Technically known as a rhytidectomy (literally, surgical removal of wrinkles), is a type of cosmetic surgery procedure used to give a more youthful appearance. It usually involves the removal of excess facial skin, with or without the tightening of underlying tissues, and the redraping of the skin on the patient’s face and neck.
In the traditional facelift, an incision is made in front of the ear extending up into the hairline. The incision curves around the bottom of the ear and then behind it, usually ending near the hairline on the back of the neck. After the skin incision is made, the skin is separated from the deeper tissues with a scalpel or scissors (also called undermining) over the cheeks and neck. At this point, the deeper tissues (SMAS, the fascial suspension system of the face) can be tightened with sutures, with or without removing some of the excess deeper tissues. The skin is then redraped, and the amount of excess skin to be removed is determined by the surgeon’s judgement and experience. The excess skin is then removed, and the skin incisions are closed with sutures and staples. Sublabial incision through which periosteum of maxilla is elevated in an endoscopic midface lift (rhytidectomy).
Facelifts are helpful for eliminating loose skin folds in the neck and laxity of tissues in the cheeks. The areas not well corrected by a facelift include the nasolabial folds and perioral mounds marionette lines, which are more suitably treated with Botox or liposculpture, respectively.
A facelift requires skin incisions; however, the incisions in front of and behind the ear are usually inconspicuous. Hair loss in the portions of the incision within the hair-bearing scalp can rarely occur. In men, the sideburns can be pulled backwards and upwards, resulting in an unnatural appearance if appropriate techniques are not employed to address this issue. Achieving a natural appearance following surgery in men can be more challenging due to their hair-bearing preauricular skin. In both men and women, one of the signs of having had a facelift can be an earlobe which is pulled forwards and/or distorted. If too much skin is removed, or a more vertical vector not employed, the face can assume a pulled-back, “windswept” appearance. This appearance can also be do to changes in bone structure that generally happen with age.
Facelifts are effectively combined with eyelid surgery (blepharoplasty) and other facial procedures and are typically performed under general anesthesia or deep twilight sleep. The most common complication can be bleeding which usually requires a return to the operating room. Less common, but potentially serious, complications may include damage to the facial nerves and necrosis of the skin flaps, or infection.
Contraindications to facelift surgery include severe concomitant medical problems. While not absolute contraindications, the risk of postoperative complications is increased in cigarette smokers and patients with hypertension and diabetes. Patients are typically asked to abstain from taking aspirin or other blood thinners for at least one week prior to surgery. Pain is experienced with the surgery, if there is, it can be lessened with the prescription pain medication. (Severe or persistent pain or a sudden swelling of your face should be reported immediately.) Some numbness of the skin is quite normal; it will disappear in a few weeks or months.
You will be told 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 the scars will be hidden within you hair and in the normal creases of your skin. 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.
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.
You will be given 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. After surgery, you’ll present a fresher, more youthful face to the world.
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.
European Society of Aesthetic Surgery
American Academy Of Cosmetic Surgery
Canadian Association for Neuroscience
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