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Mid facelift Orange County Mid-Facelift Cheek Lift and Thread Lift

MID FACELIFT INTRODUCTION

The earliest signs of aging show up in the mid-face area, an area from the corners of the mouth to the corners of the eye. The lid/cheek junction begins to drift downward, lengthening the height of the lower lid, and a drooping cheek will enhance the naso-labial fold. Frequently this occurs before the neck becomes lax. An aging face has more fullness along the jaw line and the face resembles the letter “A”, looking somewhat like an underinflated tire – a youthful face has the maximum fullness in the area of the midface, in over the cheekbones, and the face resembles the letter “V”. This condition can be improved with a midface lift as an isolated procedure, or it can be performed in conjunction with a full facelift. This information has been assembled to familiarize you with the facts regarding

mid-face lift/cheek lift/thread lift surgery. You are requested to read the following information thoroughly and to discuss any questions, which might arise with your surgeon before you proceed with the surgical procedure known as the mid-face lift. You are also requested to keep this information as a reference during your post- operative period.

Orange County Mid-facelift before and after Facial rejuvenation is at the top of the list of the most common aesthetic surgical procedures performed by your surgeon at Orange County Plastic Surgery. Most people feel physically and mentally vigorous and energetic long after their appearance has begun to deteriorate due to aging. A face, neck, brow or mid-face lift procedure is designed to provide you with a rejuvenated appearance. The degree of improvement achieved depends on the severity of the initial deformity, the age of the patient, tissue elasticity and the recommended procedure. 

A youthful face is normally curvilinear with graceful curves and with fullness in the upper mid-face region, the so called “V” shape. The lower lids appear tight and are short vertically. As faces age, the soft tissues inevitably drop – the upper cheek tissues descend, creating jowls, the “A” shaped face, a hollowness in the cheek region, and an elongated lower eyelid. The neck skin and muscles loosen as well. As patients age, the central neck becomes fuller and the jaw lines become blunter, loosing the crisp distinction between the neck and jaw seen in youth. Sun damage causes the skin to wrinkle and assume a weathered look. 

The traditional face lift is wonderful for dealing with jowls and the neck line. It was designed to pull the skin and superficial muscles backwards to minimize the jowl and to tighten the neck areas, but this procedure does not address the elongated lower eyelid and the hollowness in the mid-face region. As a matter of fact, the tension required to pull the cheek tissues backward actually flattens the mid-face region, further exacerbating the unnatural and definitely anything but youthful look! In some instances of minor neck laxity, the neck may be tightened by inserting a variety of threads beneath the surface and correcting neck laxity in cases of minor laxity. Such minimal incision, thread procedures will not give a patient an optimal result if significant laxity is present, along with a significant skin excess. 

Facelift before and after see mid face lift and chin liftThe new mid-face or cheek lift procedures specifically address this central facial hollowness and works to restore a curvilinear, youthful facial appearance. This is accomplished via short stab wounds along the fold between the upper lip and cheek, and short incisions behind the side burn, just above the ear. Through these access incisions, the surgeon can elevate the tissues which have drifted downward, back into a more youthful position, with suspension sutures. The aging face can thus be sculpted tension-free to recreate the soft and graceful curves of youth. This procedure will not tighten a neck or jowls! The midface lift, along with microfat grafting of the tear troughs, are most frequently performed in a younger patient or as adjuncts to a traditional lift. Some patients, usually those who are younger with aging limited to the mid-face region, or those who have already had a traditional facelift, will benefit from a mid-face/cheek lift as a sole procedure. Others may best be served with a mid-face lift combined with a traditional lift or other associated procedures in order to achieve the optimal result! 

Ancillary procedures are frequently utilized to enhance the final results. Frequently, the eyelids can be addressed at the same sitting. Likewise, most patients old enough to have experienced facial laxity, will also have seen their brows descend; in order to balance the rejuvenated mid-face, an endoscopic brow lift is frequently performed to optimize the results. Autologous fat grafting can be used to fill an excessively hollow face or to augment lips which have thinned as part of the normal aging process. Chin implants are frequently employed to improve jaw contour. A nasal hump may be brought down or a tip refined. Sun damaged skin can be smoothed simultaneously with laser beams or a variety of chemical peels. In order to enhance the results from the chosen procedures, a good skin care program will be recommended for the health of the skin and to enhance the appearance of the skin. 

