If the sagging is marked, the results may be dramatic. Fig. 25. In younger patients, where sagging is subtle, the improvement will be less conspicuous but remarks will be made that the face looks more alive and less tired. Fig. 26; Fig. 27. It cannot be predicted accurately how long the improvement will last. In ideal cases, the duration of the improvement is often from five to ten years. Fat faces will have shorter lasting improvement. The surgery simply "turns back the clock but does not stop it." No operation can permanently stop or prevent aging, but the individual’s appearance will always be more complimentary than if the operation had never been done. Fig. 28; Fig. 15

    If the patient has had an original face lift operation a "preventive maintenance program" can then be implemented. This is particularly indicated in younger individuals who can maintain a youthful facial appearance for the remainder of their life by having periodic "tuck ups" every few years. This is not uncommon among Hollywood personalities.

Patients with systemic diseases, high blood pressure, heart disease, or obesity are not acceptable candidates for this type of surgery. Patients with a short, stocky neck cannot expect the same amount of improvement as those with more favorable anatomy.

    The operation is usually performed with local anaesthesia and sedation. The incisions made are inside the hair line wherever possible but the hair is not cut before the operation. The hair, though, should be shampooed thoroughly before entering the hospital. Infrequently there may be some thinning of the hair for a short distance on each side of the incision line. If this occurs, the thin area can be covered by combing the adjacent hair over it. The sight of the incisions will be discussed during the preoperative visit. There is little pain and discomfort following the operation. Remember that the swelling and discolorations are temporary, as are minor changes in the configuration of the hair line which may occur and are usually unnoticed by the observers or even by the patients.

    There may be some areas of numbness particularly around the ear which improve to a great extent within three to six months. Some patches of numbness may persist indefinitely.

    Closing of the incisions is performed in such a manner as to exert no tension on the lines in front of the ear, where the scars are usually inconspicuous without makeup. The tension resulting from the stretched and lifted tissue is thus distributed to the areas behind the ear and the back of the ear skirting the hair line. These scars are therefore destined to be more visible and have to be camouflaged by combing the hair. At times, they may require a small adjustment under local freezing eight to twelve months after.