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Facelift Surgery

© Michael McLaughlin

Gravity, sun exposure, and time combine to alter the appearance of the aging face. As a result, crease lines deepen, the jawline becomes less defined and jowly, and folds and fat deposits appear along the neck. Although the aging process cannot be stopped, a facelift (rhytidectomy) can help to set back the clock.

A facelift, done alone or in conjunction with other procedures, can be used to remove excess fat, tighten underlying muscles, and redrape the skin of the face to recreate a more youthful appearance. The best candidate for the surgery is a healthy man or woman whose face and neck have started to sag, but who maintain some skin elasticity and well-defined bony structure.

Facelifts may be performed in a surgeon's office, an outpatient surgery center, or a hospital setting. Most patients are treated on an outpatient basis. Some surgeons prefer a day of hospitalization after general anesthesia. Certain medical conditions may also require a short hospitalization. Most facelifts are performed with a combination of local anesthesia and sedation. Patients remain awake but relaxed and comfortable. Some surgeons prefer general anesthesia in which the patient is asleep throughout the operation.

Facelift surgery usually takes several hours. The exact location of the incisions depends on the patient's facial structure and the surgeon's preferred technique. Incisions usually begin within the hair along the temple, run along the front edge of the ear, and then curve behind the earlobe to the lower scalp. The skin is separated from the fat and underlying muscle. Fat may be removed by excision or liposuction from beneath the chin and along the upper neck. The surgeon then tightens the underlying muscle and membrane, pulls the skin upward and backward, and removes the excess tissue. The incisions are then stitched closed.

As with all other surgeries, a facelift carries some uncertainty and risk. Bleeding complications can occur. Nerve injury can also occur, causing loss of facial motion that is usually temporary but may be permanent. Infection and anesthesia reactions may also occur. Wound healing problems can occur, and are much more common in smokers.

The discomfort following surgery can be decreased with pain medication. Some numbness of the skin is normal and generally disappears within a few weeks or months. Postoperative swelling can be decreased by keeping the head elevated. Dressings, sutures, and any drainage tubes are usually removed during the first postoperative week.

From bruising and swelling, the face looks and feels strange during the first few weeks postoperatively. Many patients are disappointed with their result during this period. Sometimes camouflage makeup is used. Patients are usually back to work by the second week. They look and feel much better by the third week. The skin may feel rough and dry for a few months, and men may have to shave in additional areas where they didn't prior to the surgery.