Lynn's Face Lift Surgery (FLS)
Copyright @ 2000-2, Lynn Conway. All Rights Reserved
[version of 2-6-02]
This webpage contains a diary of Lynn's face-lift/blepheroplasty surgery, performed by Douglas Ousterhout, M.D., D.D.S., at the Davies Campus of the California Pacific Medical Center in San Francisco, CA. This page is part of Lynn's overall Facial Feminization Surgery (FFS) site at:
In many older patients, a face-lift may be necessary as a follow-up to FFS. Some patients may have already needed a face-lift prior to FFS, and/or their facial skin may not adequately shrink and tighten up after the FFS's reduction of facial skeletal dimensions. In such patients, a face-lift can produce dramatic overall results, making them not only look more feminine, but much younger too.
Dr. Ousterhout requires a wait of at least a 3 months after FFS before doing the face-lift surgery, in order to insure adequate reduction in bony swelling after FFS. During the final month of that wait, you will not look your best due to all the wrinkles and sags. By then you'll be highly motivated to get on with the face-lift!
I hope that this information is helpful to women preparing for face-lift surgery after FFS. I also hope it will help you visualize the great differences in the impact of the two surgeries. While not "fun", the face-lift is quite mild in impact compared to the ordeal of FFS.
What is Done in Face-Lifts and Blepheroplasty?
Face-lift surgery is performed to tighten-up the skin on the cheeks, jaw and neck. Incisions are made all around the ears, out onto the temples in front, and out horizontally into the hair above the neck in rear. Through these incisions, the skin all across the lower face is loosened, muscle attachment points are moved, and then the skin is tightened by removing sections of skin before restitching the initial incisions. It's a remarkable process, and even fairly serious "turkey necks", i.e., folds of skin in front of the trachea, can be removed by pulling skin to the rear and upwards into the incisions in the hair behind the ears. Almost all the extensive incisions are concealed in the folds around the ears, and in the hair up behind the neck. Skilled stitching results in very minimal scarring in any event. Following the surgery the facial skin is very taught; it gradually softens over several months to produce a very natural rejuvenated appearance.
The blepharoplasty is done to eliminate baggy skin and excess skin folds in the areas just above and below the eyelids. Incisions are made in the crease in each upper eyelid, and crescent shaped sections of skin is removed; incisions are made must below the lower eyelashes, and sections of skin removed there too. A recent very publicly visible example of someone having this surgery is the case of TV-Newswoman Greta Van Susteren, who in early 2002 benefitted greatly from having the large sections of "hooded skin" removed from her eyelids and from hollows under her eyes (link to before/after photos of Greta).
The effects of a face-lift and blepheroplasty can be remarkably rejuvenating, especially when combined with later laser resurfacing surgery (LRS) to remove the finer wrinkles and any age-marks.
Face-Lift Surgery Diary:
On Monday February 21st, Charlie and I flew to Oakland, CA and used public transit to travel to the Beck Motor Lodge on Market Street, just a few blocks from Davies. We flew out a couple of days in advance so we could handle any contingencies or delays in winter air-travel, and also have a bit of vacation before my surgery on the 24th. We saved quite a bit of money by flying into Oakland Airport (see travel section of Lynn's FFS page). Beck's was a nice, convenient place to stay, and Charlie kept this room thru Thursday night. Trip planning this time was easier than for my FFS surgery, since we "knew the drill" at Davies already.
2-23-00 (Wed): Checked into my guest room, and then met with Doug and Mira in the late afternoon. We talked over the details of the surgery, and I paid my fees there and at Admitting. Charlie and I had a nice meal at Chow, and I settled in early for a good night's rest. Charlie went back to Beck's since he'd be staying up later. He'd return to see me when I was in recovery and then the ACU tomorrow, and would come to stay in the guest room with me on Friday night (the first night I'd be back there after one night in the ACU).
