Breakthroughs in facelift and mini facelift have been driven by the requests of our patients. Today, these conversations about aging and facial rejuvenation go something like this: First and foremost patients prefer no general anesthesia with its costs and complications including difficulty waking up, post-operative nausea and vomiting, blood pressure swings and not being able to take all of their normal medications the morning of surgery. They also want less invasive procedures with less down-time and less conspicuous scars.
The facelift (sometimes spelled as two words "face lift") we do is exactly what I would do if the patient was under general anesthesia giving the patient a modern SMAS lifting surgery combined with a short scar facelift at a much better price. Not depending on general anesthesia gives us many advantages in taking care of patients, especially in the postoperative period. Advanced local anesthesia with oral sedation is out of the comfort zone for most surgeons who have fallen into Gillies’ and Millard’s “rut of routine.” Every face and thus every facelift has its own set of nuances making each facelift slightly different.
Trying to achieve actual facelift results, there has been a glut of non-surgical options that non-surgeons tend to sell as a facelift equivalent and truly deliver minor and temporary results if you are not in need of a facelift yet. None of these modalities make it where you will not need a facelift and in some cases they accelerate the need for an actual surgical procedure. Almost all of the “new” non-surgical modalities have found their way into the trash bin of plastic surgery history. I have been refining my advanced local anesthetic techniques and our multi-tension, multi-vector SMAS lift with variable platysma tightening facelift procedure for 15 years.
Meticulous attention to the details of reconstructing stretched-out earlobes and detail to the scar inside the tragus in front of the ear keep us from leaving abnormalities which are the tell-tale signs of having had a facelift. Further enhancements including micro-drains for the limited dead-space due to progressive tension suturing allowing the liberal use of autologous fat grafting for volume restoration in the cheek, tear trough, lip and perioral regions.
We call our incision pattern the “shortest possible scar” facelift as the incisions can be different on every patient and their particular anatomy and laxity. Dr. Howard's typical incision follows along the contours of the ear, not in front of the ear, with special attention to preserving the sideburn area.
We encourage patient feedback regarding improvements to our techniques, so the nuances are constantly changing and improving with the patient’s wishes and comfort in mind. The final arbiter on any change is patient safety and absolute comfort in the operating room. Most people believe that our patient experience is second to none. We form partnerships with our patient population so that there is an easy and facile flow of information both doctor–to-patient and patient-to–doctor. Our concept of patient care will be obvious from the first minute of the hour-long initial consultation. Empowerment through knowledge and easy communication make our experience second to none. Make a consultation appointment and check out the difference for yourself. A fully informed patient is our greatest advantage and the basis of our superior results.
We believe the facelift to be the key to most facial rejuvenation procedures and as such it must be safe, effective, natural appearing, and affordable.
Dr. Howard is a real board certified plastic surgeon and the actual surgeon performing ALL facial procedures. Dr. Howard does not have associates, non-board certified physicians, or students (residents or fellows) performing any of his surgeries/procedures.
Dr. Howard's facelift patients are the only surgery case for that day. You are his sole concern and focus, he is not rushed to perform his surgery since you are the only patient and it is not performed under general anesthesia. Even your Consultation with Dr. Howard is exclusive. His office staff schedules one hour for consulations, meaning your are his only patient allowing ample time to thoroughly discuss your facelift plan without interruption.
A facelift, or rhytidectomy, is a cosmetic surgical procedure that repositions the skin and soft tissues of the face that have been affected by the aging process. The procedure is intended to give the patient a more rested and youthful contour to the face. Non-surgical rejuvenation treatments cannot achieve the same results. Dr. Howard also offers a non-surgical facelift procedures for patients who are not yet ready or in need of a mini or full surgical facelift such as facial fat grafting.
You may be candidate for if you have experienced a loss of skin elasticity and muscle tone of the face. A facelift is also desirable if you are showing the signs of aging with the development of jowls, deep creases creating frown lines, and may also be helpful if you believe you have a tired facial appearance. An ideal candidate for a facial rejuvenation is also one who:
Facelifts range in size from "mini" to "mid" to “full” depending on location and extent of skin laxity. Regardless of which type of facelift is recommended and performed, Dr. Howard does address tightening the skin and tightening the SMAS (underlying muscle layer). The operation is done on an outpatient basis under local anesthesia with oral sedation, or the facelift can be performed under general anesthesia at Grandview Hospital Outpatient Surgery Center.
