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Orlando Facelift and Neck Lift Surgery

The gold standard procedure for rejuvenation of the aging face is the facelift/necklift. Dr. Yeilding is personally passionate about facelifts because of the unique and significant improvement these patients receive compared with any other cosmetic intervention.

The modern, comprehensive facelift from Dr. Yeilding is essentially also a necklift and addresses the most difficult-to-treat elements of facial aging: a saggy neck and drooping jowls. Dr. Yeilding’s facelift provides high efficacy and unsurpassed long-lasting results far exceeding any minimally invasive alternative treatment.

As a double board-certified surgeon with extensive cosmetic surgical experience, Dr. Yeilding has the aesthetic sense and technical skills and attention to detail needed for this complex surgery. As a female physician focused on aesthetics, her patients appreciate her mindful dedication, her listening skills and her ability to say no to certain procedures patients may seek that are unnecessary or unwise.  Dr. Yeilding does not believe in shortcut quick lift, lifestyle, or thread lift procedures, preferring to invest energy on the modern comprehensive SMASectomy facelift, with neck and jowl liposuction as needed and central and lateral platysmaplasty that produces the most dramatic results that are both long lasting and natural.

Below is Dr. Yeilding’s Aunt Before and 2.5 Years after her facelift plus other procedures:

orlando facelift patient before and after photo of 68 year old female

 

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What is a Facelift / Necklift?

Historical distinctions between a facelift and a necklift vary tremendously, but the most important element is the recognition that facial aging most often impacts both face and neck.  A modern surgical technique must address both of these.   Therefore, a necklift is a built-in important element of all Dr. Yeilding’s comprehensive facelifts and she uses the term facelift with the understanding that the neck is included.   In general, a facelift is about fixing the tissues under the skin first.  Once the underneath is repositioned, the skin is naturally draped in a manner aesthetically pleasing with the excess skin being trimmed “just right”.   Never is skin simply pulled to create improvement; rather, the comprehensive SMASectomy facelift with neck and jowl liposuction and central and lateral platysmaplasty, addresses facial shape under the skin, preparing the skin for a long lasting, natural result.  After your facelift, increased skin health via medical grade, customized skincare, along with sun protection can be significantly helpful to look better longer in life.     Short story:  A facelift is about creating a more youthful facial shape while skincare is about achieving a smooth skin tone and healthy glow.

Facial aging and how a facelift impact a patient’s well-being

Aging, gravity and lifestyle cause several negative anatomic changes to happen in the face, such as sagging skin, midface volume loss, and fat and skin accumulation in the jowls.    As a youth we typically had a smooth neck and well-defined jawline, higher “cheek bones” and tight smoother skin.   Youthful high “cheek bones” and the absence of jowling in the jaw line, the youthful facial shape is somewhat like inverted triangle: wider on top and narrow below.

Facial Aging Illustration with Tringle of Youth Courtesy Allergan Inc.

With age comes the appearance of facial shape drooping from the eyes to the cheeks to those suddenly appearing fatty jowls.  The aging process causes the triangular shape of youth to flip and become wider and squarer shaped on the bottom.   The aging face can cause one to feel like they look tired and older than they feel inside.  Despite aging, patients frequently feel youthful inside and approach life with positive energy and exuberance, as a healthy thirty-year-old may do.  As time passes people look in the mirror and too often do not see the person they remember, or the person they feel like inside.   What happened?  How did I get jowls?   Where is all this lose excess neck skin come from?  With aging comes increased skin laxity and volume loss in some areas (cheeks) while fat accumulates in others (neck and jowls).

A facelift is the Gold Standard, most effective way, to deal with the complex effects of age by a fundamental reconfiguration of the sagging face to go backwards in time toward the classic youthful facial beauty shape of the triangle of youth.    The youthful triangle shape is achieved when the excess fat in the neck and jowls are reduced and the skin is reasonably tightened over the lifted tissues underneath the skin.  The technical details require the surgeon to pay strict attention to the directions of lift (technically, the lift vectors) required for each face individually.   When a comprehensive facelift is done correctly well-being is enhanced by a restoring a more youthful look, and importantly, restoring a patient’s confidence.   Re-aligning outer appearance with one’s inner spirit can be transformative.    The goal is for a patient to feel a sense of balance restored, confidence enhanced and an increase in general well-being when their inner person finally reappears in the mirror.

