San Francisco and Marin Facelift Surgery
A facelift, also called a rhytidectomy, cannot stop the aging process. However, it can “turn back the clock” by improving the most visible signs of aging. The goal of the surgery is not to make you look like another person, but to enhance your natural features and rejuvenate your face. Dr. Delgado specializes in achieving a natural and well-balanced appearance, as seen in the before and after photographs of his patients.
*Results may vary.
When a person trusts us with their facial surgery, we consider in a compliment. Dr. Delgado, and all of our staff, takes seriously the responsibility we have for our patients. Whether you live in San Francisco Bay Area, Marin or Sonoma County or fly across the United States to see us, we do everything possible to educate our patients and make them as comfortable as possible.
Early signs of aging, such as frown lines and deep wrinkles, can ususally be addressed with a variety of injectable facial fillers and neuromuscular blockers like Botox. Injectables can be very effective, especially when coupled with other treatments. Examples of complementary treatments include prescription strength skin care products, most notably Retin-A, physician supervised laser such as Ultherapy and other esthetician skin care services. These procedures are non-invasive and have minimal to negligible down time. Benefits from these treatments are temporary and the procedures need to be repeated at regular intervals in order to maintain the effects.
At some point, the advanced signs of aging begin to appear, such as jowls, loose neck skin, excessive skin in the upper and lower eyelids, heaviness in the brow, and elongated ear lobes. The time frame for these anatomical changes varies from person to person. It is influenced by genetic predisposition, sun exposure, weight and simply the passage of time. When these more significant signs of skin laxity become evident, a surgical facelift procedure may be the best option for achieving your goals.
Different parts of the face age at different rates. Some patients may wish to opt for a facial rejuvenation surgery as their facial changes appear. They may have their eyes done in their forties, an endoscopic brow lift in their late forties or early fifties and a lower facelift in their mid fifties or early sixties. By doing it in this fashion, facial rejuvenation can be achieved gradually. If, however, you start in your mid to late sixties, the entire face will have significant age-related changes and doing one surgical procedure without the others will usually not look natural and balanced. Therefore, a complete facelift is often recommended, i.e., brow lift, eyelid lift and lower facelift and neck lift. Dr. Delgado will customize your treatment to your individual needs and concerns and propose an overall plan to achieve the most harmonious and natural-looking result possible.
Dr. Delgado performs facelift surgeries for men and women at the Marin Cosmetic Surgery Center servicing San Francisco, Marin, Napa and Sonoma County.
Before and After Photos
Types Of Facelifts
Today, there are many types of facelifts. There are Mini-Facelifts, Short-Scar Facelifts, and the Modern Facelift. Other options exist such as the Lunch Time Facelift, the Weekend Facelift and the Lifestyle Lift; although these latter ones are more marketing terms than anything else and actually fall into the categories of minor or short-scar facelifts. The Modern Facelift is the most extensive, but it tends to hold up the best and last longer.
Dr. Delgado will often suggest a Short-Scar lift for a patient who has minimal to moderate laxity of his/her skin. For these patients, the Short-Scar lift is a good option because it can correct what is required without over-operation.
|Procedure||What it does||Surgery||Recovery||Results|
|Facelift||Lifts and tightens the face, addresses lax skin and loss of facial definition||Yes||About 2 weeks to heal, avoid strenuous exercise for about 6 weeks||Long-lasting (about 2-5 years)|
|Voluma||Restores lost volume in the cheeks and midface region||No||Little to no downtime||Instant results, visible for up to 18 months|
The Short-Scar Lift
The Short-Scar Facelift is a relatively new procedure since about year 2000. The demand is for this procedure among Dr. Delgado’s patients is strong, because the lift can be significant and the incision is limited to the front of the ears. The keystone of this facelift method is that it lifts the deep structure. This deep structure is called the SMAS or Superficial Musculoaponeurotic System. The SMAS is a firm and fibrous network that runs under the skin but over the facial muscles and forms the framework of the face. When the SMAS is tightened, it can yield significant and long lasting results. Since the SMAS connects to the neck region, that area can be improved modestly with this approach. A Lifestyle Lift falls into this Short-Scar Lift category.
The Mini-Facelift involves only the skin. This is not a deep lift and does little, if anything, to improve the neck. If you pull the skin back and upwards in front of the ears, this will mimic the effect of a Mini-Facelift. Since the procedure only pulls the skin, the effects will not last for more than a few years. Unlike the underlying facial muscle, the skin is not structural and stretches easily. The degree to which the skin will stretch is determined by your genetic makeup and your amount of sun exposure. The Weekend Facelift and the Lunch Time Facelift are examples of the Mini-Facelift.
The facial rejuvenation incision for women is often within the tragus of the ear. This will avoid the incision in front of the ear. However, for the male facelift, the incision is often in front on the ear to avoid pulling the beard or hair bearing skin into the ear. This takes longer to fade but results in a more natural ear for a male.
