Dr William Portuese
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Q:   What is a facelift?
A:   A facelift is an operation done on both men and women to enhance the appearance of the aging face. It is a rejuvenation procedure that addresses removal of fat in the neck, tightening of the neck and facial muscles and fascial layers to obtain a more youthful look, and tightening of the jowls and sagging facial and neck skin. This is a very common outpatient procedure, done under general anesthesia that makes patients look more refreshed and rejuvenated.

Q:   What is a neck lift?
A:   A neck lift is an operation done on the lower portion of the neck, which includes liposuction and removal of fatty deposits both below and above the platysma muscle in the neck. It also addresses tightening of neck muscles. This is an operation that is done on patients usually less than 50 years old who have good facial skin tone and have fatty deposits in the neck and sagging skin.

Q:   What are the platysmal cords?
A:   The platysma is the muscle of expression in the neck that creates two cords in the front of the neck upon aging. These cords are a result of the platysma muscle aging whereby the muscle shortens, fibroses and contracts and bow strings to create two bands in the neck. To improve the look of the platysma during the facelift surgery, these bands are lengthened by surgically softening them and tightening the neck muscles in the submental area.

Q:   What is the SMAS?
A:   SMAS stands for superficial musculoaponeurotic system, which is the fascia (gristle layer) in the face that is continuous with the platysma muscle in the neck. The SMAS is the muscle layer that is tightened underneath the skin. Tension is placed on the SMAS to produce a lift so that there is no tension placed on the skin. This allows the incisions to heal very nicely and gives the face a complete natural looking rejuvenation.

Q:   How long does a facelift last?
A:   As long as the surgery has been done appropriately, a facelift lasts approximately 10 to 15 years. At that point, further skin elasticity, jowls, neck fat, and gravity changes tend to produce the aging effects again. A facelift can be repeated.

Q:   What kind of anesthesia is used for a facelift and a neck lift only?
A:   Typically, facelifts and neck lifts are done under a general anesthesia. A neck lift only can be performed under a local anesthesia with some intravenous sedation if needed. All anesthesia is administered by a board certified physician anesthesiologist from Swedish Medical Center at the Seattle Facial Plastic Surgery Center.

Q:   Are there any wraps placed on the outside of the face after a facelift or a neck lift?
A:   No. There are no wraps placed around the face, head, or neck at any time after the surgery. There are two drains placed in the neck. These drains are called Jackson-Pratt drains and are small reservoirs with microperforations and holes. They are inserted underneath the skin and are left in place for two days to prevent blood accumulation from underneath the skin. These drains are removed by Dr. Portuese on the second postoperative day.

Q:   Can a facelift and neck lift be performed at the same time as a blepharoplasty?
A:   Yes. Many times an upper and lower lid blepharoplasty is performed at the same time as a facelift. They can either be performed together or separately, depending upon the patientís wishes and concerns.

Q:   Can a facelift and a forehead lift be performed at the same time?
A:   Yes. In many instances a forehead lift (brow lift) can be performed at the same time as a facelift. These are done simultaneously and complete a full facial rejuvenation. These surgeries, done concurrently, are frequently performed in the Seattle Facial Plastic Surgery Center. This surgery is done under a general anesthesia by a board-certified anesthesiologist from Swedish Medical Center.

Q:   What is the average age that a patient would have a facelift performed?

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Q:   The average age for a facelift in Dr. Portueseís practice at the Seattle Facial Plastic Surgery Center is approximately 50 to 55 years of age. A few are done in the 40ís and several are done into the 70ís, but 50 to 55 is the average.

Q:   How long must I refrain from exercise after my facelift or neck lift surgery?
A:   Patients are asked to refrain from any type of physical exercise including running, jogging, or anything that raises the heart rate and blood pressure for two weeks after the surgery. It is important not to exercise for two weeks following the surgery and to keep activities to a minimum so that patients do not get any undue swelling.