 

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Being a good facelift candidate

Given that a person “has the need” for it, the most important elements in a good candidate are realistic expectations, patient readiness for surgery, time available and dedicated to recovery, and the commitment to follow the detailed post-operative instructions and restrictions.  Patient health sufficient to obtain medical clearance is also required.

Three levels of facelift need are shown below, from left to right increasing jowling and neck laxity:

Being ready, includes being willing to undergo the risk of surgery. In general, facelifts surgical techniques have advanced over many decades with modern comprehensive facelift having fairly low risk of serious complications in the hands of an experienced, modern trained and skilled surgeon. Hearing Dr. Yeilding address your questions and concerns about risks and realistic results during your consultation can be helpful to become more comfortable with being ready. Dr. Yeilding encourages patients and their caregivers to actively participate in the consultation and establish trust during this process.

Having the need medically means the anatomical changes in the face are well matched to the areas reasonably treatable with a comprehensive facelift. When the need is aligned with surgical realities and limitations, as Dr. Yeilding will evaluate and discuss with you in your consultation, patients can expect a significant benefit. Perfection is not a realistic goal. Dr. Yeilding takes a conservative position with facelifts because she does not want the patient to have a windswept look or a pulled distorted mouth, or make them look like a different person. It is important to inform patients what they can realistically achieve from a conservative (aka not overly aggressive) procedure.   Prior to agreeing to proceed with surgery, we evaluate whether the patient’s expectations are well matched to the achievable results. When surgeon and patient are well aligned on this, a good candidate for a facelift emerges ready to make this important commitment to a surgeon they trust.

 

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Facelift Risks and Complications

The biggest thing on the mind of a good facelift surgeon is being careful not to damage the motor nerves in the face.  Nerve damage is a serious matter which must be watched very carefully during ANY facelift surgical technique, such that the surgery must be always be done in a highly attentive, very slow and careful manner.

Dr. Yeilding prefers general anesthesia for most of her facelift patients.  General anesthesia induced sedation eliminates patient movement that can occur under local anesthesia awake procedures and decreases risk of movement related nerve or other tissue damage.  Nerve damage post facelift is a very low occurrence risk in the hands of Dr. Yeilding.  Also, compared to local anesthesia, general anesthesia uses less lidocaine and epinephrine which can cause serious life-threatening consequences.  Dr. Yeilding uses an MD Anesthesiologist to carefully monitor you during the entire procedure.

The most common risk is bleeding underneath the skin in the first few days after surgery, which where the blood or blood products collect, and is called a hematoma.   If a smaller hematoma happens, which is fairly common, it can just be drained.   If a larger hematoma occurs, it must be evacuated right away to avoid stretching the skin too tightly for too long on the skin flaps which can cause tissue decay.  Timely attention to complications typically means patients heal with no long-term harm.    Patients are cautioned that if they are not compliant with doctors’ instructions, and engage in overly physical activity during their first two weeks after surgery, they face increased risk of hematoma, prolonged swelling or broken sutures under the skin.

Dr. Yeilding facelift approach

Dr. Yeilding performs a SMASectomy facelift with neck and jowl liposuction and with central and lateral platysmaplasty.  

The Superficial muscular aponeurotic system (SMAS) is a large tissue section of the face underneath the skin which contains fibrous fatty tissue that connects and envelops the muscles of facial expression that change with age (drooping) impacting cosmetic appearance.  When the SMAS is isolated and lifted via strong sutures, along vector directions appropriate for each specific face, a substantial cosmetic benefit is achieved.

