Facelift in St. Louis, MO

As we mature, we frequently start to lose the smooth, even-textured, well-defined facial features of our youth. Skin laxity begins to occur, which is when it loses its tightness and starts to sag. Genetics play a prominent role in the timing, speed, and extent of facial skin aging, but smoking and excessive sun exposure can accelerate this process.

Performing a facelift procedure can help turn back the signs of aging for a more youthful appearance by reducing or eliminating these symptoms:

• Wrinkles
• Fines lines
• Sagging cheeks
• Nasolabial folds (the lines extending from the nose to the corners of the mouth)
• Jowls
• Double chin and hanging skin on the neck (if a neck lift is also included, which is usually the case)

Dr. Hulsey's goal is to refresh, not alter. She repositions sagging tissue, tightens and re-drapes skin to maximally correct sagging without excessive pulling on facial features. 

Yes! Facelifts are often combined with neck lift procedures, which is discussed below, but you can also combine them with eyelid surgeries and brow lifts. Facial fat grafting can be done in conjunction with a facelift, but it is Dr. Hulsey's preference to perform the facial fat grafting after patients have healed from a facelift to more accurately fine tune a patient's result once swelling as resolved. 

The majority of patients who see Dr. Hulsey actually have primary concerns regarding the neck. There are many ways to perform a neck lift, and how a neck lift is performed depends on a patient's anatomy. Performing a neck lift alone is not as common as combining it with a facelift because combining the two procedures allows your to fully address the lower face, jawline, and neck, treating this area as one unit. 

There are subtle differences in incision placement depending on each patient and their needs, but in general, incisions run from the temple area, curving in front of the ear or just inside of it, under the ear lobe, behind the ear, and extending into the hairline behind the ear.  

Dr. Hulsey is then able to free the skin from the underlying tissues to the extent necessary for the particular surgical technique selected, but usually from mid-cheek, across the jaw line, and into the neck on both sides. After the skin has been freed, the deeper sagging tissue, also known as the SMAS is addressed. There are many ways to address this layer, some more aggressive by also completely freeing this layer in the same fashion as the overlying skin, while some simply "plicate" this layer to tighten it. Dr. Hulsey prefers either plication or limiting the release of the layer to protect important structures, such as facial nerves. She frees up this layer only as much as is necessary to then excise the excess, and secure the trimmed SMAS in a new position. SMAS plication vs. small SMASectomy (removal) with plication depends on underlying facial anatomy and shape. The skin is then carefully re-draped, pulling tight just to the point that facial features are not distorted, marked, and excess excised. AKA, the skin is tightened just enough to not be overdone and not cause undue tension during closure. 

If a neck lift is also performed, sometimes a small incision is also required just under the chin to address bands or excess fat. Dr. Hulsey does use drains to help avoid fluid collections. These drains are quite small, with one on each side, exiting in the hairline. They can usually be pulled the day after surgery. Sutures are removed 5-7 days after surgery. 

Your facial plastic surgery procedure will be performed at Seven Oaks Surgery Center, LLC, our outpatient surgical facility next door to the practice. Dr. Hulsey performs face (and neck) lifts under general anesthesia. The anesthesia team at the surgery center are all MD, board-certified physicians whom Dr. Hulsey trusts implicitly.

Dr. Hulsey will meet you in the pre-op area, mark her incisions,  review all pertinent information, and answer all questions. The anesthesia team will then takeover, and Dr. Hulsey will perform the surgery as above.

When surgery is completed, you will be taken into a recovery area, where you will continue to be closely monitored. Sometimes, small tubes are inserted beneath the skin to drain away fluids that might otherwise accumulate, but there is usually little discomfort from the surgery. You will be in a bulky head wrap to help with swelling, bruising, and help prevent fluid accumulation. This wrap is taken down the day after surgery in clinic by Dr. Hulsey. She can also usually pull your drains that same day. You will then be placed in a compression garment, with close follow up 4-5 days later.

Patients should expect to wake up with a compressive head wrap. This helps control bruising and swelling during recovery. Elevating your head when you sleep should minimize swelling and bruising. Most bruising will disappear within two weeks. Remember, you must not take aspirin or certain anti-inflammatory medications, and you should not smoke or be exposed to heavy secondary smoke for a while.

Any bandages and drain tubes will usually be removed in one or two days. At that time, you might notice puffiness and discoloration, which may be more pronounced in some portions of your face than others.

After a few days, you will be permitted to wear makeup to help conceal discoloration. Your stitches will be removed 5-7 days after surgery.

Activity restrictions include avoiding strenuous activity and heavy lifting for 4-6 weeks. This is important to avoid increases in blood pressure than can cause bleeding, or worsen swelling and bruising. Patients can resume lighter activities after 4 weeks, and ease back into the more strenuous exercises at 6 weeks. Dr. Hulsey recommends taking 1-2 weeks off work.  

You will be instructed to temporarily avoid exposure to direct sunlight and, for the long term, be conscientious about using sunblock to protect your skin.