Facial Plastic Surgery: Overview

Common facial plastic surgery procedures include rhytidectomy (facelift), rhinoplasty (nose job), blepharoplasty (eyelid surgery), browlift, genioplasty (chin augmentation), otoplasty (ear repositioning), liposuction, and fat transfer.

You might decide to have facial plastic surgery to help reduce the signs of aging by tightening muscles, removing facial fat, and smoothing and firming your facial appearance. It is important to discuss your options and expectations with your plastic surgeon.

Facial plastic surgery changes your outward appearance, so understanding all aspects of the surgery is essential. Read on to find information about facial plastic surgery, what to expect on the day of surgery, potential risks, and the recovery process.

What Is Facial Plastic Surgery?

A facelift, or rhytidectomy, is a surgical procedure that improves visible signs of aging in the face and neck. A facelift involves tightening facial muscles and trimming or redraping of facial skin to approximate a smoother, firmer facial appearance.

Rhinoplasty (nose job) reshapes nasal contours. Eyelid lift, forehead lift, laser resurfacing, and hair transplant are some of the elective surgical procedures that are done to improve visible signs of aging in the face and neck.

A facelift procedure may include surgery on the face, neck, and/or ears. A facelift alone does not decrease fine lines and wrinkles or sun damage. Because this surgery is intended to reduce the effects of aging, it is performed only on adults and is considered a scheduled elective procedure.

Cosmetic facial plastic surgery procedures may be done in the following locations:

• Accredited office-based surgical facility
• Licensed ambulatory surgical center
• Hospital operating room

If you are having surgery at an outpatient or ambulatory surgical center, you could be transferred to an affiliated hospital if you develop a health emergency. Speak to your plastic surgeon prior to the procedure to confirm the emergency plan and location of transfer if needed.

Cosmetic facial plastic surgery is usually a same-day surgery procedure that doesn’t require an overnight stay in the hospital. Because of the anesthesia and pain medications, you will need to have a friend or family member available to drive you home after the surgery.

Various Surgery Techniques

The specific surgical techniques that are used strictly depend on the procedure. The surgical technique used for a facelift will be different than the procedure used for a nose job.

For example, during a facelift procedure, an incision is made in front of the ear, extending up into the hairline and curving around the bottom of the lobule and then behind the ear. After the incision is made, the skin is separated from the deeper tissues.

The deeper tissues are tightened with sutures. After the sutures are in place, the skin is redraped over the face and all excess skin is removed.

Blepharoplasty, or the correcting of defects, deformities, and disfigurations of the eyelids, involves the removal of the excessive eyelid skin and/or removal of orbital fat.

Forehead lifts and browlifts are sometimes done via endoscopic surgery where several small incisions are placed behind the hairline. An endoscope is placed to use for visualization during the procedure in order to elevate the forehead skin. Your cosmetic surgeon will release soft tissue and create a new forehead/brow line.

Contraindications

Due to the fact that most facial plastic surgeries are performed in outpatient settings, certain patients will not qualify for elective cosmetic surgery because the potential risks are too high. Plastic surgeons, depending on experience, may have their own contraindications for surgery, but generally, individuals who fall into the following categories are not ideal candidates:

• Are morbidly obese
• Are elderly
• Have high blood pressure
• Have diabetes
• Have lung or heart disease
• Have bleeding disorders
• Use alcohol
• Use tobacco
• Consume excessive caffeine

Potential Risks

All surgical procedures carry potential risks, especially if done under general anesthesia. Facial plastic surgery risks include:

• Anesthesia risks (including shock, respiratory failure, drug or allergic reactions, cardiac arrest, coma, death)
• Bleeding
• Blood clots
• Deep vein thrombosis
• Fluid accumulation
• Hair loss at the incisions (temporary or permanent)
• Infection
• Numbness
• Paralysis or less severe nerve damage
• Persistent pain
• Poor wound healing, tissue death, skin loss
• Scarring
• Skin irregularities and discoloration
• Swelling

Purpose of Facial Plastic Surgery

Facial plastic surgery can help reverse the outward appearance of aging in the face, neck, chin, ears, and/or nose. It can help improve loose skin, decreased tissue volume around the face and neck, crow’s feet at the corner of eyes, fine lines on the forehead, loss of jawline contour, sagging jowl, and double chin.

Facial cosmetic surgeries are elective and not medically necessary. These include facelifts, blepharoplasties, forehead lifts, cosmetic rhinoplasties, facial implants, and resurfacing procedures.

Medically necessary facial plastic surgeries include facial trauma, reconstruction after head and neck cancer surgery, reconstruction after Mohs surgery, and cleft lip and palate surgery.

How to Prepare

A preoperative examination and tests evaluate whether you are healthy enough to undergo facelift surgery. They help determine potential risks of complications under anesthesia and during the recovery process.

Along with a routine physical, a coagulation test and complete blood count are usually required. Other tests may be indicated depending on the patient’s general health.

On the day of surgery, you will have a urine pregnancy test if you are capable of becoming pregnant and are of child-bearing age. Pregnancy is a contraindication of facial plastic surgery.

Before your surgery, a preoperative nurse will go over your scheduled arrival time and any last-minute instructions. You will be given instructions regarding whether you need to stop certain medications a few days before your surgery and what time you should become NPO (not eating or drinking anything by mouth) the day before your surgery.

What to Expect on the Day of Surgery

On the day of the procedure, you will meet with the entire healthcare team, including the plastic surgeon, anesthesiologist, and nurses. You will sign all operative consent forms at this time to ensure you are fully prepared and do not have any additional questions or concerns. The registered nurse will take your vital signs.

You will be given a surgical soap to use on your face to prevent infection. You will change into a hospital gown and remove any jewelry, contact lenses, dentures, etc.

The surgeon will mark the surgical sites on your face and/or neck after you are fully prepped, and they will confirm the procedure with you. The plastic surgeon might also show virtual computer models of the changes being made during the surgery.

The nurse and surgical team will review your medications. Be prepared to discuss all of your medications, vitamins, and supplements at this time. The nurse will insert an intravenous catheter (IV) that will be used to provide hydration, medications, and anesthetics during the procedure.

The surgery can take between one and six hours, depending on how many aspects of facial plastic surgery you are having done. The more work that is being done during the surgery, the longer the procedure.

After the surgery is complete, you will be transferred to the post-anesthesia care unit for recovery until the surgeon and nurses confirm it is safe for you to be discharged home.

Recovery

You can expect the following appointments during the first week. All subsequent visits will be at the discretion of the surgeon.

The day after surgery, your surgeon will likely apply antibiotic ointment to your incisions and place new bandages on your face. About a week after surgery, your healthcare provider will remove your stitches and assess the wound.

By the second week, most patients can return to work and resume light activities such as walking. Week three, you will return to work if you haven’t already and will be able to resume full activities such as weight lifting and exercising.

Long-Term Care

After surgery, it is important to continue to make lifestyle adjustments in order to continue to reduce the signs of aging as well as maintaining the results of cosmetic surgery. These include:

• Using sunscreen daily, and avoiding/limiting sun exposure
• Not smoking
• Living a healthy lifestyle
• Reducing stress, anxiety, and depression
• Drinking plenty of water
• Maintaining a daily skincare routine
• Maintaining ideal weight

A Word From Verywell

Facial plastic surgery will change your face’s outward appearance, but it is not a permanent solution to aging. Ultimately, the aging process does not stop. Other non-invasive options are available to you to continue to reduce the effects of aging, including chemical peels, facials, dermaplaning, and microdermabrasion.