The SMAS is shown in the figure below with a general illustration of the lifting vectors:

Figure Courtesy Dr. Niamtu LoveThatFace.com

Importantly, a SMASectomy facelift addresses the fundamental structure and shape of the face and is not just about pulling the skin tight.   A properly done SMASectomy gives the facelift the ability to sustain its lift over time, providing longevity to results by addressing and enhancing the structural integrity of the face.

One facelift technique that Dr. Yeilding chooses not to perform is a so-called Deep Plane Facelift.  The reason for this is the Deep Plane Facelift has a higher risk of damaging facial nerves that could affect your ability to move your face normally or cause facial asymmetry, which can become permanent.   Dr. Yeilding believes a well planned and executed modern SMASectomy facelift will achieve the same rejuvenation results with dramatically lower risk of damaging motor nerves.  The important most part of a facelift is to spend the time necessary and not cut corners.

Starting with deeper tissue SMAS work but equally critical for success is to then tighten the platysma muscle both centrally and laterally.

The platysma muscle is shown below:

Figure Courtesy Dr. Niamtu LoveThatFace.com

The platysma muscle is a very thin muscle in the neck which, like droopy skin, gets increased laxity with age that causes banding in the neck to show.  By tightening the platysma, Dr. Yeilding addresses the banding and gains more ability to tighten the neck skin over the tightened platysma muscle to yield a natural tighter neck.

What is the cost of a Facelift / Necklift?

Real Self reviews from over 5000 patients nationwide put the average Facelift price at $12,100 with the high price at just over $20,000.   After your consultation with Dr. Yeilding, you will meet with Barbara, our Surgical Patient Concierge, to discuss the medical options Dr. Yeilding has recommended for you and the associated pricing and scheduling.  Additional cost elements depend on patient need.  Typically our happiest facelift patients also receive upper and lower blepharoplasty addressing droopy upper lids and lower lid bagging that can cause patients to look over tired.   Patients frequently also need full face CO2 laser resurfacing to address skin related wrinkles and pigmentation issues.    For busy patients seeking just the right time for surgery and recovery, and therefore looking to book a long time in advance, YMD will give payment terms associated with the longer timeline.

 

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Frequently Asked Questions (FAQs)

1. What boards certification do you have?

Two Board Certifications: American Board of Facial Cosmetic Surgery and the American Board of Ophthalmology.

2. Did you receive specialty training in a specific plastic surgery field?

My specialty training was a Fellowship in Oculo-Facial Plastic Surgery with John Fezza MD in Sarasota, FL from Nov 2011 to July 2013 which included an unusually high number of cosmetic surgeries: 82 Facelifts, 496 Blepharoplasties, 210 Facial Reconstructions post MOHS and 157 CO2 Laser Resurfacings.

3. What hospital privileges do you have?

Florida Hospital Orlando

4. How much of your practice is devoted to facelifts or facial plastic surgery?

100% of my practice is Facial Plastic Surgery and approximately 30% to 50% of my scheduled Surgery Days are devoted to Facelifts, depending on the time of year.

5.  If I am a plus size person, is it important for me to lose weight prior to a facelift?

For most people with moderate excess weight, without a current weight loss goal, there is not much penalty to go ahead and have your facelift.   Your face and neck will appear smaller and more youthful afterwards.   For those who are more substantially overweight, it is helpful to lose some weight for your health during the several hour surgery and which will also help improve your results by reducing your neck and face size prior to surgery.    Patients with a near term defined goal to lose more than 15 pounds, are advised to do that before a facelift.

6. How do most of your patients hear about you?

Most patients are referred by physicians and patients; however, patients also find Dr. Yeilding via the internet.

7. What factors make a good candidate for a facelift?

Good facelift candidates start by having reasonably good health to endure a several hour procedure under general anesthesia.  Given health, a good candidate has realistic expectations about results and a commitment to being compliant to Dr. Yeilding’s advice after surgery.   Realistic expectations include considering your skin aging condition as well.  Surface skin wrinkles from sun damage cannot be addressed in a facelift only.  See FAQ 8 Below.  Engaging Dr. Yeilding in discussion about each of your areas of concern, including potential complications, and understanding her explanation of the realistic surgical results and limitations of your facelift is critical to having realistic expectations.  A commitment to avoiding physical activity post-surgery, which can cause a wide variety of problems in healing, helps to make a good facelift candidate.   Involving family members/caregivers in the process, from the beginning is also very helpful to patients.

