A Facelift (Rhytidectomy) is a surgical procedure designed to smooth the skin and to restore the youthful shape of the face.  The sun’s radiation, stress, gravity, and other factors cause the skin and deeper tissues to sag and deflate.  Though these changes are gradual, wrinkles and other signs of aging can make individuals “feel older” than they really are.

Surgery for a facelift involves the reshaping of tissues beneath the skin, and it  realigns facial and neck skin.  A facelift is often performed in combination with other facial cosmetic procedures and can be performed any time signs of aging begin to appear.  However, patients are generally in their forties or older when they elect to undergo this procedure.

Reasons for Considering a Facelift:

• Sagging skin, muscles, and fat in the face and neck
• Excess skin and fat on the neck
• Sagging jaw line
• an aged facial shape

General Procedure

                                                                                                                                                                                                                                                         The standard procedure for a facelift  The procedure commmonly involves making incisions just inside the hairline, following the contour in front of the ear, and continuing under the earlobe to the backside of the ear and to the lower scalp.  Tissue and fat deposits are separated and reshaped, the skin is tightened, and any excess skin is removed.  If the neck line requires attention, an additional incision may be made under the chin.  Often, an incision is also made in the mouth to aid with shaping deeper tissues.  Sutures are placed in the deeper layers of facial tissue in order to maintain the youthful shape.  Minuscule stitches are used to close the skin incisions, to reduce scarring. Metal clips may also be utilized at the hairline.

A face lift may take several hours or longer depending on whether other cosmetic procedures are completed at the same time.  Sometimes other procedures may be performed in separate appointments.  There are several different facelift techniques that can be employed.  Patients can discuss with their physician which method is best for them when they come in for their consultation.

Recovery Process

Immediately after surgery, the face is fitted with bandages in order to decrease the recovery time and to reduce swelling.  Generally, post-operative instructions call for plenty of rest and limited movement in order to speed up the healing and recovery process.  The stitches, clips or staples are normally removed within a week. Patients usually report less pain than they had expected.   Potential problems can be minimized by carefully following the directions given after the procedure, and by calling the doctor if any questions should arise.

 The following is an article written for other types of doctors, regarding facelift.

Facelift

A facelift is an operation designed to reverse many of the signs of facial aging. In particular, this operation takes up wrinkled skin in the uppermost part of the neck, the cheeks, and the “jowl” areas. The modern facelift can re-shape the soft tissue beneath the skin to raise the cheeks and produce a youthful facial shape. A year after a facelift, the goal is for the skin to appear neither too tight nor too loose.

It is also useful to state what a facelift does not accomplish. A facelift does not necessarily include eyelid surgery, forehead surgery, fat grafting, a midface lift, or skin resurfacing (laser, chemical, or mechanical peel) although these procedures are often performed at the same time. A facelift improves fine skin wrinkling of the portion of the cheeks in front of the ears, but it does not affect wrinkles on the lips or chin. A facelift can improve nasolabial folds, which radiate from outside the nose downward and laterally into the cheeks (the lateral boundary of the upper lip), but this effect is not always major. The effect on the “marionette lines”, which radiate downward from the corners of the lips to beneath the chin (the lateral border of the aged chin), are even less improved on a long term basis.

There are a number of different facelifting techniques. The exact technique to be used depends upon the characteristics of the patient and the philosophy and training of the surgeon. But certain general statements can be made regarding the modern facelift. The incision begins in the hair (or hairline) behind the ear; it then joins the crease where the ear meets the mastoid area rather high, so that the subsequent scar is inconspicuous. The incision continues about 1.5 mm. onto facial skin from the earlobe-to-face crease, and it continues in front of the ear. The incision usually ducks into the ear behind the tragus, then continues in front of the helix and into the temporal hair. There are several variations of incision placement, depending upon the patient’s anatomy. For example, the skin in front of the incision will move upward and posteriorly (about 2 to 4 cm.). Incisions within the hair bearing scalp are less obvious, but if a patient already has very small and high sideburns the incision is placed in front of the sideburn. Otherwise, the sideburn would be removed with excess skin. Dissection begins in the retroauricular area, staying on top of mastoid fascia, then on top of sternomastiod fascia. At about 6.5 cm. from the ear canal, the great auricular nerve and external jugular vein are encountered; the dissection is superficial to these structures. In front of the ear, dissection can be initially superficial or deep to the “SMAS”, which is an acronym for superficial musculular-aponeurotic system. The “SMAS” is the plane containing the muscles of facial expression and a variably thin fascia in between these muscles. Immediately in front of the ear, this tissue should be removed or moved, or it will cause too much fullness after closure. As dissection proceeds into the upper neck, the dissection is on top of the platysma muscle down to level of the thyroid cartilage (or below), across the midline of the neck to meet the dissection from the other side, and anteriorly as far as beyond the marionette line. Often, a separate incision is made near the submental crease, and the separated bands of platysma muscle can be sutured together or modified through this access site. In front of the ear, the dissection proceeds forward to the infraorbital area. The SMAS layer, usually with the deeper midface tissues (such as the buccal fat pad), is lifted more vertically than the overlying skin. There are several methods of accomplishing this. I usually perform a subperiosteal midface dissection via an intraoral approach, and suspend the deep tissues from the orbital rim and deep temporal fascia (Figure 1). Raising the deep cheek tissues produces a malar fullness that gives the face a youthful heart shape, as opposed to a rectangular aged appearance. Since the results of a facelift are noticeably better and longer lasting when performed as above, there are fewer indications for more minimal procedures, such as a “mini-facelift”. The older technique of simply tightening and raising the skin does usually improve facial appearance, but this approach is suboptimal and outdated. The above abbreviated description of the procedure, which the leaders in plastic surgery freely admit often takes over six hours to perform, shows that this is not a procedure to be taken lightly.

