Facelift

“Each face is different. It is the focus of our personality and identity. You can’t use a standard technique for everyone. As surgeons, we have a wide range of options. The technique must be customized to a patient’s expectations and what their anatomy will allow me to do in a safe and predictable way.”

There is an indefinable subtlety to a truly exquisite facelift. It takes a surgeon that is an artist of the beautiful, incredible hand-eye coordination, and an innate understanding of the intimate relationships between bone, muscle, supporting ligaments and skin that so define the facial features. More is not better when it comes to the delicacy and elegance of a truly magnificent facelift.

“Every one of my patients has their own unique visions of beauty. I want to make sure the patient and I have the same aesthetic vision.”

The anatomy of the face that Dr. Romano systematically evaluates with each patient may be thought of in layers in order:

1. The Bony Foundation: gives the structure to the cheeks, jaw and more. This determines facial proportions, width, height, and symmetry of the face and jawline
2. The Overlying Muscles and Ligaments: these are located above the bony foundation. Over time they stretch and relax. They may become trapped in scar from previous procedures.
3. The Complex Network of Ligaments (called the SMAS): these pass through the fatty layer and link the muscle system to the skin to modulate and impart the extremely fine and subtle movements that make our expressions and features that are unique and personal.
4. The Fatty Layer: separates the muscles, ligaments and bony foundation from the overlying skin. Together with the bony foundations, this is all about what determines the volume in the face. It can be too much or too little or uneven.
5. The Skin & Dermis Layer: the layer most important for the collagen and elastic fibers it contains among other things. This is where you have elasticity, strong healthy collagen or not. This is the “texture” layer and may need help beyond facelift with laser, peels, Retin-A or facials to complement your procedure.

These interrelated layers—as well as your hair, hairline, hairstyle, nose, eyes, eyebrows and ears—are all so intimately associated with each other that there are many different anatomic features which must be analyzed and addressed prior to your surgery. Dr. Romano will thoroughly educate you then carefully “paint” a picture with you of the harmony you seek between your expectations and lifestyle and anatomy. He will then formulate this plan with you, and guide you through this process.

What to expect from your Facelift:

Your facelift surgery is a well-defined spectrum of specific techniques that address the anatomy and the actions to be taken on each layer of your face.

The spectrum of facial rejuvenation and surgery that Dr. Romano offers are:

1. Facelift Surgery: A standard and latest state-of-the-art technique of addressing your bony foundation if needed, removing and repositioning any excess or displaced fat, tightening and/or repositioning the muscles and ligaments, and removing excess skin. Fat grafting or removal may occur if needed.
2. Mini Facelift Surgery: Similar to facelift surgery but less involved and performed through a shorter incision due to the presence of less excess skin and less laxity.
3. Suture Facelift: This occurs in those rare patients with minimal excess skin but lots of ligament laxity where you need a ligament tightening along certain vectors. The only incision is in the hairline, where a special suture is passed down to the corner mouth and jowl area in order to lift them.
4. Other Facelifts: Depending on your specific anatomy, we may want to consider the Brow Lift, Vertical Facelift, the Midface Lift, and the Weekend Lift. These depend on your vectors of laxity and the features involved.
5. Related: There are times that procedures on the eyes, ears, nose, mouth or chin will be addressed to complement or complete the results of the facelift.

Facelift surgery involves a light general anesthetic. All surgery is performed in the hospital and not in his office. Dr. Romano uses the same highly skilled anesthesiologist on all of his cases.

To begin, a customized incision follows your natural features and is hidden in your hairline, around your ear, and behind the ear for a tailored length.

During the surgery, bony foundations will be addressed as needed, volume will be addressed by liposuction of excess fat or grafting if fat is deficient. The underlying ligaments (SMAS) and muscles will be tightened. Dr. Romano will then firmly elevate, re-position and re-drape your skin over your new youthful foundation.

Immediately following surgery, a light dressing is placed. You will awake comfortably from anesthesia with no nausea, minimal grogginess and no pain. You may stay overnight in the hospital if you like.

At home you can expect to shower on your third day, minimal bruising and swelling, and to be up and around and taking walks right away. You will not be confined to bed.

All of the stitches are small and removed in 4-7 days. You can return to work in as little as five to seven days and to some physical exercise in the second week.

Dr. Romano connects with each patient, to understand their motivation, their lifestyle and what outcome they are anticipating. This is critical to guiding patients through recovery. He spends time answering questions and discussing options. A facelift is a collaborative process. Preoperatively he takes numerous photos to show you. He compares them to what you see in the mirror. After all, a mirror image is not what others see. This exhaustive assessment, education and discussion period assures the most successful result.

Knowing exactly which techniques produce a specific result can only be mastered through years of the finest training, continuing education, and hands-on experience. Dr. Romano’s schooling and training in the finest institutions is second to none. Sometimes a patient is not a candidate for a facelift. In those cases, Dr. Romano recommends delaying the surgery and, sometimes, recommends against it. Honest conversations and building trust with a patient are essential.

Facelift Surgery is Sage and Predictable

In every surgical procedure, and whenever an incision is made, there exists a potential degree of risk and uncertainty. These risks are discussed in great detail during your consultation with Dr. Romano. With these in mind, he knows when and what surgery to recommend, but more importantly, when not to have a surgery. “In all my years in practice I am humble to report I have never had a lawsuit or any tragedy at surgery”

Taking plenty of time and careful planning are essential. “It takes several meetings with patient to develop a detailed plan prior to surgery. The face is the locus of our identity so care must be taken to allow for a person’s natural expression. Millimeters make a huge difference. Tiny expressions impart emotions. To create a truly natural, beautiful result, it takes hours of preparation.”

The risks of a facelift are similar to those of other surgeries. To avoid unnecessary side effects, Dr. Romano recommends a low carbohydrate/low salt diet prior to surgery and advises on the use or discontinuation of supplements and herbs. He also utilizes proprietary processes to minimize bruising and swelling and to speed healing. This basically involves harvesting your own platelets during surgery, releasing all their hormones and growth factors, and spraying this into the operative site. He routinely talks personally with the patient’s internist to discuss health status, clearance for surgery, and lab test results. In planning for an extensive facial rejuvenation, Dr. Romano may recommend staged operations. “Sometimes it overwhelms a patient to do everything at once. It becomes too much of a facial image change. Patients want a very gentle, comfortable transition.”

Dr. Romano considers your body as a whole and constructs a system into every facial surgery both preoperatively and postop. This allows you to recover much more quickly and contributes greatly to preserving your surgical results. His system includes a full comprehensive medical, health and lifestyle evaluation, special diet, special attention to blood clotting, pre and post op vitamins & supplements, skin care services and products, special garments, physical training, and knowing what to avoid. Together all of this allows Dr. Romano to create results that are consistently very beautiful, quick to heal, and exceptionally natural.

Dr. Romano has written several articles about the theory, technique, and details of facelift surgery. You can review this article on facelift surgery in the Educational Articles section of the website and an additional article about facelift surgery in the Documents Section.