You must realize that your surgeon will tighten the sagging tissues as much as can be done safely to provide a natural result for your particular facial contour. The mid- face/cheek/thread lift procedure is directed toward improvement and does not remove each and every sag or fold of the face. The type of skin, the age, and the aging rate of each patient, are factors that help determine your final result. 

A common question regarding any procedure is "How long will the results last?" This is impossible to state for a given individual, as there are many factors involved: continued sun exposure, the age of the patient, the patient's type of skin, healing ability, changes in weight, smoking history and general health of the patient. Your surgeon expects you to look better than had you not had a midface lift for the rest of your life, but some laxity will return with time. As a matter of fact, the facial tissues continue to sag and loosen, at your natural rate, right after surgery. A small minority of patients, especially those who have a very marked degree of skin laxity in the jowl area, will not achieve a youthful look, even with a traditional facelift or a second mid-face lift, but most patients receive sufficient improvement and only require one facelift during their lifetime. Soft tissue aging continues after any operation – the best measure you can take to slow this process is to use sun block faithfully, and to take care of your skin with proper rejuvenating creams. Our office aesthetician will be glad to help you with a skin care program with our MD Performance® line of products. This surgical procedure merely turns back the aging process; it cannot stop the “hands of time.” Your surgeon may be able to give you a good idea of what can be expected following surgery by manipulating your facial tissues in front of a mirror. 

Regardless of how tightly the facial tissues are pulled, aging and stretching of the facial skin begins to occur immediately after the operation. It is usual to see some recurrence of jowls or drooping of the mid-face within three months of the operation. You can, however, look forward to a significant degree of improvement permanently. Most patients have sufficient improvement following a face, midface, brow or neck lift, which keeps them looking younger than their friends, forever. However, you may choose to have another lift, mid or traditional, in future years to maintain a more youthful appearance. 

Your surgeon always tightens your tissues as much as it is safe to do and cannot control how quickly any individual will sag. Regardless of how quickly or slowly you sag, each patient will be responsible for the cost of a subsequent procedure should the patient wish to repeat the operation. 

To maximize the degree of rejuvenation, many patients will choose to undergo a forehead lift, eyelid procedure or laser skin resurfacing at the same operative setting. Lifting the mid-facial tissues shortens the height of the lower eyelid tissues and may cause the skin to appear more wrinkles after that procedure than it was initially. In order to optimize the final result, most patients will choose to undergo a lower lid blepharoplasty procedure at the same time as a mid-face lift.

MID FACELIFT PREOPERATION PREPARATION

You may visit your surgeon as many times as you wish to have all of your questions answered. At your final preoperative visit, your final questions will be answered and you will confirm that you understand the procedure to be performed, that this material has been explained to you, that you have read Mid face lift procedure to remove sagging facial skin in Orange County and understand these information sheets, and that you accept the risks by signing the informed consent forms. You will be given prescriptions for pain pills and antibiotics along with instructions for their use. Certain laboratory tests will also be required within two weeks of surgery. If you are over the age of 50 or if you have any history of cardiac problems, you will have to obtain a cardiogram at your doctor’s office and any certified laboratory.

You may have blood drawn by our office nurse during your final preoperative visit, or, if you prefer, at your family doctor's office or any laboratory (e.g. Kaiser Hospital, etc.). All patients will be asked to stop smoking at least a month prior to surgery in an effort to maximize your body's ability to heal the incisions following the operation.

Patients should shampoo they hair the morning of or the night prior to surgery. Absolutely nothing may be taken by mouth after midnight prior to the day of surgery (except medications prescribed by your family doctor, but please mention these to the anesthesiologist in advance.)