2-24-00 (Thur): I checked in at Admitting in the Davies Lobby at 6:00am - - we hadn't done my labwork yesterday, so I went downstairs to the lab to have that done (bloodtests) - - - then got nursing briefing - - my BP was 114/68 and my pulse was 65 - - they gave me a valium and a pill to insure that BP stayed down to minimize bruising - - - had anesthesiologist prep - - and I was then rolled into the OR at 7:30 - - - everything blurred now, and soon the lights went out - - -
The surgery lasted 5-3/4 hours. I woke in the recovery room briefly - - felt a bit woozy but otherwise OK. I was moved to Room 232 in the ACU in the afternoon and dozed on. Charlie kept in touch with Dr. O's office to follow my progress. He came on up to the hospital at 3:00 to be with me as I woke up. He took some photos as this happened:
Here I am on Feb-24th at 3:20pm, dozing away:
In this next photo at 4:29pm, I'm just beginning to wake up:
And at 5:11pm, I'm awake and feeling pretty good:
Dr. Ousterhout dropped by, and said all went well. Although I was very bruised, there wasn't too much swelling - - - at least not yet. I felt little real pain or discomfort, and hardly needed the morphine PCU pump - - although I did use it a few times to help me doze-off that night. Again I was amazed at the minimal effects of the anesthetics now being used at Davies - - no "hangover" feeling, and no nausea at all. I slept on/off that night, with the reclining bed adjusted well up to keep the facial swelling down (reclining while sleeping would be the drill for the next couple of weeks) - -
2-25-00 (Fri): Doug came by early and took off the outer bandages and removed the drains that had been placed in the wound areas behind my ears. The blood oozing from the facial areas settles back the area drawn on by those drains (note the drains filling with blood in the photo sequence above). Charlie arrived at 8:30am, and mentioned that he'd found a shortcut around east and back behind Beck's to 15th street that made the walk quite a bit shorter (we've marked it on the map in the FFS site). I was very hungry, and enjoyed my breakfast of "regular" hospital food.
Enjoying breakfast on Feb 25 at 8:27am:
Doug also said that it was OK to shower today, and that I should start my Augmentin antibiotic at noon today, and then go on an 8pm/8am schedule after that for the next week. He also said don't watch TV or read with "eyes down", in order to avoid improper initial healing of the lower eyelid wounds. Also instructed me how to do a hard-squinting exercise for 12 seconds 3 times each hour, to properly maintain facial muscle tone thru early recovery. My blood pressure checked at 108/64, and my pulse was 60 this morning. I felt pretty relaxed.
That afternoon, I was moved up to my guest room, #324. Charlie checked out of Beck's and moved in with me. Had a chance to get on the phone and talk to lots of my friends this afternoon too.
By evening, my face was swelling up quite a bit more - - the "second-day effect" was kicking-in, and I began to need one full Vicodin at 8:00pm and at midnight. Just as with the FFS surgery in November, I wondered how much swelling and pain would develop over the next day or so. Slept sort of OK, but woke at 4:00am Saturday and needed another Vicodin for pain (the really serious swelling lasted for about 18 hours, from late Friday thru midday Saturday).
2-26-00 (Sat): I took a Vicodin at 8am. The swelling now seems to have stabilized with my facial skin very tight indeed. I don't look as nice as yesterday due to all the swelling and bruising. The eye bruising is less red and has started its downwards slide down the face. My throat is pretty sore; I notice the effects of the breathing tube more this time than I did after the FFS.
Doug stopped by this morning, and said all looks OK. I'm to call his office Monday morning to arrange having him remove the eyelid stitches that morning. By midday the pain started dropping and I began feeling better, but I looked pretty terrible. It was clear now that the physical impact of the face-lift would be far less than that of the FFS surgery. But in some ways I was worse-looking than after FFS: I had two large "black eyes" and lots of other facial and neck bruising. That's just the way it is with face-lifts: there is so much undermining and moving of the soft facial tissues, and so many muscles that have to be reattached in new locations, etc., that extensive bruising cannot be avoided.
2-26 at 2pm; the swelling and bruising is very noticeable:
This afternoon my friends Jorge and Susan stopped by and visited for a while. That evening Charlie and I had dinner at the hospital cafeteria. The weekend dinner selection was limited (one nice entree, salads, deserts, etc.), but it was a treat to get out of the room for a while. At 8pm things got painful enough for one Vicodin, and I took another one at midnight. Slept better tonight; woke once to take a Vicodin at 5am.
