Provider: Ronald J. Caniglia M.D.,F.A.C.S.
 As the face begins to age, the skin loses its elasticity and strength and begins to sag. Gravity begins to take its toll on the underlying structures of the face, including the muscle and fat, resulting in further sagging and pronounced aging changes. Drooping of the jowls and the skin under the chin becomes apparent, as well as muscle banding in the neck. These aging changes can be corrected or improved with a surgical procedure known as the facelift, or rhytidectomy. Facelift surgery is designed to re-suspend sagging muscles, reposition and recontour the underlying fatty tissues, and remove excess skin of both the cheeks and neck in order to rejuvenate the facial appearance.
Facelift procedures may be performed on men and women of various ages, though most patients are in their mid to late forties to early fifties. However, provided one is in good health, this procedure can safely be performed into the late eighties. The best candidates for facelift surgery are individuals with good skin tone, strong bony structures, a strong chin and prominent cheek bones, fullness in the midface, shallow cheek grooves and a deep cervicomental angle. For those who are lacking good skin tone or strong bony features, additional procedures can be added to the facelift procedure to address these aging changes.
Dr. Caniglia performs the facelift surgery at the Plastic Surgery Center at Kierland, located within the Caniglia Center in Scottsdale, Arizona. This freestanding outpatient surgery center is accredited by the Accreditation Association for Ambulatory Healthcare (AAAHC) and is licensed by both Medicare and the Arizona State Department of Health.
Most facelift procedures are performed on an outpatient basis and may take anywhere from two to four hours to complete depending on the severity of aging changes. Additional time is necessary if the facelift is combined with eyelid surgery, a forehead lift, laser resurfacing or other enhancing procedures. Because facial surgery is much different than body surgery, Dr. Caniglia prefers that all of his facelifts be performed under local anesthesia with intravenous sedation, also known as deep twilight sleep. This allows the patient to feel no discomfort nor remember anything from surgery, yet the patient is always breathing on his own and there are no tubes in the mouth. A board certified anesthesiologist is present at all times during and after surgery in order to monitor the patient's vitals. This type of anesthesia also allows the patient to feel more alert and refreshed after surgery and able to go home after recovering for one hour in the postoperative recovery room.
Proper incision placement is crucial to a good surgical outcome. Dr. Caniglia always tells his patients that if the incisions are placed in the proper position and with proper closure, their hairdresser should have a difficult time knowing that they had a facelift. The correct incision placement will preserve the natural shape of the patient's hairline and allow the scars to be all but invisible. The incision begins hidden in the hairline above the ear. It then follows the natural curvature of the ear, preferably falling inside of the ear behind the tragus in order to avoid a scar in front of the ear. The incision then continues behind the ear within the natural crease, high up, and then straight over into the hairline. At no time should there be noticeable scars below or along the hairline.
In addition to the incision described above, there is a small incision hidden within the natural crease under the chin. This incision is made first and allows for liposuction of the neck to be performed if necessary. If there is looseness or banding in the neck muscle, the bands can be divided and the muscle can be tightened in the midline working through this incision. Looseness of the skin under the chin, in the midline of the neck, will later be removed through the incision hidden in the hairline behind the ear.
After the undermining of the neck skin is complete, undermining of the temporal and cheek skin is performed through the incisions hidden in the hairline above and inside of the ear. Dr. Caniglia will first elevate the skin of the cheek and neck before elevating and tightening the fibrous layer known as the SMAS. It is this internal fibrous layer, which is adherent to the muscles, that is the key to a successful outcome. By tightening this SMAS layer, the muscles and skin are tightened with it, repositioning the jowls and neck skin for a more youthful look. The inside SMAS layer should be tightened as much as it will allow which, in turn, will tell the surgeon how much excess skin can safely be excised. It is important for the excess skin to be excised so as to leave no tension on the skin closure. It is also extremely important to not alter the natural hairline when excising the excess skin.
Prior to closing all of the incisions, many of them with dissolvable sutures, a revolutionary product called Tisseel is used. This is a natural tissue glue that is sprayed under the cheek and neck skin prior to closure of all the incisions. This natural tissue glue reduces the risk of bleeding and dramatically reduces swelling and bruising, thereby allowing the patient to return to normal activities much sooner. It also does away with the need for drains and pressure wraps which the patient used to be required to wear for a week after surgery. Once all of the incisions are closed, a light gauze dressing is applied. The patients are then dismissed to the recovery room, whereby they are discharged and allowed to return home after approximately one hour. Because of the twilight anesthesia and the length of the surgery, all of Dr. Caniglia's patients are allowed to return home until the next morning for their follow-up visit.
The recovery time for facelift surgery has been dramatically decreased due to the use of Tisseel, or natural tissue glue. Most sutures dissolve on their own. The few surgical clips used in the hairline are removed at the one-week postoperative appointment. Some patients are out and about as early as one week and most within ten days. Makeup artists are available in our medispa for the convenience of our patients. Nearly all patients are back to work and most normal activities within two weeks and some as early as seven to ten days after surgery. Dr. Caniglia advises patients to wait two weeks before resuming their normal exercise or workout routine.
As with any procedure, there are risks. However, if a facelift is performed in the hands of a very skilled facelift surgeon, these risks are greatly minimized. Some complications such as hematoma or blood under the skin, infection, and skin loss or nerve paralysis are extremely rare. Dr. Caniglia has been performing facelift procedures for over 16 years and he has the necessary training and experience to provide you with a beautiful facelift result. |
