A facelift (rhytidectomy) tightens the lower face and neck by removing excess skin and resuspending the support structures of the face to improve the jowls, nasolabial folds, downturned mouth, platysmal bands, and lax neck.
In the preoperative consultation a cosmetic and medical evaluation is completed to ensure that elective surgery is safe. Medications that interfere with clotting (i.e. Aspirin, NSAIDs) are stopped and tobacco use must be avoided for six weeks before and after surgery. The procedure takes between 2 to 4 hours and an overnight stay for observation may be required, depending on preferences, health status, and intra-operative findings.
Incisions are placed in subtle locations: around the ear and at or in the hairline in the temple and posterior scalp. The skin of the face and neck are then elevated to allow resuspension of the deeper structures of the face, the SMAS (sub muscular aponeurotic system), and removal of excess skin. Deep support rather than skin tension avoids the excessively tight, “wind-swept” or “Joan Rivers” look which was common in the past and frightens so many patients who desire facial rejuvenation.
Technique variations are utilized in appropriate patients. These include mini-facelifts for minor facial rejuvenation where less change is needed and/or minimal recovery time is available. Short scar facelifts such as the MACS lift (Minimal Access Cranial Suspension) which utilizes looped sutures to tighten the support structures of the face, composite facelift which leaves the skin attached to the underlying orbicularis, SMAS, and platysma muscle, subperiosteal facelift which elevates the face just above the bone, and endoscopic facelift which uses smaller incisions to elevate the deep structures of the face when limited skin removal is necessary.
Heavily marketed terms include “Lunchtime lifts”, “Thread lifts”, and “weekend facelift.” All of which are quite different from facelifts and have limited success. These techniques use sutures to elevate the skin without redraping and the effects are short lived, 1 – 2 years typically, but the problems with the sutures are permanent
The postoperative course is variable depending on the patient variables and the combination of procedures performed, but in most patients, a bulky dressing with or without a drainage tube is used for 1 -2 days, swelling and bruising will be significant for several days and noticeable by others for several weeks. Swelling persists for many months but is usually minor and rarely noticed by others. Temporary postoperative numbness is expected and pain is usually easily controlled. There may be scattered areas of firmness as small collections of fluid and blood go through resorption and the normal healing process.
As the swelling resolves the fine skin wrinkles will recur unless they have been separately treated with skin resurfacing: laser, peel, dermabrasion, or other modalities. Sutures are removed from the face within a week and from the hair within 2 weeks. Activity is limited for the first week and gradually increased over a month to normal. @ weeks is the most common time frame before you can be in public uncovered without standing out, sooner with sunglasses and makeup. Over 1-2 months, as swelling subsides, the scars settle and their redness fades, the results can be appreciated.
The traditional facelift will lift the jowls, neck, and cheek skin between the cheekbones and ears. It does not, however, lift the skin and tissues lying over the cheekbones themselves. With aging, the zygomatic ligaments which support the malar fat pad stretch, allowing descent, reducing the prominence of the cheek and deepening the nasolabial fold. The mid face is usually addressed as an addition to the standard facelift, but in patients with an acceptable neck and lower face, the mid facelift may be done as an isolated procedure or in conjunction with operations to rejuvenate the lower eyelids. A mid facelift takes 1 -2 hours and involves suspension of the malar fat pad through the facelift incision, lower eyelid incision, intraoral incision or endoscopic approach. This strengthens the cheek bone and improves the nasolabial fold, rejuvenating the face.