2-27-00 (Sun):
Still quite swollen and painful on awakening. Began to subside around noon. Took 1 mg Vicodin at 11am anyways. I had at least 2 full days of very heavy, painful swelling (from midday Fri to mid-Sun), but the pain eased off after that. It was a nice day outside, but I decided to stay in hospital and relax again today.
Charlie went out touring each day. I'll try to get out with him tomorrow. By noon the facial and neck bruising was becoming very severe and colorful. Had a BM at 1 today, and felt better about that. The Augmentin seems to upset digestion more than CIPRO did - - . My mouth opening was affected by all the cheek swelling, and was back down to only ~ 20mm tooth to tooth in front.
Slept so-so this night, waking at 3am. Took another Vicodin, then slept thru till morning.
2-28-00 (Mon):
Feeling almost normal today, except for my very swollen and very bruised face. The bruising is smearing down my face and neck and is very colorful. Pain was down a bit more, and my skin felt very slightly less taught today. Will try 1/2 Vicodin every 4 hours today - -
Mira took out some of the eye stitches this morning, and I put on some concealer and make-up. By using liquid eyeliner, I was able to make up my eyes OK without pressing too much on the wound areas there. Didn't look to bad now, and felt very comfortable about going out a bit.
Charlie and I went out and took the N-line downtown. We did some shopping at the - - - - and later rode the cable cars over to check out the cable car museum, etc. We probably would have done more, but now Charlie seemed to be coming down with a cold - - .
That evening I carefully used a gentle make-up remover to clean my face without any rubbing. Wow, the bruising looks so colorful once the concealer is off! Took 1 mg Vicodin before going to sleep.
2-29-00 (Tues):
Bruising shifted towards yellow now, but is even more extensive on neck and has become quite colorful. Swelling very slightly down, and less pain now. I'm feeling good, and wonder if I even need 1/2 Vicodin? Maybe for later as I move around a bit.
2-29: Though very bruised and still swollen, I'm feeling pretty good now.
It's a rainy day today, and Charlie has a cold; we'll take it easy. Got made-up later and this afternoon we took a bus over to the Bridge Theatre and saw the film Boys Don't Cry. What a wonderful movie; joyful, sad, then tragic; glad I didn't see it alone - - . Took 1/2 Vicodin to sleep. Slept thru till 6am.
3-1-00 (Wed):
Face sore on first rising. This was to be the drill for the next few weeks. Swells up at night
from reclined position. Took 1/2 Vicodin.
Sunny day today. We took the N-Line to the CalTrans station, and then took a train down to Mountain View, and had lunch there with friends Dick and Terri. It was fun to ride the train down and back too. Had dinner over at the Bagdad Cafe. Watched TV and turned in early. Charlie now feeling better from his cold. I got tired and sleepy from the active day, but felt good.
3-2-00 (Thur):
Slept OK last night, waking once and taking 1/2 Vicodin at 4am. Went down to get a set of "after" pictures taken by Mira for the office files, to save time tomorrow morning when we leave early. We went downtown again today, and shopped at North Face, Macy's and Nordstrom's. Then saw a movie at the Sony Metreon, which is a very nice downtown theater complex.
Had wine and pizza at Chow to wrap up our stay in the Castro District that evening, and did some preliminary packing. Took the last of the Augmentin today.
3-3-00 (Fri):
Wore early in some pain, and took 1/2 Vicodin. Showered and went down early to have Mira remove stitches and go over all final instructions. She was able to get all of them except two in the center area of my right ear; those were so embedded in a deep scab that they were incredibly painful when tugged on. She cut them and left them in, saying that they'd pull easily later when the scab healed (I hope!). Charlie and I packed and left early for our flight out of Oakland, taking the N-Line, BART, and AirBart shuttle-bus to get to the airport. We had a pleasant flight home.