The Modern Facelift
The Modern Facelift has evolved over many years, starting with the discovery of the SMAS. Surgeons have dissected and pulled the SMAS every which way as they learned how to best utilize this tissue plane.
The Modern Facelift technique often includes an incision behind the ear and into the hairline. This is needed if a significant amount of redundant skin is present, especially in the neck. This lift is a gold standard and will typically last eight to ten years. The SMAS is more extensively supported in the Modern Facelift than in any of the other facial rejuvenation surgeries.
The modern approach to facelift surgery has recognized the importance of facial fullness from fat. As we age, fat is lost in many areas of the face, such as the cheeks, the eyes, lips and other facial regions. As this occurs, we look older. The skin loses its fullness and begins to appear deflated and saggy. In this situation, the facelift becomes a slightly flat pull with less contour or curvature, like in the cheek region. This shows as a more operated and un-natural look. This is the reason for fat conservation and fat injections. Dr. Delgado often incorporates fat injection into his facelifts. An additional technique Dr. Delgado may use to restore fullness to the face is to overlap the SMAS, as opposed to removing a segment of this structure.
Dr. Delgado incorporates fat cell banking to his practice. The company Adicyte is a FDA registered location in Tucson, Arizona. It is under the direction of world-renowned cell biologist, Dr. David Harris and features state-of-the-art equipment designed for processing fat and stem cells. Dr. Delgado retrieves the fat during surgery or in the office and sends it Federal Express to Arizona. The fat is processed and frozen. The annual storage fee is 120 dollars. A portion of the fat is sent back when needed and injected the same day.
Even though fat is key component in facial aging, men do not require quite as much fat volume replacement as women. It should be much more subtle and not exaggerated, like a full cheek.
“Liquid Facelift” is a term used to describe injections of products to fill various facial areas and create more fullness. A patient’s own fat is commonly used, but products such as Sculptra, Radiesse, and Voluma can be used as well.
Every patient’s needs, means, and desires are unique. For example, patients in San Francisco Bay Area and Marin County often seek to work around their busy schedules, while patients who fly from around the United States often need a place to convalesce. We work with our patients to ensure that we meet their particular needs. Please don’t hesitate to tell us about your particular situation. We work with all of our patients to ensure that your experience goes as smoothly as possible.
Fat Injection (Stem Cell Facelift)
Fat injection can be used to rebuild volume anywhere on the body and is a technique that has been advanced since 2008. Dr. Sydney Coleman of New York City developed a new purification process. In the Coleman Technique, fat is gently taken from areas such as the abdomen or the legs using a low-vacuum liposuction. The fat is then placed in a centrifuge to gravitationally separate it into three layers: a top layer of oil, a central layer of concentrated fat and a bottom layer of blood.
Research has determined that the bottom 20% of the fat layer has the most fat stem cells and growth factors. This stem cell rich fat layer is believed to produce fat cells with the best survival rate for transplantation into specific regions of the face.
The fluid and oil is discarded and the fat is transferred to small, 1cc syringes. The skill of the technique is in the injection process. Small amounts of fat are injected underneath the skin in fine tunnels. This creates beads of fat, which are crosshatched in the injection area. This slowly and effectively builds up the area and gives the fat cells an opportunity to establish a blood supply. The technique yields better results than simply injecting boluses of fat into the injection areas. With the Coleman Technique, more than 50% of the fat can become long lasting.
Therefore, a Stem Cell Facelift refers to the injection of fat into the face to increase volume. Facelifts can be done with or without the use of fat volume replacement. Scientific research seems to support the stem cell concept, making the term, Stem Cell Facelift, to have some validity but much research is needed to determine its true value. The American Society of Plastic Surgery feels it is false marketing at this current time. Even though there are some stem cells present, it is primarily fat cells.
The most common question patients ask about the “Stem Cell Facelift” is, “How long does the fat last?” That depends on the injection area. For example, injections in a cheek location will have a better take, 60%, than the augmentation of the lips, 10-20%, which are constantly in motion.
Dr. Delgado takes great pride in providing each patient with a natural and elegant facelift. Whether you live in the San Francisco Bay Area, Sonoma or Marin County we have two office locations to serve your needs. Our San Francisco location is located at 450 Sutter at Union Square and our Marin County location in Novato at the Sutter Hospital Campus. If you travel from around other parts of California or the United States we have a great travel package and accommodations.
Before Facelift Surgery
A consultation with Dr. Delgado can be scheduled at either his San Francisco Bay Area office or his Marin County office.
At your consultation, Dr. Delgado will ask you to discuss your concerns about your face. He will want to know your short- and long-term goals. Based on these desires, he will explain the best technique for your needs. This conversation may include your eyes and eyebrows.
