Male Facelift

Men who are generally healthy (no cardiac, pulmonary or kidney diseases), who are non-smokers (smoking severely compromises wound healing( and who have reasonable goals and favorable anatomy may be good candidates for a male facelift. Dr. Rad is often asked by patients whether this is the right time for facelift, and through detailed discussion he will advise you candidly about the advantages and disadvantages of facelift surgery. The 10 most common reasons male patients seek facelift are as follows:

1. You have had a change in your professional life, perhaps making you feel the need to look more youthful, energetic and commanding.
2. You have had a change in your personal life such that attracting a partner has become more important.
3. You are concerned that you look older than your actual age which causes you to feel more pressure in the workplace or in your social life.
4. You have tried non-surgical treatments and you now want a more significant and/or permanent improvement.
5. Your busy schedule does not favor multiple visits and so a “one and done” refresh is appealing to you.
6. You are interested in reversing the early signs of aging rather than waiting for greater laxity to appear which may require a more significant “overhaul.”
7. You have a big life event forthcoming, perhaps a wedding or professional occasion, and you want to look fresh and confident.
8. You want to improve certain problem features such as blunted jawline or weak chin.
9. You have lost a lot of weight and now see looseness in your facial tissues.
10. You view your success or livelihood to depend on looking and feeling your absolute best.

When there is significant skin looseness and Dr. Rad’s “scarless” approach is not suitable, then facelift incisions that pass around the ears require the deep plane approach. Face lift scars for a man varies depending on the degree of skin laxity and the pattern of hair in front of the ear. In terms of skin laxity, the general rule of thumb is that the greater the looseness the longer the incision must be. The reason for this is because, when excess skin is smoothed and “redraped” in a diagonal direction, it would otherwise bunch around the ear unless the incision is extended appropriately and transition contour smoothly from cheeks and neck to the ear. Prematurely ending the incision line will cause “dog ears” which is a term used to describe the bulging of extra skin at the ends of incision lines that were not extended long enough. Therefore, a skilled surgeon must prioritize smoothness of contour rather than incision length. The art of facelift incisions in men lies in 2 aspects: (i) incision placement in front and in back of the ear, such that they are optimally hidden from view, and (ii) how much tension is pulling on the incision line which determines how well scars heal and how much ear structures distort. A highly skilled surgeon will optimize both aspects as follows.

Dr. Rad treated this middle aged male with deep plane face and neck lift. Notice that scars are unnoticeable because of precise placement of the scar line following natural hills and valleys around the ear structures, zero tension pulling on ear structures, and meticulous management of beard and sideburn hair distribution. This result is 6 months post-op]

With respect to incision placement, let’s consider the incision line in front of the ear, and then also in back of the ear. Generally speaking, incision placement must be precise and meticulous to follow the undulating hills and valleys of ear structures. Not doing so, by placing a straight line incision in front of the ear, makes the scarline very conspicuous.

Instead, Dr. Rad takes great care to place his incision following the natural contours of the ear as follows: first, curved around the helical rim (top curved part of the ear), then behind the tragus cartilage (“retro-tragal”), then at a 90 degree angle around the incisura (the structure between tragus and earlobe), and finally curving then around the earlobe just outside its junction with the facial skin. Dr. Rad frequently sees patients for revision work because of poorly placed scarlines which most commonly is straight down in front of the ear. The rationale given to patients is that there are often wrinkles in front of the ear in which to hide the scar. While logical in concept, it does not result in less conspicuous scar because after facelift the wrinkles will have been smoothed and the white scarline is then quite visible.

Incision placement behind the ear should follow the natural crease where the ear meets the head, and then transitions to the hairline and into the hair-bearing scalp. A meticulous surgeon tailors the incision line to each patient’s unique anatomy and degree of skin laxity: when there is minimal skin laxity, then Dr. Rad routinely extends the incision into the hair-bearing scalp, whereas with significant skin laxity Dr. Rad places the incision line along the hairline rather than extending it into the hair-bearing scalp, in order to avoid a “stair step” or “zig zag” hairline deformity which can be very difficult to correct. Suffice to say that Dr. Rad has extensive experience correcting these problems in patients treated by other surgeons.

Incision placement also relates to whether a man wears sideburn hair or a beard. In this case, when the excess skin is pulled up, the sideburn hair and beard hair can be pulled onto the ear structures, or directly adjacent. To avoid this, the meticulous surgeon will direct skin redraping in a more vertical direction so that hair-bearing skin replaces hair-bearing skin, rather than the hairless skin in front of the ear. The other delicate maneuver that Dr. Rad routinely employs is very precise cautery (“burn”) of the hair follicle bulbs in the region of skin that is in front of the ear in a precise pattern that recreates the contour of the sideburn and beard hair. This is a delicate move because there is a fine line between clearing the unwanted hair from ear skin and potentially burning the skin and causing skin necrosis. Needless to say there are many details to which your surgeon must pay close attention, and of course Dr. Rad does so with every one!

With regard to how incisions heal, it is essential for incision lines to have ZERO tension. Think about a rubber band – if you pull on it, the rubber band widens and eventually the band will stretch out. However, if you let the band be in its natural resting state, then it does not widen and does not stretch out. Skin acts the same way: it has elasticity like the rubber band and scars will widen and skin will stretch when pulled with tension. This causes terrible looking scars and distortions of the ear that can be very distressing to patients. The only way not to have tension is to redrape skin in a way that allows the skin to lay gently in place, rather than pulling the skin tightly. This is essential for optimal scar healing!

