As we age, the tissue of the face and neck relaxes, producing saggy skin, jowls, and deepening of the facial folds. In addition, there is volume loss, which results in poor definition of the cheek and jawline. Patients exhibiting gravitational changes of the face and neck, such as loose skin, prominent jowls, and deep facial folds require surgically lifting the descended tissue and removing the excess lax skin. For this reason, a facelift and necklift is considered one of the pillar procedures in the field of facial aesthetics, since it is the most effective means of reversing those changes caused by age, specifically in the area of the cheek, jawline, and neck.
Dr. Couto is a Cleveland Clinic trained plastic surgeon, and one of the few plastic surgeons in Latin America to have completed an American Society of Aesthetic Plastic Surgeon (ASAPS) endorsed subspecialty training in Aesthetic Surgery and Medicine.
During his training, Dr. Couto had the privilege to have mentors that are considered top leaders in the field of facial aesthetic surgery. This includes, Dr. James E. Zins, one the largest contributors to the field of facelift and necklift. Furthermore, because of his strong passion for facial rejuvenation, Dr. Couto has co-authored multiple scientific articles and book chapters about facelift and necklift. Furthermore, Dr. Couto has been an invited faculty member of the annual American Society Plastic Surgery (ASPS) face and neck rejuvenation course.
The facelift is one of the most comprehensive procedures performed to reverse facial aging. This operation removes excess skin, softens skin wrinkles, and repositions descended facial soft tissue into an aesthetic pleasing position. The facelift is commonly combined with a necklift , since both areas complement each other. Therefore, achieving a smooth transition between the face and the neck is crucial for a youthful appearance. In addition to skin laxity, facial aging is marked by tissue volume loss; thus, adding volume to the face with fat transfer or hyaluronic acid fillers can aid in a more rejuvenated look.
The consultation is divided into five parts:
1 )Health and Medical History Evaluation
A comprehensive evaluation of your medical history is performed. During this part of the consultation, we focus on identifying any potential risk factors for the surgery. It is important to tell Dr. Couto if you utilize any nicotine products (e.g cigarette, nicotine patch, vape, etc), if you have uncontrolled high blood sugar levels (e.g. diabetes) or if you take any medications, supplements, or other drugs as these can have a big impact on your surgery. An example is aspirin or blood thinners, which can lead to the formation of a hematoma after your procedure. These are common risk factors that can be easily modified with lifestyle changes and can affect your surgical results. Although this procedure is low risk, your health and safety will always be our main priority. We like to set the patient for success, not for failure; therefore, modifying any potential risks is essential to obtain the best possible result.
2) Discuss with the Patient About Surgical Goals
Dr. Couto has a deep discussion with the patient to learn about their concerns and goals. Listening to our patient’s interest is crucial, since it is our priority to determine if we can meet their expectations. We focus on learning whether the patient is particularly interested in addressing an specific area of the face or if the patient is interested in a global face and neck rejuvenation.
3) Physical Exam
A complete systematic analysis of the face and neck is performed. Dr. Couto treats the face and neck as whole, not by areas. A youthful appearance is marked by harmonious transitions between different areas of the face and neck. Consequently, Dr. Couto not only examines the regions the patient is mainly concerned with, but also those surrounding areas and structures of the face and neck that could help achieve a balanced and refreshing look.
4) Recommendations & Surgical Plan
Following the physical exam, Dr. Couto develops a personalized surgical plan aimed to meet the patient’s expectations, achieve optimal aesthetic results, and maximize patient safety. During this time, Dr. Couto discusses with the patient the indicated surgical techniques and explains in detail everything pertaining to the procedure and its recovery.
5) Pricing and Scheduling Information
Once the evaluation has been completed, our team will provide an individualized price quote that is tailored to the procedures discussed during the consultation and review the steps involved to book the procedure with us.
Individuals exhibiting gravitational changes of the face and neck, such as skin laxity, prominent jowls, and loss of definition of the jawline and cheek. In order to correct these aging changes, the excess skin must be removed and soft tissue repositioned through a facelift & necklift procedure.
Facelift operations have evolved over the last decades. First generation techniques were skin only facelift, which consisted in addressing the loose skin by simply excising and tightening it. The problem with this approach was that it resulted in a pulled, unnatural look. Consequently, modern facelift surgery has transitioned to focus not only on the skin, but mainly in the tissue layer below the skin. This layer is called the “SMAS”, and it is manipulated in order to lift and reposition droopy facial tissue and improve the cheeks and the jowls. Furthermore, this technique facilitates the excision of that loose skin in a tensionless fashion; thus, preventing that overtightened look, and instead producing a natural and freshened appearance.
Dr. Couto selects the correct facelift technique based on the patient’s facial aging changes, anatomy, and previous facial aesthetic treatments. Dr. Couto only utilizes cutting edge facelift techniques, such as deep plane facelift, sub-SMAS facelift or SMAS plication facelift.
A facelift surgery usually requires a well-hidden incision that starts at the sideburn, it travels just in front of the ear, around the earlobe, behind the ear, and then partially into the hair behind the ear (illustration). Through this incision, the SMAS tissue is lifted and repositioned to better define the cheeks and eliminate the jowls. In younger patients, who have minimal neck skin laxity, a short scar facelift can be performed. This modification consists of omitting the incision behind the ear; however, we believe that this technique provides inferior results when compared to the traditional facelift.