Q:   How long does the swelling and bruising last after a facelift or neck lift?
A:   Typically, the majority of the swelling and bruising subsides in the first two weeks after the surgery. Most patients are able to get back to their social and work environments within two weeks. Approximately 70% of the swelling disappears from the face at two to three weeks and the other 20-30% takes an additional month or two. Bruising is easily camouflaged with makeup. There is usually not a lot of associated bruising with the facelift because of the use of the Jackson-Pratt drains, which drain blood out from underneath the skin. Blood is a cause for bruising and when the blood is removed by the drains, there is very little bruising. There is a mild-to-moderate amount of swelling that tends to disappear, for the most part, within the first two weeks.

Q:   What type of stitches are placed for a facelift and a neck lift?
A:   A combination of dissolvable and removable stitches are placed in front of the ears and behind the ears during the facelift and neck lift surgery.

Q:   Where are the incisions for a neck lift?
A:   The incisions for a neck lift are usually two small 1/2-inch incisions behind each ear and one 1-inch incision underneath the submental area of the neck.

Q:   Where are the incisions placed for a facelift?
A:   Dr. Portuese places the incisions for a facelift at the area of the junction for the temporal tuft at the hairline and then behind the ear at the tragus. In the postauricular area, the incision is located in the crease behind the ear and then down along the hairline. The incision proceeds upward so that patients are able to place the hair up off their shoulders within a month or two after their surgery. The skin that is removed is the non hair-bearing skin and therefore does not give a pulled, tightened, or wind-tunneled look. Hairlines are not shifted and remain the same.

Q:   Is a facelift an outpatient surgery?
A:   Yes. Patients are discharged to home from the Seattle Facial Plastic Surgery Center after a facelift. Out-of-town patients stay in one of the local area hotels. There are four hotels conveniently located within a block of the office. Patients do not need to stay overnight in the hospital unless there are some other medically-related conditions.

Q:   Do you perform computer imaging for a facelift or a neck lift?
A:   Yes. We can perform computer imaging at the Seattle Facial Plastic Surgery Center. These pictures are taken from the lateral side view and this demonstration is done at the time of the consultation in the privacy of our office.

Q:   Is there financing available for my facelift or neck lift?
A:   Yes. Our office takes VISA and MasterCard and third party financing options are available through Care Credit.

Q:   Do you ever perform chin implant surgery with a facelift or a neck lift?
A:   Yes. It is very common to see a weak and retrusive chin profile at the same time as large fatty deposits in the neck. When this occurs, the chin is out of balance with the remainder of the face and the neck. For that reason, Dr. Portuese will insert a synthetic chin implant made out of Silastic plastic through the same incision used in the submental area for the neck tightening procedure. A chin implant is placed over the bone in the subperiosteal space, which keeps the chin implant in the proper anatomical position. This is done to give more facial balance and to give a stronger chin profile, which also accentuates the neck work currently being performed.

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Q:   Can a rhinoplasty be performed in addition to a facelift or neck lift?
A:   Yes. In many instances a rhinoplasty is done in conjunction with either a facelift or a neck lift.

Q:   Can cheek implants be done at the same time as a facelift?
A:   Yes. Cheek implants are used for people who have very flat cheek bones and it is an excellent operation to augment the cheek area. This is done frequently at the time of the facelift if there are flat cheeks in addition to the laxity that is in the face from the aging process. Cheek implants can be done alone if the existing problem is only flat cheeks.

Q:   How much does a facelift cost?
A:   Typical cost for a cosmetic neck lift is around $5,500 and $10,800 for a facelift, depending upon the complexity. This includes the operating room, anesthesia, and the surgeonís fee.

Q:   What do I need to do to prepare for the face neck lift surgery?
A:   Our office policy is to avoid aspirin, ibuprofen, vitamin E, and all herbal products for two weeks prior to the facelift surgery. This is to prevent any bleeding underneath the skin in the postoperative healing phase.

Q:   Is there much pain after a face neck lift?
A:   No. There is only moderate discomfort after a face and/or neck lift surgery. Patients usually take pain medication for the first day or two after the surgery and switch to Tylenol for minor discomfort after the first few days.

