Brian P. Dickinson, M.D. Facelift Surgeon in Newport Beach, California
Facial rejuvenation surgery has been the focus of my practice for the past 12 years. This includes facelift, neck lift, blepharoplasty, and rhinoplasty. These surgeries are my favorite procedures to perform. Patients who come to me for facelift surgery have previously undergone breast cancer reconstructive surgery or have had previous aesthetic procedures done and have lost a significant amount of weight. Successful weight loss often results in facial laxity. The most common groups of patients who lose weight after procedures are abdominoplasty patients who have lost additional weight post abdominoplasty through diet and exercise. The second most common group are patients who underwent removal and replacement of mammary prosthesis to a smaller size or simply removal of mammary prosthesis and who have lost weight because now they are more active.
In general patients who seek out facelift surgery in my practice are people who have a great attitude, are happy, and have an overall positive outlook on life. They typically are patients who have lost a significant amount of weight or who have simply aged and developed laxity in their neck, jowls, or nasolabial folds. Facelift patients typically have a lot of energy and enjoy being active. However, universally, the facelift patient will say that despite getting a good night of sleep, or eating right, or exercising, that they have a tired appearance to their face. More importantly, this tired look on their face is not consistent with how they feel on the inside. It is this person who is an excellent candidate for a facelift. After surgery, these patients now have a youthful and rested appearing face which is commensurate with the energy they are experiencing from their core.
The other group of patients who seek out facelift surgery or facial rejuvenation are people who have gained weight and do not like the appearance of their neck, jowls, etc. In these patients it is important that we explore their reasons for gaining weight and if any of these reasons are reversible, we do our best to reverse them. There are two habits that we tell all of our patients to try to stop for their overall health so they can maximize their life in the future going forward. One is to quit smoking. Smoking cessation is one of the best decisions one can make in their life. It is especially important for patients to quit smoking prior to their facelift procedure. Cigarette smoking can negatively impact the outcome of the facelift surgery. We instruct patients to quit smoking six weeks prior to surgery and for six weeks after surgery. Usually patients do not even return to smoking after surgery.
In patients who have gained weight and who seek out facelift surgery, we try to have them first lose weight. The weight loss goal needs to be a realistic one. Once we find the cause of the weight gain, we find a solution for weight loss. This typically is a change in diet, either the content or timing of eating and some form of exercise. Exercise or weight training usually is the addition to a cardiovascular program that the patient is already doing or it can be the introduction to one. If patients are rapidly losing weight as a result of the dietary or exercise changes, we have the patient continue to lose weight until they plateau. This is a good time for the patient to proceed with facelift or facial rejuvenation surgery. On the other hand, if, despite concerted efforts at diet and exercise modification, the weight remains stable, it is ok to proceed with facelift surgery. What is important, is that the patient should not have excessive weight fluctuations after surgery as this will make the facial laxity recur.
I hope you find the following sections on facelift and blepharoplasty to be informative and helpful. If you are interested in facelift or blepharoplasty surgery, please call the office at 949-612-8632 and ask to schedule consultation. My staff are extremely friendly, helpful, and care about your outcome and your experience. They will be glad to help you.
Brian Dickinson, M.D.
Facelift Frequently Asked Questions
What is involved in facelift surgery?
Facelift surgery is a real operation. It requires preparation on the part of the patient and surgeon. Pre-operative clearance is usually recommended based on the patient’s age. A healthy diet high in protein is important for an excellent outcome. We tell our patients to allow two weeks before they start to feel comfortable going out in public. But it may take several weeks to months and upwards of one year for the final result to come to fruition. After an appropriate amount of healing time, patients can resume physical activity.
There are many different options with face lift surgery but the technique I use almost exclusively is the deep plane facelift. We try to spend time first determining your goals and expectations. Many patients wish to undergo facelift surgery so that they can have a more youthful appearance to the face without the tell tale signs of surgery.
I'm afraid of looking tight and surprised. How do I make sure that doesn't happen?
The facelift procedure that I perform most commonly is the deep plane facelift. In general, I have found that the deep plane facelift can help produce natural results in our patients who want to make significant changes in the youthful appearance of their face, yet don’t want to have a “pulled” or “done” appearance to their face. I do tell all of our patients that the deep plane facelift is a real surgery that requires a general anesthetic and appropriate attention to pre- and post- operative care to ensure proper healing and maximize the aesthetic outcome. This often entails a diet rich in protein. I encourage patients to consume 80-100 grams of protein per day for 4-6 weeks prior to surgery and for 4-6 weeks after surgery. This is to ensure proper healing and maximize the aesthetic outcome.
How much pain can I expect after my face lift surgery?
The face lift or lower face and neck lift is performed under a general anesthetic. You won’t see, hear, or feel anything during the procedure. At the end of the procedure a drain is placed beneath the neck skin and exits out the back of the scalp. A cotton wrap is placed around the head and neck.
Facelift operations are performed on Monday, Tuesday, and Thursday. Patients stay in the surgery center one night after the facelift operation and go home the next day. The drain is removed the following day prior to discharge from the surgery center. During the overnight stay in the surgery center the nurses will provide you with medications for pain and nausea and to control your blood pressure. The facelift operation does not involve a very painful recovery. Typically, patients may take pain medications for 2 to 3 days before converting to Tylenol or Motrin for appropriate pain control.
