Facelift (& Necklift) Procedure in Norwalk, Connecticut

Dr. Laurence Kirwan. is one of the most experienced Board Certified Plastic Surgeons in Norwalk, Connecticut, and in the entire country. He is a recognized international leader in Aesthetic Plastic Surgery. He offers a superior level of knowledge, care and understanding to help you achieve the youthful, bright and contoured look you desire.

Conveniently Located: Every patient is a VIP. For your facelift and necklift appointment, you will see Dr. Kirwan himself at every single appointment. Our Norwalk, CT location is conveniently located in between Manhattan, New York and New Haven, Connecticut. Patients regularly visit from across Connecticut (Stamford, Greenwich, Stratford, Fairfield, Westport, Bridgeport, Darien, New Canaan, Trumbull), New York ( Manhattan, NYC, Larchmont, Mamaroneck, New Rochelle, Port Chester, White Plains, Harrison), New Jersey and other neighboring cities/towns for their facelift and necklift surgery and other plastic surgery procedures. Our office is close to all of the New York Airports for patients who are coming from out-of-state or other countries.

What is a Facelift?

The gold-standard for facial rejuvenation. A facelift is a surgery that results in a rejuvenation of the lower face from the temples to the lower neck. It includes a neck lift (submental platysma-plasty) if required (see below) It does not routinely include a browlift, eyelift or any of the other adjunctive and additional procedures mentioned below, although all of these can and often are performed at the same time as a facelift. The terms ‘mini-facelift’, ‘lunchtime facelift’ or similar terms are often used by dermatologists and non-plastic-surgeons. They imply a lesser procedure with a quicker recovery and shorter scars. The first is certainly true and the results are usually ‘minimal’ and of ‘minimal’ duration. Dr. Kirwan does not perform a ‘mini-facelift’ except as a secondary procedure to correct skin relaxation after a standard face-lift which can occur in someone with extreme facial skin laxity and early relaxation. This may occur in someone who is having their first facelift in their late sixties or older. A facelift can correct midface sagging, marionette lines, jowls and a double chin.

What’s the best age to get a facelift?

There is no set age. As we live longer, patients are having facelifts, often for the first time in their 70′ and 80’s. The average patient has their first facelift between the age of 45 and 65 years of age. These are guidelines and the indications for a face-lift vary, depending on age and facial anatomy. A face-lift will create a more oval shaped face with wider and fuller cheek bones creating the inverted triangle of youth. Some patients age prematurely and vice versa. Aging can be more pronounced in the face or the neck. Reasons for premature aging include a multiple of causes. The most common ones are sun exposure, changes in weight, smoking and lifestyle choices. Other causes of premature aging are inherited conditions such as Ehlers Danlos syndrome, cutis-laxa, lighter skin tones (such as freckly Celtic skin) and just simply bad genes. Individuals with a good bone structure such as a strong chin and jawline and prominent cheek bones as well as those with a higher BMI (heavier) tend to age better. Face-lifts address skin excess and muscle laxity rather than volume loss. However, a facelift will improve the cheek contour by lifting and restoring fat that has sagged. Restoration of volume loss with fat can correct the effects of facial fat depletion. We lose about one teaspoon of facial fat (5 syringes of filler) every decade after the age of 40. Fat injection is often combined with a face-lift. Other procedures that will also help to rejuvenate the aging face are:

Facelift technique

Surgery is performed under local anesthesia with conscious sedation (LACS) in Dr. Kirwan’s accredited surgical suite in Norwalk, Connecticut. There are many advantages of LACS versus a general anesthetic.

Stable blood pressure without dangerous fluctuations caused by inducing and reversing a general anesthetic.
Significant reduction in risk of a facelift hematoma.
Significant reduction in nausea and vomiting after surgery.
Less pain because of local anesthesia.
A quick recovery after surgery allowing for discharge after 30-45 minutes instead of the 2-3 hours after general anesthesia.
Elimination of pressure areas from prolonged immobility under general anesthesia.
Elimination of risks of blood clots (deep vein thrombosis or veno-thromboembolism VTE).
No sore throat or cough from the endotracheal tube.
No dangerous spikes in blood pressure caused by shivering as a result of hypothermia induced by general anesthesia.

Special Surgical Features of a Kirwan Facelift

‘Pre-tunneling’ with a small liposuction cannula to reduce tissue trauma and limit skin elevation to maintain skin blood supply and improve healing.
Hidden scars with recreation of a natural ear with a pre-tragal depression.
A natural earlobe contour without a ‘pixie’ earlobe deformity.
Invisible scars in your scalp, not below the hairline behind the ear or in front of the sideburn.
Liposuction of the neck, only when necessary.
VISTASEALÔ Fibrin Sealant – tissue glue, to reduce bleeding and allow for a smooth directional skin ‘re-draping’ during surgery without tell-tale ‘guy-rope’ tension lines.
Repair of platysmal bands under the chin and recreation of a youthful neck contour.
Permanent deep sutures for a durable result.