8. What is the unique relationship between a facelift and full face CO2 laser resurfacing?

Years of sun exposure (sun damage) and aging together create surface wrinkles on the skin.   For patients with significant deep wrinkles, stretching the skin in a facelift to smooth out surface skin wrinkles may cause the type of windblown facial distortion patients want to avoid and Dr. Yeilding will not attempt this.   There is a direct remedy for skin surface wrinkles using CO2 laser resurfacing for certain candidates.   Laser treatment can dramatically reduce fine, moderate and deep skin surface wrinkles without the stretching that causes facial distortion.  Laser resurfacing will also reduce hyperpigmentation at the same time.   Therefore, there is a strong synergy for patients to consider both procedures.

9. Are any non-surgical procedures offered that could meet my needs, even partially?

Dr. Yeilding’s 30 Minute Lift, using Botox and 2 modern HA facial fillers does address forehead or glabellar dynamic wrinkles, nasolabial fold reduction and cheek volume enhancement.  Unfortunately for aging patients with saggy neck and jowls, only a comprehensive facelift will address jowling, jawline definition and significantly tighten loose skin in the neck.   The good news is that a facelift is a much longer lasting procedure compared with injectables.

10. How long does a facelift last?

Most surgeons would agree that an average or good facelift outcome is where a visually significant improvement in the jowls with neck tightening occur and will last approximately 10-15 years.  Dr. Yeilding tells patients their facelift will likely turn the clock back about 10-15 years but of course the aging process will continue.  Variations in longevity of result are according to patient age and health, lifestyle, diet, weight fluctuations and genetics.

11. Do you have before and after photos of facelifts you have done?

We have many before after pictures to share with you.  One source of pictures is from our patients that have given us Full Release to use pictures, and they can be found on our website, or be contained in our Facelift Guide and can be downloaded of emailed to you.  There are also additional pictures that patients have given us the right to show you in the clinic at YMD (but not for full internet release), and these will be shared with you during your complimentary cosmetic consultation.

12. May I talk to a prior facelift patient about their experience?

We can arrange communication with a prior patient or two.  From a privacy standpoint, most patients are often reluctant to grant such a request but we do have patients who have been super gracious, and we very much appreciate them providing time to talk to facelift candidates.

13. Do your surgical facilities have national accreditation?

Yes, the Millenia Surgery Center (MSC), which is an outpatient ambulatory surgery center (ASC) has two levels of national accreditation.  They are an approved ASC nationally for the U.S. Government Medicare Program, and they also possess independent ASC certification by the Accreditation Association for Ambulatory Health Care, or AAAHC.

14. Do you used board certified MD anesthesiologists?

Yes the Millenia Surgery Center provides Dr. Yeilding with a board certified MD anesthesiologist, who is in the operating room directing your anesthesia.    Additionally, the anesthesiologist will review your medical records and medical clearance information prior to surgery and will independently interview you just prior to surgery.

15. IF an emergency happens during surgery, is there a plan and procedures already in place?

Dr. Yeilding has privileges at Florida Hospital and any patient having an emergency situation will be transported by ambulance to Florida Hospital South 601 E. Rollins St Orlando FL 32803.   Additionally, the Millenia Surgery Center has dedicated emergency equipment (crash carts etc) and procedures in place for patient safety that comply with safety standards from the AAAHC.

