Facelifts – Rhytidectomy
As people age, the effects of gravity, exposure to the sun, and the stresses
of daily life can be seen in their faces. Deep creases form between the
nose and mouth; the jawline grows slack and jowly; folds and fat deposits
appear around the neck.
A facelift (technically known as rhytidectomy) can’t stop this aging
process. What it can do is “set back the clock,” improving
the most visible signs of aging by removing excess fat, tightening underlying
muscles, and redraping the skin of your face and neck. A facelift can
be done alone, or in conjunction with other procedures such as a forehead
lift, eyelid surgery, or nose reshaping.
If you’re considering a facelift, this article will give you a basic
understanding of the procedure when it can help, how it’s performed,
and what results you can expect. It can’t answer all of your questions,
since a lot depends on the individual patient and the surgeon. Please
ask your surgeon about anything you don’t understand.
The best candidates for a facelift
The best candidate for a facelift is a man or woman whose face and neck
have begun to sag, but whose skin still has some elasticity and whose
bone structure is strong and well-defined. Most patients are in their
forties to sixties, but facelifts can be done successfully on people in
their seventies or eighties as well.
A facelift can make you look younger and fresher, and it may enhance your
self-confidence in the process. But it can’t give you a totally
different look, nor can it restore the health and vitality of your youth.
Before you decide to have surgery, think carefully about your expectations
and discuss them with your surgeon.
A facelift can improve the deep cheek folds, jowls and loose, sagging skin
around the neck that come with age.
All surgery carries some uncertainty and risk
When a facelift is performed by a qualified plastic surgeon, complications
are infrequent and usually minor. Still, individuals vary greatly in their
anatomy, their physical reactions, and their healing abilities, and the
outcome is never completely predictable.
Complications that can occur include hematoma (a collection of blood under
the skin that must be removed by the surgeon), injury to the nerves that
control facial muscles (usually temporary), infection, and reactions to
the anesthesia. Poor healing of the skin is most likely to affect smokers.
You can reduce your risks by closely following your surgeon’s advice
both before and after surgery.
Planning your surgery
Facelifts are very individualized procedures. In your initial consultation
the surgeon will evaluate your face, including the skin and underlying
bone, and discuss your goals for the surgery.
Your surgeon should check for medical conditions that could cause problems
during or after surgery, such as uncontrolled high blood pressure, blood
clotting problems, or the tendency to form excessive scars. Be sure to
tell your surgeon if you smoke or are taking any drugs or medications,
especially aspirin or other drugs that affect clotting.
If you decide to have a facelift, your surgeon will explain the techniques
and anesthesia he or she will use, the type of facility where the surgery
will be performed, and the risks and costs involved. Don’t hesitate
to ask your doctor any questions you may have, especially those regarding
your expectations and concerns about the results.
Preparing for your surgery
Your surgeon will give you specific instructions on how to prepare for
surgery, including guidelines on eating and drinking, smoking, and taking
or avoiding certain vitamins and medications. Carefully following these
instructions will help your surgery go more smoothly. If you smoke, it’s
especially important to stop at least a week or two before and after surgery;
smoking inhibits blood flow to the skin, and can interfere with the healing
of your incision areas.
If your hair is very short, you might want to let it grow out before surgery,
so that it’s long enough to hide the scars while they heal.
Whether your facelift is being done on an outpatient or inpatient basis,
you should arrange for someone to drive you home after your surgery, and
to help you out for a day or two if needed.
Where your surgery will be performed
A facelift may be performed in a surgeon’s office-based facility,
an outpatient surgery center, or a hospital. It’s usually done on
an outpatient basis, but some surgeons may hospitalize patients for a
day when using general anesthesia. Certain conditions such as diabetes
or high blood pressure should be monitored after surgery, and may also
require a short inpatient stay.