Risks of facelift include skin necrosis, which results from detaching tissue from underlying circulation, and then applying more tension than an individual patient’s circulation will tolerate. Such skin loss is not rare, but when it occurs it is usually behind the ears where it is not very noticeable. Skin loss on the cheeks is rare. Exposure to tobacco products within three weeks before the surgery until three weeks after the procedure increases the risk of skin loss by 12 fold!

Infection after facelift is usually localized and easily treatable; however more severe infections can occur, causing significant scarring and/or skin loss.

Facial nerve injury, resulting in inability to move part of the face, is possible because the dissection is very near to (or on) the nerve branches. The areas most at risk are movement of the forehead and movement of the lower lip. Fortunately, movement usually returns in several weeks (or months). Loss of sensation of the skin near the ears, cheeks, and in the upper neck is expected in every case, because this skin has been dissected from the deeper tissues. Injury to the great auricular nerve or occipital nerve can cause more loss of sensation, or more pain, than usual. Each person’s nervous system has a different tolerance for facelift dissection, and in rare cases chronic pain or disturbing sensations can be long-lasting or permanent.

Skin tension can result in hair thinning of even hair loss in the temporal areas, ear (or earlobe) deformity, or widened scars. Individual differences can also result in more visible scars. But usually scars are not very noticeable in the long run.

Bleeding is well controlled at the end of surgery; however bleeding can start after the surgery, causing a painful hematoma that may necessitate evacuation or even reoperation. Significant bleeding can less commonly occur up to two weeks after surgery. Aerobic activity increases fibrinolysis, which can cause more bleeding and/or swelling. Postoperative hematoma is at least twice as common in men, as compared to women. High blood pressure and/or vomiting can contribute to bleeding or hematoma formation. Aspirin, fish oils, high-dose vitamin E, and several herbal products also predispose to excess bleeding and hematoma.

For unknown reasons, people who have visible tiny cutaneous blood vessels (“spider veins”) may have an increase in these vessels after surgery.

The cumulative incidence of significant complications of facelift approximates 5%, according to the literature. And this does not include suboptimal or asymmetrical results, or less common complications such as salivary fistula. And there are minor complications, such as small hematomas which can be drained easily with a percutaneous needle approach.

Because a facelift is a major operation, it is important that candidates for the procedure are in good general health. Systemic complications, such as blood clots in the legs or lungs (pulmonary embolism) -- even death, have occurred.

Considering all of the above, it is interesting that postoperative pain is not usually as severe as the reader might surmise. When pain is significant, it is usually due to irritation of the great auricular nerve or as a result of subperiosteal midface dissection (if this was done).Most patients initially feel that their tissues were pulled very tightly, and indeed the face should appear as though it was pulled too tightly for the first month-- or even longer. Tension of the closure increases when the patient is looking down, as if to read; therefore, patients are asked not to read very much in the first week after surgery. Yet swelling can be rather dramatic. Swelling increases for about three days, and yet much of it is usually gone in about two weeks. It takes months for all of the swelling to subside. A few people resolve much more slowly than the above description, especially when a midface lift was also performed (as the author usually does). The author’s technique results in gathered excess scalp in the temporal areas, and it takes several months for these “lumps” to flatten. Bruising most often appears on about the third postoperative day, and lasts for two or three weeks. In some cases a dark stain, resulting from the breakdown of blood, may persist in the neck or lower eyelid area for several months. Generalized fatigue is common after a long anesthetic.

Most plastic surgeons require that their patients have specialized care for the evening following this procedure. Most patients can return to a reasonably normal, yet sedentary, lifestyle within a few days. Many people limit their social contacts until the swelling and bruising subside. A number of postoperative visits are necessary in order to track progress and intercept any possible early complications.

Choosing a surgeon is encumbered by marketing techniques, such as video imaging, showing photos of best results, testimonials, and scripted messages used by doctors and staff.

The fact that the modern facelift can usually produce a very significant rejuvenation that lasts longer than prior techniques helps to offset the issues of risks, recovery, and cost for many people.