Dr. Delgado may use computer imaging to show a visual impression of the proposed outcome. This is a popular tool that is extremely helpful and enhances communication.
Before surgery, you will be given a detailed preoperative instruction booklet that will explain your medications and any preparations you need to make at home. This preoperative booklet has a comprehensive list of medications, including aspirin products and anti-inflammatories, which need to be discontinued two weeks prior, as well as the two weeks following your surgery. However, Tylenol (acetaminophen) can be safely taken during this time. However, do not exceed 1 gram over 4 hours or 4 grams per day from all sources since this can cause liver damage. You will also be given a list of vitamins and homeopathic drugs to take before and after your surgery to reduce bruising and swelling.
The surgery takes place at Marin Cosmetic Surgery Center, Dr. Delgado’s private surgery suite, located in his Marin County office on the Sutter Marin County Community Hospital campus. This allows Dr. Delgado to offer his patients private, concierge medical care, while providing the extra measure of safety and reassurance afforded by the surgery center’s contiguous location to the hospital.
The procedure begins with preoperative markings. Dr. Delgado will make drawings on your face for the location of the incisions and the direction of the pull vector. The SMAS location will be outlined. You will be lightly sedated and taken to the Operating Room. Once anesthesia is complete and all is sterilely prepped, the operation will begin.
An incision is made in front of the ear. If a Minor Lift is done, the cheek skin is undermined, pulled and the redundant skin is excised and finally sutured. If a Short-Scar lift is done, the skin is further undermined into the cheek area and down toward the neck. The SMAS is then elevated and anchored, pulling the neck tissue and facial tissue upward. The skin is trimmed and closed. A chin incision is sometimes used to further tighten the neck region. If the Modern approach is used, the incision continues behind the ear and into the hairline. This incision exposes much of the neck and cheek area. The SMAS can be completely modified to achieve a stronger face and neck improvement in a natural fashion. Much more skin can be excised and then meticulously closed. A drain is often placed and a light compression dressing is used. At the same time, additional facial procedures can be done, such as a chemical peel, fat injection for facial fullness, or a lip augmentation.
The vast majority of face lift procedures are done under light general anesthesia. However, in some cases, one may use local anesthesia with intravenous sedation. At Marin Cosmetic Surgery Center, only a physician who is board-certified in anesthesia administers anesthesia. Dr. Delgado and the anesthesiologist will assist you in making the best decision for your rhytidectomy surgery anesthesia. (See credentials for Randy Gaynor, MD on our website.) The anesthesiologist will call you the night before your surgery to review your medical history, confirm last minute instructions and answer any questions you may have relating to your anesthesia.
After Facelift Surgery
The first few hours after surgery will be spent in the Recovery Room. When you are completely alert and oriented, you will be able to go home with someone to assist you. You are to apply cold packs around your face and neck area for 48 hours to reduce swelling and sleep with your back and head elevated at 45-60 degrees for approximately four to five days.
Some patients will spend the night in the Recovery Room at Marin Cosmetic Surgery Center in Novato, California, especially if a complete facelift is performed. If you are staying overnight, your care will be provided by a Registered Nurse with post-operative training, including ACLS (Advanced Cardiac Life Support) certification. An additional person will be assisting her overnight with your care. These recovery personnel have been hand picked and trained by Dr. Delgado to provide the highest level of surgery after care.
Dr. Delgado will see you the next morning and inspect your incisions. If drains were placed, they may be removed. You will be discharged with a responsible adult to transport you to your home and settle you into your recovery environment. You may shower and wash your hair the following day if the drains have been removed.
Maintaining elevation of your back and head is very important to minimize swelling. You may experience minimal pain, but most patients report primarily a sensation of tightening from the swelling. Pain medication is prescribed, but usually it is needed for just a day or two.
Much of the swelling and mild bruising will resolve in seven to ten days, as long as proper care is taken. Makeup may be applied after one week. Most patients return to work or social activity after seven to ten days. Strenuous physical exercise is to be avoided for four to six weeks following surgery.
Male and female facelift surgery has many similarities and differences. We have discussed the aging, the incisions and volume replacement. The male facelift should produce a strong jawline; this may even require a chin implant. The female jawline should be very distinctive but in a softer way. More attention is spent on the female neckline to achieve a tight and smooth appearance. It is imperative for both the male and female facial rejuvenation that the hairline not be altered. This is especially true for the male who doesn’t, in general, wear long hair.
Risks and Complications
As with any surgery, there are risks and complications. However, with a board certified plastic surgeon, a board certified anesthesiologist and a well-trained surgical team, complications are rare. The facial surgery carries the possibility of nerve injury, but this risk is minimal with a skilled, mature surgeon, such as Dr. Delgado. Occasionally, incisions need to be modified with scar improvement techniques. In general, the incisions blend and fade beautifully over time.
