Need a Facelift?  Who’s Not a Good Candidate for Plastic Surgery?

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Thinking of a facelift?  You’re not alone.  Despite the pandemic, in 2020 some 234,000 people had facelifts, and over 325,000 had eyelid surgery, according to the American Society of Plastic Surgeons.  Those who got facial plastic surgery had good reason:  Research continues to show that younger-looking, more attractive people earn more, are more likely to get promoted, and less likely to be laid off.  The Zoom boom probably intensified that effect.  One of the most popular Google searches last year was: How to look better on Zoom.

If you’re considering a facelift or any other facial plastic surgery procedure, it’s important to know that not everyone is a good candidate for plastic surgery.  While a facelift is one of the safest surgical procedures, it’s not minor surgery.  Not everyone is a good candidate for facial plastic surgery.  What could prevent you from getting one of these popular and beneficial procedures?

Facelift procedures: Not for active tobacco users

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Tobacco use causes wrinkles

It’s hard to find a plastic or facial plastic surgeon who perform facial plastic surgery on people who smoke or vape.  Facelift patients and their surgeons want good results.  Unfortunately, nicotine reduces blood flow to the skin.  That interferes with proper healing.

In addition, smoking, vaping and other tobacco use can damage your skin.  The Mayo Clinic reports:

Smoking can speed up the normal aging process of your skin, contributing to wrinkles and other changes to the appearance of your face.  These changes include crow’s-feet, pronounced lines between the eyebrows, uneven skin complexion, a grayish tone on lighter skin, deep creases and puffiness below the eyes, wrinkles around the mouth, and thinner lips.

Heart disease and cancer remain the biggest reasons not to smoke.   After all, wrinkles might make life less enjoyable but won’t kill you.  But tobacco can do long-term damage to your skin.  Some surgeons require 2,4, or 6 tobacco-free months before having facial plastic surgery.  I require no tobacco for 2 weeks before and 2 weeks after surgery.  Whichever surgeon you choose, you’ll do yourself a favor if you quit using tobacco.

A heavy drinker is not a good candidate for plastic surgery

As we reported in “Facelift Before and After – How Long Do Facelifts Last?”  heavy drinking can wreak havoc with your skin.  Facial plastic surgeons’ good reputations depend on their patients’ good results.  Outstanding surgical procedures can be undone by regular excessive drinking, especially when combined with second-hand smoke.  The Journal of Clinical and Aesthetic Dermatology reveals:

In heavy drinkers (i.e., those who consumed eight or more drinks per week), seven facial features were significantly associated with an appearance of more severe aging than in women who did not consume alcohol.

Note that studies show that more than one drink a day is “heavy drinking” when it comes to your skin.  Poor quality, sagging skin can ruin a good facelift.  So, while reputable facial plastic surgeons probably won’t bar moderate drinkers from getting facelifts, few would recommend a procedure for heavy or binge drinkers.   I require one week with no drinking before surgery.  I have to wonder if smoking and binge drinking would be popular if people realized that they cause premature facial aging.

Certain medical conditions can disqualify you from facial plastic surgery

Reputable plastic and facial plastic surgeons sometimes must turn patients away to preserve their health.  For instance, if you have a bleeding disorder or need to be on blood thinners, elective surgery of any kind may not be safe for you.  Many who are on Coumadin, Plavix, Heparin, or even aspirin to prevent serious blood clots are not good candidates for facial plastic surgery.  Unless specifically cleared by a specialist, patients with heart conditions should not risk plastic surgery.

Sensitivity to anesthesia is another issue that prevents some from getting a facelift.  Some patients who don’t tolerate general anesthesia can have a procedure using a local anesthetic plus oral sedation.  I use this safer approach.  But some don’t react well to this, either.  They would not be good candidates.

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Obesity can disqualify you from plastic surgery

Some surgeons do not like to operate on seriously overweight or obese patients.  The medical journal Aesthetic Surgery reported on a study involving some 127,000 patients.  Those who were overweight or obese were significantly more likely to suffer complications from plastic surgery.  Infections and blood clots were significantly higher for these patients.  Their risks increased along with their weight.  If you’d like to improve your appearance, it’s wise to lose excess weight.

Diabetes poses risks for any invasive procedure, including facial plastic surgery.  Medical journals report that diabetes increases post-surgical risks.  These include heart attack, cardiac arrest, post-op infections, and a generally poorer outcome.  However, if your diabetes is well controlled, you can often have a facelift.

High Blood Pressure (hypertension) can pose problems during surgery, especially with general anesthesia.  However, if patients’ hypertension is well-controlled and monitored by their primary care physician, facial plastic surgery will be fine at many practices, including mine.

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Patient, 70 – Before and After facelift and neck lift by Dr. Brian Machida

Your state of mind can make you a good or bad candidate for a facelift

Your state of mind can have a big impact on whether you should have facial plastic surgery.  An article in an American Psychological Association publication described a woman who consulted with a plastic surgeon about a facial scar that really bothered her.  She was often late for work trying to adequately cover it with makeup.  She rarely went out to eat with her husband because she feared people would stare at her scar.  She believed it disfigured her.

body dysmorphic disorder, bad candidate for plastic surgery
Body Dysmorphic Disorder can cause difficulties

But the plastic surgeon and a psychologist she consulted could barely see it.  The woman was suffering from body dysmorphic disorder.  This has been defined as “obsessive concern about a supposed bodily flaw that may not even be visible to others.”  According to JAMA Facial Plastic Surgery magazine, while 2.4% of the general population has body dysmorphic disorder, about 10% of those seeking plastic surgery suffer from it.  Studies show they are rarely satisfied with the results.  So, if you have a facial flaw that bothers you, while many others say they can barely see it, you might not be a good candidate for facial plastic surgery.

An analysis of 37 studies published in Plastic and Reconstructive Surgery found that people who had plastic and facial plastic surgery generally improved in their self-image and quality of life.  But the same research found several conditions that predicted a poor outcome:

  • History of depression
  • History of anxiety
  • Unrealistic expectations

One 24 year old woman came to me seeking the kind of tight facelift facial plastic surgeons try to avoid.  She wanted that look for a specific reason.  But how would she feel about it later?  Or some may hope that the right surgeon can make them far more attractive than their bone and muscle structure will permit.  Those with similar unrealistic expectations wouldn’t be good candidates for a facelift.

Your reasons for getting plastic surgery

A skilled, experienced facial plastic surgeon can help you look like a younger, more attractive version of yourself – not someone else.

Additionally, for whom are you getting the procedure?  While those who are doing it for themselves are often good candidates, patients who primarily want to please others often are not.  If you’re not sure if you’re ready for facial plastic surgery, it might be better to wait until you are.

A good candidate for the right facial plastic surgery procedure

If after reading this article you feel that you’re a good candidate for a cosmetic procedure, it’s important to choose the right surgeon.  For facial plastic surgery, it’s best to choose a board-certified facial plastic surgeon or a plastic surgeon who specializes in the face and neck.  Experience counts – a lot.  Choose a surgeon who has performed many of the kind of procedures you need with good results.

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Before and After Deep Plane Facelift by Dr. Brian Machida, MD, FACS – just 1 week after surgery

If you’re in Inland Empire, California, you can find me at STC Plastic Surgery in Ontario.

CONTACT Dr. Machida Inland Empire, CA

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About Dr. Brian Machida, MD, FACS

Dr. Brian K. Machida, MD, FACS is a double board certified facial plastic surgeon. He has an exceptional level of experience, having performed ( read more )

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