Because a smooth transition between the face and the neck is crucial for a youthful look, a neck lift is commonly performed at the same time as a facelift. This usually requires an additional small incision below the chin, which allows the removal of fat and tightening of the neck muscles, also known as a platysmaplasty.
Once we have completed the facelift and necklift then we usually proceed with facial fat grafting . Fat harvested from the patient’s abdomen or thigh is processed and injected in areas of the face that have suffered fat volume loss, a common facial aging change. This technique helps enhance the cheek areas and better define the jawline.
Several weeks before the procedure, a preoperative appointment will be scheduled. During this appointment, we will discuss the surgical plan again, and clarify any questions involving the surgery. Furthermore, we will thoroughly review with the patient the preoperative/postoperative instructions and medication regimen, and schedule your future post-operative appointments.
We always emphasize to our patients that medication (e.g. aspirin, ibuprofen), vitamins and herbal supplements (e.g. Fish oil, Omega-3, Garlic or Tumeric pills, Ginko Biloba) should be stopped at least 3 weeks before surgery, as this increases the risk of bleeding. Furthermore, we remind them that smoking, vaping, or using any nicotine products will affect the results and recovery. There are significant scientific evidence that patient actively using of nicotine (eg. cigarettes, vaping, chewing, etc) have 12 times higher risk of complications following facelift surgery when compared to non-smoker patients. Nicotine affects a person’s capacity for healing; thus, affecting your wounds and scars. During the initial consultation, Dr. Couto will ask the patient to stop smoking at least 8-12 weeks before the operation to reduce the risk of complications. Patients with a history of diabetes mellitus must have a glycosylated hemoglobin (HbA1c) of 7 or less to be able proceed with surgery. If the HbA1c is above this level, Dr. Couto will refer the patient to their primary care physician or endocrinologist to optimize your medications or diet to help lower the HbA1c levels. Lastly, nutrition is crucial for an effective healing and recovery process. Therefore, we recommend to our patients to optimize their protein intake and avoid foods high in salt/sodium after any surgical procedure. This could be easily achieved with post-operative supplements available in our practice.
We provide our patients with a detailed postoperative protocol to ensure that they have a comfortable and quick recovery. Following surgery, the patient may have drain tubes placed, which helps prevent fluid collection in the face and neck and expedite the recovery. They are typically removed 24-48 hours after surgery. The patient will wear specialized face and neck compression garments that help minimize swelling and skin contour irregularities. Swelling and bruising are to be expected, and they can be noticeable for a week. Rarely, patients experienced pain or discomfort following this surgery. It is very unusual for a facelift and necklift patient to require narcotic pain medications. We normally recommend our patients to take 7-10 days off from work (less if working from home). The same day after surgery, Dr. Couto always instructs the patient to have a couple of walking laps around the house or neighborhood. Patients can resume their exercises (eg. running, spinning, biking) 6 weeks after surgery.
The truth is that there isn’t! Every person ages in a different way and at a different rate; therefore, there isn’t a correct age to undergo a facial rejuvenation. The timing of a facelift is mainly determined by the skin quality and elasticity of an individual. These intrinsic skin characteristics are not only influenced by age, but also by genetics, weight changes, sun exposure, smoking history and other lifestyle qualities. It is for that reason that during the consultation we perform a systematic analysis of the entire face and neck. This enables us to develop customized surgical plans that are based on your facial features, personal needs, and aesthetic desires.
A mini facelift is an ineffective version of the facelift surgery. This procedure was designed as a marketing stunt, which promises the patient a shorter recovery time, because of its short incision. Commonly, patients present to our clinic just a few months after a mini-facelift unsatisfied by the short lasting and underwhelming results. The reason for this is that the mini-facelift, unlike the facelift, is limited to only tightening of the facial skin. It does not address the SMAS, which is the soft tissue lying below the skin producing the droopiness of the face, and it does not address the neck. Consequently, not only does this create an unnatural, pulled facial look, but also produces results that do not last long enough.
The question is when to do fillers and when to do surgery. During the consultation, Dr. Couto will explain what changes are occurring on the face, and most importantly the reason why it is happening. This is crucial to determine if the patient is a candidate for a non-surgical or surgical treatment.
Non-surgical therapies, such as fillers are great for patients undergoing early facial aging changes where volume restoration and enhancement of shape are mainly required. On the other hand, patients exhibiting gravitational changes, such as a saggy skin, prominent jowls, and loss of definitions of the jawline and neck, require a surgical treatment. A facelift and necklift are procedures designed to specifically achieve those things: remove excess skin and lift descended soft tissue into an aesthetic pleasing position.
Dr. Couto specializes in both surgical and non-surgical facial aesthetic treatments. Therefore, an objective and unbiased recommendation will always be provided during your consultation. The ability to know firsthand what can be accomplished non-surgically and when a surgical intervention is a unique and essential quality in the field of facial aesthetic surgery.
Surgical drains are usually used for this procedure since it prevents fluid from accumulating in the face or neck region and helps expedite the recovery. Surgical drains are commonly removed 24-48 hours after surgery.
Uncontrolled diabetes can affect the ability of the body to heal wounds properly. Therefore, it is crucial for diabetic patients to have their blood sugar levels under control for this procedure. Patients with an HbA1c of 7 or less are candidates for this procedure.
There are numerous scientific studies showing that smoking cigarettes and/or using nicotine products increase your risk of postoperative complications. Nicotine affects the vascularity, and thus prevents the body from healing wounds properly following surgery. We recommend patients to stop smoking or use nicotine products at least 6 -8 weeks before surgery.