There are no shortcuts when it comes to achieving a durable natural result but there are ways to make the journey as pain free and pleasant as possible. So-called minifacelifts have a diminishing return with similar scars and cost to a regular facelift but limited results. Patients needing minimal improvements are more suited to GAP procedures such as FaceTite™ and Morpheus 8 instead of excisional surgery.

All facelifts including neck-lifts and midface lifts, require removal of excess skin and tightening of the underlying deep muscles which are attached to the SMAS layer. Every patient is unique. Skin excess is greater in older patients, first time facelifts and after significant weight loss, sun damage and smoking. Patients who have previously had a facelift, require less skin removal, usually just a skin ‘redraping’ with minimal skin removal. Older patients will often need a repair of the plastyma muscles under the chin (submental platysmaplasty). Upper lip lifts and chemical peels are also common in this older age group. All deep muscle repairs are done with permanent sutures for long lasting results.

You can judge how much extra skin you have by pinching the skin in front your ear and in your neck under the chin in the midline. As part of a facelift procedure fat may be suctioned from the jowls and under the chin. The deep plane muscles attached to the Superficial Musculo-Aponeurotic System (SMAS) in the face and the Platysma in the neck, are tightened and lifted. Cheek fat is elevated recreating the cheek highlights. The incisions are hidden inside (retro-tragal) and behind the ear so that you can wear your hair back. In men the incision is placed in the crease in front of the tragus (the cartilage that pokes out in front of the ear canal) of the ear to avoid bringing beard skin into the ear. The sideburn is left in its youthful position. Scars are not placed in visible areas such as the nape of the neck below the hair behind the ear and in front of the sideburn. If the muscles under the chin produce bands, then these should also be corrected as part of the face-lift. These bands are formed as a result of the splitting and descent of the inner edge of the flat platysma muscle in the neck.

Platysma bands under the chin corrected with a submental platysmaplasty.

Platysmal bands may be visible, even in a youthful neck, when you are animated, but they should not be visible at rest. Muscle bands and fat below the chin affect the angle between the horizontal chin/jawline and the neck (cervico-mental angle (CMA)). A CMA between 90 and 100 degrees is the hallmark of the youthful neck. The CMA is formed by the angle between the horizontal plane of the jaw and chin and the vertical plane of the neck. CMA greater than 100 degrees or loss of the angle with a straight, concave or convex curve, can occur at any age but is one of the signs of aging in the neck.

To recreate a youthful CMA often requires a combination of procedures. The most common one, performed as part of a facelift, is the submental platysmaplasty. This is performed through an incision under the chin (submental incision) and the platysma muscles on each side of the neck are advanced and sewn together. Fat under the chin maybe removed. An obtuse CMA, greater than 100 degrees may also be associated with a weak or a ‘retruded’ chin. The most prominent point of the chin in a female on the side view is ideally at the same level or behind the sublabial crease, the indentation below the lower lip. A chin implant, placed through a submental incision, will pull the muscles under the jaw forward and improve the CMA

59-year-old one year after endoscopic brow-lift, upper and lower blepharoplasty, facelift, submental platysma-plasty and chin augmentation with implant. Retro-tragal incision inside the ear.

As part of the removal of extra skin in the face, it is important not to raise the hairline in the sideburn area and behind the ear and also to avoid any distortion of the earlobe. Skin is evenly redraped using VISTASEAL™ Fibrin Sealant – tissue glue, to reduce bleeding and allow for smooth directional skin ‘re-draping’ during surgery without tell-tale ‘guy-rope’ tension lines. All incisions around the ear are closed with buried dissolving stitches to avoid the need to remove stitches and stitch marks known as ‘rail-road’ tracks. After a successful facelift surgery, you should be able to style your hair according to your preference and be able to tie your backwards without being self-conscious that any scars will be visible.

Philosophy

Everyone ages in their own unique way. Sometimes the neck is the tell-tale sign with crepy skin, ‘necklace lines’ and ‘bands’ that stretch from the chin to base of the neck. Other times the cheeks lose volume and sag creating deep lines around the nose and mouth whilst the neck remains reasonably tight. The jawline may become square-shaped with ‘jowls’ on either side of the chin. The face becomes a triangle shape with the base at the jawline instead of the ‘inverted triangle of youth’ or the classic oval shape of a Modigliani or a Brancusi sculpture.

Aesthetic cosmetic surgery is often about maintenance, staying fresh and young looking with regular procedures. However, a face-lift is more about turning the clock back. Generally, sudden age changes, illness or weight loss can make us aware that we no longer look our best. Expressions such as “I am beginning to look like my mother” are common. You may feel you always look angry or tired or that your partner and you have a visual age disparity when other people see you together at social events. Or you may have the ‘Mommy-at-the-school-gates Syndrome’ when you are an older mother and have to wait there with all the other mothers who are 10-15 years younger. Alternatively, you may have lost a loved one or divorced and be wanting to start a new life. Special events such as a child’s wedding, a graduation and changing jobs in mid-life, can also precipitate a decision to have a facelift. Sometimes grandchildren will play with the waddle in your neck! These days, Selfies, Videoconferencing and Facetiming make us even more self-aware. Even after the Pandemic, it is likely that these forms of communication will continue to be more the norm than the exception.