Sometimes, your anesthesiologist will call you the night before surgery to discuss the anesthetic care plan with you. But if you miss the call or your anesthesiologist does not call you, do not worry as you will be able to discuss your anesthesia and have all your questions answered in the morning, at the Surgery Center prior to your procedure (Orange County Surgery Center in Newport Beach, Southern California or Tracy Surgery Center in Tracy, Northern California). It is absolutely imperative that you make arrangements in advance to have someone drive you to and from the surgery center on the day of your operation. Most patients who choose to have a midface lift by itself can go home with any responsible adult who can spend the next 24 hours with you at home – if you choose to have a traditional facelift in addition to the midface procedure, care by a trained nurse for the first night will be imperative.

Please wear loose fitting clothing, which will be easy to get off and on after the operation. When you arrive for your operation, please give the receptionist the name and phone number of the person who will take you home and spend the first night with you. Wear no makeup to the surgical facility on the day of surgery, and do not apply facial moisturizers.

All patients anticipating an elective surgical procedure are to stop taking any medication containing anti-inflammatory agents (Aspirin®, Advil®, Motrin®, etc.) as these interfere with the body’s clotting mechanism and can result in dangerous blood loss and excessive bruising.


MID FACELIFT OPERATION

A mid-face/cheek lift is an elective, cosmetic surgical operation in which the loose muscles of the mid-face are tightened and tightened in an upward oblique direction. Access to the surgical field is achieved through incisions behind the sideburn above the ear and also through stab wounds along the nasolabial folds. Through these access incisions, the surgeon can mobilize the drooping tissues and suspend them upward, back into a more youthful position, with a variety of suspension sutures. Thread lifts may also be utilized to tighten the appearance of a neck, but the neck tightening procedures are not as effective as the midface or cheek lifts. These are inserted through a variety of short stab wounds on the cheeks and posteriorly in the region of the ear and temple.

Occasionally, the patient and surgeon may decide that in order to obtain the desired optimal result, additional ancillary procedures such as microfat grafting, a traditional facelift, eyelid surgery, a brow lift, skin resurfacing, or a chin implant may be required. These additional procedures will be discussed separately as they are not an actual part of the mid-face, cheek or thread lift operation. If desired, your surgeon will go over these additional procedures with you.

A straight forward mid-face lift/cheek lift procedure or neck thread lift requires approximately one and a half hours to perform. Of course, if additional procedures are requested, a longer time will be required. The surgery will usually be performed under a light general anesthetic or under deep sedation supplemented with local anesthesia, insuring patient comfort. An anesthesiologist will always be present to administer the medications and to monitor all patients to ensure their safety.

At the completion of the operation, you will be taken to the recover room with ice packs placed over your surgical site. Patients may choose in advance to spend the first night with a nurse in a local hotel. Otherwise, after you have recovered to the point where you are awake and comfortable, you will be discharged with a responsible adult of your choosing.

MID FACELIFT POST-OPERATIVE CARE

All external incision should be cleansed with peroxide on a Q-Tip and a light layer of Vaseline applied four times per day. Patients can expect bruising and swelling of the face, especially if combined with an eyelid procedure. The discoloration will be most noticeable on the second and third days, and diminishes anywhere from one to six weeks after surgery, depending on ancillary procedures performed at the same sitting. Most patients who only have a midface lift, with perhaps light makeup, can resume everyday tasks approximately three to four days after surgery. Bruising and distortion will be minimal with a thread lift of the neck, and many patients can return to work or their normal social routines within a few days. You may shower and begin using MD Performance® Professional Skin Care Cleansers

and Moisturizers by the second or third day. You may begin walking as soon as you feel able, but all lifting, straining and other vigorous activity is to be avoided until all bruises have faded. The best rule of thumb is to avoid any activity that causes you discomfort and to enjoy those that do not. 

Most patients are pleasantly surprised to discover the relatively mild degree of post-operative discomfort. Patients are requested to call the office if the discomfort is not readily quelled by the pain pills, or if significant bleeding appears around the incisions. The external sutures will be removed four to ten days post-operatively.

