The Risks of Facelifts


Join Joyce Collin as we listen to her story and learn about facelift surgery risks and benefits. Find out if facelift risks far outweigh the benefits of looking younger.

Bucking the traditional rituals that less inspired people might enjoy on their 60th birthday, substitute science teacher Joyce Collin (not her real name) marked her 60th earlier this year in nonconformist style.

The Derwood, Md., mother of two went under the knife that very day in February for a facelift, a cosmetic operation paid for by her mother from whom Joyce had inherited the self-described "turkey wattle" that gradually settled on her once firm, youthful neck.

Having lived six decades now, Joyce doesn't see herself as vain. "Fairly confident," yes. And "very sensible." So why would a woman with a healthy self-esteem—and a long-time marriage she describes as "world-class," to boot—turn to plastic surgery to transform her look?

Her face and neck were aging faster than her same-aged husband's, Joyce was noticing. But beyond that, the birthday facelift celebrated her credo, born years ago from a hard-won victory over breast cancer: "Make the most of the life you've got."

Life-embracing Attitude

The life-embracing attitude is common among cosmetic surgery seekers, according to Mark E. Richards, M.D., who counts Joyce's facelift among the hundreds he has performed. His patients tend to be active, social, baby boomers who could live till they're 90.

"It's a different world than when people died at age 60," says Richards, a board-certified plastic surgeon for the past 10 years. "At 60, their health is good. Some still run miles a day, and juice their vegetables."

All told, 73,000 people got facelifts in 1999, according to the American Society of Plastic Surgeons, with some 6,700 men among them. There are the eccentrics who capture the media spotlight for wanting to look like Barbie or Catwoman, Richards says, and then there are typical patients, who are "so much smarter and more normal than the myths make them out to be."

Richards' patients are workaday professionals, he says—mail carriers, doctors, engineers, newspaper reporters, politicians and schoolteachers like Joyce—who "look in the mirror and see their mother. They're not people who want to change who they are. They want to look like they already do, but a little prettier, so that the reflection in the mirror matches the way they feel inside."

The Risks of Facelifts (<i>cont'd</i>)

A facelift promises to revitalize an aging face, it's true, but people shouldn't jump headlong into this elective cosmetic operation without understanding the procedure itself and weighing its potential risks.

Facelift Facts

By removing extra fat, tightening the muscles, and re-wrapping the skin around the face and neck, a facelift, technically known as a rhytidectomy, can improve the most visible hallmarks of aging.

Years of gravity, sun exposure, and daily stress can cause deep creases to form between the nose and mouth, the jaw line to go slack and jowls to form, and the excess skin and fat to appear as folds in the neck area and under the chin.

A facelift basically functions to return an aged face, which tends to take on a square shape, to its younger, oval look. But, clarifies plastic surgeon Richards, a facelift "will do nothing to turn back the clock for the upper face, eyes, and for facial skin wrinkles." Distinct operations such as a brow lift, eyelid surgery, and laser surgery focus on those areas.

Sometimes a facelift is performed under local anesthesia combined with a sedative, which leaves the patient awake but relaxed and insensitive to pain, and in other cases the patient chooses to sleep through the operation under general anesthesia.

Facelift Techniques Vary

Specific facelift techniques vary from surgeon to surgeon, but basically, doctors make incisions that allow them to separate the skin from the fat and muscle underneath. Then they might trim or suction any extra fat from the neck and chin, and tighten the neck, cheek and other muscles and tissues. Finally, they return the skin to its position, trimming off any excess and securing it with stitches and, sometimes, metal clips on the scalp.

A facelift operation can take several hours, or more if it is combined with other procedures such as a forehead lift, eyelid surgery, or skin surface procedures using a laser.

To minimize bruising and swelling after the operation, surgeons typically wrap the patient's head in bandages. Also, they will often insert a small, blood-draining tube under the skin behind the ear.

"I looked like a robot," Joyce recalls of the day she left the hospital following her surgery, "with three drains coming out of my head, a pressure bandage all around my face, and my face all swollen."

The Risks of Facelifts (<i>cont'd</i>)

For the days and weeks immediately after surgery, patients might choose to take some prescription pain medication, and they might experience some numbness of the skin, which could take weeks or months to go away. Also, patients must follow their doctors' post-surgical advice about elevating the head to keep the swelling down and otherwise taking it easy for awhile.

While the stitches are usually removed after about five days, the bruising and puffiness following surgery typically last from two weeks to a month or more, and can take even the most well-braced patient by surprise, according to Brian Kinney, M.D., who teaches at the University of Southern California.

People "expect to be younger and beautiful, and instead they're puffy and bruised. The waiting period for unveiling the final result can be tension-filled, and some people go through a short-term downer for a couple of weeks or months."

The Risks of Facelifts, Realistically

Beyond the expected discomfort associated with a facelift, there are some surgery-related risks involved, too, which the American Society of Plastic Surgeons characterizes as "infrequent and minor."

Risks include post-surgical infection; adverse reactions to anesthesia; hematoma (meaning blood has collected under the skin that may need to be removed by the surgeon); injury to the facial nerves that control muscle movement; and failure of a wound to heal, which is more likely in patients who smoke. For most patients, the healed incisions leave only minor scars, in the form of fine lines behind the hairline.

A facelift is riskier for people with certain medical conditions, such as uncontrolled high blood pressure, blood clotting problems or the tendency to form obvious scars. And, some people are better candidates than others for a facelift, based largely on the elasticity of their skin and the strength and definition of their bone structure.

From a doctor's perspective, Dr. Richards' biggest fear is that he can't control how even an otherwise healthy individual will heal. To minimize the chance of complications, Richards insists that patients take certain precautionary steps before surgery—not taking aspirin or other drugs or dietary supplements such as vitamin E that may inhibit clotting, for example, and not smoking for a month before surgery.