Male facial surgery patients have a higher rate of postoperative bleeding due to the added hair to the face. This brings in more blood supply to the area. The blood pressure needs to be controlled after surgery and the patient often stays overnight at the Marin Cosmetic Surgery Center.
The results of the procedure are to rejuvenate the face, neckline, jawline and their relationships. The angle of the neckline and facial area will be improved with more contours as a result of removal of fat and tightening of the musculature. The skin around the mouth and the prominent folds below the sides of the nose will be improved. You will look rejuvenated with a natural and elegant appearance. The improvements can be expected to last for many years. Although you will continue to age and gravity will continue to affect your face, the area will remain rejuvenated. Facial surgery can be done again in the future and combined with other procedures, as desired.
Frequently Asked Questions
What is a facelift?
A facelift is a cosmetic surgery procedure, the purpose of which is to erase, or at least ease, the telltale signs of aging seen in the face. A facelift reduces heavy wrinkles and eliminates sagginess of the neck and facial skin. Fat deposits can be removed in some areas like around the neck or replaced in the cheek region. The underlying muscles of the neck and face are tightened. The skin is then re-draped over the firmer underlayment and the excess skin is removed.
Who is a good candidate?
The best candidate is a man or woman whose skin has begun to sag and/or develop laxity. Most patients are between 40 and 60 years of age.
What are the risks?
Like any surgical procedure, it does involve certain risks. The most common risks include: infection, bleeding, and adverse reaction to anesthesia, poor healing, asymmetrical results and the very remote risk of temporary or permanent nerve damage.
Can I have other cosmetic procedures at the same time?
It is common for patients to have other cosmetic procedures at the same time. These procedures can include a brow lift, neck lift, eyelid lift, chemical peel, and volume replacement in the face, such as fat injections. Dr. Delgado may advise you to consider one or more of these additional procedures in order to achieve the most harmonious and natural results possible.
Who is an ideal candidate?
The ideal candidate will understand that a facelift is intended to enhance the appearance, not to give an entirely new look. It is vital that you are realistic with your goals. You can have dramatic results, but it is not designed to make you look like someone else. What it does is turn the clock back eight to ten years.
What happens during my initial consultation?
Dr. Delgado offers consultations at both his offices; the San Francisco Bay Area office at 450 Sutter and his Marin County office in Novato, California. All of Dr. Delgado’s surgeries are performed at Marin Cosmetic Surgery Center. During your consultation, he will discuss your concerns and your goals. He will examine your face to evaluate the extent of skin laxity and assess other aspects of your face that may need correction in order to achieve a balanced and natural appearance. Dr. Delgado will explain incision placement, often with the aid of computer imaging. He will show you before and after photographs of patients on whom he has performed facelifts so you can see actual results of his work. You will receive a DVD that has recorded the experience of one of Dr. Delgado’s patients. This patient’s story extends over the nine-month period following her lift so you can be acquainted with the process. An exact price quote will be explained.
Are the results permanent?
Although a facelift will improve your appearance; it will not stop the aging process. While patients have a more youthful appearance than they would naturally, wrinkles will eventually reappear with the progression of skin laxity over time. In general, depending on when you have your procedure, you will look eight to ten years younger. This will always be the case. For example, when you are 70, you will look as though you are 60 years old.
Will I have scars?
Dr. Delgado will make minimal incisions in well-concealed areas. The incisions resolve extremely well over time. It is always the goal to minimize the incisions, as well as preserve the natural hairline. The incisions are slightly different for men and women and Dr. Delgado will review this issue.
Where are the incisions made?
Your incisions will be made within your hairline and along the natural contour of your ears. The incision will go behind the ear as well. In men it is often placed in front of the ear to keep the beard hair from going into the ear region. Depending on the extent of the procedure, an additional incision may be hidden underneath your chin to complete a neck lift. Dr. Delgado will show you exactly where your scars will be located during your initial consultation.
When can I return to work, exercise and driving?
A typical patient undergoing a facelift procedure will be very comfortable returning to work in approximately two weeks. Minor concealing makeup may be desired in areas where bruising has not yet completely resolved. You can plan to drive seven to ten days after surgery, or as soon as you are comfortable and off pain medications. Exercise routines can be resumed approximately four to six weeks after surgery, advancing slowly. The post-operative goal is to reduce swelling as quickly as possible, allowing you to return to your usual activities looking as natural as possible. Men may require a little extra-time because make-up is not usually worn.
What is the cost of a facelift?
The cost of a facelift can vary greatly depending on the combination of procedures to be done. At the time of your consultation you will be given a personalized quote showing a breakdown of all fees.
Do men have facelifts?
Yes, men are having facelifts at a higher rate each year. The reasons are similar to women. Some of the most common are work related issues, divorce, midlife crisis or just want to look how they feel.