For the first two nights we encourage patients to sleep with their head elevated. It is easiest to sleep on a recliner or couch. A traveling neck pillow is helpful to keep your head elevated or propped up when sleeping on the couch or recliner. Sleeping with your head elevated for 2-3 nights helps control swelling and pain. In general patients do not experience a lot of pain after a facelift operation. A neck wrap or compression bandage is worn around the neck day and night for two weeks and then at nighttime for two weeks. Compliance with head elevation and compression can facilitate healing and pain control.
How noticeable are the results from an upper or lower blepharoplasty?
The results from an upper or lower blepharoplasty are very powerful with the goal of not being very noticeable. As the face ages, the brow descends, and skin accumulates around the upper lid and fat begins to herniate through the lower lid creating a tired appearance to the eye. Small, subtle changes to the eye can yield a large difference. In younger men, simply performing an upper blepharoplasty alone or in combination with a lower blepharoplasty can give a significantly more youthful appearance to the face without performing surgery on the lower face. Often men choose to have an upper and lower blepharoplasty first and then come back several years later for a lower face and neck lift. In patients who wish to have upper and lower blepharoplasty as well as a facelift, I often encourage patients to do this in stages. The first stage being the upper and lower blepharoplasty and then the second stage being the lower face and neck lift. The results from the upper and lower blepharoplasty are noticeable in that friends and family will often notice a youthful appearance to your face, but they may not be able to directly identify the change. Family and friends will simply state that you look more refreshed, healthier, or that you are healthfully losing weight.
What is the process to get started?
When you select Dr. Brian Dickinson as your surgeon, the process for getting started is as follows:
- Initial consultation: Call the office to make an appointment for an initial consultation. The consultation will take approximately 30 minutes to one hour. During the consultation we will look at your medical history and we will then listen to your concerns regarding your facial aging. We will listen to what your goals are to improve your facial appearance. We will then formulate a surgical plan based on your desires and what is possible. During this consultation we will take photographs of your face and neck with standard photography as well as with a 360 degree photography.
- Medical Clearance: In general, patients who are undergoing facial rejuvenation surgery will need to have a medical examination by their primary care physician prior to their surgery. The pre-operative clearance labs and physical examination by your primary care physician should be done within 4-6 weeks of your surgery. Lab results are also collected which include CBC platelets, Chemistry, PT/PTT/INR. These are labs that are necessary to complete your pre-operative clearance. If you are older than 50 years old and a male you will need an EKG and if you are older than 60 years old and a female you will need an EKG. If you currently have a cardiologist who manages your blood pressure you may see them, and it may be easier for you to see them for your medical clearance.
- Second consultation (if needed): There are times when the initial consultation does not address all of your concerns or my concerns regarding your surgery. I highly encourage facial rejuvenation patients to come back in for a second consultation if they have any questions. It is very important for me to understand what your goals are and which part of your facial aging you would like to correct.
- Pre-operative appointment: Prior to your surgery we will meet for a pre-op appointment. During the pre-op appointment we will collect any payment for your procedure, or you will have paid for your procedure. During this appointment we will prescribe your medications prior to your surgery. You will be prescribed medication for nausea, medication for pain, antibiotics, and medication for swelling. During this visit we will likely take another round of photographs and we will go over your goals and answer any additional questions you may have.
- Procedure: The facelift or lower face/neck lift surgery lasts approximately 4.5 hours. The procedure simply takes as long as it takes. It is not a procedure that I rush to complete. The surgery requires a general anesthetic. You will not see, hear, or feel anything during the procedure. Even though the surgery is under a general anesthetic, we still use local anesthetic for pain control. In the recovery room and during your overnight stay in the surgery center the nurses will give you medications for pain and nausea. Patients usually report that the pain following a facelift is minimal and they are surprised at how painless the recovery is.
- Follow-up: I will see you the next morning in the surgery center. At that time we remove the dressings and examine the skin. This examination is more for me than for you. During this examination I look for any signs of hematoma and for any signs of infection. You may have a general idea of the improvement from surgery, but there is often swelling which makes it difficult for patients to appreciate the improvement. I will see you once a week for six weeks, then at six months, and then again at one year. In general, I tell patients that it is about two weeks before you are comfortable going out in public, but this is varies. Some people walk around with bandages on the next day and go to the grocery store. I don’t recommend this, but it has been done. Where the suture lines are around the ear and behind the neck there is bunching of the skin and there is often puckering at the jawline or beneath the chin. This can take about two to four weeks to improve. Along the scar patients may notice that the scar becomes thick which normally increases until about 6 to 8 weeks after surgery. This is a normal healing process, and the scarring continues to become thicker before it starts to improve. The scar continues to remodel and soften over the next six months to two years.
- Post-op Instruction Cheat Sheets can be downloaded by clicking on the link. Facelift/Neck-lift post-op instruction sheet: Brian P. Dickinson MD-Post op Lower Face-Necklift Procedure Medication Instructions Version 7-202
- Post-op Instruction Cheat Sheets can be downloaded by clicking on the link. Blepharoplasty post-op instruction sheet: Brian P. Dickinson MD-Post op Blepharoplasty Procedure Medication Instructions July 2022 Version