3-5-00 (Sun):
Been quite sore on awakening this weekend due to facial and neck swelling. I found that an ACE bandage wrapped like a submental bandage (around my jaw/chin up around the top of my head) helped contain the neck-area swelling overnight - - some patients who get liposuction around the neck area are required to use a submental bandage - - - although I wasn't, I found that the ACE bandage helped over the next few nights - - took 1/2 Vicodin and some Tylenol to get to sleep - -
3-7-00 (Tues):
Sleeping better now, and feeling good during the day taking Tylenol only - - however, the skin is VERY tight, swollen and numb in the cheek and jaw areas - - now look pretty good in make-up, but don't "feel like I do" because it's hard to make facial expressions - - Lots of energy now, and I wish I could work out at the Y already (gotta wait a while yet to prevent edema, etc.) - - transitioned to a pencil eyeliner today, since the eye healing is coming along well and that didn't cause any pain or irritation - - could resume normal work activities today w/o problems - -
3-9-00 (Thur; 2 weeks postop):
The swelling is still heavy now and my facial skin is quite tight, but I can begin to feel more individual facial muscles and the numbness in my cheeks is down. The neck bruising is almost gone, but the "half-moons" are still very prominent under my eyes, as is some bruising on the left side of my chin. However, with some effort using the concealer and make-up, my appearance is beginning to look OK.
My mouth opening is up to ~25 mm now. I'm sleeping easier, and can almost lie all the way down at night without too much swelling by morning, although this varies night to night. Taking some Tylenol during the day, but there's not much pain left either. Am feeling very rested and fit.
Doug had said that I could resume normal workouts at 2 weeks postop, so I started back to my regimen at the Y today. Tired a bit quickly, but otherwise felt pretty good.
3-12-00 (Sun):
Been sleeping lying down, and that's working OK except for some painful areas around the ears. The scabs are finally almost gone from all across the front inside of the ears, making it easier to make-up and not have to pull my hair over my ears. However, the scab just inside each ear is till there; tried to pull on the cut stitches in my right ear, but they still hurt incredibly with even the lightest pull.
I'm still using a little Tylenol before sleeping, and again in the morning due to morning swelling.
Bruising still quite noticeable under the eyes, and it's tough to fully conceal if out all day and into the evening. Also, my face gets quite "tired" if I need to be "up" and smiling in public for a whole day, since the facial skin is still so tight. Otherwise, I feel great now.
3-16-00 (3 weeks postop):
There's no need for Tylenol now. Face is still very tight and a bit sore in places, but I'm used to that. It's clearly going to take a long time to fully settle down. The bruising from the blepheroplasty is still noticeable, as is one bruise by my chin. I'm beginning to sleep normally lying down now.
This week I attended several important functions at Univ. of Michigan. Even though needing to use concealer and careful application of make-up, I think I'm starting to look pretty good. Many folks who hadn't seen me for a while seemed to feel strongly compelled to say something - - usually something like "Gee Lynn you look GREAT! What've you been doing? Lose some weight?" - - I usually replied, "yep, been working out, lost some weight, and also enjoying retirement!" - - -
3-23-00 (4 weeks):
Face is still very tight. My left cheek is still a bit swollen and numb, but I think that is a leftover from the FFS that will take a long time to settle down. The bruising under my eyes is now red rather than purple, smaller in size and a bit easier to conceal. On the 26th, those two nuisance remaining stitches suddenly pulled out very easily with no pain at all.
3-30-00 (5 weeks):
The facial bruising is almost gone now, and easily concealed by normal daytime makeup with a tiny bit of concealer over the residual "half-moons" under the eyes. Although it will be several more months before the tightness, numbness and swelling become imperceptible, normalcy is returning now. I'm full of energy again, and enjoying getting out with a new smile on my face!
On March 29th I took some snapshots of the overall FFS + FL results and posted them to my FFS website (see full set of four there). I'm really thrilled at how this has all turned out. The profile shots in particular seem amazing to me (see below). I think Doug got it "just right".

  March 29, 2000: Lynn at 4-1/2 months post-op from FFS and 5 weeks postop from face-lift surgery


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