MID FACELIFT POSSIBLE COMPLICATIONS AND SCARS

Every activity in life, whether driving automobiles or having surgery, is associated with risk. The following inherent risks must be understood and assumed by the patient if we are to proceed with this surgery. Although complications and bad results are uncommon from this type of operation, they do sometimes occur. Your surgeon cannot guarantee a favorable result from any operation you are considering, but every effort will be made to provide you with the best result possible. Some of the possible complications from this operation include: infection, asymmetry, ectropion (pulling down of the lower lid lash line), infection, erosion of the threads through the skin, bleeding, unequal discoloration and swelling of the face, abnormal contour, nerve damage causing temporary or permanent loss of feeling

in the face and weakness of portions or all of the face, personality changes and mental difficulties following the operation which may occur even when the operation has been a success, potentially fatal blood clots in the leg veins as a result of decreased physical activity, and allergic or other adverse reactions to one or more of the medications used during or after the operation. 

Some of the complications associated with this operation can cause the need for further or touch-up surgery, which will result in additional fees to the patient. Some of the complications can cause prolonged healing, unsightly and painful scars, deformity and inconvenience. Some unsightly scars or asymmetry caused by nerve damage cannot be improved by further surgery. 

Complications, particularly healing problems, without question are seen more frequently in smokers, and you are urged not to smoke for at least a month prior to and after your surgery to minimize the likelihood of such complications. (And if you can stop for that long, why not do your body a favor and quit this nasty habit permanently!) 

There are also other very rare potential complications from this operation in addition to the ones that have been mentioned, but it is not possible to advise you of every conceivable complication. 

Complications after any type of cosmetic surgery are relatively rare and most patients end up with a very satisfactory result. The purpose of this information is not to frighten you, but to insure that your decision to have this operation is not made in ignorance of the potential risks of cosmetic operations on the face.

Scars

The surgical scars are permanent; however, the incisions are placed so that they are barely discernable on normal visual observation, barring complications. If this problem occurs, treatment by excision or steroid injections may be indicated, but it may be impossible to improve an unsightly scar.

SOCIAL ACTIVITY AND MAKEUP

Social activity should be limited for as long as you feel uncomfortable with the degree of swelling and bruising that you have. Light activities such as walking may be begun as soon after surgery as the patient desires. Strenuous exercises may be resumed when it is physically comfortable to do so, usually in a few weeks when all visible swelling and bruising have subsided. Cosmetics and moisturizers may be applied over the skin of the face two days after the operation. The office aesthetician will not only be able to assist you with makeup application to help hide bruising, but also to give you guidance regarding skin care after you have healed.

SHAMPOO AND HAIR COLORING, SHOWERS AND BATHS

Coiffure procedures may usually be carried out after the incisions have healed well enough not to have any crusts on them – this can be expected to take approximately two weeks. By the second or third day, the patient will be encouraged to begin showering and shampooing normally, but care must be taken not to rub the incisions firmly.

FEES

Fees will be discussed freely in advance by the patient coordinator. Naturally, additional fees will be required if the patient desires ancillary procedures such as microfat grafting, a traditional lift, an endoscopic brow lift, eyelid surgery, chin or nasal surgery at the same time. In compliance with suggestions adopted by the American Society of Plastic Surgeons®, it is customary for the patient to pay all fees for cosmetic surgery prior to the desired operation. This insures that the patient is sincere in her motivation and can afford the surgery, thus creating a better patient/physician relationship. A non-refundable deposit will be required to secure your desired surgery date. The remainder of the fees must be paid prior to the surgery, usually at the time of the preoperative visit, but no later than two weeks before surgery.

Additional fees are also required for laboratory tests, surgical facility fees, and the anesthesiologist. If additional surgical procedures become necessary, additional facility, laboratory, anesthesia, implant costs and professional fees will be incurred. The surgical facility and anesthesiologist fees quoted will be based on our best faith estimate; the final fee may vary as these fees are based on surgical time, and it is not always possible to predict exactly how long a procedure will take to complete.

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