Richards' best advice on minimizing risks: Choose the surgeon carefully to make sure he or she is certified by the American Board of Plastic Surgery and is skilled and experienced in a specific procedure.

Great Expectations for Facelifts

With recovery completed, it's realistic to expect to appear 10 years younger after a facelift, and for that to translate into increased self-confidence, says Los Angeles plastic surgeon Kinney.

The Risks of Facelifts (<i>cont'd</i>)

Joyce feels her facelift—coupled with some laser eye resurfacing performed at the same time—has taken 10 years off her appearance. Some acquaintances have told her it's more like 15.

Being a little prettier—looking younger and feeling more confident—are fine reasons for desiring a facelift, plastic surgeons agree. But doctors shy away from working on someone who has unrealistic expectations or is going through an emotionally unstable time.

"Don't expect that a facelift will make you more competitive in the workplace," Kinney warns. Other misguided reasons for wanting a facelift, according to the doctor: "I want to get a younger boyfriend," or "I think my husband will leave me if I start to look too old."

It is common, Kinney says, for a person to aspire to look like a certain attractive entertainer—Raquel Welch or Catherine Deneuve, for example. "The public sometimes has astronomical expectations of what cosmetic surgery can achieve," Kinney says. "The reality is, plastic surgery isn't about making fantasies come true. What it can do is enhance what you have, to help you look and feel more youthful, happy, fulfilled, confident."

Most people look for this youth booster in their 40s, 50s, and 60s, like Joyce did. But according to the American Society of Plastic Surgeons, people can have successful facelifts into their 70s and 80s.

There is a trend toward having smaller, subtle operations starting at a younger age, according to Kinney. He fears, however, that some young people seek a facelift before they're ready because of what he calls the "relentless pursuit of perfection among baby boomers."

He has talked some young people out of having the operation; others return to him for a facelift after honoring his request to rethink their decision, bearing in mind the financial investment, recovery time, and risks involved in the surgery

All things considered, Joyce is delighted with the results of her facelift. "It's really nice to have a chin again." Joyce's face will continue to age, she knows, but she knows, too, that she can expect to always retain a more youthful appearance than if she never had the facelift at all. She doesn't plan to have another face operation in 10 or 20 years like some people do. "I'm very content. It's not my goal in life to look 50 when I'm 80."

The Risks of Facelifts (<i>cont'd</i>)

It's anybody's guess, then, what Joyce's mother will buy the spirited cancer survivor on that birthday 20 years from now.

Want to know what alternatives there are to a surgical facelift? Click here to find out.

Selecting a Plastic Surgeon

Finding a plastic surgeon with a combination of artistic flair plus extensive experience performing facelifts could be the key to achieving a pleasing new look.

You can search for a doctor on our site, or call the American Society of Plastic Surgeons toll-free at 1-888-4-PLASTIC (1-888-475-2784) to get a list of five board-certified facelift surgeons in your area. If you don't want to take their word for it, friends and other doctors might be able to recommend a talented surgeon. Interviewing several doctors and some of their previous patients can also help you feel comfortable with your choice.

Before getting her facelift, "Joyce" got some recommendations from her internist. But she followed up on the Internet for more information about the doctors' credentials and handiwork.

"You need to do your homework. You pick up these little pamphlets, and here's this perfectly fine looking middle-aged woman who suddenly becomes this babe. Online, you can see pictures of real patients."

Considering the Cost of a Facelift

When asked by a reporter in 1994 what it took to achieve her natural beauty, model Veronica Webb reportedly responded, "Two hours and $200. I could never make myself look the way I do in a magazine."

People considering a facelift should take into account that they'll need to shell out much more than a couple hundred dollars, and out of their own pocket, too. Insurance generally doesn't cover the cost of this kind of cosmetic operation.

Only a doctor can accurately predict the price of an individual's facelift because the cost can vary greatly depending on the techniques used, the part of the country where the surgery is performed and other factors.

The Risks of Facelifts (<i>cont'd</i>)

Following are the fees that surgeons charge in some of the biggest cosmetic surgery markets in the country. The quoted prices don't include other fees such as operating room charges or anesthesiologists' fees, which plastic surgeon Mark Richards says can add some $5,000 to $7,000 to the total cost of a facelift.

  • New York — $6,633
  • Florida — $4,463
  • California — $5,540
  • Texas — $5,304

Source: American Society of Plastic Surgeons (1998 survey).

Experts Evaluate the Alternatives to Facelifts

Experts agree the best way to retain the bloom of youth is to stem sunbathing, and to wear a broad-spectrum sunscreen every day. Tans and sunburns are signs of skin damage.

What's the number two anti-aging strategy? There's a consensus on that, too: Quit smoking. By the time smokers reach their 40s, they have developed more wrinkles than their nonsmoking peers.

Some other techniques touted as quick-fix alternatives to help people stay young-looking are more controversial. So, is there any truth to the claims that you can obtain a facelift...in a bottle?

While face creams can't substitute for a facelift—they don't reach down to the deep tissue—creams containing alpha hydroxy acids can help a person's skin look "significantly better," says dermatologist and plastic surgeon David H. McDaniel, M.D. Prescription-strength creams are stronger, as a rule, than over-the-counter versions, and generally work better, too, to smooth skin and reduce the appearance of fine lines.

On the other hand, people selling "weekend facelifts" are selling a mere gimmick, says plastic surgeon Mark Richards, M.D. "Nobody gets a true facelift and goes back to work in two days."

What about laser surgery? Unlike facelifts, laser surgery helps to improve the quality of the skin by eliminating fine lines and other cosmetic distractions. It doesn't combat the effects of sagging tissues, though. A person could need one or the other operation, and some people choose to have both of these procedures done.