16. Will I see the Doctor on all visits?

You will see Dr. Yeilding during your initial surgery consultation.  You will also see her before and after your surgery where she will speak with you and any family members or caregiver present that you wish.   She will see you directly for most post-operative visits, as Dr. Yeilding wants to stay very close to personally evaluate how your healing is progressing especially during the first 2 weeks.   There are times when you may not see Dr. Yeilding directly, such as your Pre-Op visit, 2-3 weeks prior to your surgery, where you will receive detailed instructions to prepare you for your surgery and your recovery.  Additionally, if you should have an issue or concern after your surgery on a day/time when Dr. Yeilding is operating, we may ask that you come to YMD to be seen by a staff member, who may take pictures, or perform a test, to be able to describe your issues to Dr. Yeilding, rather than rely on telephone discussion.   Sometimes telephone discussion is all that is needed.

17. How long is the facelift procedure?

A facelift by itself is approximately 3 hours of surgery (2 to 4 depending on patient need).  If Upper and Lower Blepharoplasty, Ptosis repair, and/or Full-Face Laser Resurfacing or Chemical Peel is also added, that will add about 1-2 hours.   Recovery is about 2 hours, but can be longer depending on many factors.

18. Are there lab tests and medical clearances required prior to surgery?

Facelift patients require certain lab tests and a current EKG in addition to their physician’s medical clearance indicating they are safe to receive the specific surgery and specific anesthesia for the planned surgery date.  Patient medical history may dictate the specifics.

19. What are the common complications that occur?

Bruising is common and lasts about 2 to 3 weeks.    Infections can occur but are very rare; however, all infections must be treated quickly to avoid more significant issues.  Bleeding and other fluid buildup can collect to form a hematoma or seroma and if not treated can reduce efficacy of neck tightening, or in rare cases are severe enough to potentially degrade the skin itself.   It is important to inform Dr. Yeilding immediately if you see/feel pockets of fluid and she will see you quickly to fix the problem fast which typically avoids long term negative consequences.

Numbness in the lower face is common and is actually helpful for reducing pain after surgery.  Normal feeling typically returns in several months.  More severe nerve damage impacting normal facial movement is possible, but rare and also typically resolves over a few months.

Facial asymmetry between left and right sides of face can occur; however, Dr. Yeilding surgeries typically improve facial symmetry compared to the pre-op situation. Thickened scars or hair loss around the incision site are reported nationally, however Dr. Yeilding uses advanced techniques that typically do not cause hair loss or result in highly visible scars.  Dr. Yeilding’s incisions are made in front of the ear and behind the ear hidden in the sideburn area hair and behind the ear. It is also hidden inside the ear and behind the lobe and the ear (below left image). After 2-3 months there is very little for anyone to see of the actual facelift incision.  Facelift incisions heal extremely well and rarely present a problem of scaring.  If a rare undesirable scar forms, Dr. Yeilding can improve it with laser resurfacing.   See Below regarding Dr. Yeilding facelift incisions:

20. How often do significant complications occur?

Common post-operative healing effects such as bruising and swelling happens almost every surgery.

Significant Complications occur in approximately 2% of patients according to a 2016 Study by Vanderbilt University.

In general, rapid communication from the patient to the doctor, and swift doctor action will turn most potentially significant issues into NON-Issues for patient safety and efficacy.

21. Will I be able to call you directly if I have a concern or question?

All facelift patients receive Dr. Yeilding’s personal cell phone number.  They also will receive the Doctor’s Husband’s (and Practice Manager) cell phone and you will also receive the cell phone of Ashley, our surgery center coordinator.

22. What is the level of pain or discomfort after surgery?

Facelift pain post-op is surprisingly low.   The nature of a facelift causes sensory nerves responsible for pain to be temporarily deadened and contributes to patient comfort.   Patients typically describe a tightness feeling (makes sense) and sometimes they get a dull headache immediately after the procedure.  Patients however usually do not need to take pain medication, but Dr. Yeilding will prescribe some just in case.

 

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* DISCLAIMER: With all Before and After images, stock photos, Patient Testimonials or Reviews shown on the site, no claims are made that results are typical. Results vary with each individual patient, and results are cannot be guaranteed. All Before and After images and Patient Testimonials are Dr. Yeilding patients; however, all photos, testimonials and stock photos are shown for informational purposes only. All Patient Testimonials are individual patient opinions and do not represent claims or guarantees of results by YMD Eye & Face.