A rhytidectomy, or 'facelift', is a procedure used to reduce flabby or sagging skin around the face and neck. The procedure is usually carried out under general anesthetic.A facelift can be done alone or with nose reshaping, a forehead lift, or eyelid surgery.
As part of the aging process that happens to all of us sooner or late, our skin progressively loses its elasticity and our muscles tend to slacken. The stresses of daily life, effects of gravity and exposure to sun can be seen on our faces. The folds and smile lines deepen, the corners of the mouth droop, the jaw line sags and the skin of the neck becomes slack. Around the eyes, the eyebrows droop and the skin of the eyelids gathers in loose folds. In the skin the first sign is fine wrinkles developing around the lips, at the outer corners of the eye and lines of expression. The rate at which this happens varies from one person to another and is probably determined by our genes. Aging of the skin of the face does not necessarily reflect the rate that the rest of our body and mind is ageing and many people feel frustrated that the face they see in the mirror is not the one they feel should be there. Substantial weight loss can produce similar changes in facial appearance to those of the aging process.
The best candidate is one whose face and neck has begun to sag, but whose skin still has some elasticity and whose bone structure is strong and well defined. Most patients are in their 40's to 60's, but facelifts can be done successfully on people in their 70's or 80's.
It should not be obvious that a patient has had a facelift, but instead they look younger, more vital and cheerful. It is a procedure that technically works well but also increases morale and is well appreciated by the patient.
What a facelift does not do?
A facelift works better for the lower half of the face and particularly the jaw line and neck. If you have sagging eyebrows and wrinkles of the forehead then you should perhaps consider an endoscopic brow lift. Loose skin with fine wrinkles, freckles and rough areas will benefit more by chemical peel or laser resurfacing.
How long does a facelift last?
A facelift does not stop the clock, but it does put the clock back. The effect of the facelift is likely to always be there, in that you will not look as old as you would have done if it had not been carried out.(1)
There are many different kinds of facelift, but generally incisions are made above the hair line at the temples, extending under and behind the ear and into the hairline. The skin is then pulled backwards and upwards before being stitched into its new position.
At the end of the operation, the surgeon closes up the incisions with stitches and applies a dressing to protect the area where the incisions were made
The procedure can take up to six hours to complete and an overnight stay in hospital is usually required.
Most surgeons will bandage the face to minimize bruising and swelling. These bandages will stay on for one or two days and the stitches are removed after seven to eight days.
Drainage tubes will be removed a day or two after surgery.
During a facelift, the surgeon may:
Remove and "lift" some of the fat tissue underneath the skin (called the SMAS layer; this is the main lifting part of the facelift)
Remove or move loose skin
Perform liposuction of the neck and jowls
Use stitches (sutures) to close the cuts(2)
What should you do before the operation?
If you are overweight and intend to lose it you should do so before the operation. This allows the surgeon to remove more skin and therefore achieve a more pleasing result. You should avoid taking tablets containing aspirin and non steroidal anti-inflammatory drugs such as Voltarol and Indocid for at least two weeks before surgery as they increase the risk of bleeding.
You should stop smoking at least two weeks before surgery as this is the main cause of reduced healing. It decreases circulation of the skinflaps, particularly behind the ears.
Have your hair permed and tinted, if you wish, before your operation as fresh scars are sensitive to these chemicals for a few weeks.
There will be swelling around and below the eyes, which gradually resolves in about a month. There will also be scars beneath the eyelashes of the lower eyelid and sometimes in the upper gum line. There is a slight risk of damage to the nerve that supplies the muscles of the forehead. This weakness is usually partial and temporary, on rare occasions it may be permanent.
After your surgery there is usually some bruising of the cheeks and with gravity this tends to descend into the neck. Discomfort is usually mild and can be controlled with Paracetamol. It is normal for there to be some numbness of the skin of the cheeks and ears. This will usually disappear in a few weeks or months. It is better to keep the head elevated for a couple of days to reduce swelling. Avoid strenuous activity, saunas and massage for at least two weeks.
At the beginning your face will look a little puffy and may feel rather strange and stiff. The scars can be very well hidden by women with their hair and disc shaped earrings so that they should be able to resume work and social activities within a couple of weeks. Camouflage make-up can be helpful in masking bruising.
Men find it more difficult to disguise the scars and will need to shave their beard closer to the ear in front and also behind the ear where the skin has been lifted.
The scars in the hair do not usually show except that the hair is cut shorter immediately around the wound. There may be some slight reduction in hair growth in the temples, but this is not usually a problem unless the hair is very thin and repeated facelifts are being carried out.
You should be allowed to wear concealing makeup after the first week. Your doctor or nurse will give you instructions.
Mild swelling may continue for several weeks. You may also have numbness of the face for up to several months(3)
As well as the general risks of surgery (see below), risks of facelifts include:
There may be a small but permanent reduction in hair growth around your temples
Your face may feel swollen, stiff and numb for a few weeks or months after surgery
Your eyes and facial features may appear asymmetrical(2)
Maintain a full and balanced diet for over all health and well being.
Eating in moderation will help you feel satisfied and at the same not overweight.
Eat a diet suited to your age, gender, ethnicity, body type and most importantly medical history.
Skin is constantly fighting a battle with the sun, and constantly repairing and regenerating itself. Your skin needs the right nutrition to stay young and healthy looking. If you're eating lots of junk food, you're feeding your skin junk, too.
Antioxidants like vitamin C and E, as well as vitamin A and the B vitamin biotin, are particularly important for healthy skin. You'll get all of these nutrients, and more, by eating five to seven servings of fresh fruits and vegetables each day. Tomatoes, citrus, green leafy vegetables, and carrots are a good place to start.