Health
More women and men turn back the clock with a facelift

By Katherine Nichols
Advertiser Staff Writer

A facelift gets under way in the office of Dr. F. Don Parsa. The procedure can be done under a local anesthetic, allowing the patient to remain conscious. Richard Ambo • The Honolulu Advertiser

Surgical pen marks on the patient's face provide the map for the scalpel. "Open your eyes and look up," says Dr. F. Don Parsa, chief of plastic surgery at the Queen's Medical Center, professor at the John A. Burns School of Medicine and a plastic surgeon for more than 20 years. With deft movements of his gloved hands, he stitches the fine cut along the lower eyelid.

More people than ever are deciding that looking younger and feeling better via a facelift are worth the risk, expense and pain. Technically known as a rhytidectomy, an estimated 40,000 people nationwide chose to have a facelift in 1992; by 1999, that number had risen to 73,000. Nine percent were men.

Though the aging process is inevitable, a facelift can turn back the clock by "improving the most visible signs of aging by removing excess fat, tightening underlying muscles, and redraping the skin of your face and neck," according to the Plastic Surgery Information Service.

"Indeed, the results of facelift surgery coincide with the patient's goals: a more refreshed, youthful version of themselves, without changing their intrinsic appearance," wrote Alan Matarasso, a physician with the department of plastic surgery at Albert Einstein College of Medicine in New York. "Patients often state that they want to reconcile their facial appearance with how they feel; in essence: 'look as good as I feel.' "

Sandra Vickers confirmed this.

"I can't say enough times how wonderful it has been to get rid of that sagging flesh," said Vickers, a San Diego resident who often visits Hawai'i to compete in open-water swims. "I remember feeling very guilty that I spent all that money ($8,000) on my face, but I don't anymore."

Vickers, who had her facelift 10 years ago at age 51, said, "I wasn't happy with the way I looked because I was very fit, and I wanted my face to match my body. I've been blessed with good skin, no stretch marks, no sagging breasts ... and this face!"

Dr. Robert Schulz, a plastic surgeon at Straub with over 23 years of experience, performs between five and 12 facelifts each month. "There's so much public knowledge about plastic surgery today that it's almost like getting your hair done," he said. People no longer hesitate to make changes in their appearance.

Despite the ease with which plastic surgeons perform this procedure, there are risks. Complications include a hematoma (a collection of blood under the skin that must be surgically removed) and injury to facial nerves. "It feels a little weird for a while," said Vickers. "There are places in your neck that feel numb."

Schultz said that surgery "denervates sensory fibers for a while," and the ensuing numbness lasts anywhere from six weeks to three months. However, he also said that "injury to the motor nerves (those controlling facial movement) is rare."

Other hazards include infection — though Schulz said this is also infrequent — reactions to anaesthesia (post-surgical nausea is common) and failed expectations. This is why clear communication between the physician and the patient is imperative.

Before surgery, the doctor will obtain a detailed history to evaluate any medical conditions that might interfere with surgery, such as high blood pressure, which should be diligently controlled. Medications such as female hormones, steroids and products containing aspirin can alter blood coagulation, and must be discontinued for at least two weeks before and after surgery.

Smokers are required to stop for at least a month before and after surgery. In fact, said Schulz, "we rarely do a facelift on a smoker." The risk? Inadequate blood supply can interfere with healing and create severe skin problems.

Alcohol should be avoided the night before and after surgery, and otherwise used in moderation.

Women who color their hair should do it three or four days before surgery because it will be at least three to four weeks before the doctor will allow any coloring agent on the scalp. Additionally, Schulz encourages his patients to eat a strict vegetarian diet during this time.

While some physicians use a general anesthesia, most employ a local anaesthetic combined with a sedative that allows the patient to remain awake but relaxed.

A common misconception is that a facelift includes rejuvenation of the entire face. The reality is that a basic facelift only pulls the corners of the mouth, the middle of the face and the neck, and might involve the removal of a small submental (under the chin) fat pad. Everything else is a la carte. Want the forehead pulled to erase lines? Want drooping upper eyelids tightened? Want the bags under your eyes to disappear? The more you want, the more expensive it will be.

After surgery, the entire face remains bandaged for 24 hours. Three days later, some stitches are removed; the rest, after a week.

Dudley Wood, a San Diego resident who also frequents Hawai'i for swim competitions, said she returned to work 10 days after her facelift at age 60.

Schulz suggested that patients can go to the market after three or four days, using makeup to hide the bruising, and brushing hair to hide the stitches behind the ears. But "for sure you look pulled," he said, so if you want to keep the surgery a secret, you'll need about three weeks before returning to work and social activities.

Schulz discourages a patient from turning her head, talking excessively, or making a lot of facial expressions to avoid tugging the skin when swelling is present and the skin is tight. He indicated that light exercise is fine a few days after surgery. However, patients should eschew vigorous exercise for at least a month.

Because a patient must keep her head elevated — even while sleeping — for a week after surgery, Wood prepared beforehand by stuffing towels and blankets under the mattress. Ice compresses are also recommended.

In Schulz's practice, the ratio of men to women seeking surgery is about one to four. "I think men age better because their skin is thicker," he said. But he also acknowledged other factors: "We determine attractiveness in men based on a lot of things other than just pure appearance." Money, politics and power, for instance. "Women have to stand in a more critical arena."

For many, however, the bottom line is feeling good. Said Vickers: "If it makes you happy and you can afford it, and you're not hurting anybody, why not?"

Katherine Nichols can be reached by e-mailing knichols@honoluluadvertiser.com.