Q:   Is revision face neck lift surgery different than a primary facelift?
A:   Revision face neck lifts are always more difficult than the first time. The unpredictability of healing and scar formation, the location of the previous incisions and the raising of the preexisting hairline from prior surgery all add to the difficulty the second or third time.

Q:   Who performs my anesthesia for my face neck lift?
A:   Board certified physician anesthesiologists from Swedish Medical Center perform the anesthesia in our Medicare-certified ambulatory surgery center.

Q:   Where is the facelift and/or neck lift performed?
A:   All surgeries are performed at the Seattle Facial Plastic Surgery Center, a Medicare-certified ambulatory surgery center. This is located next to our office, which is in the Swedish Hospital Medical Center complex on First Hill in Seattle, Washington.

Q:   If I am traveling from out of town to have my facelift and/or neck lift, how long do I need to spend in town before I can go home?
A:   Typically, Dr. Portuese likes patients to be in town for at least ten days after their facelift surgery so that he can check and monitor the healing progress. In an ideal situation, he also likes to see patients back at approximately three weeks, three months, six months and one year after the surgery to monitor the postoperative course.

Q:   What if I have questions about my facelift after the surgery?
A:   At the Seattle Facial Plastic Surgery Center, our caring staff of three registered nurses, patient coordinator, ancillary staff, and administrative staff are able to answer most questions. If they are unable to answer the patientís questions, Dr. Portuese will personally answer all questions necessary to make sure that patients feel comfortable with their new face neck lift.

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Q:   How long do I need to take off work after my facelift or neck lift surgery?
A:   Most patients take approximately two weeks off from work. The swelling, bruising and postoperative edema will last upwards of two weeks after the surgery. Patients are certainly able to work from home doing computer, phone, and book work but may not feel comfortable venturing out of the house until the majority of the swelling has subsided.

Q:   When can I put makeup on after my facelift or neck lift?
A:   The sutures are removed one week after the surgery. Makeup can be directly placed over the incisions approximately ten days postoperatively to cover up and conceal any swelling or bruising that may exist. Facial cleansers and lotions can also be used at this time.

Q:   When can I color my hair after a facelift?
A:   Most patients are able to color their hair two weeks after the facelift without harming any of the incisions.

Q:   When can I use a blow dryer after my facelift?
A:   Most patients have some degree of temporary numbness around their ears after a facelift procedure and it is very important that they do not burn themselves with a hot curling iron or a blow dryer. Within the first two to three weeks after a surgery, it is important to refrain from using any heat-related items such as hair dryers and curling irons around their ears.

Q:   Is there any other blood work I will need to have prior to my facelift or neck lift surgery?
A:   This depends upon your medical conditions. If you are taking a diuretic, a potassium level will need to be performed within the week before the surgery. Men 45 and over and women 55 and over will need a recent EKG performed within six months of surgery to make sure that there are no heart issues. Patients who have high blood pressure need to be taking their current medications to make sure that their blood pressure is under control going into the surgery so that they do not have any bleeding issues.

Q:   What about nausea and vomiting after my surgery?
A:   Nausea and vomiting after surgery usually have two sources. The first is from the anesthetic itself, which can last the first 12 hours after the surgery. After that, nausea and vomiting can be related to pain medicine. We ask patients if they are not having much discomfort to switch to Tylenol to eliminate the nausea and vomiting associated with taking narcotics. Patients also receive anti-nausea pills to take the morning of the surgery. Scopolamine patches are also used behind the ear, which help for motion sickness. The anesthesiologist will also give intravenous anti-nausea medications while patients are asleep under anesthesia before being brought to the recovery room. These are all methods that can help prevent nausea and vomiting in the postoperative period.

Q:   Why do I need to have a preop visit for my facelift or neck lift surgery?
A:   All patients have a preop appointment with one of our nurses. For the out-of-town patients, this can be done over the phone. Pictures are taken, a thorough health history is reviewed, and all medications are recorded. At this time, within two to three weeks prior to surgery, all needed laboratory or medical testing will be performed.

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For a facelift in Seattle Washington contact Dr. William Portuese. View facelift before and after photos.


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