair.
- With ‘hair-sparing’ incisions, you can safely repeat your facelift surgery in time, without any hair loss in your scalp. This is important for two reasons: people are choosing to have facelift surgery at an earlier age, and living longer to choose to have a “touch-up” facelift later in life.
- When the part of your facelift incision behind the ear is made along (not within) you hairline, Dr. Szachowicz can now remove just the excess skin of the neck, without distorting your hairline or removing hair-bearing scalp.
- Loss of hair in the temple tuft of hair ‘widens’ the look of your face, and removes some of the beauty that the hair creates by framing your face. Many clients with overly raised hair in the temple region respond by saying they look better but not younger.
During your consultation, Dr. Szachowicz will demonstrate the natural path of his preferred hair-sparing incisions, and show the typical healing results for his patients. Most clients appreciate the attention to the details of your hair and hairline, which matter over the lifetime of your facelift surgery.
Is there anything that can be done for the swelling & bruising after a facelift?
Dr. Szachowicz’s clinic, Facial Plastic Surgery in Minneapolis-St. Paul, Minnesota, uses a multi-method program to limit the swelling and bruising phase of facelift surgery. The program is as follows:
- Pre-surgical planning to minimize the tendency to bleed or bruise.
- Stop all medications which can increase bleeding/bruising for at least two weeks prior to surgery. These are some of the main medications and/or supplements to avoid:
- Aspirin or aspirin-containing medications. Even one baby aspirin daily can significantly increase the chances of bleeding. Many common household medications (for example, Excedrin for aches and pains) contain aspirin in their formulations.
- Non-steroidal anti-inflammatory medications (often called NSAID’s) may also increase bruising and bleeding. Common names for these frequently used medications are Advil, Nuprim, and Alieve; all of which are in a generic class of ibuprofens.
- Omega-3’s or concentrated fish/plant oils. Fish oils or vegetarian plant oils (such as GLA, CLA, primrose or borage oils) all severely limit the effect the platelets in your blood to stop bleeding. Included in this category is Vitamin E; do not supplement with any more than Vit. E 400 I.U. daily which is the usual amount in your daily multi-vitamin.
- High Blood Pressure – For any surgery, normal blood pressure is key to minimize excessive bleeding or bruising. During your consultation, Dr. Szachowicz screens for a history high blood pressure (called hypertension) which is common as we age. For many reasons, care should be taken to ensure that your resting blood pressure is normal before surgery. Certain supplements, such as gingko, and Siberian ginseng can raise your blood pressure, and therefore should be stopped before surgery.
- Arnica – Scientific studies have shown that starting homeopathic arnica montana before and after your facelift surgery reduces bruising, swelling and soreness. Dr. Szachowicz recommends all his surgical patients to start homeopathic arnica montana beginning two days prior to surgery and up to 3 weeks thereafter. Arnica cream is given after surgery to directly apply to any bruising.
- During your procedure and recovery
- Blood Pressure Control - Your doctor of anesthesia will help to maintain your blood pressure within normal levels during and after your surgery.
- Tissue Sealant - Dr. Szachowicz, at Facial Plastic Surgery in Edina, Minnesota, also prefers to use a tissue sealant, called fibrin glue, at the conclusion of your facelift. The fibrin glue adheres the repositioned skin of the facelift onto the underlying tissues, which dramatically reduces the bruising.
- Light compression dressing – After your facelift, you will have a fluffy cotton dressing held gently together with an elastic bandage. The light compression bandage provides a gentle support to your tissues overnight helps to control swelling.
What is the aftercare of a facelift?
After your Facelift Surgery: The Three Phases of Healing: Swelling, followed by Stiffness which then yields to Softening. Dr. Szachowicz has developed a post-facelift protocol which assists the body in moving through the phases of healing.
- Frequent Visits – Your recovery timetable consists of several appointments in the immediate post-operative period to monitor and assist in your healing.
- Day #1 – An important day-after visit in which Dr. Szachowicz removes your cotton dressing, cleanses all the areas of surgery and places a gentle elastic garment to support the delicate tissues after surgery.
- Day #3-5 – Check-in office visits for the early delivery of ultrasound and light therapies to speed your healing.
- Day #7-10 – All your sutures are removed by this time and corrective makeup is possible.
- Starting at 4-6 weeks - Fraxel Restore laser treatments to your incision lines
- Summary of your post-operative therapies:
- Arnica montana – A homeopathic formula of arnica montana is taken under the tongue beginning before your surgery and for up to 3 weeks after your facelift. Additionally, Dr. Szachowicz supplies arnica montana cream to use topically on any bruising after the surgery.
- Light Therapy- After surgery, Dr. Szachowicz uses a light device promoted by physical therapists which contains the red through orange frequencies of light. The red-orange spectrum is considered the ‘healing’ range of visible light and is used early in the recovery process to assist the healing.
- Ultrasound Therapy – Gentle stimulation with ultrasound helps the micro-circulation and diminishes some of the swelling that occurs after surgery. Ultrasound therapy is often used in physical therapy to assist delicate tissues in their healing, and Dr. Szachowicz uses ultrasound early after surgery to stimulate the circulatory phase of healing.
- Suction-Massage – After the swelling subsides (usually within the first week), the tissues begin to feel ‘stiff’ as healing progresses. When indicated, Dr. Szachowicz uses a suction-massage device to provide a calming massage to the delicate tissues to promote more rapid resolution of the stiffness.
