What is my Facelift Recovery?
Recovery is a process of tissue healing and feeling back to normal that requires time. The length of time depends on which facial areas are treated, the complexity of surgery, and individual healing factors. The key principle of surgery that Dr. Rad always adheres to is minimizing surgery to achieve best results, thus minimizing healing and recovery time. The recovery process after a facelift can vary from person to person, but here are some general guidelines:
Immediately after surgery in PACU
You will be escorted by the anesthesia team from the OR to the recovery room (PACU). Your head will be wrapped with a light dressing and you will have drainage tubes to remove excess fluid. Tissue swelling is moderate and due to the injection of numbing medicine throughout facial tissues. Pain is mild and you will spend a few hours in PACU before being released to go home or to your hotel. Discharge criteria are drinking liquids, good pain control, ability to walk with minimal assistance, and no need for IV nausea medicine. Because anesthesia is light, most patient meet discharge criteria within a few hours.
First 1-2 days after surgery
Recovery can be either at home or a hotel. For your safety, as you’ll be somewhat sleepy, you will need a responsible adult to stay with you for at least the first night. We work with experienced private duty nurses for those who prefer this.
We have a relationship with The Jefferson Hotel, the only privately owned 5 star boutique hotel in downtown DC, close to our office. Their back-door access allows patients to go straight to their room without crossing through the main lobby. Dr. Rad has personally trained hotel staff to help his patients enjoy a private and comfortable recovery. They can help meet any needs and requests, from private dining to helping obtain basic supplies. We have a private room rate arrangement with The Jefferson for patients to enjoy 20% off best rates. (Note that we do not receive any payments for patient stays at The Jefferson – it is purely for patient comfort and convenience.)
Once home or in hotel, you will mostly rest, although you should be able to perform “activities of daily living”, meaning being up and about and doing basic self care. Since your head will be wrapped, you’ll defer showering until your first post-op appointment with Dr. Rad 1-2 days after surgery.
During the daytime you should walk 10-15 minutes each hour. You should not be on bed rest.
Pain is relatively mild and most patients need a mild pain medicine to help them sleep. Tissues react with swelling and bruising that distorts facial appearance and causes facial muscles not to work normally, but this is normal and temporary. Cold compresses and head elevation helps with comfort and swelling.
Since nausea is not uncommon after anesthesia, no matter how light the anesthesia given, nausea prevention is essential and straight forward by taking an anti-nausea medicine such as Zofran (Ondansetron). Nausea side effects typically wear off in 24-48 hours.
Other side of effects of anesthesia include feeling a bit groggy or “out of it”, but this is relatively mild and wears off quickly. Dr. Rad recommends not planning important work-related activities or phone calls as you will not feel your sharpest.
Drinking liquids is most important to maintain hydration. Dr. Rad recommends Gatorade, or Drip Drop and Liquid IV electrolyte replacement powders mixed in water.
If deep neck sculpting has been done then patients often feel some neck tightness that is normal, common and temporary. You will see Dr. Rad within the first few days to check on your early healing.
Your first post-op appointment
Dr. Rad will see you in our office on day 1 or 2 (sometimes 3) after surgery. Your head will be unwrapped, wounds assessed and drains checked. Typically Dr. Rad leaves drains in place for 4-5 days, and so he will explain how to manage drains.
Your facial appearance will look swollen, bruised and distorted (see images). This is normal and should not cause concern. Over time, this resolves and Dr. Rad will review the timeline of healing.
After this visit, shower as you usually would, and use your usual shampoo/conditioner. Dr. Rad recommends either Johnson&Johnson Baby Shampoo, or Mane&Tail shampoo and conditioner. You may notice reddish fluid wash out from your hair – this is not blood, but rather the prep solution used to cleanse your facial skin.
Only walking is encouraged for activity. No driving while on daytime narcotic pain medications (i.e. the first week).
First 2 weeks after surgery
Dr. Rad will remove drain tubes at 5-7 days after surgery. If you had eyelid surgery then sutures are removed at this step.
For bruising you may have laser treatment under Dr. Sherber’s care. Laser breaks up hemoglobin and allows the immune system to clear it more quickly.
Call 202-517-7299 or email [email protected] to schedule a laser appointment with Dr. Sherber. She will also give advice for how to optimize scar healing, optimize skin care and “protect your investment” to get the most longevity out of your facelift results.
Only walking is encouraged for activity. You may restart work-related activities and calls as needed. No heavy lifting for 2 weeks. Use your best judgment regarding items to lift: grocery bags, handbags and the like are fine. Heavy boxes of water are not. A general guide is < 15 lbs.
Weeks 3-8 after surgery
Subsequent recovery phase (2-6 weeks): Swelling and bruising gradually subside during this period, although they may still be present to some extent.
Most patients can resume light activities after the first week but should continue to avoid vigorous exercise and activities that could strain the incisions. Follow-up appointments with Dr. Rad will be scheduled to monitor your progress.
Long-term recovery (6+ weeks): By this point, the majority of swelling and bruising should have resolved, and you should start seeing the full results of your facelift. However, it’s important to note that individual healing rates can vary, and it may take several months for all swelling to completely dissipate and the final outcome to be evident.
Physical Restrictions/Return to Work
• Getting back to exercise is progressive: Dr. Rad recommends walking the first week, Peleton/stationary bike the second week, stretching and working small muscle groups the third week, low weight/high repetitions the 4th week, more intense core-focused or heavier weights from fifth week onwards.
• You can return to work when you feel comfortable and capable. Most patients plan to take a few weeks off.
Recovery varies based on the extent of the facelift, individual healing abilities, and other factors. Ask Dr. Rad to guide you through the recovery process based on your unique situation.
What anesthesia is used for facelift?
