As we age, it’s inevitable that we start to develop fine lines and wrinkles on our skin, as well as changes in skin laxity and elasticity. It’s often when these changes accumulate and really start to add up, that many of us decide to do something about it. Addressing aging in the face is one of the areas of medicine that has seen the most technological advancements over the years. Cosmetic surgery has advanced and improved in the sense that with any area of medicine, as more and more cases are done, the outcomes become better. Also, innovations in surgical techniques, materials and technologies all lead to increased safety and efficacy of procedures. For patients considering a facelift or eyelid surgery, the question often comes up whether or not to “combine” the two. After all, having one surgery is less painful and costly than two. But, is it better to combine a facelift and eyelid surgery? Let’s explore.
Facelift (Rhytidectomy)
A facelift, or rhytidectomy, is an operation which is traditionally designed to correct the signs of aging in the lower two thirds of the face as well as the neck. It is used to correct jowling along the jawline, deep nasolabial folds (lines running from the nose down to the corners of the mouth) and sagging skin and muscle laxity on the neck. The modern facelift, rather than just pulling the skin and soft tissue taut, focuses on repositioning the underlying structural tissue layer called the SMAS and reshaping and redistributing volume and fullness in the face, to restore the face’s natural, heart-shaped youthful contour. The result is a much smoother jawline and a lifted neck.
Eyelid Surgery (Blepharoplasty)
Eyelid surgery or blepharoplasty, on the other hand, is designed to correct the signs of aging around the eyes. The two eyelids have distinct signs of aging that develop as we age. On the upper eyelid, the aging signs are drooping, heavy skin that may even start to impair vision, as well as flattening or disappearance of the eyelid crease. On the lower eyelid, aging often results in puffy bags from protruding fat pads, as well as dark circles, loose skin, and troughs which can lead to a hollowed, sunken look. Blepharoplasty aims to remove or reposition excess fat, trim excess sagging skin and tighten the underlying muscle. The goal is to create a brighter, more open and youthful looking eye by eliminating the bags of skin, fat and muscle which cause a chronically tired, older look.
The Question of Combining a Facelift and Eyelid Surgery
It’s important to note that both of these procedures are great on their own and can really do a wonderful job at their specific focus area. However, the face is an interconnected unit. It’s rare that someone develops extreme signs of aging around the mid-face without there being some involvement around the eyes. Rarely is the only area of significant aging on the face just around the eyes either. A person may have a beautiful facelift, which lifts the cheeks, jawline and neck, but the upper eyelids are still heavy and droopy or the lower eyelids are still puffy and dark, leading to a tired look that doesn’t completely match the youthful, fresh look of the rest of the face. Or a patient who has blepharoplasty only may be left with eyes that look great, but still has jowls and neck laxity which make the eye area look a bit out of place, and doesn’t give the rejuvenation that they were hoping to achieve.
Facelift combined with Blepharoplasty
Performing a facelift and eyelid surgery at the same time is a great way to get to that next level of rejuvenation. This combination allows the surgeon to sculpt the face as a single unit rather than in isolation, and create a result that is beautifully balanced, with the refreshed and open looking eyes perfectly complimenting the lifted, contoured lower face and neck. A patient will look refreshed, youthful and completely rejuvenated as opposed to “worked on”. And this can also be achieved in a single operation, as opposed to having one procedure, then waiting months later for the second.
The Final Result
The resulting transformation from a facelift and eyelid surgery combination is not only noticeable to the patient, but also to the patient’s friends, family and co-workers. The surgery will dramatically decrease the signs of facial aging, and the patient will look, brighter, more refreshed and more youthful. Although there is no specific number of years “taken off”, many patients often report that people comment on how good their skin looks or how much better they look than when they last saw them. This allows patients to have a much more youthful appearance for many more years than if they did not have the procedure at all.
Facelift and Blepharoplasty Cost
Facelift and eyelid surgery prices can vary quite widely depending on geographic location, the experience and qualifications of the surgeon, and the exact extent and surgical techniques required to achieve the desired result. In the U.S., facelift surgery alone can range anywhere from $6,000 to $15,000, with a similar range for eyelid surgery as well. However, many surgeons that offer both facelift and eyelid surgery also offer a discount for a combined procedure. This is both because it is one surgery session with one anesthesia, and also because the technical difficulty of performing the eyelid surgery in combination with a facelift is greater. Having both the eyelids and face worked on at the same time means the eyelid work can be tailored to the face, and vice versa, to create the most beautiful result.
Facelift and Blepharoplasty Recovery
The recovery time for eyelid surgery and facelift surgery can be quite similar as the swelling and bruising from the facelift will often mask and or cover the bruising and swelling from the eyelid surgery. Immediately following surgery there will be a bandage on the head and face to minimize swelling and help support the new contours. Drainage tubes may be placed which will be removed after a day or two. The bruising and swelling along the eyelids and cheeks is to be expected, and while it is most severe in the first 48-72 hours, may last for a few weeks. The head should be kept elevated even while sleeping to minimize swelling. The eyes will have cold compresses applied to minimize bruising. Pain should be minimal, and is easily controlled with the prescribed medication. The majority of patients will begin to feel comfortable enough to leave the house in public after about two weeks, when the worst of the bruising is gone and swelling is down to the point that makeup can be applied. Strenuous activities and heavy lifting should be avoided for at least 4-6 weeks. The final, fine-tuned results will be seen as the residual swelling goes down over the course of the following months to reveal a smoother, tighter, more brilliant looking face.
Facelift and Blepharoplasty Side Effects and Risks
As with any surgery there are some risks involved with eyelid surgery and facelift surgery. In the case of these procedures, this may include bleeding, infection, scarring and risks from anesthesia. As the surgery is more extensive there may be more swelling and bruising initially after surgery. For the eyelid surgery there is risk for dry eyes, temporary or rarely permanent changes in eyelid sensation and/or an inability to close the eyes. For the facelift surgery there are risks for temporary or permanent nerve injury leading to weakness in the facial muscles, as well as possible alterations to the hairline or skin irregularities. The surgeon’s experience and skill level is the most important factor in minimizing the side effects and risks of these procedures.
Facelift and Blepharoplasty Candidates
The best candidates for a facelift and eyelid surgery combination are patients who are in good general health, are nonsmokers and have realistic expectations for the outcome of the procedure and the process of recovery. If you have thought about a facelift or eyelid surgery, then you have probably already given a lot of consideration to these points and would likely be a great candidate. It is important that a thorough consultation with a board certified plastic surgeon who is experienced in both of these surgeries is performed to ensure that the patient has the best potential outcome.
While both a facelift alone and eyelid surgery alone can yield great results when performed on patients with specific problem areas, when the signs of aging are more generalized to multiple areas of the face then performing both of these surgeries can really achieve a harmonious, beautiful and comprehensive rejuvenation result that isolated surgeries could not do on their own. If you are in good general health, do not smoke and have a good sense of what the surgery can and cannot do then this powerful combination of a facelift and eyelid surgery is an excellent option to consider. Remember to have a consultation with a board certified and experienced plastic surgeon to ensure that you are a good candidate and that they can help you achieve your goals.