Types of anesthesia
Most facelifts are performed under local anesthesia, combined with a sedative
to make you drowsy. You’ll be awake but relaxed, and your face will
be insensitive to pain. (However, you may feel some tugging or occasional
Some surgeons prefer a general anesthesia. In that case, you’ll sleep
through the operation.
A facelift usually takes several hours-or somewhat longer if you’re
having more than one procedure done. For extensive procedures, some surgeons
may schedule two separate sessions.
Every surgeon approaches the procedure in his or her own way. Some complete
one side of the face at a time, and others move back and forth between
the sides. The exact placement of incisions and the sequence of events
depends on your facial structure and your surgeon’s technique.
Incisions usually begin above the hairline at the temples, follow the natural
line in front of the ear, curve behind the earlobe into the crease behind
the ear, and into or along the lower scalp. If the neck needs work, a
small incision may also be made under the chin.
Facial, neck tissue and muscle may be separated; fat may be trimmed or
suctioned and underlying muscle may be tightened.
In general, the surgeon separates the skin from the fat and muscle below.
Fat may be trimmed or suctioned from around the neck and chin to improve
the contour. The surgeon then tightens the underlying muscle and membrane,
pulls the skin back, and removes the excess. Stitches secure the layers
of tissue and close the incisions; metal clips may be used on the scalp.
After deep tissues are tightened, the excess skin is pulled up and back,
trimmed and sutured into place.
Following surgery, a small, thin tube may be temporarily placed under the
skin behind your ear to drain any blood that might collect there. The
surgeon may also wrap your head loosely in bandages to minimize bruising
After your surgery
There isn’t usually significant discomfort after surgery; if there
is, it can be lessened with the pain medication prescribed by your surgeon.
(Severe or persistent pain or a sudden swelling of your face should be
reported to your surgeon immediately.) Some numbness of the skin is quite
normal; it will disappear in a few weeks or months.
Your doctor may tell you to keep your head elevated and as still as possible
for a couple of days after surgery, to keep the swelling down.
If you’ve had a drainage tube inserted, it will be removed one or
two days after surgery. Bandages, when used, are usually removed after
one to five days. Don’t be surprised at the pale, bruised, and puffy
face you see. Just keep in mind that in a few weeks you’ll be looking normal.
Most of your stitches will be removed after about five days. Your scalp
may take longer to heal, and the stitches or metal clips in your hairline
could be left in a few days longer.
Most of the scars will be hidden within you hair and in the normal creases
of your skin.
Getting back to normal
You should be up and about in a day or two, but plan on taking it easy
for the first week after surgery. Be especially gentle with your face
and hair, since your skin will be both tender and numb, and may not respond
normally at first.
Your surgeon will give more specific guidelines for gradually resuming
your normal activities. They’re likely to include these suggestions:
Avoid strenuous activity, including sex and heavy housework, for at least
two weeks (walking and mild stretching are fine); avoid alcohol, steam
baths, and saunas for several months. Above all, get plenty of rest and
allow your body to spend its energy on healing.
At the beginning, your face may look and feel rather strange. Your features
may be distorted from the swelling, your facial movements may be slightly
stiff and you’ll probably be self-conscious about your scars. Some
bruising may persist for two or three weeks, and you may tire easily.
It’s not surprising that some patients are disappointed and depressed at first.
By the third week, you’ll look and feel much better. Most patients
are back at work about ten days to two weeks after surgery. If you need
it, special camouflage makeup can mask most bruising that remains.
Your new look
The chances are excellent that you’ll be happy with your facelift-especially
if you realize that the results may not be immediately apparent. Even
after the swelling and bruises are gone, the hair around your temples
may be thin and your skin may feel dry and rough for several months. Men
may find they have to shave in new places-behind the neck and ears-where
areas of beard- growing skin have been repositioned.
You’ll have some scars from your facelift, but they’re usually
hidden by your hair or in the natural creases of your face and ears. In
any case, they’ll fade within time and should be scarcely visible.
After surgery, you’ll present a fresher, more youthful
face to the world.