Facelift procedures require anesthesia to ensure patients’ comfort and safety during surgery. The choice of anesthesia depends on various factors, including surgeon preference, the extent of the procedure, the patient’s health status (presence of heart, lung, kidney or endocrine illnesses), and patients’ preference. The 3 most common types of anesthesia used for facelift surgeries are:
General anesthesia (GA)
Patients are asleep and are unaware during the surgery. During GA, the anesthesia team administers a combination of anesthetics to optimize the depth of anesthesia while minimizing side effects. This usually involves propofol for quick induction, and inhaled gas anesthetic for stable maintenance, and an array of anti-nausea medicines to reduce nausea side effects, the most common issue with GA.
In terms of what patients experience, your last memory of the process is rolling into the OR, and then the next memory is waking up in the recovery room. You feel nothing or experience nothing of surgery. Dr. Rad’s anesthesia teams are exceptionally skilled in ensuring comfort and safety. Patients do not experience “waking up” episodes, nor do they have any memory of the procedure.
GA involves administering intravenous medications and inhaled anesthetic to induce sleep and keep the patient pain-free throughout the procedure. This involves an airway tube (“endotracheal tube”) which serves two purposes: (i) to deliver the inhaled anesthetic which gives long lasting anesthesia, and (ii) protects your windpipe preventing any fluids, secretions or phlegm from getting into your lungs which can cause a pneumonia or airways spasm/constriction (“laryngospasm”). Without protection of your airway, such as with IV sedation only, the risk of airway/lung problems is higher.
Patients awaken quickly because the depth of anesthesia is not nearly as deep as required for other types of surgery (think liver, kidney or heart surgery). Within 15-20 minutes you are awake enough to remove the airway tube, and then you are rolling to recovery. Typically patients stay for a couple or a few hours in recovery before going home.
This type of anesthesia is needed when deep plane face and neck lift with deep neck sculpting (gland reduction) is being done.
Dr. Rad advises not thinking of GA as “being on a breathing machine” or being dangerous. Rather, the anesthesia machine is supporting your natural breathing and protecting your airway. In fact, GA is for comfort and safety. In the hands of a board certified anesthesiologist (with whom Dr. Rad always works) in the safest possible environment (accredited hospital-based surgery centers) GA is very safe, in fact it is much safer that the cumulative risk of driving a car every day.
IV sedation with local anesthesia
In some cases, combining sedation with local anesthesia (injected numbing medicine) is used. In this case, patients often receive propofol for the IV anesthetic to induce sedation and which helps them relax and feel drowsy during the procedure. While the patient is not fully unconscious with this approach, they are generally not aware of the surgery and experience little to no discomfort.
This does not involve the inhaled anesthetic as in GA, and does not require an airway tube. You are breathing on your own anesthesiologist maintains your level of anesthesia with propofol and other IV medicines. Oxygenation is supported with supplemental oxygen.
Patients may be a candidate for this type of anesthesia for shorter procedures and neck lift that does not involve deep neck sculpting.
Local anesthesia only
This type of anesthesia is the simplest of all, and involves injecting numbing medicine throughout the tissues to be lifted. Dr. Rad uses local anesthetics routinely in the office and this does not require going to an OR.
We start with applying topical numbing which dulls sensation, then injected numbing medicine is given while you are awake.
Patients are candidates for this approach when undergoing in-office mini-face lifts, upper blepharoplasty, buccal fat reduction and direct brow lifts.
Overall, the choice between these types of anesthesia will be discussed during the pre-operative consultation with the surgeon. The surgeon will consider the patient’s medical history, the complexity of the procedure, and the patient’s preference when deciding on the appropriate anesthesia.
What skincare should I use to optimize my healing after facelift?
Proper skin care is critically important as your tissues will be inflamed after surgery. “Inflammation” is a common term that is commonly associated with harmful internal processes. However, inflammation is a normal process whereby the immune system is activated to heal tissue trauma caused by surgery. This is a normal part of healing. However, too much inflammation can be harmful and so we must be sure to avoid anything that can irritate your skin or worsen inflammation.
It is important to use the right products immediately after surgery. Dr. Rad recommends avoiding products that have stimulatory ingredients such as retinols and using a gentle skin care with products that have high concentrations of anti-oxidants to calm and soothe inflamed skin. Drs. Sherber and Rad recommend the following curated, science-backed products for daily use after facelift surgery (you may order products online or ask our staff for these products from our Boutique). Products are at different price points but we have vetted these products for their high quality ingredients and calming formulations for optimal facelift healing.
• Cleanser: use a high quality oil-based cleanser. Drs. Sherber and Rad recommend Eve Lom Gel Balm Cleanser or Sturm Facial Cleanser. Follow the instructional video on the website. Massage a grape-sized amount of balm or 2 pumps of foam onto dry skin for 60 seconds, then enter the shower. Apply a warm/moist muslin cloth to your face for 30 seconds, repeat twice more, then buff your skin on the last application.
• Incision Care: use La Mer The Concentrate or to your incisions only.
• Face and Neck Care: you may select from the following:
– Sturm Face Cream (fragrance free, best for sensitive skin)
– Creme de la Mer (contains fragrance).
– Augustinus Bader The Rich Cream for dry skin (fragrance free)
– Augustinus Bader The Cream for oily skin (fragrance free)
– Caudalie Premier Cru (contains fragrance)
• Eyelid Care: using a separate eye cream for eyelids is important to prevent milia, small bumps that can develop when using thick face creams or ointments.
– Sturm Eye Cream
– La Mer Eye Concentrate
– Augustinus Bader Eye Cream
– Caudalie Eye Cream
• Lip Care:
– Sturm Lip Balm
– La Mer Lip Balm