Incisions are made along the ear, extending down around the earlobe, and ending behind the ear (an extended incision behind the ear may be required for some patients who require more lifting in their neck area). Dr. Howard does NOT place facelift incisions on the face or in front of the ear, but rather along the contours of the ear so that they hide within the ear and around the earlobe. The subcutaneous layers and facial muscles are tightened, the facial skin is re-draped and lifted, and the excess skin is removed. The patient goes home with head and neck wrapped in dressings, which are usually removed the next day. Minimal initial discomfort is easily controlled with oral medication and ice compresses. Sutures are removed within 7 days. Bruising and swelling will decrease over 7-14 days. Most patients are able to be socially presentable with the use of sunglasses, a scarf, and/or full coverage make-up after one week.
Yes, Dr. Howard tightens the SMAS (Superficial muscular aponeurotic system) with his facelifts. In fact, Dr. Howard was trained in Paris, France by the plastic surgeon who discovered the SMAS layer. Dr. Paul Tessier is considered to be one of the world's greatest plastic surgeons to ever live. The SMAS is a fibrous muscular layer of the face, and is the most important part of a facelift. Tightening the skin alone will not yield lasting results. Dr. Howard's facelifts are NOT "skin only."
The average recovery for Dr. Howard's patients is approximately one to two weeks (Patients who use nicotine products, including vaping, can expect a significant longer recovery). Some patients are able to drive after only a few days and have been known to take excursions out of the house with simple sunglasses, a hat, and maybe a scarf. Dr. Paul Howard is one of the first plastic surgeons to offer this minimum incision facelift for over 15 years.
Most patients experience very little pain; often stating they only needed the pain medications for the first night after surgery. A majority of Dr. Howard's facelift patients report switching to Tylenol on the second or third day following their procedure if they experience any discomfort.
Facial swelling and bruising is controlled with a compression dressing placed around the face following the facelift procedure. This dressing can also help in the prevention of hematomas, along with the drainage tubes, by reducing the dead-space from the surgical procedure. This dressing also helps protect the incisions and the ear itself form the post-operative trauma. The dressings tend to make the ears more comfortable and reduce any possibility of night-time disturbance. The dressings we place in the operating room are removed and replaced with ace bandages which can be removed daily to wash the hair (baby shampoo only) and take care of the incisions. These lighter and less restrictive bandages do not need to be tight, just snug in order to keep the swelling under control and assist with proper healing. Failure to wear this bandage as instructed will allow for fluid to collect under the chin and in the neck area causing the skin to sag and not heal taut.
Most patients experience swelling after any kind of surgical procedure whether on the face or body. Swelling is to be expected and usually resolves completely after a few weeks. In some cases, swelling after facelift can last longer depending on your particular life-style and personal health. Some factors that prolong swelling after facelift are as follows: smoking and other tobacco use including second-hand smoke exposure, vaping, high blood pressure, anxiety, high sodium diet, depression, stress, sun exposure, and other pre-existing health conditions that may affect your ability to heal. Facelift patients are encouraged to drink plenty of purified water, avoid high sodium food products, use of cold compresses is encouraged, sleep elevated, and avoid alcohol for two weeks before and after your procedure.
Dr. Howard's facelifts begin at $6500.
The typical facelift address the face, neck and jowls only. Other areas of the face are not included with a facelift because not every patient needs other facial procedures such as eyelid lift (blepharoplasty), forehead lift (eyebrow lift), and/or facial fat grafting. However, these procedures are commonly performed with a facelift.
Almost all facelift lift candidates need tightening of the neck in addition to the facelift as the result wouldn't be nice to only have the face lifted and not the neck as well. Dr. Howard almost always includes tightening of the neck with his facelifts is achieve the most ideal results. In more severe cases neck laxity, an additional ancillary neck procedure may be neccesary.
The plastic surgery industry has long known about the compromising effects nicotine has on healing facial procedures. Nicotine compromises not only the immune system in general, but the blood flow to surigcal incisions on the upper body. Consuming nicotine products, including vaping, has been proven to increase recovery by delaying the healing of facelift incisions. These incisions usually take three to five times longer to heal than our non-smoking patients. Dr. Howard recommends patients desiring facial plastic surgery to stop all nicotine products at least six weeks prior to surgery and to avoid being around second-hand smoke during the recovery. Just because you healed from knee surgery while you smoked doesn't mean you will heal the same with facial surgery if you are still smoking. Additionally, the recent fascination with vaping is raising great concern in the medical community. Patients who vape are presented with significantly slower recovery and healing; increasing the recovery period from two weeks to three months.
