When is it realistic to see final results of a FL?
At about 6 months most of the final result is there regarding the tightness of the jawline and neck. It may be 9-12 months to be absolutely certain that all of the honeymoon swelling is gone to know the final result, but sometimes there is not much change between 6-12 months.
Over-reacting too soon? If so, when can one expect to see the final result? Is this a normal stage of healing? Do you tend to look a little worse (even without bruising and major swelling) before you get better? Why would I start out looking so great, and then turn a little in the wrong direction? Or, how do you know if your Doc did too conservative of a job? And if a revision is necessary, when would this take place, and how involved would it be?
At 3 weeks, it is too soon to see the final result. After the initial “bad” swelling and distortion (looking worse) immediately after surgery begins to resolve, there is still some swelling present. I call this “honeymoon” swelling. For someone with a thin face this mild swelling will make them look better than their final result. If the person has a very full round face, then the mild swelling may look distorting for their faces. The volume added to the face from the swelling which helps to smooth out smile lines, facial wrinkles, and marionette lines, but will not be part of the final result. As this honeymoon swelling goes away over the period of 3-6 months the real result begins to show. If you compare these patients one year result with their pre-surgery results, you can still see the improvement, but may not see complete elimination of all lines and wrinkles or a perfectly straight jawline. For some younger patients, a perfectly straight jawline can be achieved, but if the patient is older and has moderate to severe jowling, then this may not be possible and only a significant improvement is realistic.
This is why it is not fair to show patient before and after photos so soon after surgery. Although many of the rapid-recovery type of lower/mini-facelifts show the early result to demonstrate that the bruising and swelling is not that bad, they rarely show longer term results that are closer to a year or more.
To gauge the true result of a facelift the one year results would be most accurate. Although some people may reach this one year “look” sooner than a year, since everyone heals differently, it is better to standardize the before and after photos for facelifts to a year for consistency. If we use 6 month photos, some people may still have some slight honeymoon swelling making them look better than other people whose honeymoon swelling has already resolved.
If a revision is desired, I will wait for the 9-12 month period, since the area that was operated on, has not fully healed. If the patient is operated on, during the first 6 months, the tissues may still have some inflammation, and the collagen fibers have not fully remodelled and are not at full strength. When the tissues are still inflamed it is like “wet tissue paper.” Another term that we use is “friable.” If the tissues are not tight enough, and the surgeon tries to put stitches through the SMAS which is still friable, then how tight do you think that surgeon can tighten the SMAS? The sutures will cut through like a cheese wire through cheese, and the goal of the revision will not be easily achieved.
If the tissues are allowed time to “set” and the scar tissue heals properly, then the collagen actually strong enough to allow for anchor stitches for further tightening. If the surgery is performed too soon, then any tightening performed may be short-lived, and it may look the same as prior to the revision. Instead of waiting an additional 3-6 months to reach the 9-12 month mark for a proper revision, then the clock has reset and will need to start over and wait another 9-12 months to make sure that the patient will benefit from the revision.
When I consult with a patient, I will perform a mirror simulation. I will show them using my fingers lifting gently on their face and/or neck to show what I will try to achieve during surgery, which is to tighten the jawline as much as it will tighten without risking the suture breaking or cutting through the SMAS. Then I will relax how tightly my fingers are lifting by 30-50%, and show them what I think the final result will be. When I do this, I will point out any relaxation of the jawline, marionette lines, or distortion/stretch lines which can sometime occur with certain patients. For example, for some patients with very deep marionette lines, their marionette lines don’t smooth out easily, and instead change direction. Instead of having vertical marionette lines, it becomes more angled. I will point this out in the mirror and compare it to when I am not lifting at all. If they still like the improvement then they are a good candidate for surgery. If they don’t like the look, or feel it is not enough of an improvement, then I would rather that continue on their surgeon search. I try to show them the most accurate prediction of the post-surgical result I can achieve, and not more than that. If they are happy with a real improvement with minimal problems versus looking for a perfectly smooth _______ (fill in the blank) then I think their expectations are realistic.
In some ways, the patients who are sagging the most, will have the the most “improvement,” when before and after photos are compared, although a “perfect” result is less likely to be achieved. I think that over-tightening can result in other problems which I would rather avoid for my patients. In trying to get an extra 10-25% more result, then other factors come into play, which the patient does not realize. Sometimes the over-stretching around the mouth area, does not completely relax, and becomes an obvious sign that the person has had a facelift. If the patient want a tighter result and would not mind having a stretched mouth and other potential problems in order to achieve a perfect jawline, then I am not the right surgeon for them.