Waiting for face-lifting surgery until you are 65 and then going in for the “works”, expecting to come out looking natural, is unrealistic. More natural results are achievable at a younger age such as between 45-55. But if you already had a facelift at 45 or 50, then you should look natural after a second facelift at 65 or older. Those who ignore this advice and have their first facelift in their sixties may need a secondary facelift within a few years of the first surgery because of the poor elasticity of their skin. It is difficult to accept that you have finally reached an age when non-invasive skin-tightening and a syringe of Botox or filler will no longer suffice. In fact, one way to decide if you are ready for a facelift is when non-invasive procedures fail to give you a result that you are happy with. Another decision piont is when the accumulated cost of your regular injectable and other treatments exceeds the cost of a facelift.

A facelift, fat injections and the other procedures mentioned above can reduce the need for these non-invasive treatments which have to be repeated every three to six months.

Surgical time and recovery

Surgery takes four to six hours depending on the number of procedures performed at the same time. A facelift by itself usually takes three to four hours to perform. Tissue glue (Vistaseal VISTASEAL™ Fibrin Sealant (Human) is used to prevent bleeding.

Drains are not routinely used unless a submental platysma-plasty is performed. Small soft drains are used that are removed after forty-eight hours. Dr. Kirwan sees all of his facelift patients the day after surgery, without exception.

Stitches are dissolvable and do not need to be removed. Staples are used in the scalp. These are removed between seven and ten days. The patient can go back to work at 10-14 days. Light exercise is permitted at two weeks (walking). Return to the gym at four weeks (light exercise: heart rate up to 100 pulses per minute). Full exercise is allowed at six weeks (heart rate up to 140). Inverted positions including ‘downward-dogs’ are prohibited for 8 weeks. It is important not to lift heavy bags or do household work such as making beds. For the first three weeks after surgery avoid putting your head down below your heart (squat instead). Showers should be tepid. For the first two weeks, wash your hair with baby shampoo and use your fingers only to wash and rinse. No combs or brushes! Be extra gentle around the ears. Avoid wearing clothes such as T-shirts and a hoodie that you have to put over your head. This can pull the stitches apart around your ear lobes, where you may not have normal feeling in the skin. The skin in your cheeks and neck will feel numb. This is normal and will improve over several months. Wear shirts or button-down blouses and front zippered or buttoned jackets. Hoods, (on jackets) scarfs and sunglasses are good camouflage. That’s what the celebs do! Don’t drive for at least one week. Make sure that you can turn your head safely to see when you drive. Turn your head together with your shoulders, rather like C-3PO of Star Wars fame. Make sure you can wear a seat belt comfortably! It may chafe on your neck.

Related cosmetic procedures

The most frequent related procedures are blepharoplasty (eyelift) and an endoscopic browlift. Other procedures are a chin implant and upper lip shortening as well as injections with filler or fat. A nasal tip-plasty can reduce a bulbous tip and elevate the tip of the nose creating a more youthful appearance.

Adjuncts to Facial Rejuvenation

Facial aging results in loss of cheek and chin projection due to descent of the fat pads as well as loss of volume in the fat compartments of the face. Loss of facial fat is more pronounced after significant weight loss, illness and in habitual joggers (exercise anorexics).

A retruded chin can one part of the cause of an obtuse CMA angle, contributing to a loss of neck definition. Using a chin implant in these cases can help to redefine the CMA.

Chin implants are also corrective when the chin fat loses volume and/or slides downwards over the edge of the jaw line resulting in a flat contour to the front of the chin and a crease underneath known as the ‘witch’s chin deformity’. Fat injection is an alternative to a chin implant. Fat injections can also be used in other parts of the face such as the lips, cheeks and temporal areas.

Another sign of aging is enlargement of the cartilages in the tip of the nose and often a dropping of the nasal tip, creating a hooked appearance. As the tip descends, the bridge of the nose appears more prominent. Small refinements of can make a big difference. The tip cartilages can be reduced, and the tip can be elevated. At the same time, the bridge of the nose can be shaved without needing to break the nasal bones. The effect is subtle but overall a definite boost to the facial appearance.

The pointy nose, long upper lip and sagging chin of the mature face. This was corrected with a subtle rhinoplasty, elevation of the tip of the nose and a chin implant, combined with a facelift.

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What questions should I ask my plastic surgeon about facelift surgery?

Use this checklist during your facelift consultation:

Are you certified by the American Board of Plastic Surgery?
Were you specifically trained in the field of plastic surgery?
How many years of plastic surgery training have you had?
Do you have hospital privileges to perform this procedure? If so, at which hospitals?
Is the office-based surgical facility accredited by a nationally-or state-recognized accrediting agency?
Am I a good candidate for this procedure?
What will be expected of me to get the best results?
Where and how will you perform my procedure
What surgical technique is recommended for me
How long of a recovery period can I expect, and what kind of help will I need during my recovery?
What are the risks and complications associated with a facelift?
How are complications handled?
How can I expect my face to look over time?
What are my options if I am dissatisfied with the cosmetic outcome of my facelift?
Do you have before-and-after photos I can look at for this procedure and what results are reasonable for me?

Facelift & Necklift