All of Dr. Howard's facelifts tighten the skin and underlying muscle layer. Tightening the skin not only improves wrinkles. but can also improve the appearance of acne scars. Some acne scars are deeper than others and may require additional fat grafting to help fill-in the scarred area, but tightening the skin with a facelift is often indicated to improve the appearance of acne scars.
Facelift incisions are hidden within the ear, following along the ear, around the earlobe, and behind the ear. Almost all facelift scars fade completely within 6 months. There are other factors that can delay healing such as genetics, skin type, smoking or vaping, and environmental factors.
A facelift does not stop the aging process, but helps turn back the clock by removing wrinkles and sagging skin. Since the aging process continues, facelift patients must protect their investment through proper skincare, maintaining ideal body weight, and refraining from using any nicotine product. Some patients decided to undergo secondary facelift, or a facelift tuck-up, approximately every ten years after their first facelift.
A facelift by itself addresses nasolabial fold wrinkles and sagging jowls. Some patients with lines above the upper lip should consider fat grafting to improve these smokers lines. If a facelift is pulled so tight from the cheek area so as to pull these lines above the lip, then you will get a undesired appearance as it will also pull the corners of the mouth. To address smokers lines, Dr. Howard almost always performs facial fat grafting to fill-in these fine lines without making the lips appear to be overly augmented. Dr. Howard is likley to also recommend facial skin resurfacing such as a physician's strength chemical peel or microdermal needling with PRP.
Every facelift performed by Dr. Howard is done to give the most natural appearing results. Dr. Howard turns away the patients desiring unrealistic results. A great facelift is the one where your friends notice something different and claim you appear "refreshed." The goal of a facelift is to turn back the clock, not to make you look like a different person, but to restore your face to a younger version of yourself.
For over 10 years, Dr. Howard has performed his popular in-office facelift procedure under oral sedation and using his advanced local anesthesia techiniques. All of his facelift patients report the procedure as a very pleasant experience and liken it to a long day sleeping at the dentist's office. Most patients are comfortable enough to sleep through the entire procedure and report very little discomfort.
The facelift procedure is performed after the patient is made comfortable, local anesthesia is administered and allowed time to activate. The facelift incisions are made around the ear and the skin is separated from the underlying muscle layer (SMAS). The muscle layer of the face and neck is tightened using sutures, then the skin is tightened and smoothly draped over the tightened muscle. Excess skin is then trimmed to contour back to the natural contours around the ear. A tiny micro drain is placed underneath the skin to capture excess swelling. The incision is closed and a compression dressing is placed to minimize swelling and bruising. The patient does not need to do anything with these drains as they are tucked up in the dressing. The micro drains are removed when the patient returns to Dr. Howard's office the following day. Removal of these drains is simple and painless.
Dr. Howard's is okay with his patients returning home after surgery as long as they have someone to stay with them. If a patient needs assistance with their post-operative recovery, Dr. Howard's office staff can help you arrange for a caretaker to help you.
Dr. Howard has performed facelifts, mid-facelifts, mini-facelifts for over 20 years. Dr. Howard has been performing minimal incision facelift procedures under local anesthesia with "twilight" for over 15 years. Dr. Howard has always offered his exclusive "One Facelift a Day Promise" where patient's receive the VIP treatment and are truly special as his ONLY PATIENT THAT DAY!
Absolutely! Don't let our competitors lie to you and claim my facelifts aren't real. They will lie to you because they want your business. "My facelifts are the exact same whether done under local anesthesia or general anesthesia," says Dr. Howard. "The only difference is swelling. Facelifts done under general anesthesia experience more swelling than the ones performed with local anesthesia. All of my facelift patients state their experience as pleasant, like going to the dentist, and that they would do it again."
Comfort of the surgeon, thats why. It's all about the surgeon's experience, true facial plastic surgery training, and expertise. Another factor is daily case load. With local anesthesia, the facelift is staged. Depending on the patient's other ancillary procedures such as blepharoplasty, the time to perform the facelift may pressure the surgeon to speed through in order to finish due to general anesthesia time safety limits or to move on to the next patient. This is another reason why Dr. Howard only does one facelift a day: to add that additional level of comfort to the patient, knowing he won't be rushing through their facelift surgery.