This is a very common concern that Dr. Rad addresses with his male facelift patients. While Dr. Rad always performs facelift with the highest level of attention to detail, the need for virtual imperceptibility of scarlines is great in male facelift patients, particularly if they wear short hair or are bald. While individual tendencies for scar healing is largely genetic, there are many details that go into incision management in order to optimize scar healing for men.

Incisions closed under tension notoriously heal poorly and cause many visible problems. Most notably, scars tend to be wide, hypertrophic (thickened), and distort ear structures such as the tragus (called “ear canal show”) and earlobe (called “Pixie ear deformity”). These undesirable distortions are difficult to correct and typically require a revision facelift. Therefore, doing the facelift right the first time is of paramount importance and management of tension is essential. This means that, while deeper tissue layers, I.e. the muscle layer, may be holding significant tension, the skin incision line should not. Skin does not have tensile strength and tends to stretch out, and will do so at the “weakest point.” As the saying goes, “a chain will break at the weakest link,” so too will a scar widen because it is weaker than native skin. Furthermore, tension placed erroneously at ear structures will distort their features. These telltale signs of a poorly executed facelift are to be avoided. For these reasons, Dr. Rad’s deep plane facelift technique places tension on the deep muscle layer and zero tension on the skin incision line making his facelift results second to none.

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:

1. 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- 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 than the cumulative risk of driving a car every day.

1. 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 and the anesthesiologist will maintain 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.

1. 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.

You may hear that the safest plastic surgeons have “operating privileges” at major hospitals. “Operating privileges” allow surgeons to perform surgery at that hospital, and they are granted following a 6-month process of evaluating a surgeon’s background.

Dr. Rad’s credentials have rigorously been vetted by the top hospitals in DC and northern Virginia, specifically Sibley Hospital (DC), Inova Fairfax Hospital and Fair Oaks Hospital (northern VA), and George Washington University Hospital (DC). This means that his training, board certification and safety record meet the high standards of these top hospitals in DC and northern Virginia.

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 gentle skin care with products that have high concentrations of antioxidants 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: La Mer The Concentrate
• Face and Neck Care: 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), or Caudalie Premier Cru (contains fragrance)
• Eyelid Care: using a separate eye cream such as Sturm Eye Cream, La Mer Eye Concentrate, Augustinus Bader Eye Cream, or Caudalie Eye Cream for eyelids is important to prevent milia, small bumps that can develop when using thick face creams or ointments.
• Lip Care: Sturm Lip Balm, La Mer Lip Balm

If you are planning to undergo a facelift, it is important to properly prepare for the procedure to ensure the best possible outcome. Here are some tips to help prepare for a facelift:

• Follow your surgeon’s instructions: Your surgeon will prepare for the procedure to ensure the best possible outcome. Follow these instructions carefully to avoid any complications.
• Stop smoking: Smoking can interfere with the healing process, and it is recommended to stop smoking at least two weeks before the procedure.
• Avoid blood-thinning medications: Some medications, such as aspirin and ibuprofen, can increase the risk of bleeding during and after surgery. Avoid these medications at least two weeks before the procedure.
• Arrange for someone to drive you home: You will need someone to drive you home after the procedure as you will feel groggy from the anesthesia.
• Prepare a comfortable recovery area: Prepare a comfortable area for you to rest and recover after the procedure.
• Stock up on supplies: make sure to stock up on supplies like ice packs, gauze, and comfortable clothing before the procedure
• Follow a healthy diet: A healthy, well-balanced diet can help improve the healing process, so make sure to eat plenty of fruits and vegetables leading up to the procedure.

It is important to have a thorough consultation with your surgeon to properly understand the procedure and discuss any specific preparations that need to be made.

In Dr. Rad’s DC practice, the cost for facial aesthetic lifts starts at $18,000+ for targeted in office “mini lift”, $29,000+ for more advanced face and neck lifts, (“deep plane” or ponytail methods), $49,000+ for surgeries combining other procedures (blepharoplasty, brow lift, fat grafting, etc.), $75,000+ for complex anatomy, corrective work and up to $150,000 for extensive facial surgery requiring multiple operations (such as adding rhinoplasty, facial bone augmentation or shaping, custom facial implants, etc.). Note that pricing is customized for each patient and these guidelines do not necessarily apply uniformly. Also keep in mind these are approximate ranges and total cost depends on multiple factors: your unique anatomy, goals, complexity of the procedures, recommended techniques, whether corrective work is needed, in-office or hospital-based operating facility, and combining multiple procedures (increasing concessions apply for multiple procedures).

Although you may receive varying cost estimates from other practices, keep in mind that your surgeon’s education and training, plastic surgery board certification, his/her experience (at least 8 years of experience after residency is recommended), and the “X” factor of aesthetic artistry and surgical skill (i.e., talent) of your surgeon are important factors in pricing. Dr. Rad’s goal for every patient is to achieve nuanced and natural results with minimal recovery, and we have mechanisms in place to bring your goals in financial reach.

Dr. Ariel Rad strives to deliver the best facelift Washington, DC has to offer. To find out more about facial cosmetic surgery and our financing options, schedule your consultation by contacting our office today.