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Koch Facial Plastic Surgery

R. James Koch, MD, Facial Cosmetic Surgery

Facial Plastic Surgeon located in San Mateo, CA

It is a natural part of the aging process to experience facial skin sagging due to the effects of gravity and changes in the quality of the skin (such as being less firm and more lax).  Facial fat also changes in response to aging and gravity.  If you’re interested in a facelift but aren’t ready for invasive surgery, an in-office facelift may be the procedure for you.

At Koch Facial Plastic Surgery in San Mateo, California, R. James Koch, MD specializes in in-office facelift procedures that are less invasive than a traditional facelift without the need for general anesthesia.  This treatment helps to refresh your appearance and the natural contours of your face without extensive surgery.  An in-office facelift also offers a faster recovery time and less risk than a traditional facelift and still gives you amazing results.  It should be noted that Dr. Koch has trained the most physicians in the in-office facelift in the country.  Call Koch Facial Plastic Surgery to schedule an in-office facelift consultation or book one online today.


Facelift Q & A

What is a Facelift?

A Facelift, usually performed in the office setting, is a surgical procedure that improves the visible signs of aging in the face and neck.  It specifically targets the lower third of the face and neck where it can: improve jowls and tighten the jawline, remove loose skin and excess fat in the neck (“turkey neck”), improve vertical lines that extend from the outer corners of the mouth (“marionette lines”), and also indirectly improve the nasolabial folds that run from each side of the nose to the corners of the mouth (“smile lines” or “laugh lines”) in most patients.

Dr. Koch performs the state-of-the-art “Vertical SMAS Imbrication Facelift” to fully address the aging lower face and neck.  He believes that there is no better treatment available for these aging issues.  He also performs a “Mini-Facelift” in select patients which has less downtime.  In either case, he performs these in the office setting with local anesthetic and oral sedation, and uses inconspicuous incisions while preserving the hair.  Dr. Koch also has significant experience doing male and revision facelifts.  His goal with facelift surgery is to give you a more youthful, natural appearance, and not to make you look “different”. 

Am I a good candidate for a Facelift?

If you have visible jowling, a less defined or sagging jawline, and loose neck skin, you may be a good candidate for a facelift.  If you only have mild jowling, some sagging of the jawline, and your neck skin is still fairly tight, you may be a candidate for a “mini-facelift”.   

What does it mean that the procedure is performed in the “office setting”?

Dr. Koch performs many procedures in his on-site procedure room in Suite A under “twilight” conscious sedation using oral medications and tumescent anesthesia.  These are not “Mini” versions of the procedures, but the Gold Standard ones.  Although patients are fully monitored and pre-screened for this approach, they are performed without an IV or the cost and risks of a general anesthetic.  Dr. Koch finds that most patients enjoy a twilight anesthetic where they are completely comfortable but can still communicate with their surgeon.

Generally, in-office facelift procedures are less invasive than a traditional facelift because of the anesthetic techniques used.  Dr. Koch believes that a “breathing tube” and general anesthesia are unnecessary in the vast majority of facelift candidates. You can also expect to recover faster and with fewer risks after an in-office facelift than you might with a traditional facelift procedure. 

What happens during a Facelift?

During an in-office facelift, you are awake yet comfortable (“twilight”).  You will be given medication by mouth to help you relax.  Usually an IV is not necessary.  Dr. Koch then administers a local anesthesia to numb the skin, and this is followed by a tumescent solution which further anesthetizes the skin.  Incisions are camouflaged by their placement:  in front of the ear in natural creases to break-up their visibility, hidden in the crease behind the ear, and then hidden in the hairline behind the ears.  We go to great lengths to produce the most inconspicuous scars and to preserve your hair.

The skin is then elevated, and the underlying SMAS muscle layer is tightened in a safe area and based upon the surgical plan that we have personalized to your unique facial features and your aesthetic goals.  The excess skin is then trimmed, and the incisions closed.  Before we continue to lift the other side in an identical fashion, we usually give you a lunch break which patients tell us is another advantage of the in-office facelift.

How long does it take to recover from a Facelift?

Because of the in-office anesthesia techniques, most swelling and bruising is gone after 1 week, but the sutures are in for 2 weeks.  So we call it a “2 week recovery period”. 

You will need a ride to and from the office on the day of surgery, and someone to stay with you that night.  You will be seen the following day to remove the pressure dressing and drains.  The drain removal is not painful.  You will be then re-wrapped with another pressure dressing for an additional 3 days.  There is no direct wound care for the facelift itself while the dressing is in place.  On the 4th day after surgery, the dressing will be removed and a facelift support strap placed.  This is when you will be able to shower and wash your hair.  Wear the facelift support strap “23/7” for 2-3 weeks (i.e.- you may remove it 1 hour per day to shower).   

You will need to return periodically to have sutures removed.  We will keep you updated on your appointments and all instructions, so you do not have to worry about writing everything down. The sutures in front of your ears will usually be removed 7-8 days after surgery.  If you have had an incision made under your chin, those sutures will also be removed.  Sutures behind the ear are usually removed 14-15 days after surgery.  Most patients are cleared to travel at 4 weeks, and return to all routine activities (including heavy exercise and hair dying) at 6 weeks.   

What can a Facelift not do?

Because a facelift specifically targets the lower third of the face and neck it can directly improve the jowls, tighten the jawline, remove loose skin in the neck, and improve the “marionette lines” at the corners of the mouth.  The lifting pull has an indirect effect on the “smile lines” or “laugh lines” (nasolabial folds that run alongside the nose); some patients may have significant improvement in these while others have less.  Dr. Koch can give you an idea of how much improvement you may see in this area.  Also, even though a facelift does not target the mid-facial area, many patients see improved cheek definition because their lower face and jawline are tighter, narrower, and more symmetric. 

A patient’s preexisting anatomy has a significant role in the initial results and longevity of the procedure.  The goal is a natural, more youthful appearance, and any attempts to overcompensate for the patient’s existing bone and skin deficiencies may interfere with a natural looking result.  For example, patients with thick skin, significant facial fat, and heavy, round faces may not experience a well-defined and long-lasting result along the jawline.  They usually do see significant improvement from where they are starting from, but those with a “heavy face” need to balance their expectations with their preexisting anatomy.  In addition, if the neck also has a significant amount of loose skin and fat such as with a “Turkey Neck”, then a submentoplasty may be added to the facelift to obtain an optimal result.

Dr. Koch will discuss the best options for you considering your individual condition and desires.  To find out if you’re a candidate for a facelift or another face-enhancing procedure, call Koch Facial Plastic Surgery to schedule a consultation or book one online today.