Well Healed

Thanks to recent innovations, the recovery period is no longer the scariest part of a facelift.

For most of us, committing to a facelift is pretty heady stuff, ranking high on the list of life-defining moments. Not only is it an admission that our looks aren't what they used to be - a potentially distressing thought in itself - but with the decision comes a host of valid concerns, among them: How soon will I heal? Will I look completely different? Will my recovery be painful?

According to statistics recently released by the American Society of Plastic Surgeons, facelifts rounded out the list of the five most frequently performed cosmetic surgery procedures last year, with nearly 119,000 female patients going under the knife. (By comparison, only 15,000 men did the same.) And just as the idea of a facelift continues to shed any shameful connotations, recent innovations in recovery methods and an enlightened embrace of holistic remedies are making the experience even easier.

"There's a psychological aspect to recovery," says Manhattan plastic surgeon John E. Sherman. "Like any significant event, such as the birth of a child, you're going to have fears. Most people end up not verbalizing these fears because they think that the doctor doesn't want to hear them." Some of these moody blues, Sherman says, are triggered by the physical aftereffects of the surgery, such as an uncomfortably tight feeling, bruising and swelling; in all, the patient just doesn't feel like herself. "On a facelift you can't see the results right away," he adds. Rest assured, however, that this mild depression is both normal and temporary.

While some facelift procedures have been made less invasive - the mini facelift, for instance, works only on the jowls and jaw line - they still disrupt the face's lymphatic system, nerve endings and blood circulation. But Farrokh Shafaie, a plastic surgeon with practices in Manhattan and Summit, New Jersey, employs a homeopathic regimen that he believes accelerates the healing process.

"There is a big move toward homeopathic remedies," says Shafaie, who has been recommending a wellness regime to his patients for almost 20 years. His favorite ingredient is arnica Montana, a plant indigenous to Central Europe that works by absorbing hemosiderin, a blood component that contributes to a bruise's appearance. "I was introduced to it by a patient from Germany," Shafaie recounts. "And I've found that with arnica the bruising lasts for just a week versus three weeks without it." Shafaie, along with many of his colleagues, prescribes arnica - in either ointment or tablet formula - both pre- and postoperatively.

Rounding out his regimen are protein powder, lime, ginger and bromaline, an enzyme found in pineapples that aids with swelling. "The Chinese have been healing themselves this way for 5,000 years, long before there were drugstores," notes Shafaie.

For Manhattan-based plastic surgeon Steven J. Pearlman, the postop regimen is so crucial that he sends his patients to renowned nutritionist Oz Garcia. Garcia, who just wrote his second book, The Healthy High Tech Body (Regan Books), recommends a smorgasbord of supplements, some are basic, like vitamin C, and others are more obscure, like MSM, a dietary sulfur purported to be key in producing collagen.

As important as what to do, say surgeons, are the things that one should be meticulous about avoiding. "It all boils down to wound healing," says Manhattan plastic surgeon Z. Paul Lorenc. The highly competitive plastic-surgery community might bicker over techniques and bragging rights, but when it comes to stating the worst offenses that can be committed against a healing face, it is unanimous: smoking and exposure to the sun. "We would never recommend that a facelift patient go to St. Barth's," Lorenc says. "If you do so, you're likely to return with a raised and glistening scar."

On a positive note, if scars - those little souvenirs that scream to the world where you've really been for the last two weeks - are what you fear, then worry no more. Operating techniques are now so sophisticated that only you and your surgeon need know your little secret. "Scars aren't even an issue," says Manhattan plastic surgeon Bernard Shuster. "Even a patient's hairdresser has a difficult time finding them." Today, the incision is usually tucked behind the ear, a vast improvement over that telltale white line in front of it. The key to fading a scar to virtual invisibility is to keep it moist and coated. Surgeons' favorite healing moisturizers include Aquaphor Healing Ointment and A+D Original Ointment (yes the kind used on baby rashes).

Most surgeons encourage their patients to resume their normal skin-care routine, since a facelift by definition, doesn't disturb the actual texture of the skin. The only exception is the day after surgery, when the skin is at its most vulnerable. In that case, most doctors recommend only a very basic cleanser, preferably one that can be wiped off without water. A few days later, it's helpful to reach for skin-enriching products that moisten and protect. Dermatologist Fredric Brandt, of long-standing Botox fame, caters to postop patients with a variety of products from his namesake collection: Anti-Irritant Cleanser is free of any potentially sensitizing ingredients, while Advanced Eye Crème #2 contains arnica. Susan Ciminelli of the Susan Ciminelli Day Spa in New York favors the essential oils and marine ingredients in her own skin-care collection. "They are exceptional for healing the skin and reducing pain," says Ciminelli. Similarly, the Enessa Wellness Spa in Los Angeles touts its Facial Nourishment Geranium Oil for its gentle moisturization.

Lorenc credits his patients' quick healing time to is use of the Karin Herzog skin-care line of oxygen-based products. The collection's founder, scientist Paul Herzog, was honored by the Nobel Institute for developing the artificial respirator and, together with his wife, Karin, translated his findings into an at-home collection. While some doctors contend that it's impossible to bottle oxygen in a cream, Lorenc says he's able to measure the increased oxygen levels on skin treated with the product. "We can't afford to have patients in hyperbaric chambers," he says with a laugh. "Oxygen is very beneficial for healing. It dilates the blood vessels and delivers more nutrients to the incision."

The latest buzz in healing the skin after surgery comes from a technique that surgeons actually employ during the facelift. Made with donated blood plasma, fibrin glue, an adhesive, is concocted in the operating room and sprayed onto the flap of skin. Its main function is to seal off any leaky blood vessels that might remain open, a job that is typically done with use of drains and compressive bandages. Because fibrin glue is fairly new to the cosmetic-surgery arena, very few surgeons have yet to embrace it.

Newer still is the Autologus Platelet Gel, a technology that uses the patient's own blood in order to create an adhesive that has the advantages of the fibrin glue, plus another major one.

"Autologus Platelet Gel is rich in bioactive proteins and growth factors," says Manhattan plastic surgeon Thomas Romo III, one of the few cosmetic surgeons currently using the Platelet Gel. "Because of this, many fantastic things happen: Collagen-producing fibroblasts start to grow, making the wound heal a lot faster, and red blood cells are decreased, making for less bruising."

In a perfect world, one would skip to the plastic surgeon's office, be rejuvenated and - presto! - jump back into life. But since the world is far from perfect, it's best to not have unrealistic expectations; "You're not fully healed in two weeks - that really takes a year," says Romo. "What we do is try to get patients back to work as soon as possible. People want to have a facelift and be back to normal in 10 days."

-PATRICIA REYNOSO