- Fraxel Restore Laser Resurfacing to the Incisions – An important barrier for people considering a facelift is the concern of incision lines around the ears. The Fraxel Restore laser is FDA-approved to help the appearance of surgical scars. Dr. Szachowicz includes (3) Fraxel Restore laser treatments to the incision lines as part of his facelift protocol. The laser treatments begin as early as 4-6 weeks after your facelift surgery, and are repeated every 3-4 weeks for a total of three sessions. The improvement in the healing of the surgical incisions is important enough that few people miss any of their Fraxel treatments sessions.
- Advanced Medical Skin Care – Prescription-strength advanced medical skin care can complement the results of your facelift surgery. Prescription-strength products primarily act to increase the cell turnover of your skin, resulting in plump, smooth skin with a youthful color. Also, included are skin bleaching agents which diminish and blend the pigment spots which form on the skin, and skin nutrients such as vitamin C. A medically-supervised skin program can showcases your facelift and helps your results become more enduring.
When can I get back to my usual activities or exercises after a facelift? (Recovery Timetable)
Recovery after a facelift is generally within 2-3 weeks.
The healing passes through three phases of healing: beginning with the swelling phase which generally lasts one week, followed by the most variable phase which is stiffness. Stiffness occurs as natural healing occurs which brings the necessary components to remove bruising and to repair to the areas of surgery.
All sutures and metal clips are removed in the within the first 7-10 days after surgery. Camouflage makeup can be used any time after the sutures are removed. By the third week, most people feel they can gradually resume their routine activities. However, neck turning, which may occur with swimming and sports such as tennis, may need to wait until the tissues are more healed (another 3 weeks).
Recovery Timetable After Your Facelift
Day #1 – First day after surgery: visit to the office where the cotton dressing and elastic wrap placed at the time of surgery is removed. All incision areas are cleansed, and a light elastic garment is fitted to provide support and limit swelling. This visit includes time to evaluate medications and your recovery needs.
Days #3 to 5 – During these visits to the office, Dr. Szachowicz follows protocols to speed the resolution of the swelling. Ultrasound therapy is used to stimulate the micro-circulation. Additionally, light therapy, consisting of the red/orange frequencies of light, is used to stimulate the healing. Home therapy consists of Arnica montana cream to any sites of swelling or bruising, which has been shown to accelerate e the body’s rate of healing.
Days 7 to 10 – Removal of any sutures and metal clips takes place during these visits. Camouflage makeup can now be applied. As your energy returns, you can assume regular daily activities, such as driving, shopping, etc.
Weeks 2 to 3 – Any remaining bruising resolves. Physical activities such as going to the gym, treadmill, etc. can now be gradually included in your routine. Swimming and tennis need to be delayed until more stiffness has resolved in the neck area. Most people return to work or social activities during this time.
One month – Fraxel laser skin treatments begin to the incision lines. A medical skin care program can be started or resumed. You can safely get your hair cut, colored and/or styled.
There are precious few times in life were you can invest a few weeks and take back years – facelift recovery time is one of them. In our time-pressured society, few people regret the time taken for themselves.
Will I be in pain after my facelift?
Most people report that the discomfort after their facelift is generally focused on the region of the incisions lines around the ears. There is also a variable amount of perceived ‘tightness’ in the neck where the muscles were sutured. Most people report that they can relieve the discomfort with the oral medications prescribed.
Other measures such as chilling ice mask for around the eyes, keeping the head elevated higher than the heart and not moving around too much after surgery contribute to your comfort.
Dr, Szachowicz will remove the fluffy cotton dressing covered with the elastic wrap on the visit to the office the next day. This is replaced with a thin Lycra garment which feels supportive. Most people report that they are just tired and need to rest the next day, focusing on eating soft foods and drinking plenty of fluids.
It is also fair to mention that multiple procedures can influence the sensation after surgery. A browlift can ‘feel’ tight across the forehead similar to a headache and fat harvested from the stomach area may feel as you did an abdomenal workout. However, Oral narcotic medications are generally effective for post-operative surgical pain management
What are Dr. Szachowicz’s credentials for doing my facelift surgery?.
Edward Szachowicz, MD, PhD of Facial Plastic Surgery in Edina, Minnesota has a life-long legacy of education, learning and teaching. He is only one of a few double board certified facial plastic surgeons in Minnesota.
He started with his first board-certification in Otolaryngology-Head & Neck Surgery from the University of Minnesota. During his training, he took extra time to earn a PhD for the Graduate School of Medicine at the University of Minnesota. He went on to be awarded over $200,000 in grants to study wound healing and had a research association with the Walter Reed US Army hospital in Washington, DC.
Thereafter, he became a teacher at the University of Minnesota Medical School and trained residents in maxilla-facial trauma at St. Paul-Ramsey hospital (now Regions Hospital) in St. Paul, Minnesota.
He went on to do a year-long fellowship in Facial Plastic and Reconstructive Surgery through the American Academy of Facial Plastic & Reconstructive Surgery. With all his qualifications, Dr. Szachowicz was nominated and elected as a Fellow to the American College of Surgeons (FACS), after his surgical cases were reviewed by his peers.
Dr. Szachowicz then received his second board certification by the American Board of Facial Plastic and Reconstructive Surgery after submitting his surgical cases to peer review, and passing a rigorous written and oral examination. Recently, Dr. Szachowicz has voluntarily re-taken all these exams for ‘Maintenance of his Certification’ by the prestigious American Board of Facial Plastic & Reconstructive Surgery.
Dr. Szachowicz regularly teaches at national & international meetings (most recently at the European Society of Plastic Surgery in Edinburgh, Scotland) and has participated in ‘pro bono’ efforts in places across the globe, form the Marshall Islands in the Pacific, to Croatia in the Balkan Peninsula in Europe.
Dr. Szachowicz specializes exclusively in cosmetic facial plastic surgery and has advanced certification and training in exclusively facial plastic surgery, including facelift surgery.